جستجوی مقالات مرتبط با کلیدواژه "arthroscopy" در نشریات گروه "پزشکی"

The exact role and safety of arthroscopy in SAH management remain contentious. This systematic review aims to assess the outcomes and complications of arthroscopic treatment, shedding light on its efficacy and safety profile.

Following PRISMA guidelines, searches were conducted in PubMed, Scopus, Embase, and Web of Science until January 25, 2024. Eligible studies included SAH patients undergoing arthroscopic treatment. Data extraction covered demographics, clinical findings, and functional outcomes. Quality assessment used NIH case series assessment and Newcastle-Ottawa Scale. Quantitative analysis focused on Hip Harris Score, post-operative pain rate, and revision rate using a random-effects model. Comprehensive Meta-Analysis (CMA) software version 3.3 facilitated analyses.

The primary search yielded 1,662 articles, after screening the records, 35 study included. In case report studies, 18 patients were analyzed with an average age of 33.7 years. Complications included joint ankylosis, osteonecrosis, muscle atrophy, and osteopenia. Revision surgery was performed in three cases, with one due to infection. In case series studies, 295 patients with an average age of 15.6 years had complications such as joint collapse, femoral nerve palsy, and avascular necrosis. Thirteen revision cases were reported. Among 18 case series, arthroscopic complications were noted in nine studies, while six studies reported none. Full range of motion was achieved in 13 studies, and pain resolution in 11.

Utilizing arthroscopic techniques for treating septic arthritis of the hip represents a safe, effective, and minimally invasive choice, demonstrating favorable clinical results, relatively low rates of revision and complications, and rapid rehabilitation periods. Level of evidence: IV

This study aimed to introduce a new arthroscopic method to reconstruct the popliteus tendon (PT). This minimally invasive technique is performed through the posterolateral corner (PLC) of the knee, which can reconstruct the posterolateral rotary instability (PLRI) of the knee. Thirty-nine patients (8 females, 31 males) with PLC injury and normal knee alignment underwent arthroscopic PT reconstruction. Among them, 27 patients had combined ACL and PLC injuries, and 9 had been involved in PCL and PLRI. In 3 of them, injuries involved ACL, PCL, and PLC. Physical examination, imaging, and arthroscopic evaluation were performed to assess instability stages. In grade I instability, when the PT had not been injured, the patient was treated with the modified Larson technique and semitendinosus autograft. With grade II injury involving the PT component, arthroscopic reconstruction of the PT was the preferred technique. In grade III injuries, arthroscopic PT reconstruction and the modified Larson technique were used concurrently. All patients were followed up for 58 ± 1 months postoperatively. Varus and external rotation instability were restored with arthroscopic PLC reconstruction. All patients gained near-normal knee stability and significant improvement with pain, along with improved ability to carry out daily activities. In cases of varus instability, a significant improvement was observed in external rotation and reverse pivot shift. There were no cases of arthrofibrosis or limitations in knee motion. Arthroscopic reconstruction of the PT, using our protocol for PLC reconstruction of the knee (with midterm follow-up), showed encouraging results while minimizing surgical morbidity. Level of evidence: IV

Anterior shoulder instability with minimal glenoid bone loss has several options fo r Bankart repair. We aimed to evaluate the results of a modified technique using two anchors with double and single loaded suture (three stitches in total) in arthroscopic Bankart surgery. Thirty-eight patients underwent arthroscopic Bankart surgery and were assessed after an average 40 months follow-up. They underwent two-anchor repairs with single loaded of a high-strength, non-absorbable braided suture and double loaded suture. The participants were assessed preoperatively and postoperatively in terms of range of motion, CONSTANT Scores, and visual analogue scale (VAS). Recurrence of subluxations, dislocations, and other complications were also assessed. The mean follow-up time was 40.1±6.99 months. The mean Constant scores were 80.32±4.81 (95%CI: 78.73-81.90) preoperatively and 94.45±3.71 (95%CI: 93.23-95.67) postoperatively (P = < 0.001). A significant change was noted for the VAS score from 2.74±0.95 (95%CI: 2.42-3.05) to 0.63±0.75 (95%CI: 0.38-0.88) (P < 0.001). Mean preoperative external rotation and forward flexion were also preserved postoperatively (P < 0.001). The incidence of nonclinical subluxation was 2/38, 5.3%, however no case of clinical subluxation or re-dislocation was occurred; infection or neurovascular complications have not been observed as well. Using two anchors with single and double loaded arthroscopic suture showed acceptable clinical results for traumatic anterior shoulder instability repair in properly selected patients. Level of evidence: IV

