Etiology, Classifications, and Treatment by Arthroscopic Procedures

Setting.Seven organ/space surgical site infections (SSIs) that occurred after arthroscopic procedures and were due to Pseudomonas aeruginosa of indistinguishable pulsed-field gel electrophoresis (PFGE) patterns occurred at hospital X in Texas from April 22, 2009, through May 7, 2009.Objective.To determine the source of the outbreak and prevent future infections.Design.Infection control observations and a case-control study.Methods.Laboratory records were reviewed for case finding. A case-control study was conducted. A case patient was defined as someone who underwent knee or shoulder arthroscopy at hospital X during the outbreak period and subsequently developed organ/space SSI due toP. aeruginosa. Cultures of environmental and surgical equipment samples were performed, and selected isolates were analyzed by PFGE. Surgical instrument reprocessing practices were reviewed, and surgical instrument lumens were inspected with a borescope after reprocessing to assess cleanliness.Results.The case-control study did not identify any significant patient-related or operator-related risk factors. P. aeruginosa grew from 62 of 388 environmental samples. An isolate from the gross decontamination sink had a PFGE pattern that was indistinguishable from that of the case patient isolates. All surgical instrument cultures showed no growth. Endoscopic evaluation of reprocessed arthroscopic equipment revealed retained tissue in the lumen of both the inflow/outflow cannulae and arthroscopic shaver handpiece. No additional cases occurred after changes in instrument reprocessing protocols were implemented. After this outbreak, the US Food and Drug Administration released a safety alert about the concern regarding retained tissue within arthroscopic shavers.Conclusions.These SSIs were likely related to surgical instrument contamination with P. aeruginosa during instrument reprocessing. Retained tissue in inflow/outflow cannulae and shaver handpieces could have allowed bacteria to survive sterilization procedures.

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The influence of the variety of the infrapatellar branch of the saphenous nerve on the risk of iatrogenic injuries during arthroscopic procedures in the knee joint

Translational Research in Anatomy ◽

10.1016/j.tria.2021.100120 ◽

2021 ◽

pp. 100120

Author(s):

Dawid Szwedowski ◽

Katarzyna Herman ◽

Radosław Grabowski ◽

Ignacio Dallo ◽

Marcin Domżalski

Keyword(s):

Knee Joint ◽

Saphenous Nerve ◽

Iatrogenic Injuries ◽

Infrapatellar Branch ◽

Arthroscopic Procedures

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Opioid Overprescription in Adolescents and Young Adults Undergoing Hip Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00055 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0005

Author(s):

Mahad M. Hassan ◽

Omar F. Rahman ◽

Zaamin B. Hussain ◽

Stephane L. Burgess ◽

Yi-Meng Yen ◽

...

Keyword(s):

Young Adult ◽

Hip Arthroscopy ◽

Pain Syndrome ◽

Adult Patients ◽

Adolescent And Young Adult ◽

Bivariate Analysis ◽

Opioid Use ◽

Duration Of Surgery ◽

Opioid Medications ◽

Arthroscopic Procedures

Background: Previous studies have examined factors related to the increased use of opioids after hip arthroscopy in adults. However, few have focused on the adolescent population. Purpose: The purpose of this study was to compare the opioids prescribed to opioids consumed after hip arthroscopic procedures in adolescent and young adult patients, and to determine patient or surgical factors associated with increased postoperative opioid use. Methods: Adolescent and young adult patients who underwent hip arthroscopy and associated arthroscopic interventions between January 2017 and January 2020 were included. Patients with a diagnosed pain syndrome or history of chronic pain, as determined by the patient taking opioid medications prior to surgery, were excluded. Daily postoperative opioid intake was recorded via pain-control logbooks. The outcome of the study was defined as the average total number of opioid tablets consumed postoperatively. Results: Fifty-eight patients returned completed logbooks, 72% of whom were female patients. The average age was 21.30 years (range, 14.9 – 34.2). Most patients (73%) were prescribed 30 oxycodone tablets. The median amount of tablets consumed was 7 (range, 0-41) over a median duration of 7 days (range, 1-22). The median ratio of tablets consumed to prescribed was 20% and the 95th percentile of opioids consumed was 28 tablets. Bivariate analysis showed that patient age at surgery was positively correlated to the total amount of tablets consumed (r=0.28, p=0.04) and to the ratio of tablets consumed to prescribed (r=0.30, p=0.03). Duration of surgery was negatively correlated to the number of days tablets were consumed (r=-0.31, p=0.03). Multivariate analysis showed that patients who were prescribed more than 30 tablets took on average 7.8 more tablets overall compared to those prescribed 30 or fewer tablets (p=0.003), and that for each additional year of age, the ratio of tablets consumed to prescribed increased by 1% (p=0.02). Conclusion: After undergoing hip arthroscopy and associated arthroscopic procedures, adolescents and young adult patients are commonly overprescribed opioids, consuming on average only one-fifth of the tablets prescribed. This finding mirrors trends in the pediatric knee arthroscopy literature and provides an opportunity to reassess current opioid prescribing behaviors in the adolescent and young adult populations. [Table: see text][Table: see text][Table: see text][Table: see text][Table: see text]

