Journal of Arthroscopy and Joint Surgery最新文献

This study investigated the immediate biomechanical effects of a biter-width partial medial meniscectomy. Small tears on the free edge of the meniscus are occasionally discovered during arthroscopic knee procedures. Removal of these tears often requires no more width than that of a biter from the edge. While past cadaveric partial meniscectomy studies have reported on the effects of meniscectomies from resection of one-third to three-quarters of meniscal width, the biomechanical sequelae of substantially smaller meniscectomies remain unknown. This study was performed to determine how single-biter-width meniscectomies affect the pressure distribution and peak pressure on the tibial plateau, as these parameters are correlated with increased likelihood of development of osteoarthritis. Eight cadaveric knees were instrumented with a thin-film pressure sensor underneath the menisci while retaining the major ligaments and most of the capsule. Knees were loaded to 1000 N at angles of flexion of 0, 15, 30, and 45 in normal tibio-femoral angles and in 7° of varus. Pressure, peak pressure, force and contact area were recorded. Afterwards, biter-width meniscectomies were performed, and measures repeated. There were significant changes in contact area at most flexion and tibio-femoral angles. There were no changes in the amount of force that was transmitted through the medial compartment. The overall pressure on the tibial plateau did not change in most knee conditions and peak pressure did not change significantly in any condition. The changes in contact area were consistent with our expectations. Similarly, the lack of change in force was also expected. However, the lack of significant changes in pressure and peak pressure represent findings indicating that a biter sized meniscectomy may have clinically insignificant effects on biomechanics.

Background

Prolonged wound drainage (>72 h), has been associated with increased risk of surgical site infection and prolonged hospital admission. This study reviews the outcome in three different wound closure methods, following total knee arthroplasty. We also analysed the cost effectiveness of these methods.

Methods

A total of 69 patients undergoing total knee arthroplasty: 22 with stapled skin closure; 21 with tissue adhesive and stapled skin closure and 26 with subcutaneous barbed suture instead of a non barbed suture with stapled skin closure, were studied to review the number of dressing changes, prolonged wound drainage (>72 h), length of hospital stay and delayed discharge (>5 days). Statistical analysis was conducted using Minitab Statistical Software® and statistical significance was set at p < 0.05.

Results

The median hospital stay for the staples only group was 4 days (inter-quartile range [IQR] 3–5), for the adhesive group was 4 days ([IQR] 3–6) and for the barbed suture group was 3 days ([IQR] 3–4) (p = 0.009). The rates of prolonged wound drainage for the staples only group was 8 (36.4%), for the adhesive group was 4 (19.0%) and for barbed suture group was 0 (0%) (p = 0.004).

Conclusion

The use of subcutaneous barbed sutures was associated with reduced number of wound dressing changes, reduced risk of prolonged wound drainage and shorter hospital stay, as well as conferring a saving of at least £236.60 per patient, compared to the other two skin closure methods.

Objective

Soleus is an effective plantar flexor that has distinct functional roles and behaves differently during different biomechanical actions. Different footwear types may give rise to adjusted muscular effort and biomechanics of Soleus muscle action. Consequent altered ground reaction forces created at the foot may give rise to injuries/fatigue during different activities. Relatively little is known about in vivo behavior of the Soleus muscle during walking and running. Surface Electromyography (SEMG) is commonly analyzed by researchers to understand lower limb muscle activity. The Objective of this study was to systematically review available research literature investigating Soleus SEMG activity in healthy subjects under different footwear conditions during different tasks.

Methods: electronic databases PUBMED, EBSCOHOST (Academic Elite) and SCIENCEDIRECT were searched on 30.11.2020 for the combination of keywords “Surface Electromyography” AND “Shoe” AND “Soleus”. Inclusion and exclusion criteria were specified in advance. The methodological quality of each relevant study was independently evaluated for “Risk of bias” on Modified Downs and Black checklist. Studies with quality score >50% were considered reasonable to be included in this review.

Results

Total 435 research publications were generated in search; 247 articles were excluded on the basis of initial title screening (including duplicates), 155 articles were excluded after Abstract and (or) full text screening, 33 studies were included for quality assessment. 15 studies were considered of reasonable quality (>50% score) to be selected for this review. Information was extracted from each selected study on: PICOT terms and Outcome Measures (SEMG activity) reported in each study.