Surgical fixation is required for displaced posterior cruciate ligament (PCL) tibial bony avulsion fractures or with fractures having grade 2 or more posterior instability. The purpose of this study is to evaluate the results of arthroscopic fixation of PCL tibial bony avulsion fractures using the double suture bridge technique.

A retrospective study was done involving 24 patients having displaced PCL tibial bony avulsion fractures. The arthroscopic double suture bridge technique was used to fix these fractures. Patients were followed up for a period of 3 year and assessed for knee related symptoms, signs, Lysholm knee score and satisfaction.

The study group consisted of 21 males and 3 females. Fracture union was achieved in all cases by 2 months post operative. The mean Lysholm knee score at follow up of 3 months, 6 months, 1 year, 2 years and 3 years was 86.6, 96.5, 98.8, 99.1 and 99.4 respectively.  At latest follow up all the patients were satisfied with their knee function with respect to pain, range of motion, stability and resumption of pre injury activity level.

The arthroscopic double suture bridge technique is an effective method for fixation of PCL tibial bony avulsion fractures with respect to knee stability, range of motion and resumption of pre injury activity level.

This study aims to evaluate the effectiveness and safety of Aspirin and LMWH in an arthroscopic anterior cruciate ligament (ACL) reconstruction of low-risk patients. 

We conduct a single-center, assessor-blind, simple randomized clinical trial from March 2019- May 2020. 18 to 45 years old patients with ACL rupture without concomitant injury, diagnosed by magnetic resonance imaging, enrolled in the study. Selected subjects were allocated between three parallel arms of the study, with 46 participants. Three parallels are 8o mg aspirin bid for 14 days, LMWH subcutaneous injection for 14 days, and no treatment parallel. Effectiveness outcomes were estimated by the DVT rate and PE rate, and safety was checked out by bleeding or hemarthrosis. Orthopedists assessed knee effusion with stroke score and ask patients for any symptoms during weekly clinic visits. The radiologist performed ultrasonography of lower extremities, searching for a sign of DVT. 

Mean age of participants was 31.4 + 5.6, and 93 individuals (67%) were male and 23% were female. No DVT and PE were observed. Three cases in the LMWH and one case in aspirin groups had minor surgical site bleeding. One case of hemarthrosis with normal ultrasonography occurred in the LMWH group. Regarding safety and effectiveness, there was no statistically significant difference between the parallels. 

Use of LMWH or Aspirin after simple arthroscopic ACL reconstruction in low-risk patients have no different effectiveness. Hence routine use of thromboprophylaxis in this setting is questionable, although adverse events are rare.

Soft tissue in the shoulder contributes to anterior shoulder instability that results in humeral head displacement from the glenoid fossa. Repair of Arthroscopic Bankart is considered as a broadly accepted method for restoring labrum to the glenoid rim. Our study's objective is to assess the clinical outcomes of Bankart repair by knotless suture anchors at medium-term follow-up.

To study the functional outcomes of using knotless suture anchor for recurrent instability of anterior glenohumeral and perform the clinical assessment using Rowe score in patients at 6-week, 3-month, and 6-month intervals.

In this prospective trial, patients undergoing arthroscopic Bankart repair with 2.8 mm knotless suture anchor (MINI-VIM PK®) were enrolled in the study. Patients were assessed for stability, movement, and function of shoulders using the Rowe scale at the baseline, 6-week, 3-month, and 6-month follow-up period planned for early efficacy measures.

