Revista Espa?ola de Artroscopia y Cirugía Articular最新文献

Posterior meniscal roots lesion can appear in 10-12% anterior cruciate ligament (ACL) tears, but the frequency of associated injuries of anterior roots still remains unkown, due to its lower incidence. No cases about concomitant anterior and posterior root lesions have been published to the moment.

The case of a 17-year-old woman is presented, with associated posterior lateral root (PLRT), anterior medial root (AMRT) and anterior cruciate ligament tears, with the AMRT going unnoticed on magnetic resonance imaging (MRI) study. ACL was reconstructed with outside-in technique; PLRT was reinserted with transosseous technique and AMRT with a 5-mm suture anchor. After 18 months, the patient keeps asymptomatic and practising sports.

It is important to detect the posterior root lesions due to its biomechanic consequences, similar to those that occur after total meniscectomy, although it may be difficult because they can go unnoticed on MRI study. Transosseuous reinsertion of PLRT and suture anchor reinsertion of AMRT provide good results in the medium term.

Purpose

To assess the outcomes of the arthroscopy-assisted technique indicated for the treatment of chronic acromioclavicular instability (CAI), based on coracoclavicular (CC) non-rigid fixation plus CC anatomical reconstruction with a tendon allograft.

Methods

The study included patients with CAI managed surgically between 2008 and 2012. Clinical assessments were made using the SF36, a VAS, and DASH scale, at a visit prior to surgery (VPS) and at the last follow-up visit. The Constant score and the overall satisfaction (0-10) were assessed at the last follow-up visit. Development of secondary subluxations was also evaluated.

Results

A total of 10 patients were included, with a mean age of 41 years (range 33-55). In all patients surgical treatment was indicated after conservative measures failed. The time elapsed from shoulder injury to surgical intervention was more than three weeks in all cases, with a mean of 6.75 months (range 1.5-12). At a mean follow-up of 25.50 months (range 24-30), a significant improvement was registered as regards the preoperative values of the physical SF36 (from 29.6 ± 3.41 to 59.6 ± 1.98, P < .001); the mental SF36 (from 46.6 ± 3.80 to 56.6 ± 1.89, P < .001); VAS (from 5.2 ± 2.40 to 1.7 ± 2.07, P = .022), and DASH (from 63.3 ± 23.56 to 2.6 ± 1.79, P < .001). The Constant score and the overall satisfaction registered at the last follow-up visit were 95.6 ± 3.28 and 9.2 ± 0.67, respectively. No secondary subluxations were recorded.

Conclusion

Treatment of CAI by means of an anatomical reconstruction of the CC ligaments plus an arthroscopically placed CC suspension device, may offer a significant improvement to the quality of life of patients. It could also be used as a strategy that might minimise the possibilities of failure and development of secondary subluxations by adding a CC primary mechanical stabiliser.

Clinical relevance

The technique described represents a valid alternative for the management of patients with chronic and symptomatic acromioclavicular joint instability, providing good results at two years follow-up, without any complications recorded.

Level of evidence

Level IV Case series.

Hip arthroscopy is a safe and less invasive surgical technique. Mayor complications such as infections, fractures, dislocations or avascular necrosis are exceptional. Minor complications are more frequent, such as pudendal paraesthesias, labral damage, or chondral lesions. These complications are mostly related with the positioning of the patient and the surgical technique. Even if the clinical consequences are not so significant, emphasis must be made on preventing these iatrogenic lesions by optimising the details for a safe positioning of the patient, as well as the optimal surgical technique.

Failure or unsatisfactory results after hip arthroscopy can be a consequence of poor patient selection, progression of chondral damage, or failure to correct the bony alteration causing femoroacetabular impingement. The insufficient resection either at the acetabular or femoral side leads to a persistent impingement. It is one of the main causes for revision hip arthroscopy. The excessive or non-anatomical resection at the acetabular or femoral side can cause hip instability or femoral neck fractures. Essential to prevent these complications are the detailed planning of the amount of bony resection, as well as the correct surgical technique.

Purpose

To compare the results between arthroscopic and open surgery in the treatment of lateral epicondylitis.

Methods

A prospective cohort study was conducted on 30 patients treated with lateral epicondylitis, in which rehabilitation treatment during 3 months had failed. They were distributed into 2 groups: open surgery and arthroscopic surgery.