Discussion

Results of the reviewed studies generally reported that, “Shoe conditions lead to different soleus activation patterns”, however there is weak to moderate evidence on difference in soleus muscle activity on SEMG under different footwear conditions. All studies involved highly variable features on PICO (terms) characteristics.

Conclusion

The clear effect of shoe on Soleus muscle activity is not fully understood; further research work especially investigating effect of footwear in non locomotor actions of soleus muscle in real life setting is recommended.

Introduction

In approximately one-third to half of patients of ankylosing spondylitis (AS), involvement of the hips may occur with 50–90% of these presenting with bilateral hip involvement. Total hip arthroplasty (THA) in these patients provide mobile hip, which significantly improves their functional capability and lifestyle. Aim of our study was to assess the clinical outcome of unilateral THA in AS patients with bilaterally ankylosed hips in terms of pain, hip mobility, ability to perform functional activities like sitting and walking and radiological evaluation in terms of position of acetabular cup, heterotrophic ossification (HO) and any sign of osteolysis.

Methods

Eight male patients (8 hips), between 25 and 40 years with ankylosed hips and spine in which only unilateral cemented THA was done due to financial constraints, were studied with average follow-up of 18.25 months (Range- 12–30 months). Results were assessed by walking ability, Harris Hip Score (HHS) and radiological findings.

Results

Mean pre-op HHS was 31.3. All these patients were more or less dependent on others for daily activities. None of the patient was able to sit on chair and all were able to walk indoor only. Mean HHS at final follow-up was 76.4. At final follow-up, all the patients could sit comfortably on a chair for more than 1 hour and were walking independently, although with a limp. Radiologically, acetabular cup inclination and anteversion was within Lewinnek’s safe zone in all the patients.

Conclusion

Unilateral cemented THA is a potential option in rehabilitation of patients of AS with bilaterally ankylosed hips, who cannot afford bilateral THA. But these young patients with rigid spine, who are very much dependent upon hip mobility, must be kept under observation to discover complications like loosening and for maintaining hip mobility.

Isolated posterior cruciate ligament (PCL) injuries are rare but PCL injuries commonly occur as part of multiligament knee injuries. PCL is the largest ligament in the knee and has two main bundles: anterolateral and posteromedial. These two bundles are thought to work in a co-dominant relationship to provide restraint/stability to posterior tibial translation. The PCL also has good capacity to heal following an injury. Majority of isolated PCL injuries can be treated non-operatively with rehabilitation focusing on prevention of posterior tibial sag, progressive weight bearing, prone range of movement exercises and quadriceps strengthening. PCL reconstructions are undertaken in chronic injury with persistent symptoms, failure of non-operative treatment and combined multiligament knee injuries. Common PCL reconstruction techniques include single bundle vs. double bundle and transtibial vs. tibial inlay. There is controversy on which reconstructive method is best.

Background & aim

Diabetic patients are susceptible for surgical site infections, periprosthetic infections, and increased hospital stay. Present study was aimed to determine the influence of HBA1c level on perioperative hemodynamic, recovery room stay and postoperative discharge times in patient undergoing total hip arthroplasty.

Methods

After institutional ethical clearance, this prospective, observational, study was conducted on 70 diabetic patients aged 18–65 years of either sex. Patients under study were enrolled into either group A (<7.5 HbA1c) or group B (≥7.5 HbA1c). On the morning of surgery fasting blood sugar and serum potassium levels were checked. Random blood sugar (RBS) at time of incision, at the time of closure, and postoperatively at 6, 12, 18, and 24 h were measured. Intraoperative hemodynamic variables, recovery room stay and hospital stay times were noted.

Results

Association of hypertension (p value 0.001), gm intake (p value 0.003), post-operative blood glucose levels (p value < 0.001), duration of recovery room stay and total duration of hospital stay were found significantly higher in group B (p value < 0.001). Surgical site infection (SSI), duration of illness, ECG changes, and postoperative complications were not significant. Although incidence of SSI was more in group B (p value 0.303).