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Classification, Treatment, and Arthroscopic Procedures

Ankle Joint Arthroscopy ◽

10.1007/978-3-030-29231-7_14 ◽

2020 ◽

pp. 117-123

Author(s):

Alberto Branca ◽

Marco Merlo ◽

Clara Terzaghi ◽

Cecilia Pasquali

Keyword(s):

Arthroscopic Procedures

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A Useful MRI Classification for Symptomatic Discoid Lateral Meniscus

Knee Surgery and Related Research ◽

10.1186/s43019-021-00108-0 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Eui Yub Jung ◽

Seongmin Jeong ◽

Sun-Kyu Kim ◽

Sung-Sahn Lee ◽

Dong Jin Ryu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Lateral Meniscus ◽

Meniscal Repair ◽

Discoid Lateral Meniscus ◽

Resonance Imaging ◽

Mri Findings ◽

Signal Change ◽

Magnetic Resonance Imaging Mri ◽

Arthroscopic Procedures ◽

Group 1

Abstract Purpose The purpose of this study is to classify the discoid lateral meniscus (DLM) according to the signal and shape in magnetic resonance imaging (MRI), and to provide information not only in diagnosis but also in treatment. Materials and Methods We reviewed 162 cases who diagnosed with DLM by MRI and underwent arthroscopic procedures from April 2010 to March 2018. Three observers reviewed MRI findings of all cases and predicted arthroscopic tear using three MRI criteria (criterion 1,2 and 3). Among three criteria, the criterion that most accurately predicts arthroscopic tear was selected. Using this criterion, the cases of predicted tear were named group 1. In addition, group 1 was divided into three subgroups (group 1a, 1b and 1c) by deformation or displacement on MRI and arthroscopic type of tear and procedures were analyzed according to these subgroups. Results The intra-meniscal signal change itself (criterion 3) on MRI showed the highest agreement with the arthroscopic tear. No meniscal deformation and displacement on MRI (group 1a) showed no specific type of tear and more cases of meniscal saucerization. The meniscal deformation on MRI (group 1b) showed more simple horizontal tears and more cases of meniscal saucerization. The meniscal displacement on MRI (group 1c) showed more peripheral tears and more cases of meniscal repair and subtotal meniscectomy. Comparing arthroscopic type of tear and type of arthroscopic procedure between three subgroups, there were significant differences in three groups (P < .05). Conclusions Intra-meniscal signal change itself on MRI is the most accurate finding to predict arthroscopic tear in symptomatic DLM. In addition, subgroup analysis by deformation or displacement on MRI is helpful to predict the type of arthroscopic tear and procedures.

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Deep Brachial Artery Pseudoaneurysm Following Arthroscopic Shoulder Debridement

Vascular and Endovascular Surgery ◽

10.1177/1538574418762922 ◽

2018 ◽

Vol 52 (5) ◽

pp. 378-381

Author(s):

Andrew E. Yang ◽

Jamie M. Hall ◽

Gilford S. Vincent ◽

Lowell Chambers

Keyword(s):

Brachial Artery ◽

Orthopedic Procedures ◽

Vascular Injuries ◽

Review Of The Literature ◽

Artery Pseudoaneurysm ◽

Pseudoaneurysm Formation ◽

Arthroscopic Procedures

Vascular injuries resulting from arthroscopic surgeries are rare with a reported incidence of 0.005% of elective orthopedic procedures. We report a case of a 49-year-old male who developed a deep brachial artery pseudoaneurysm following an arthroscopic shoulder debridement and lysis of adhesions. He was successfully embolized with resolution of the pseudoaneurysm within 6 weeks of treatment. A review of the literature demonstrates that pseudoaneurysm formation after arthroscopic procedures is rare and pseudoaneurysms of the deep brachial artery have yet to be reported.

