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

Objective

Hip dysplasia is a recognised cause of femoral acetabular impingement and early osteoarthritis. The purpose of this study is to determine the role of arthroscopic treatment in symptomatic mild hip dysplasia.

Method

A literature review is presented on the usefulness of arthroscopy surgery in dysplastic hip disease.

Results

Good outcomes were reported in the symptomatic treatment of mild dysplasia in published series of hip arthroscopy. Special care must be taken in preserving the labrum and joint capsule.

Conclusions

Hip arthroscopy has a role in the treatment of mild symptomatic dysplasia, but in moderate dysplasia it is only useful as a complementary treatment

Level of evidence

5

Clinical relevance

Knowledge of the correct indications of arthroscopic surgery in hip dysplasia achieves better results and reduces errors.

Hip and trochanteric pain is some of the common symptoms mentioned by patients to the orthopaedic surgeon, and they are sometimes difficult to diagnose. Management of this condition, as well as correct diagnosis, make treatment easier and prevent recurrences.

A case is presented of a patient with longstanding hip pain with initial conservative treatment failure, diagnosed with ischiofemoral impingement and gluteus medius tendinosis and managed using our own endoscopic treatment technique.

Objectives

Acetabular labral tears are a common cause of hip pain. The aim of this article is to describe the surgical technique for arthroscopic labral repair, reconstruction, and treatment.

Material and methods

A review is presented of the types and classification of labral lesions, vascular supply, and surgical techniques for labral repair.

Results and conclusions

A reproducible and reliable surgical technique for arthroscopic labral repair and the intraoperative surgical decision making is very important to achieve success in this kind of hip problem.

Clinical relevance

An improved understanding of labral vasculature, classification of labral lesions, and surgical techniques have implications for the surgical treatment of labral tears.

Level of evidence

Level IV, case series.

Background

Femoroacetabular impingement (FAI) is the main cause of young adult hip ostheoarthritis. Deformity calculation is the key step to make a correct diagnosis and to assess an efficient surgical technique.

Objective

Evaluation of different resection calculation methods in femoroacetabular impingement surgery, with diferentation of pre, intra and postoperative.

Methods

We made a research on Pubmed of originals or revisions about resection calculation. We excluded papers of author's opinion and clinical cases.

Data recopilation and analysis

The four authors made an independent evaluation. Papers where divided between pre, intra and postoperative with one author in each group. The fourth author was responsible of selection and recopilation of the papers.

Main results

101 papers where analized related with femoroacetaublar impingement, being 10 revision papers and 6 clinical studies.

Authors conclusions

Resection calculation is a key step for the exit of arthroscopic femoroacetabular osteoplasty as a method of treatment of femoroacetabualr impingment. It needs an accurate preperative planification, correct intraoperative valoration, and follow up results correlates with clinical results.

This video shows most of the steps used in the protocol used for performing hip preservation arthroscopic surgery. Young people, in particular, are diagnosed with femoroacetabular impingement (FAI) and suffer mild chondral defects. The video shows the treatment of one of these cases. An «outside to inside» approach is used, which includes, a vertical capsulotomy and detachment of the ileo-femoral ligament, reinsertion of the labrum. An autologous matrix induced chondrogenesis (AMIC) technique was the used, and finally reconstruction of the capsule using anchors and «side to side» convergence stitches.

Objectives

To present the new therapeutic options currently offered by endoscopic surgery in order to resolve tendon pathology around the hip joint, in the so-called ‘outside the box surgery’.

Methods

A review of the literature and the authors’ experience is presented on the use of endoscopic surgery in resolving tendon pathology around the hip joint.

Results

Although there are still no large published series, there already appears to be sufficient evidence that endoscopic surgery offers at least similar results to those of open surgery for the treatment of this pathology, as well as having lower morbidity and complication rates.

Conclusions

For those surgeons treating hip pathology, mastering arthro-endoscopic surgical techniques is extremely useful in order to resolve problems that would require complex or deep approaches using open surgery.

Level of evidence

5

Clinical relevance

Knowledge of arthro-endoscopic therapeutic possibilities will help surgeons to choose the best surgical option for patients.

Hip arthroscopy has progressed over the last few years, both in technical aspects and scientific evidence level. Clinical history and physical examination are without a doubt the most common and reliable tools for diagnosis of hip pathologies. Many of these pathologies can be resolved by minimally invasive surgery such as arthroscopy or endoscopy. The evaluation before and after surgery with hip-specific questionnaires allows us to objectify the outcomes of our surgeries, as well as helping us with our decision algorithm when it comes to planning the most appropriate treatment for our patients.

Aim

The aim of this work was to evaluate the clinical results of the matrix-induced autologous chondrocyte implantation (MACI) technique on chondral defects of the knee and ankle. A study was conducted on 150 patients treated with MACI (performed by the same team of surgeons in all cases) during 2002-2007.

Methods

The lesion was evaluated by arthroscopy, and a cartilage biopsy was taken. The cellular implant was performed by arthroscopy in 53 patients, and by open surgery in the remaining cases. The results were measured following an in-house clinical protocol. Data corresponding to a mean follow-up period of 24 months were available in 50 out of the 150 implanted patients. Histological studies were performed in a second biopsy taken by arthroscopy in 5 patients 2 years after cell implantation.

Results

In 89% of patients without previous surgeries, and in 66% of patients with previous surgeries, the results were good or excellent for pain and motion, and most of them were able to return to their previous physical activities, including professional sport. Histological studies performed on a second biopsy showed that the new tissue is hyaline-like cartilage with lower cell numbers and subjectively softer than normal cartilage.

Conclusion

Arthroscopic MACI is a promising procedure to treat chondral lesions in the knee and ankle, although the histological analysis suggests that increasing cellular dosage would improve the results of the technique.

Level of evidence

Level III.

Clinical relevance

The importance of this study is that it presents an increased number of patients with chondral lesion treated with MACI. A high number of these patients were treated with arthroscopic MACI. In the present study it is shown that the treatment gives good results.

Objective

To evaluate the functional results of arthroscopic shoulder arthrolysis for the treatment of the shoulder stiffness due to conservatively treated proximal humeral fractures.

Material and methods

Retrospective study of 9 patients with shoulder stiffness after suffering a proximal humerus fracture despite at least six months of rehabilitation treatment without satisfactory outcomes. An arthroscopic shoulder arthrolysis was performed on all of them, working on both the glenohumeral and subacromial-deltoid spaces. The passive range of motion, pain scale, with a simple numerical scale of 0-10, and functioning with the Constant test, were evaluated before surgery and at the end of the follow-up period.

Results

After a 12-month (standard deviation: 1.5) follow-up, there was a significantly increase in the Constant test values from 37.6 (19.9) to 74.1 (12.8) (p = .004). The shoulder overall range of motion increased significantly from 213° (84.1°) to 377° (53.6°) (p<0.001); with improvements in all ranges of motion: arm flexion from 91.7° (37.1°) to 146° (19.0°) (p = .001); abduction from 88.3° (40°) to 132° (15.8°) (p = .003); external rotation from 14.4° (5.27°) to 50° (14.1°) (p = .0001), and internal rotation from 18.9° (11.7°) to 48.9° (12.7°) (p = .0003). The vertebral level achieved with the hand behind back improved from S1 to T11. The simple numerical scale decreased from 5.33 (3.24) to 1.33 (2.06) (p = .006).

Conclusion

Arthroscopic arthrolysis is effective in decreasing pain, increasing the range of motion, and improving function in the post-traumatic stiff shoulder.

Level of evidence

Level IV.