scholarly journals Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Michael Ryan ◽  
Benton Emblom ◽  
E. Lyle Cain ◽  
Jeffrey Dugas ◽  
Marcus Rothermich
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Osteochondritis Dissecans ◽  
Surgical Techniques ◽  
The Other ◽  
Return To Play ◽  
Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

Autologous Osteochondral Mosaicplasty for Centrally and Laterally Located, Advanced Capitellar Osteochondritis Dissecans in Teenage Athletes: Clinical Outcomes, Radiography, and Magnetic Resonance Imaging Findings

2018 ◽  
Vol 46 (8) ◽  
pp. 1943-1951 ◽  
Author(s):  
Tadanao Funakoshi ◽  
Daisuke Momma ◽  
Yuki Matsui ◽  
Tamotsu Kamishima ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Osteochondritis Dissecans ◽  
Case Series ◽  
Return To Play ◽  
Joint Surface ◽  
Resonance Imaging ◽  
Level Of Evidence

Background: Autologous osteochondral mosaicplasty (ie, mosaicplasty) results in satisfactory clinical outcomes and reliable return to play for patients with large or unstable lesions due to osteochondritis dissecans (OCD) of the humeral capitellum. However, the association between the healing of the reconstructed cartilage and clinical outcomes remains unclear. Purpose: To evaluate the efficacy of mosaicplasty in teenage athletes through use of clinical scores and imaging. The secondary purpose was to compare the clinical outcomes with images of centrally and laterally located lesions. Study Design: Case series; Level of evidence, 4. Methods: This study analyzed 22 elbows (all male patients; mean age, 13.5 ± 1.2 years) with capitellar OCD managed with mosaicplasty. Patients were divided into 2 groups according to the location of the lesions: central (10 patients) and lateral (12 patients). Evaluation was performed through use of the clinical rating system of Timmerman and Andrews, plain radiographs, and magnetic resonance imaging (MRI; the cartilage repair monitoring system of Roberts). The mean follow-up period was 27.5 months (range, 24-48 months). Results: Lateral lesions were significantly larger than central lesions (147.1 ± 51.9 mm2 vs 95.5 ± 27.4 mm2, P = .01). No other significant differences were found between central and lateral lesions. Timmerman and Andrews scores for both central and lateral lesions improved significantly from 125.0 ± 30.1 points and 138.3 ± 34.5 points preoperatively to 193.5 ± 11.3 points and 186.7 ± 18.1 points, respectively, at final follow-up ( P < .0001, P < .0001). Radiography identified complete graft incorporation in all cases and the absence of severe osteoarthritic changes or displaced osteochondral fragments. In the lateral group, the radial head ratio at final follow-up (1.83 ± 0.23) was significantly larger than the preoperative findings (1.75 ± 0.14, P = .049). The quality of joint surface reconstruction was found to be acceptable for central and lateral lesions on MRI evaluation. Conclusion: Mosaicplasty resulted in satisfactory clinical outcomes and smooth cartilage surface integrity in teenage athletes with OCD on their return to competition-level sports activities irrespective of lesion location.

Predictors of Mid- to Long-Term Outcomes in Patients Experiencing a Knee Dislocation: A Systematic Review of Clinical Studies

2021 ◽  
Author(s):  
John-Rudolph H. Smith ◽  
John W. Belk ◽  
Jamie L. Friedman ◽  
Jason L. Dragoo ◽  
Rachel M. Frank ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Clinical Studies ◽  
Small Sample ◽  
Cochrane Library ◽  
Long Term Outcomes ◽  
Short Term ◽  
Female Sex

