Journal of Arthroscopy and Joint Surgery最新文献

Introduction

Heel pain is a common foot and ankle complaint in the Orthopaedic OPD. Posterior heel pain occurs due to a handful of etiologies, more prominent of which is retrocalcaneal bursitis. Management of posterior heel pain in majority of the cases is non-operative. However, surgical intervention may be indicated if conservative therapies fail. This study aims at finding the functional outcome after arthroscopic management of retrocalcaneal bursitis.

Methodology

A total of 29 patients were recruited for the study after applying the selection criteria. Standard knee arthroscopy equipment and instruments were used with gravity assisted fluid system. After making medial and lateral portals, the inflamed bursa was debrided using a motorised shaver and an arthroscopic burr was used to resect the calcaneal prominence. A post-operative rehabilitation protocol was followed and the cases were followed up at regular intervals for a minimum of 12 months.

Results

After excluding losses to follow-up and post intervention exclusions, data of 23 patients were considered for statistical analysis. There was a consistent improvement in the variables of the AOFAS score at the follow up intervals. The total AOFAS score showed consistent improvement from a pre-operative mean score of 66.96 to a mean score of 88.44 at 03 months to maximal mean score of 96.00 at 6 months (p < 0.001). There were 02 minor complications in the form of hypoaesthesia in sural nerve distribution which were managed non-operatively. None of the cases required revision surgery.

Conclusion

Arthroscopic decompression is a feasible and efficient procedure for the treatment of retrocalcaneal disorders. The time to return to normal activity level is short. Sufficient exposure of the Achilles tendon and adequate removal of the calcaneal prominence and bursal tissue can be done effectively using an arthroscopic technique. It yields cosmetically better results with low incidence of complications.

Hallux valgus is a complex three-dimensional deformity. Surgical correction of the hallux valgus is technically demanding and has a significant risk of recurrence and complications. There is a learning curve associated with the operative technique. The aim of the realignment procedures include.

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  Re-positioning the first metatarsal head over the sesamoids

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  Restoring the intermetatarsal and hallux valgus angles to normal levels

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  A congruous metatarsophalangeal joint

Great toe metatarsophalangeal fusion offers an effective salvage option for recurrent hallux valgus and severe deformities. Clinical and radiological examination aid choice of operative management of the deformity of the great toe. Different techniques may be prioritised according to the patient's presentation.

Purpose

In-vitro models of cartilage regeneration based on pellet cultures have been widely used to evaluate chondrogenic potential of the cell of interest and predict probable in-vivo behavior. However, pellet processing is a major challenge during handling (due to small size and possible damage to structural contour following sectioning and staining). The present study aimed to utilize human articular cartilage derived chondroprogenitors to assess if agarose-encapsulation of pellets prior to paraffin processing enable easier handling without affecting tissue morphology, glycosaminoglycan staining and immunohistochemical analysis of Collagen type II protein.

Methods

Passage 3 chondroprogenitors (n = 3) were evaluated for MSC markers using flow cytometry and subjected to chondrogenic differentiation as pellets cultures. Post-differentiation, the pellets were subjected to either: a) paraffin embedding, b) agarose encapsulation followed by paraffin embedding or c) agarose encapsulation followed by cryosectioning. All sections were subjected to histological staining for glycosaminoglycan uptake: Alcian blue, Safranin O (Bern score) and Toluidine blue with immunohistochemical processing for collagen type II protein deposition.

Results

With respect to staining and structural integrity, comparable uptake was seen in both paraffin sections and agarose embedded sections while the latter exhibited notably uniform pellets with distinct marginal demarcation. Although plain paraffin and agarose encapsulated sections demonstrated equivalent staining as represented by comparable Bern scores, glycosaminoglycan uptake, and Collagen type II deposition, cryosections exhibited significantly poor staining properties.

Conclusion

Agarose encapsulation of differentiated pellets prior to routine paraffin embedding, eases handling difficulties whilst maintaining structural integrity with optimal staining outcomes.

Purpose

The OPTY-LINE extendable nail is a magnetically-controlled, intra-medullary realignment device that is specifically designed for open-wedge high tibial osteotomy (HTO). The aim of this study was to perform a comprehensive retrieval analysis of OPTY-LINE nails and assess them for any signs of damage, corrosion and wear.