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Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1666-9382 ◽

2021 ◽

Author(s):

Bjarke Viberg

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Joint Replacement ◽

Orthopaedic Surgery ◽

Thromboembolic Events ◽

Reduce Blood Loss ◽

Fracture Surgery ◽

Arthroscopic Procedures

AbstractTranexamic acid (TXA) has been studied extensively during the last 5–8 years. It inhibits clot dissolution during surgery and can therefore reduce blood loss. However, there has been concern that this could result in more frequent complications, specifically in terms of thromboembolic events. The indications for TXA are widespread, and this review covers the literature on orthopaedic indications such as joint replacement, fracture surgery, and arthroscopic procedures. In general, TXA is safe and can be used in a wide variety of orthopaedic procedures, lowering blood loss without increasing the risk of complications.

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Is Diagnostic Arthroscopy at the Time of Medial Patellofemoral Ligament Reconstruction Necessary?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120945654 ◽

2020 ◽

Vol 8 (8) ◽

pp. 232596712094565

Author(s):

Christopher L. Shultz ◽

Samuel N. Schrader ◽

Benjamin D. Packard ◽

Daniel C. Wascher ◽

Gehron P. Treme ◽

...

Keyword(s):

Postoperative Pain ◽

Knee Flexion ◽

Medial Patellofemoral Ligament ◽

Perioperative Complications ◽

Mpfl Reconstruction ◽

Tibial Tubercle ◽

Level Of Evidence ◽

Diagnostic Arthroscopy ◽

Patient Reported ◽

Arthroscopic Procedures

Background: Although medial patellofemoral ligament (MPFL) reconstruction is well described for patellar instability, the utility of arthroscopy at the time of stabilization has not been fully defined. Purpose: To determine whether diagnostic arthroscopy in conjunction with MPFL reconstruction is associated with improvement in functional outcome, pain, and stability or a decrease in perioperative complications. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary MPFL reconstruction without tibial tubercle osteotomy were reviewed (96 patients, 101 knees). Knees were divided into MPFL reconstruction without arthroscopy (n = 37), MPFL reconstruction with diagnostic arthroscopy (n = 41), and MPFL reconstruction with a targeted arthroscopic procedure (n = 23). Postoperative pain, motion, imaging, operative findings, perioperative complications, need for revision procedure, and postoperative Kujala scores were recorded. Results: Pain at 2 weeks and 3 months postoperatively was similar between groups. Significantly improved knee flexion at 2 weeks was seen after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and reconstruction with targeted arthroscopic procedures (58° vs 42° and 48°, respectively; P = .02). Significantly longer tourniquet times were seen for targeted arthroscopic procedures versus the diagnostic and no arthroscopic procedures (73 vs 57 and 58 min, respectively; P = .0002), and significantly higher Kujala scores at follow-up were recorded after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and targeted arthroscopic procedures (87.8 vs 80.2 and 70.1, respectively; P = .05; 42% response rate). There was no difference between groups in knee flexion, recurrent instability, or perioperative complications at 3 months. Diagnostic arthroscopy yielded findings not previously appreciated on magnetic resonance imaging (MRI) in 35% of patients, usually resulting in partial meniscectomy. Conclusion: Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI. Postoperative pain, range of motion, and risk of complications were equal at 3 months postoperatively with or without arthroscopy. Despite higher Kujala scores in MPFL reconstruction without arthroscopy, the relationship between arthroscopy and patient-reported outcomes remains unclear. Surgeons can consider diagnostic arthroscopy but should be aware of no clear benefits in patient outcomes.