AbstractKnee dislocations (KDs) are devastating injuries for patients and present complex challenges for orthopaedic surgeons. Although short-term outcomes have been studied, there are few long-term outcomes of these injuries available in the literature. The purpose of this study is to determine factors that influence mid- to long-term clinical outcomes following surgical treatment of KD. A review of the current literature was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies published from 2010 to 2019 with a minimum 2-year follow-up that reported outcomes following surgical treatment of KDs. Ten studies (6 level III, 4 level IV) were included. At mid- (2–10 y) to long-term (>10 y) follow-up, concomitant arterial, cartilage, and combined meniscus damage were predictive factors for inferior Lysholm and International Knee Documentation Committee (IKDC) scores when compared with patients without these associated injuries. Although concomitant neurological damage may influence short-term outcomes due to decreased mobility, at longer follow-up periods it does not appear to predict worse clinical outcomes when compared with patients without concomitant neurological injury. Frank and polytrauma KDs have been associated with worse mid- to long-term outcomes when compared with transient and isolated KDs. Patients who underwent surgery within 6 weeks of trauma experienced better long-term outcomes than those who underwent surgery longer than 6 weeks after the initial injury. However, the small sample size of this study makes it difficult to make valid recommendations. Lastly, female sex, patients older than 30 years at the time of injury and a body mass index (BMI) greater than 35 kg/m2 are factors that have been associated with worse mid- to long-term Lysholm and IKDC scores. The results of this review suggest that female sex, age >30 years, BMI >35 kg/m2, concomitant cartilage damage, combined medial and lateral meniscal damage, KDs that do not spontaneously relocate, and KDs associated with polytrauma may predict worse results at mid- to long-term follow-up.

scholarly journals Return to Play Rates Following Arthroscopic Treatment of Elbow Osteochondritis Dissecans Lesions in Adolescent Baseball Players

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Somnath Rao ◽  
Christopher Hadley ◽  
Michael Ciccotti ◽  
Steven Cohen ◽  
Christopher Dodson ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
The Other ◽  
Arthroscopic Treatment ◽  
Return To Play ◽  
Osteochondral Lesions ◽  
Elbow Arthroscopy ◽  
Baseball Players ◽  
Overhead Throwing ◽  
Mayo Elbow Score

Objectives: Osteochondritis dissecans (OCD) of the humeral capitellum is a common elbow injury in adolescent overhead throwing athletes likely secondary to the excessive valgus stress placed on the joint during the throwing motion. The purpose of this study is to retrospectively investigate the clinical findings and outcomes, including return to play rates, of overhead throwing athletes who underwent elbow arthroscopy for the treatment of osteochondral lesions of elbow. Methods: Throwing athletes who underwent elbow arthroscopy over an eight-year period, 2010 to 2018, were identified and included in our analysis. From this cohort of patients, those who were treated for OCD of the elbow joint and were baseball players were selected for analysis. Non-baseball athletes and those who underwent a concurrent procedure that required an open approach were excluded. Patients were contacted via phone to complete the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), the Mayo Elbow Score as well as a custom return to play and re-injury questionnaire. The minimum follow-up was 2 years from arthroscopic treatment. Results: Twenty patients met the inclusion criteria and were assessed in this analysis. All of the patients were male with an average BMI of 24.7 (range, 17.8-36.6). The average age at the time of surgery was 15.8 years old (range, 11.7-19.9). All 20 athletes played baseball pre-operatively and had no injury history or previous elbow surgery. Two patients had complications post-operatively. One patient received surgery for contracture release and debridement 7 months post-operatively. The other patient had a repeat arthroscopic microfracture procedure 4 months post-operatively followed by placement of an osteochondral allograft 11 months post-operatively for continued symptoms. Furthermore, three patients sustained an injury to the throwing shoulder or elbow after the operation. Two patients reported that the post-operative injury was throwing-related. One sustained an elbow stress fracture which was treated non-operatively while the other had a UCL reconstruction at 48 months post-operatively. The last patient reported sustaining an acromioclavicular joint separation that was treated operatively but not related to baseball or throwing. A total of 16 patients were available to complete the assessment. The average final follow-up was 5.5 (2.1-10.2) years with average KJOC of 64.6 (range, 13.9-97.0) and a Mayo Elbow Score of 90.0 (range, 60-100). Following surgery, 13/16 (81.2%) patients were able to return to their pre-injury sport and all returned to the same or higher level of competition. Seven patients reported improved symptoms, eight reported resolution of symptoms and one reported worsening of their symptoms after surgery. Overall patients were quite satisfied with their surgery, reporting an average 85.6% satisfaction rating. Conclusions: The results of this study indicate that elbow arthroscopy for osteochondral lesions in overhead throwing athletes is a reliable operation with 81.2% of athletes returning at the same or higher level of competition with low re-operation rates. In addition, these results boast a low complication rate and high patient satisfaction rate following elbow arthroscopy for OCD.