Patients and methods

Two routinely explanted OPTY-LINE nails were initially radiographed and force tested before mechanical section and disassembly. Macroscopic and microscopic inspection was performed and specific areas of the nails were identified for profilometry and scanning electron microscopy.

Results

Radiographs did not show any evidence of implant failure. Force testing resulted in no force output from one nail, while the second nail generated a maximum force of 706 N. Macroscopic inspection revealed wear patterns consistent with off-axis loading. Energy Dispersive X-Ray Spectrometry did not identify physiologic fluid ingress, however, O-Ring seal wear and moisture within the mechanism was concerning. Black debris was embedded within the O-Ring grooves of both nails.

Conclusion

This retrieval study is the first to evaluate the performance of the OPTY-LINE nail. Signs of off-axis wear and corrosion were identified and we support current recommendations for routine implant removal within one year. This study will inform and guide further retrieval analyses of the OPTY-LINE nail.

Purpose

To determine the test–retest reliability, concurrent validity and minimal detectable change of the 3-m backward walking test (3MBWT) in patients with Total Hip Arthroplasty (THA).

Methods

A total of 29 patients after unilateral primary THA were enrolled in the study. All evaluations were carried out by the same physiotherapist. The test-retest reliability of the 3MBWT was assessed at an hour interval and analyzed by the Intraclass correlation coefficient (ICC). In the concurrent validity analysis, the Spearman correlation coefficient between 3MBWT and Harris Hip Score (HHS) was calculated. In addition, the standard error of measurement (SEM₉₅) and Minimal Detectable Change (MDC₉₅) values were also calculated.

Results

The mean age of the patients was 75.6 ± 10.0 years. The mean time of the second test was 2.41 s better than the first assessment. The ICC score of 3MBWT was 0.983. Test-retest reliability was excellent. SEM₉₅ and MDC₉₅ values were 1.56 and 4.33, respectively. Both test and retest evaluations of the 3MBWT were correlated with the HHS (p < 0.01). The degree of correlations was moderate.

Conclusion

The 3MBWT is a valid and reliable test in patients with primary unilateral THA. The MDC value of 3MBWT provides essential information to clinicians about patients’ clinical progression.

Background

Metal cables exhibit favorable clinical performance because of their high fixing force. Cables composed of ultra-high-molecular-weight polyethylene (UHMWPE) are relatively new and were first used for trauma around 2010; only a few cases involving the use of UHMWPE cables have been reported. Surgeons need to know whether the fixing force of UHMWPE cables is higher or lower than that of metal cables. This study aims to compare the fixing forces of UHMWPE cables and a titanium cable using the contact pressure as an index.

Method

We studied UHMWPE cables with widths of 3 mm and 5 mm and a titanium cable. A thin pressure sensor was set on the femoral diaphysis, and the cables were wrapped on simulated tissues and tightened with clamping forces based on the indication values displayed on the tensioner of each cable. During osteosynthesis, tissues can remain unremoved depending on the fracture site and procedure. Sus scrofa domesticus thigh tissues with thicknesses of 2 mm and 5 mm were prepared for simulating tissues, and the contact pressures in cases with and without tissues were compared.

Results

When no tissues were remained, the contact pressure of the titanium cable with a clamping force of 50 kgf was equal to that of the UHMWPE cables with a clamping force of 30 kgf. When tissues were remained, the contact pressure of the titanium cable with a clamping force of 50 kgf was twice as high as that of the UHMWPE cables with a clamping force of 30 kgf.

Conclusion

It was revealed that the contact pressure of UHMWPE cables clamped with the maximum force was twice as high as that of metal cables. This result is expected to contribute toward the selection of cables according to a desired clamping force.

Background

Plantar fasciitis is one of the most common causes of heel pain and in its severe forms it can lead to functional disability also. This study has been taken up to evaluate the role of Platelet Rich Plasma (PRP) in managing chronic severe plantar fasciitis when other techniques have failed. This article also focuses on the pathophysiology, diagnosis, other non-operative treatment modalities and surgical options earlier used for plantar fasciitis.

Methods

For 92 patients of plantar fasciitis, PRP was prepared by double spinning technique, and then immediately injection was given after dorsiflexion of the ankle and injecting from the medial aspect of the foot. It was done as a day care procedure and the patients were examined after 1 week, 4 weeks and 12 weeks after the procedure.