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A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119882001 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711988200 ◽

Cited By ~ 3

Author(s):

William J. Uffmann ◽

Garrett V. Christensen ◽

Minkyoung Yoo ◽

Richard E. Nelson ◽

Patrick E. Greis ◽

...

Keyword(s):

Cost Minimization ◽

Direct Costs ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Inpatient Setting ◽

Level Of Evidence ◽

Related Factors ◽

Cross Sectional ◽

Arthroscopic Bankart Repair ◽

Arthroscopic Procedures

Background: The optimal surgical treatment of anterior shoulder instability remains controversial. Hypothesis: (1) Implants and facility-related costs are the primary drivers of variation in direct costs between arthroscopic Bankart and Latarjet procedures, and (2) distal tibial allograft (DTA) is more costly than Latarjet as a function of the graft expense. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Intraoperative cost data were derived for all arthroscopic anterior stabilizations and Latarjet and DTA procedures performed at a single academic institution from January 2012 to September 2017. Cost comparisons were made between those undergoing arthroscopic stabilization and Latarjet and between Latarjet and DTA. Multivariate regressions were performed to determine the difference in direct costs accounting for various patient- and surgery-related factors. Results: A total of 87 arthroscopic stabilizations, 44 Latarjet procedures, and 5 DTA procedures were performed during the study period. Arthroscopic Bankart repair was found to be 17% more costly than Latarjet, with suture anchor implant cost being the primary driver of cost. DTA was 2.9-fold more costly than Latarjet, with greater costs across all domains. Multivariate analysis also found the number of prior arthroscopic procedures performed ( P = .007) and whether the procedure was performed in an ambulatory or inpatient setting ( P < .0001) to be significantly associated with higher direct costs. Conclusion: Latarjet is less costly than arthroscopic Bankart repair, largely because of implant cost. Value-driven strategies to narrow the cost differential could focus on performing these procedures in an outpatient setting in addition to reducing overall implant cost for arthroscopic procedures. Perceived potential benefits of DTA over Latarjet may be outweighed by higher costs.

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The Patello-Femoral Joint Degeneration and the Shape of the Patella in the Population Needing an Arthroscopic Procedure

Medicina ◽

10.3390/medicina54020021 ◽

2018 ◽

Vol 54 (2) ◽

pp. 21 ◽

Cited By ~ 5

Author(s):

Rimtautas Gudas ◽

Laimonas Šiupšinskas ◽

Agnė Gudaitė ◽

Vladas Vansevičius ◽

Edgaras Stankevičius ◽

...

Keyword(s):

Physical Activity ◽

Articular Cartilage ◽

Knee Joint ◽

Cartilage Defects ◽

Type I ◽

Physically Active ◽

Group Iii ◽

Type Iii ◽

Group I ◽

Arthroscopic Procedures

Background: the main goal of the study was to investigate the prevalence of the articular cartilage defects (ACD) in the patellofemoral (PF) region of the knee joint based on the anatomical shapes of patella and its impact on the level of physical activity in the population needing arthroscopic procedures for all types of pathologies in the knee. Methods: The articular cartilage status of the PF region was obtained from 1098 arthroscopic procedures of the knee joint. The ACD were correlated to Wiberg’s shape of the patella and classified according to the degree, size and depth of the ACD in the PF region using the ICRS (International Cartilage Repair Society) system: group I consisting of patients with Wiberg type I shape (W1), group II—patients with Wiberg type II shape (W2) and group III—patients with Wiberg type III shape (W3). The Tegner physical activity scale was used to evaluate the physical activity of the patients. Results: The mean of ACD size (PF region) in the W3 group was 3.10 ± 0.99 cm2, which was a statistically significantly larger area in comparison with the W1 (1.90 ± 0.63 cm2; p < 0.0000) and W2 (1.95 ± 0.71 cm2; p < 0.0000). The patients from the W3 group (mean 3.10 ± 0.99) were less physically active (<4 Tegner) compared to the W2 group (mean of 4.48 ± 0.88; p = 0.004) and W1 group (mean of 4.55 ± 0.72; p = 0.002). Conclusions: The patients with the Wiberg type III patella shape had a higher incidence and larger size of ACD in the PF of the knee compared to the groups of Wiberg type I and II. Wiberg III patients with a lower level of physical activity had a larger size of ACD in the PF joint.

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