Surgical Treatment of Coronary Artery Fistula

2000 ◽  
Vol 8 (1) ◽  
pp. 24-26
Author(s):  
Chun Jiu Gu ◽  
Zhi Wei Zhang ◽  
De Min Yan ◽  
Tian Xiang Gu ◽  
Yi Hua Yuan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Ventricular Fibrillation ◽  
Surgical Techniques ◽  
Clinical Manifestations ◽  
Coronary Artery Fistula ◽  
The Other ◽  
Heart Murmurs ◽  
Indications For Operation

Six patients with coronary artery fistula were treated surgically between October 1977 and November 1998. The clinical manifestations, diagnostic criteria, indications for operation, and surgical techniques were evaluated. One patient died from ventricular fibrillation on the 2nd postoperative day. The outcome for the other 5 patients was good; symptoms and heart murmurs disappeared and all are alive and well after 10 to 21 years of follow-up. It was concluded that analysis of clinical data can confirm the diagnosis and this condition can be treated satisfactorily by suitable surgery.

Systematic Review of the Surgical Treatment of Moderate to Severe Post-Thrombotic Syndrome

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3170-3170
Author(s):  
Rachel T Bond ◽  
Jacqueline M. Cohen ◽  
Susan R. Kahn
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Medical Therapy ◽  
Ulcer Healing ◽  
Surgical Techniques ◽  
Seroma Formation ◽  
Venous Valve ◽  
Post Thrombotic Syndrome ◽  
Anatomical Outcomes

Abstract Abstract 3170 Background: Post-thrombotic syndrome (PTS) occurs frequently following deep venous thrombosis (DVT) and is severe in 5–10% of patients. PTS is a burdensome and costly condition due to its chronicity. Management of PTS has included the use of medical therapy such as compression, and less frequently, surgical therapies. Objective: To summarize surgical approaches to the treatment of PTS reported in the literature and to systematically review their effectiveness and safety. Method: A computerized search was conducted using PubMed and reverse citation searches to retrieve articles reporting on the surgical treatment of PTS. We limited our search to English and French language articles published after 1980. Only articles that presented results of outcomes after a surgical technique performed in patients with confirmed PTS were considered. Results: A total of 302 titles were retrieved, of which 27 full publications were reviewed. Eleven articles (8 prospective and 3 retrospective cohort studies) were identified that met criteria for inclusion in our review. Five were single center and six were two-center studies, and none included control patients who did not undergo surgery. The studies reported on a total of 315 patients with moderate to severe PTS who had failed medical therapy. Surgical techniques included percutaneous interventions such as vein dilation and stent placement (1 study), venous bypass grafting (2 studies), endophlebectomy with reconstruction (1 study), valve reconstruction/transplant (6 studies) and interruption of perforating veins (1 study). Follow-up period after surgery ranged from 10 months-5 years. Effectiveness outcomes measured in the studies varied widely. Anatomical outcomes included rates of venous valve competency and patency, venous filling times and ambulant venous pressure as determined by venography or Doppler ultrasound. Clinical outcomes assessed included improvement in signs and symptoms (e.g. pain, swelling, hyperpigmentation), ulcer healing, ability to return to work and reduced need for elastic compression stockings. Three studies used a quantitative scoring system to report clinical outcomes while 8 studies reported qualitative change only. Safety outcomes reported included surgical site bleeding, vessel injury, hematoma/seroma formation, infection, DVT, cellulitis, lymphocele, dysesthesia and acute valve rejection. Ten of 11 studies included for review described some improvement in PTS after the given surgical intervention. Seven of 11 studies found improvement in all anatomic measures assessed, 2/11 studies found anatomical improvement in valve competence and patency but no hemodynamic improvement, 1/11 studies showed no anatomical improvement and 1/11 studies did not discuss anatomical outcomes. The same 10 of 11 studies also reported clinical improvement over the follow-up period, with rates of ulcer healing ranging from 50–100%. Eight of 11 studies (representing 264 patients) reported safety outcomes; no instances of mortality or pulmonary embolism were reported. Complications reported most frequently were hematoma/seroma formation and wound infection. One study that examined transplantation of cryopreserved venous valve allografts found no improvement in PTS after surgery and had a complication rate of 12/25 (48%). Important limitations of the studies reviewed included a lack of randomized controlled trials, absence of control groups, small sample sizes, short follow-up periods, retrospective data collection, imprecise definition of PTS, heterogeneity of study participants with regard to use of anticoagulants, comborbidities and DVT risk factors and in three studies, lack of reporting on procedure safety. Conclusion: PTS is a frequent and chronic condition for which treatment advances are clearly needed. Surgical treatment of moderate to severe PTS to reduce venous valvular reflux and/or improve venous obstruction could have the potential to be effective where conservative and medical treatments have failed. Our review describes studies of surgical techniques that have been used to treat PTS, but highlights important limitations of such studies. Further research using stricter research methodology is needed to evaluate the potential role of surgical techniques for the treatment of moderate to severe PTS. Disclosures: No relevant conflicts of interest to declare.