Conclusion

Diabetic patients, not on insulin therapy, with no renal impairment, with ASA grading II-III, and with no other contraindication for spinal anaesthesia; 7.5% can be used as a new cut-off for level of HbA1c for total hip arthroplasty.

Purpose

Plantar Fasciitis is a widely prevalent condition and is extremely disabling if it remains unresolved. Despite many available treatment modalities, the management of recalcitrant cases is still a dilemma. We conducted this study to evaluate and compare the role of two novel modalities: Intralesional PRP (Platelet Rich Plasma) injection and Extra Corporeal Shockwave Therapy (ESWT) for the management of this condition.

Methods

60 patients with a clinical diagnosis of recalcitrant plantar fasciitis were randomized into 2 groups; PRP Group (n = 30) and ESWT Group (n = 30). In PRP group patients received 3 intralesional injections of PRP and in ESWT group 3 sessions of Extra Corporeal Shockwave Therapy were administered. The Primary outcome measures were Visual Analogue Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Roles and Maudsley Index and Heel Tenderness Index (HTI). The secondary outcome measures were complications. The patients were followed up for a period of 6 months and evaluated for various scores.

Results

At 6 months follow-up, significant results were found only on VAS score for both groups (p-value <0.05). However, both modalities resulted in significant clinical improvement with no complications reported. No statistically significant differences were reported between the two test groups.

Conclusions

Both autologous PRP and ESWT can become extremely useful modalities for management of recalcitrant cases of plantar fasciitis with no known adverse effects.

Background

A prospective study was conducted to evaluate the results of endoscopic plantar fascia release (EPFR) and its safety in treating patients with chronic plantar fasciitis.

Patients and methods

Thirty patients who had chronic plantar fasciitis for more than 6 months participated in this study from March 2015 to June 2018. Seventeen patients were females, and thirteen were males with an average age of 46 years (ranged between 35 and 52 years). All patients had a failed history of conservative treatment. They were treated with endoscopic plantar fascia release. If a heel spur existed, it was resected by an arthroscopic burr. Pain and functional limitations were evaluated with the American Orthopedic Foot and Ankle Society Scale (AOFAS) and Roles and Maudsley score.

Results

At the end of follow-up, the mean AOFAS scoring changed significantly from 67 points before surgery to 93 points (P < .0001) which was clinically significant. Sixteen (53.3%) patients had excellent results, 8 (26.6%) patients had good results, 4 (13.33%) patients had acceptable results, and 2 (6.66%) patients had poor results. Three cases complained of postoperative superficial infection at the medial portal. Two cases developed numbness and paraesthesia at the sole of the foot. Three patients had ongoing start-up pain that resolved within two months. The mean duration to full weight bearing after surgery was 40 days. All patients returned to full activities by a mean of 10 weeks.

Conclusion

Endoscopy offers the optimum solution for the resistant cases, but is not without complications. EPFR should be reserved only for severe cases after a trial period of conservative methods of treatment.

Ankle arthrodesis is the gold standard treatment for end stage ankle arthritis as it provides pain relief, whilst also allowing patients to regain function and mobility. Although it is conventionally performed via an open approach, arthroscopic ankle arthrodesis (AAA) is rapidly gaining in popularity. This article reviews the current literature regarding AAA including its benefits and limitations, and various techniques used.

Background

While haemorrhagic bursitis and Morel Lavallee lesions occur in the prepatellar region, hematoma secondary to ruptured superficial vein, mimicking the above lesions, has not been reported. It is important to be aware of this entity as it would need further evaluation and surgical management.

Case report

We report a rare case of prepatellar hematoma of Right knee following a fall in a 72-year-old lady associated with severe varicose veins in both lower limbs, treated by evacuation and suction drain and followed by reinforcement sutures three days after the evacuation. There was no recurrence after the procedure. We discuss the MRI findings of our case, revisit the anatomy related to the prepatellar bursa, the differential diagnosis for a prepatellar hematoma, how to differentiate this lesion from others and their treatment options.

Conclusion

A detailed assessment of the patient is necessary to identify varicose veins in such cases which need surgical treatment to prevent recurrences or persistent ooze.