The mean age of the subjects was 28.10±6.14. In this trial, the patients have been diagnosed with recurrent shoulder dislocation on the left side in 51(69.86%) patients and right side in 22(30.14%) patients. The Rowe score shows significant (p<0.0001) improvement from 44.73±1.64 to 95.62±18.33 at the 6-month follow-up period. Thus, provided better clinical outcomes and less movement of recurrent instability with knotless suture anchor.

The knotless suture anchor showed reduced recurrence rates, improved post-operative shoulder motion, and increased stability without adding complexity to the procedure.

This study aimed to introduce a novel arthroscopic treatment for medial and posteromedial instability of the knee and present the primary and follow-up results.

All patients who underwent the arthroscopic approach to treat medial and posteromedial corner instability from 2007 to 2017 were included in this report. Overall, 45 patients were included, among which 75.6% were male. The mean age of patients was 32.2 ± 8.4 years. Overall, 44.4% and 15.6% of patients had associated meniscal injuries and chondral lesions, respectively. The mean follow-up duration of patients was 84.2 ± 25.3 months.

Overall, 37 patients developed a full range of motion (82.2%), and most patients (95.6%) showed excellent quadriceps strength (grades 4 and 5). All patients had a normal or 1+ posterior drawer test, Pivot shift test, and Lachman test on physical examination. Moreover, 60% had an associated isolated anterior cruciate ligament injury, 17.8% had an isolated posterior collateral ligament injury, and 17.6% had a combination of more than one ligament injury. One patient developed septic arthritis. Two patients experienced pain, and one pain patient developed pain with a bony spur formation in the medial epicondyle. Three patients showed a 2+ medial collateral ligament (MCL) test (moderate instability) at the final follow-up, all of whom had multi-ligament injuries. All patients, except the three patients who had a failed MCL reconstruction, returned to their previous activities.

This study described a novel arthroscopic treatment of MCL injury, and the results showed acceptable postoperative and clinical outcomes. As the use of minimally invasive surgery may minimize multiple complications associated with open surgery, it is suggested that further studies be conducted regarding this approach when faced with patients who have MCL injuries requiring surgery. Level of evidence: IV

Compare, retrospectively, the medium- and long-term of return to sport rates and re-injury of the anterior cruciate ligament (ACL) in patients submitted to single -bundle (SB) compared to doublebundle (DB) technique reconstruction. Athletes operated by SB or DB ACL reconstruction, with at least five years of follow-up at a single center, were included. The following data were collected: demographic data; competitive sports practice before the injury; previous surgery; injury/surgery to the contralateral knee; return to sports and level of the return; re-injury (time of the re-injury after the first surgery; mechanism of trauma for the re-injury; necessity of operative treatment); signs and complaints related to the knee the last clinical consultation. Seventy-six athletes (27 SB and 49 DB) were included. The return to sport rate (98%) was the same for both groups, and the return to the previous level rate showed an improvement in the DB group but without statistical significance (63% vs. 79%; P = 0.173). However, other outcomes showed higher results for the DB group: lower reinjury rate throughout the follow-up period (41% vs. 18%; P = 0.034) and during the first year of follow-up (22% vs. 4%; P = 0.021), and less stiffness (0% vs. 22%, P = 0.001). While in primary reconstruction cases, there was not a higher re-injury rate using SB (P = 0.744), in the revision cases, SB was correlated with more re-injuries than DB (P = 0.002). The overall re-injury in the medium- and long-term and the return to practice sports at the same level as before surgery in athletes submitted to DB reconstruction were slightly better than those submitted to SB reconstruction, especially in the cases that were asecond time lesion ( revisioned knees). Level of evidence: II

Tenosynovial giant cell tumor (TGCT) is a rare hyperplastic disease of the synovial membrane of the joint with a high recurrence rate and tumor-like features, affecting large joints such as the hip, knee, and ankle. Dull and chronic pain is common, as is swelling of the joint, which can make definitive diagnosis difficult. The gold standard of treatment is complete resection of the lesion. In this case report, we present a TGCT at the knee joint of an adult patient with nonspecific clinical presentation.