Osteochondritis dissecans of the medial femoral trochlear ridge in two bulldog siblings

2003 ◽  
Vol 16 (03) ◽  
pp. 200-203 ◽  
Author(s):  
J. Marti ◽  
A. Chico
Keyword(s):  
Surgical Treatment ◽  
Osteochondritis Dissecans ◽  
Pathological Findings ◽  
First Report ◽  
Long Term Follow Up

SummaryOsteochondritis dissecans (OCD) of the medial femoral trochlear ridge was diagnosed in two seven months-old bulldog puppies. The disease was suspected radiographically and confirmed at exploratory arthrotomy. Both dogs showed a concurrent Grade I patellar luxation in the affected stifle. Treatment of the two conditions consisted of a recession wedge sulcoplasty and removal of a large cartilage flap. The outcome of the surgery, after a long-term follow-up (22 months) was excellent. To the authors’ knowledge, this is the first report of this type of OCD in the dog, its pathological findings and successful surgical treatment.

Osteochondritis Dissecans of the Talus: Long-Term Results of Surgical Treatment

Foot & Ankle ◽  
1989 ◽  
Vol 10 (3) ◽  
pp. 161-163 ◽  
Author(s):  
Peter Angermann ◽  
Peter Jensen
Keyword(s):  
Surgical Treatment ◽  
Osteochondritis Dissecans ◽  
Long Term Results ◽  
Short Term ◽  
Time Of Surgery ◽  
Pain At Rest ◽  
Results Of Surgery ◽  
Generalized Osteoarthritis

Twenty patients with osteochondritis dissecans of the ankle were reviewed for a clinical and radiographical follow-up 9 to 15 years after surgery including multiple drilling of the lesion combined with excision of loose fragments. The short-term results of surgery were satisfactory: 85° of the patients were improved or cured. At follow-up, more than half of the patients had some degree of pain during activity, and swelling of the ankle, but only a few had locking or pain at rest. Only one of the 18 patients without osteoarthritis at the time of surgery had developed generalized osteoarthritis at the followup. Although the initial good results of surgery were demonstrated to deteriorate with time, the procedure can still be recommended in patients with longstanding symptoms.

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

Long-Term Follow-Up of Early Cochlear Implant Device Activation

2021 ◽  
pp. 1-11
Author(s):  
Stefanie Bruschke ◽  
Uwe Baumann ◽  
Timo Stöver
Keyword(s):  
Speech Recognition ◽  
Side Effects ◽  
Cochlear Implant ◽  
Surgical Techniques ◽  
Control Group ◽  
First Year ◽  
Safe Procedure ◽  
Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

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