Lymphedema and arm symptoms following three-dimensional conformal radiation therapy (3DCRT) for node-positive breast cancer (BC) patients.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 130-130 ◽  
Author(s):  
I. Sparks ◽  
P. Prior ◽  
Q. Xiang ◽  
X. A. Li ◽  
T. W. Yen ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Progesterone Receptors ◽  
Median Number ◽  
Axillary Node ◽  
Conformal Radiation Therapy ◽  
Arm Morbidity ◽  
Patient Reported ◽  
Target Volumes ◽  
The Mean

130 Background: Regional nodal irradiation for lymph node (LN) positive BC after lumpectomy/mastectomy can be subject to controversy due to the potential for treatment morbidity particularly lymphedema. Little is known about lymphedema and other arm morbidity rates after 3DCRT approaches. Methods: 172 LN positive BC cases treated from 2000 to 2007 using 3-DCRT and Dose Volume Histogram analyses were studied. All cases underwent axillary node dissection (AND). Axillary target volumes (ATV) were delineated on all treatment planning CT scans. Field arrangement and beam modifications were selected to deliver a min of 45 Gy to 90% of the ATV. Post-treatment bilateral arm circumference measurements (96%) and patient reported ipsilateral arm symptoms (thickness, heaviness, tingling, numbness) were recorded. Results: Median follow-up was 83.7 months. Median (med) patient age was 50. 52% were premenopausal. 76/66% had positive estrogen/progesterone receptors and 16% were HER2+. 52% underwent lumpectomy and 46% mastectomy. Median number of LN removed was 17 (1-46), number +LN was 3 (1-29), and tumor size was 3.7 cm. For 79 patients with separate AND the mean resected axillary volume was 157.8 cc (med 171 cc, range 25-472 ). The mean contoured ATV was 69 cc (med 58cc, range 16-608). On average 95% of the ATV was covered by a med of 44.7 Gy. Local control was achieved in 94.7% regional LN control in 99.4%. 16.7% met criteria for lymphedema (> 2 cm difference in circumference). Arm symptoms were reported by 51 (30%) of these 20 (39%) had measured circumference change > 2 cm. Referral to physical therapy was documented for 15% for reduced ROM but at last follow-up noted in 2.3%. The measured lymphedema rate was higher in patients who had mastectomy – 22 v. 11% (p=0.042) and worse with increasing resected axillary dissection volumes (p=0.032), ATV volume (p=0.883), and RT dose inhomgeneity coefficient (p = 0.049). Conclusions: Measured lymphedema rates following AND and 3-DCRT in this study were similar to those reported for AND in randomized studies compared to sentinel node. Careful attention to 3DCRT methods may help optimize lymphedema rates.

scholarly journals The Efficacy of Surgical Treatment in the Correction of Adult Acquired Flatfoot Deformity: A Three- dimensional Biometric Weightbearing Computed Tomography Evaluation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Cesar de Cesar Netto ◽  
Jonathan Day ◽  
Alexandre L. Godoy-Santos ◽  
Jonathan H. Garfinkel ◽  
Chris Cychosz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Joint ◽  
Surgical Procedures ◽  
Three Dimensional ◽  
Spring Ligament ◽  
Patient Reported ◽  
Significant Correction ◽  
Adult Acquired Flatfoot Deformity ◽  
The Mean