Case Report:

 We present a 33-year-old male patient who presented with chronic swelling, warm sensation, and limited range of motion (ROM) in the knee. He had no history of trauma and infectious disease had been ruled out. After several nonspecific orthopedic procedures and inadequate treatment of signs and symptoms, he was finally diagnosed with local TGCT.

To make the correct diagnosis, the unusual and somehow deceptive clinical presentation of TGCT must be considered.

Arthroscopy procedures for the knee are excellent and tend to be outpatient procedures. Pain control after arthroscopic surgery is an important aspect of patient satisfaction and quicker return to daily activities following surgery. The objective of this article was to review the current literature regarding pain management after knee arthroscopy using intra-articular (IA) injections. Our goal in this article is to review the drugs that have been suggested in various articles for IA injections following knee arthroscopy to control pain. In conclusion, the current evidence suggests that combining IA lidocaine and morphine with tranexamic acid (TXA), in addition to ketorolac, is effective for pain relief after arthroscopic knee surgery.

Clinical decision-making for treating anterior shoulder instability relies on accurate glenoid bone loss quantification precision. This study aimed to assess the accuracy of the axial view of a 2-D CT scan compared with arthroscopy to measure glenoid bone loss following 3-D CT scanning.

This study was performed from March 2019 to February 2020 on patients who presented to the shoulder clinic of a referral teaching hospital in Tehran, Iran. Eighteen patients with at least one history of unilateral anterior shoulder dislocation without shoulder surgery participated in the study. Before surgery, the qualified participants had their injured and uninjured shoulders CT scanned. The Griffiths index was used to estimate the size of glenoid bone loss in CT scan imaging. Subsequently, the affected shoulders were arthroscopically evaluated, and glenoid bone loss was measured using a standard probe.

Among the 18 participants, glenoid bone loss was underestimated for 11 patients (61.1%) in CT scans compared to arthroscopy. The mean ± SD of glenoid bone loss percentage on CT scan (9.5% ± 4.9%) was significantly lower than on arthroscopy (11.7% ± 3.9%, p = 0.04). Nevertheless, Pearson’s correlation showed a significantly moderate correlation (r = 0.55, p = 0.01) between arthroscopic and CT scan measurements of glenoid bone loss.

Our findings indicate that glenoid bone loss width measurement via the axial view of a CT scan should not be considered a reliable method to measure glenoid bone loss.

Deep infection after rotator cuff repair (RCR) can cause significant morbidity and healthcare burden. Outcomes of surgical treatment of infection following RCR are limited. This study aimed to assess the clinical course and outcomes related to surgical management of deep infection following RCR. Patients treated with debridement for infection after RCR at a single institution were included. Postoperative deep infection included the following criteria: persistent drainage more than five days from index surgery, development of a sinus tract to the joint, ≥ 2 positive cultures at the time of revision surgery with the same bacteria, or presence of purulence. Functional outcomes (ASES, SANE, SF-12) were assessed at a minimum of 1-year post-debridement.  Twenty-three patients were included and analyzed at mean six years post-debridement. All were free of infection at the final follow-up. The average age was 55 years; fifteen (65.2%) had infection after primary RCR and eight (34.8%) after revision RCR. Twelve (52.2%) patients required a repeat debridement prior to eradicating infection for an average of 1.9 surgeries before clearance of infection. Statistically significant predictors of need for a repeat debridement included initial open RCR (P = .02), open debridement (P = .002) and infection requiring IV antibiotics (P = .014). Postoperative ASES, SANE, SF-12M, SF-12P, and satisfaction scores were 71.7±25.7, 67.0±28.1, 55.5±6.5, 38.4±14.3 and 3.7±1.3, respectively.   Deep infection after RCR can be treated with open or arthroscopic debridement. However, more than 50% of patients may require multiple debridements. Final functional results after infection control following RCR are satisfactory. However, chronic infection predicts worse functional outcomes. Level of evidence: IV

The aim of the study is to compare the results of anterior cruciate ligament reconstruction (ACL-R) in people aged more than 50 and under 30 years of age.

