Arthroscopic treatment of anterior impingement in the ankle.
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We performed a prospective study to assess the long-term outcome of 57 arthroscopic debridement procedures carried out to treat anterior impingement in the ankle. Using preoperative radiographs, we grouped patients according to the extent of their osteoarthritis (OA). The symptoms of those with grade-0 changes could be attributed to anterior soft-tissue impingement alone. Patients with grade-I disease had both anterior soft-tissue and osteophytic impingement, but no narrowing of the joint space. In those with grade-II OA, narrowing of the joint space was accompanied by osteophytic impingement. Radiographs taken before and after operation and at follow-up were compared to assess the recurrence of osteophytes and the progression of narrowing of the joint space. At a mean follow-up of 6.5 years (5 to 8) all patients without OA had excellent or good results. There were excellent or good results in 77% of patients with grade-I OA, despite partial or complete recurrence of osteophytes in two-thirds. In most patients with grade-II OA, narrowing of the joint space had not progressed at follow-up. There was a notable improvement in pain in these patients, 53% of whom had excellent or good results. Although some osteophytes recurred, at long-term follow-up arthroscopic excision of soft-tissue overgrowths and osteophytes proved to be an effective way of treating anterior impingement of the ankle in patients who had no narrowing of the joint space. (+info)
The pneumatic tourniquet in arthroscopic surgery of the knee.
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In a randomized study 56 patients undergoing arthroscopic surgery of the knee were randomly allocated to one of 2 groups: surgery with a tourniquet and surgery without a tourniquet. No significant difference was found between the 2 groups with regard to operating times, technical intraoperative difficulties, identification of intraarticular structures, postoperative pain or postoperative complications. In neither group was the procedure abandoned due to technical difficulties. The pain scores in the non-tourniquet group were lower than those in the group of patients operated on with the use of a pneumatic tourniquet. The study suggests that the use of a tourniquet in arthroscopic surgery of the knee is unnecessary. (+info)
Rehabilitation after arthroscopic meniscectomy: a critical review of the clinical trials.
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We reviewed the literature on patient management following arthroscopic meniscal surgery. A critical appraisal of the literature produced 8 randomized controlled trials evaluating the use of non-steroidal anti-inflammatory drugs or various forms of physiotherapy and pain control. Different treatments and outcome measures precluded meta-analysis. The limited evidence suggests that this is a relatively pain-free procedure with rapid recovery, and that in most cases simple analgesia in the first 1-2 days following surgery and a well-planned home-based exercise program should be sufficient. It is possible that routine daily non-steroidal anti-inflammatory drugs post-operatively for 3-6 weeks may enhance recovery rates. One study found that physiotherapy was beneficial for regaining muscle strength and on pain assessment but this did not translate into functional improvement. Descriptive studies are required to ascertain the types and duration of treatments being offered to patients after arthroscopic meniscectomy. Further research is needed to perform well-designed studies of current treatments that take into account predisposing factors and their impact on outcome, including use of prerandomization and real-life functional outcome measures. (+info)
Survey of arthroscopic surgery for carpal chip fractures in thoroughbred racehorses in Japan.
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Medical and racing records of 155 Thoroughbred racehorses that underwent arthroscopic surgery for carpal chip fractures were investigated. Articular damage for 98.4% of the fractures was classified as G1 or G2 using McIlwraith's criteria. The rate of return to racing after surgery was 82.6%. Evaluation of racing performance after surgery was attempted using a placing index (PI) based on race finish position. There was no significant difference in the PI distribution between horses that underwent surgery and other healthy horses. (+info)
Arthroscopic subacromial surgery in inflammatory arthritis of the shoulder.
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OBJECTIVE: To evaluate the effectiveness of shoulder arthroscopy, with predominantly subacromial surgery, in patients with inflammatory arthritis. METHODS: Twelve patients with inflammatory arthropathy underwent arthroscopic shoulder surgery with subacromial decompression, debridement, and limited synovectomy. All clinically had symptoms predominantly arising from the subacromial region. RESULTS: In the final review, ten patients (83%) were satisfied with the result. Two year follow-up was achieved in 11 patients. Seven rated their recovery as good or excellent, one was fair, and three were poor. All three poor results had fairly advanced glenohumeral chondral damage. CONCLUSION: In patients with inflammatory arthropathy and shoulder pain which clinically appears related predominantly to the subacromial region, provided there is no major chondral damage, then a reasonable result can be expected with arthroscopic debridement and modified subacromial decompression. (+info)
Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: a dose-response study.