Category: Hindfoot; Ankle; Midfoot/Forefoot Introduction/Purpose: Multiple surgical techniques are used in the correction of Adult Acquired Flatfoot Deformity (AAFD). Assessment of the efficacy of a surgical treatment in the correction of the deformity is usually performed by clinical evaluation and conventional radiographic imaging. Weightbearing CT (WBCT) allows a more reliable and multiplanar evaluation of AAFD. The Foot and Ankle Offset (FAO) is a WBCT biometric semi-automatic measurement that gauges the relative positioning between the foot tripod and the center of the ankle joint. This study aimed to investigate the efficacy of surgical treatment in correcting AAFD, comparing preoperative and postoperative FAO measurements. We hypothesized that surgical treatment would provide significant correction of the deformity, centering the tripod of the foot underneath the ankle joint. Methods: In this prospective comparative study, 21 adult patients (22 feet) with flexible AAFD were included, mean age 55 (range, 23-81) years, 13 females and eight males. Patients underwent preoperative and postoperative standing WBCT examination. Three-dimensional coordinates (X, Y and Z planes) of the foot tripod (weightbearing point of the first and fifth metatarsals and calcaneal tuberosity) and center of the ankle (apex of the talar dome) were harvested by two independent and blinded observers. The FAO was automatically calculated from the harvested 3D coordinates by dedicated software. Data regarding the surgical technique used was recorded. Patient Reported Outcomes (PROs) were collected preoperatively and postoperatively at a mean follow-up of 22 (range, 8-36) months. Pre and postoperative FAO measurements were compared by paired T-tests. Multivariate analysis was used to assess the influence of surgical procedures in the amount of FAO correction. P-values of less than 0.05 were considered significant. Results: We found excellent intra (0.98) and interobserver reliability (0.96) for FAO measurements. The mean preoperative FAO was 10.4 (95% CI, 8.5 to 12.1). There was a significant correction of the deformity postoperatively (p<0.0001), with a mean postoperative FAO of 1.4 (CI, -0.1 to 2.9), and mean improvement of 8.9 (95% CI, 6.6 to 11.2). Average increase in PROs was (p<0.05): physical function (8; CI, 4 to 12), pain interference (10.3; CI, 4.8 to 15.9), pain intensity (5.3; CI, -10:20.6), mental health (4.2; CI, 0.2:8.2), physical health (4.3; CI, 0.9 to 9.8), and depression (10.4; CI, -0.6 to 21.4). The mean number of surgical procedures performed was 8 (range, 2-12). Spring ligament reconstruction was the only technique that influenced the amount of FAO correction (P<0.001). Conclusion: To the author’s knowledge, this is the first study to assess the amount of surgical correction of AAFD using standing WBCT images and semiautomatic 3D measurements. We found that surgical treatment provided a significant and pronounced amount of correction in the FAO, with the foot tripod more centered underneath the ankle joint. We also found a significant improvement in the PROMIS after an average postoperative follow-up of 22 months. Among multiple different surgical procedures performed, reconstruction of the spring ligament was the only technique that significantly influenced the amount of FAO correction. Longer-term follow-up studies are needed. [Figure: see text]

scholarly journals The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children

2021 ◽  
Author(s):  
Tran Anh Quynh ◽  
Pham Duy Hien ◽  
Le Quang Du ◽  
Le Hoang Long ◽  
Nguyen Thi Ngoc Tran ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Pediatric Patients ◽  
Three Dimensional ◽  
Dentate Line ◽  
Robotic Arms ◽  
Robotic Assisted ◽  
The Mean ◽  
Pull Through

AbstractRobotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

scholarly journals THU0517 THE ROLE OF ULTRASOUND-DEFINED SYNOVITIS GRADE I IN PATIENTS PRESENTING WITH INFLAMMATORY ARTHRALGIA, A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 497.2-497
Author(s):  
J. Arroyo Palomo ◽  
M. Arce Benavente ◽  
C. Pijoan Moratalla ◽  
B. A. Blanco Cáceres ◽  
A. Rodriguez
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
Statistical Tests ◽  
Median Number ◽  
Painful Joint ◽  
Significant Difference ◽  
The Mean ◽  
Specialized Unit