Results

After 12 weeks review, more than 60 patients showed great improvement in pain, with their VAS score of pain being below 7.

Conclusion

The article suggests good and effective use of PRP in treatment of plantar fasciitis, along with being a simple and safe procedure.

Ankle arthrodesis has for decades been the ‘gold standard’ treatment for end-stage ankle arthritis. Total ankle arthroplasty (TAA) surgery, first introduced in the early 1970's, was initially plagued with poor outcomes and high complications, leading understandably to limited uptake. Since then, their design has evolved tremendously, and with it, there has been renewed interest in its role in the surgical management of end-stage ankle arthritis. In this article we discuss the current clinical evidence for TAA, its indications and contra-indications for use, its outcomes and results, the role of concomitant surgical procedures, complications and comment on areas of further study required.

Background

Pain after anterior cruciate ligament reconstruction (ACLR) can be attributed to both arthroscopic surgery and graft - donor site. Conventionally used techniques of peripheral nerve blockade may not provide complete analgesia to graft - donor site. Moreover, femoral nerve blockade is known to cause quadriceps strength deficit. The purpose of this study was to evaluate whether addition of peri-hamstring infiltration to adductor canal block can lead to better analgesia after surgery than block alone.

Methods

60 ASA grade I & II patients scheduled for anterior cruciate ligament reconstruction surgery using ipsilateral hamstring autograft under subarachnoid block were randomly distributed into 2 groups to receive postoperatively either adductor canal block alone (group A) or peri-hamstring infiltration along with adductor canal block (group AH). Adductor canal block was given in both the groups using 15 ml of 0.5% ropivacaine with 1:200000 adrenaline. Patients in Group AH received additional 20 ml 0.5% ropivacaine with 1:200000 adrenaline at hamstring donor site. Postoperative pain on Visual Analogue Score (VAS) at various time intervals, time to first rescue analgesic requirement, cumulative analgesic requirement over 24 h, quadriceps strength, adverse effects and patient satisfaction were recorded.

Results

Statistically significant difference in mean VAS score (resting & dynamic) was observed in both the groups at 8 and 12 h (p value < 0.001). Time to first rescue analgesic was longer in group AH (11.47 ± 2.92hrs) compared to group A (8.13 ± 1.28hrs). Cumulative ketorolac requirement was lower in group AH (34 ± 18.86 mg) in contrast to group A (49 ± 20.06 mg). Quadriceps strength was comparable in both the groups and no major complications were observed in either group. However, patient satisfaction measured by Numeric Rating Scale (NRS) was much better in group AH.

Conclusion

Peri-Hamstring infiltration of local anaesthetic along with adductor canal block is better than adductor canal block alone at allaying postoperative pain due to hamstring autograft.

Joint preserving surgical options are essential in modern orthopaedic care. The aim of this study was to review current literature about distal tibial osteotomies for varus osteoarthritis of the ankle joint. A clinical librarian searched electronic from inception to August 2019 using standard terms. Studies that assessed distal tibial osteotomy outcomes (clinical, radiological and complications) in the treatment of varus ankle osteoarthritis with a minimum of one-year follow-up. The search identified 968 studies. Duplicates (225) were removed. On applying inclusion/exclusion criteria to title and abstract review 686 papers were excluded. 57 full-texts were reviewed and a further 45 were excluded. Twelve papers underwent quality assessment and finally only nine included. The nine papers underwent full data extraction and inclusion within the study. Pain scores (VAS) improved in all studies examined. Mean pooled pre-operative VAS was 7.0 and post-operative VAS was 2.5. These results were for 166 ankles. Mean pooled Pre- and post-operative AOFAS scores available for nine studies showed an improvement from 57.7 to 83.6 for 242 ankles. Satisfaction rates were 89.1% from four studies, including 92 ankles. Out of the total number of osteotomies (242) there were four (1.7%) patients who underwent total ankle arthroplasty and five (2.1%) who had arthrodesis at mean follow-up of 45 months (range; 21–99). Distal tibial osteotomy can provide significant pain relief and improvement in functional scores. Satisfaction is high with a low level of complications. It is a viable option for joint preservation in carefully selected patients.