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BACKGROUND: The aim of this study was to evaluate the association of a small dose of intrathecal ropivacaine with small doses of intrathecal clonidine for ambulatory surgery. METHODS: One hundred twenty patients, classified as American Society of Anesthesiologists physical status I and scheduled for knee arthroscopy, were studied. Patients were randomly assigned to receive 4 ml of one of the following double-blinded isobaric intrathecal solutions: 8 mg of ropivacaine (group 1; n =30); 8 mg ropivacaine plus 15 microg clonidine (group 2; n =30); 8 mg ropivacaine plus 45 microg clonidine (group 3; n =30); and 8 mg ropivacaine plus 75 microg clonidine (group 4; n =30). The level and duration of sensory anesthesia were recorded, along with the intensity and duration of motor block. Patient and surgeon were interviewed to evaluate the quality of anesthesia. RESULTS: Intrathecal ropivacaine (8 mg alone) produced short sensory anesthesia and motor blockade (132 +/- 38 min and 110 +/- 35 min; mean +/- SD). However, the quality of anesthesia was significantly lower than in any other group (P < 0.05). Ropivacaine (8 mg) plus 75 microg clonidine produced significantly longer sensory and motor anesthesia (195 +/- 40 min and 164 +/- 38 min; P < 0.05). However, this was associated with systemic effects, such as sedation and reduction of arterial blood pressure. Ropivacaine (8 mg) plus 15 microg clonidine did not prolong sensory or motor blockade, afforded high quality anesthesia, and was not associated with detectable systemic effects. CONCLUSION: Small-dose intrathecal clonidine (15 microg) plus 8 mg intrathecal ropivacaine produces adequate and short-lasting anesthesia for knee arthroscopy. (+info)
Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage.
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We evaluated the outcome of partial lateral meniscectomy of 31 knees in 29 patients whose knees were otherwise normal. The mean follow-up was 10.3 years. According to the Lysholm score, 14 knees were rated as excellent, four as good, five as fair and eight as poor, with a mean score of 80.5 points. Radiologically, only one lateral compartment was classified as grade 0, eight as grade 1, nine as grade 2, 11 as grade 3, and two as grade 4 according to Tapper and Hoover. No significant (p < 0.05) correlation was found between the amount of tissue resected and the subjective, clinical and radiological outcome. Although early results of lateral meniscectomy may be satisfactory, we have demonstrated that in the long term there was a high incidence of degenerative changes, a high rate of reoperation (29%) and a relatively low functional outcome score. (+info)
Long-term outcome of meniscectomy: symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls.
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OBJECTIVE: To describe the long-term influence of meniscectomy on pain, functional limitations, and muscular performance. To assess the effects of radiographic osteoarthritis (OA), gender and age on these outcomes in patients with meniscectomy. DESIGN: 159 subjects (35 women), mean age 53 years, were examined 19 (17-22) years after open meniscectomy. Self-reported symptoms and function were assessed, performance tests were carried out and radiographs were taken. Sixty-eight age- and gender-matched controls were examined likewise. The data was analysed in two steps. First, subjects with meniscectomy were compared to the controls, and subgroup analyses were carried out with regard to radiographic OA, gender and age. Second, similar comparisons were carried out within the meniscectomized group. RESULTS: Meniscectomized subjects reported significantly (P< 0.001) more symptoms and functional limitations than did controls. This was also true when operated subjects without OA were compared to controls without OA. Within the meniscectomized group, severe radiographic OA (joint space narrowing grade 2 or more) and female gender, but not older age, was associated with more symptoms and functional limitations. Meniscectomy was associated with worse muscular performance. Female gender and older age were associated with worse muscular performance in the study group. CONCLUSIONS: Meniscectomy is associated with long-term symptoms and functional limitations, especially in women. Patients who had developed severe radiographic OA experienced more symptoms and functional limitations. Age did not influence self-reported outcomes, however older age was associated with worse muscular performance. (+info)