Results

The mean age of the patients was 47.63 ± 1.19, 17 women and 13 men, with a mean follow-up time of 69.07 ± 4.01 days. Preoperative pain (visual analogue scale (VAS) 9.27 ± 0.12) decreased (p < .001) with both techniques a week after surgery (7,33 ± 0,25 in open surgery and 3.40 ± 0.21 in arthroscopic) and at the time of discharge (2.00 ± 0.20 in open surgery and 1.33 ± 0.16 in arthroscopic), this decline being significantly higher one week after surgery (p < .001), and at the time of discharge (p = .03) in arthroscopic surgery than in open surgery. Pre-operative functionality (Mayo Elbow Performance Score (MEPS) 45.00 ± 0.98 in open surgery and 44.00 ± 0.87 in arthroscopic surgery) significantly improved (p < .001) in both groups after surgery (87.67 ± 1.45 in open surgery and 90.33 ± 1.98 in arthroscopic surgery), with no significant differences between the two groups. The time to discharge for the return to work activity was significantly lower (p = .004) in arthroscopic surgery (58.87 ± 4.15 days) than in open surgery (79.27 ± 5.88 days).

Conclusions

In patients with lateral epicondylitis, pain and functionality improved with both techniques. Relief of pain was greater with arthroscopic surgery than with open surgery, with no significant differences in functionality scores at the time of discharge between the two groups. Post-operative time to discharge was significantly lower with arthroscopic surgery than with open surgery.

Level of evidence

II.

Clinical relevance

Arthroscopic surgery of lateral epicondylitis achieves as good functional results, but with less pain, and also an earlier return to work activity than open surgery.

Posterior dislocations of shoulder represent less than 5% of all shoulder dislocations, and may include significant bone loss of the anterior humeral head (a reverse Hill-Sachs lesion) requiring surgical treatment. The orthopaedic surgeon often diagnoses this injury in the chronic phase due to an incorrect primary diagnosis. These lesions were traditionally treated with open reduction and transfer of the subscapularis tendon or the lesser tuberosity to the bone defect. A surgical technique for the arthroscopic management of these lesions is presented, as well as its application and outcome in two clinical cases. The technique is based on the filling of the bone defect of the humeral head with the subscapularis tendon.

Hip arthroscopy has increased in popularity in recent years as a minimally invasive technique for diagnosis and treatment of various intrinsic hip-related pathologies. From 2006 to 2010, hip arthroscopic procedures have increased by over 600% in the United States.

Hip arthroscopy in trauma cases is often performed after the initial treatment and if the patient continues with symptoms, usually related to physical activity, and sometimes accompanied by mechanical symptoms. Another advantage of arthroscopy in traumatic hip injury is the repair of the soft tissues that are damaged at the time or with the initial treatment, the extraction of loose fragments between the joints, and to visualise incongruent joint reductions directly. Although there are no specific indications, the use of hip arthroscopy in trauma cases is a very useful tool that will continue to increase its indications and treatment options.

Hip arthroscopy can be performed with the patient in different positions, and by different accesses to the joint. These variations have been associated with the technical capacity of the surgeon during the procedure, the functional outcomes, and the occurrence of complications. The aim of this paper is to describe these variables and rationally review their characteristics.

Objective

Hip joint anatomy has a number of peculiarities that determine the arthroscopic treatment. The aim of this article is to describe the most significant anatomical and biomechanical findings for clinical and therapeutic applications.

Method

We divide the chapter into hip biomechanics with clinical application and anatomical structures of the central or peripheral compartment.

Results

Access and mobility into the hip joint is difficult, and requires understanding the normal anatomy and its variants. In the central compartment, we describe important structures such as the labrum, acetabular cartilage, round ligament, acetabular cartilage, and cartilage of the femoral head. In the peripheral compartment, femoral head cartilage, non-articular labrum, capsule and synovial folds are described.

Conclusions

Understanding hip arthroscopic anatomy and its variants, along with the basics of hip biomechanics, allow us to improve our orientation in a joint with a difficult access.

Clinical relevance

The knowledge of applied anatomy and arthroscopic hip biomechanics allows us to reduce our surgical learning curve in hip arthroscopy technique.

Level of evidence

Level IV Expert opinion.

Imaging techniques are frequently used in the diagnosis and management of patients with hip pain prior to arthroscopy. In recent years the capabilities of imaging techniques, such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), have expanded. At present, imaging techniques help to confirm a suspected diagnoses, to exclude other potential source of intra-articular or peri-articular hip pain, and to provide the hip surgeon with a pre-operative map. They also assess difficult to see areas during hip arthroscopy, and therefore may be used for clinical decision-making.

Plain radiographs are usually the first step in the imaging management. Ultrasound can be used in the assessment of extra-articular disease and, along with CT, it can be used to guide intra-muscular and peri-neural injections, or to perform joint fluid aspiration. Three-dimensional CT reconstruction of the hip and pelvis offers a global view of hip-bone anatomy, and is often used for pre-operative planning. Recent developments in hardware and software have increased the potential use of MRI in the current diagnosis of hip disorders with increasingly accuracy.

In this article, the current role of imaging techniques in the diagnosis of hip joint disorders and surrounding soft tissues is described.