A total of 64 patients with ACL rupture were evaluated for eligibility. Thirty-two patients with ACL rupture, aged more than 50 years (54.38 ± 1.26) were matched in all of the background factors, with 32 patients suffering from ACL rupture under 30 years old. They were followed for clinical and functional results at six and on average 45.58 months after surgery. These evaluations included the Lachman test, KT-1000, International Knee Documentation Committee (IKDC) score, Lysholm knee score (LKS), return to exercise activity, post-operative satisfaction rate, and pain intensity based on Visual Analogue Scale (VAS) and rates of extension and flexion loss.

Our findings indicated that knee stability, return to exercise activity, LKS and IKDC scores, as well as pain intensity and satisfaction were significantly improved in both groups. Indeed, the satisfaction rate of patients over 50 years at six months after surgery was less than those under 30 years (P < 0.001); however, it was approximately similar to the group under 30 years of age in the final follow-up (P > 0.05). The rate of return to sports activity was also lower in patients over 50 years.

The comparable results at the patients with < 30 years demonstrated that arthroscopic ACL-R in patients over 50 years of age with no or mild DJD has good results.

This study aimed to prevent and control the pain after arthroscopy that leads to patient satisfaction, rehabilitation, and return to normal life as soon as possible. It is hypothesized that there is no difference between intraarticular injection of dexmedetomidine and placebo after knee arthroscopy regarding pain level. 

This double-blind randomized clinical trial was conducted on 70 patients aged 18-60 years who were candidates for elective knee arthroscopic surgery with the American Society of Anesthesiologists Classification I-II. All patients underwent spinal anesthesia equally and were randomly divided into two groups of 35 cases per group. The drug group (D) received 2 μg/kg dexmedetomidine with 0.9% normal saline reached to a volume of 20 ml, and 20 ml of 0.9% normal saline was injected into the knee joint through the cannular sheath in the control group (C). Postoperative pain intensity was recorded 1, 2, 4, 8, 16, 24 h after injection using the Visual Analogue Scale. The time of requesting the first analgesic and the amount of analgesics consumed were recorded after 24 h.

There was no significant difference between the two groups in terms of age, height, weight, duration of spinal anesthesia, and duration of surgery (P>0.05). In group D, there was a decrease in postoperative pain, a decrease in the amount of analgesic consumed, and an increase in the time of the first analgesic request, compared to group C (P<0.05).

This study showed that intra-articular injection of dexmedetomidine relieved postoperative pain, reduced analgesic consumption, and increased the time of first analgesic request after knee arthroscopy. Level of evidence: I

Numerous attempts have been made to decrease the incidence of opioid dependence after orthopedic surgeries. However, no effective means of preoperative risk stratification currently exists. The purpose of this study was to determine the ability of the Opioid Risk Tool (ORT) to predict the rate of opioid dependence 2 years after arthroscopic rotator cuff repair (ARCR).

We prospectively evaluated all patients undergoing primary ARCR at a single institution over a 1.5 year period with a minimum of 2-year follow-up. All patients completed the ORT prior to surgery and were stratified into Low, Moderate, and High risk categories. The primary outcome was postoperative opioid dependence, defined as receiving a minimum of 6 opioid prescriptions within 2 years following surgery. Secondary outcomes included the total number of morphine milligram equivalents prescribed, total number of opioid prescriptions filled, and total number of opioid pills prescribed during this time interval. All outcome variables were compared amongst Low, Moderate, and High risk groups. Assessment of a statistical correlation between each outcome variable and individual numerical ORT scores (1-9) was performed.

A total of 137 patients were included for analysis. No statistically significant difference was noted in any primary or secondary outcome variable when compared between Low, Moderate, and High risk groups. The total cohort demonstrated a 19% rate of post-operative opioid dependence. No correlation was identified between any outcome variable and individual numerical ORT scores. A greater rate of dependence and quantity of opioids prescribed was noted amongst patients with a history of prior opioid use.

The ORT was not predictive of the risk of opioid dependence or quantity of opioids prescribed after ARCR. Attention should be focused on alternative means of identification and management of patients at risk for opioid dependence after orthopedic procedures, including those with a history of prior opioid use. Level of evidence: III