Background:Musculoeskeletal ultrasound (MSUS) is frequently used in several rheumatology units to detect subclinical inflammation in patients with joint symptoms suspected for progression to inflammatory arthritis (IA). Synovitis grade I (EULAR-OMERACT combined score) is known to be a casual finding in healthy individuals, but studies headed to unravel its possible role on rheumatic diseases are sparse.Objectives:To investigate the correlation between synovitis grade I, and the diagnosis of IA made after a year follow-up period since MSUS findings, in patients of an MSUS-specialized unit of a Rheumatology Department.Methods:We conducted a descriptive, retrospective and unicentric study. 30 patients were selected from the MSUS-specialized unit of our Rheumatology Department from July-18 to January-19. Patients presenting synovitis grade 0 (exclusively), 2 and/or 3 on combined score were excluded. Data collection at baseline included age, sex, immunological profile and previous physical examination to the MSUS findings, as well as the diagnosis made by the rheumatologist in 1-year visit follow-up: dividing the patient sample into two groups: those who were diagnosed with IA and those not. Non-parametric statistical tests for comparing means were used.Results:The mean age was 51,6 years and 70% were females. 6 (20%) patients were diagnosed with inflammatory arthritis after a year follow-up: 2 (4,8%) psoriatic arthritis, 1 (3,3%) undifferentiated arthritis, 1 (3,3%) rheumatoid arthritis, 1 (3,3%) Sjögren’s syndrome. Non-inflammatory arthropathies were also found 24 (80%), of which, 12 (40%) were non-specific arthralgias and 8 (19%) osteoarthritis.In the group of patients who did not developed an IA the mean C-reactive protein (CPR) value was 3,12 mg/L and erythrocyte sedimentation rate (ESR) was 8,2 mm; all of them were rheumatoid factor (RF) positive and ACPA-negative except one patient. 5 (31,3%) patients presented low antinuclear antibodies (ANAs) levels. In those who HLA B-27 and Cw6 were tested (4,25%); both were negative except for one that was HLA B-27 positive. The median number of swollen and painful joint count was 0, and the mean of joints with MSUS involvement was 3,5; the mean involved metacarpophalangeal (MCP) joints was 1,83; proximal interphalangeal (PIP) joints was 1,48 and distal interphalangeal (DIP) joints 0,21.Among the group of patients that developed an IA the mean of CPR and ESR was 9,27 mg/L and 14,17 mm respectively; 2 (33%) patients were RF- positive, and 1 ACPA-positive. ANAs were positive in 3 cases (50%). The median of swollen joint count was 2 and for painful joint count was 0, the median of joints with MSUS involvement was 4,5. The mean of MSUS involvement was for MCP, PIP and DIP joints: 1,67, 2 and 0. Comparing the means of CPR values in the two groups with Student’s t-test we obtained a statistically significant difference (p=0,023). No other significant differences were found.Conclusion:Despite the limitations and possible statistical bias, the presence of MSUS-defined synovitis grade I and elevated CRP levels could be related to further diagnoses of inflammatory arthropathy. Besides, the absence of synovitis in DIP joints might have a diagnostic role. Normal physical exploration and normal levels of CRP might suggest low MSUS value. However, further research is needed to clarify the role of MSUS-defined synovitis grade I.References:[1]D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1):e000428.[2]Van den Berg R et al. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature review. Arthritis Research & Therapy (2018) 20:228.Disclosure of Interests:None declared

No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽  
2021 ◽  
pp. 194760352110219
Author(s):  
Danielle H. Markus ◽  
Anna M. Blaeser ◽  
Eoghan T. Hurley ◽  
Brian J. Mannino ◽  
Kirk A. Campbell ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Lesion Size ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

scholarly journals Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

2019 ◽  
Vol 98 (5) ◽  
pp. 291-294 ◽  
Author(s):  
Saudamini J. Lele ◽  
Mickie Hamiter ◽  
Torrey Louise Fourrier ◽  
Cherie-Ann Nathan
Keyword(s):  
Treatment Option ◽  
Case Series ◽  
Complete Response ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Effective Treatment Option ◽  
Patient Reported ◽  
History Of ◽  
The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

Outcomes of Hip Arthroscopic Surgery in Adolescents With a Subanalysis on Return to Sport: A Systematic Review

2019 ◽  
Vol 48 (6) ◽  
pp. 1526-1534
Author(s):  
Sarah L. Chen ◽  
David R. Maldonado ◽  
Cammille C. Go ◽  
Cynthia Kyin ◽  
Ajay C. Lall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Short Form ◽  
Adult Population ◽  
Arthroscopic Surgery ◽  
Return To Sport ◽  
Functional Improvement ◽  
Harris Hip Score ◽  
Patient Reported ◽  
The Mean

Background: There is a plethora of literature on outcomes after hip arthroscopic surgery in the adult population; however, outcomes in the adolescent population have not been as widely reported. Additionally, as adolescents represent a very active population, it is imperative to understand their athletic activity and return to sport after hip arthroscopic surgery. Purpose: To analyze patient-reported outcomes (PROs) after hip arthroscopic surgery in adolescents (aged 10-19 years) and present a return-to-sport analysis in the athletic adolescent subgroup. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, Embase, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify articles that reported PROs after hip arthroscopic surgery in adolescents. The standardized mean difference was calculated to compare the effect size of hip arthroscopic surgery on various PROs. For the athletic subgroup, a return-to-sport summary was also provided. Results: Ten studies, with 618 adolescent hips and a collective study period of December 2004 to February 2015, were included in this systematic review. Across all studies, the mean age was 15.8 years (range, 11.0-19.9 years), and female patients composed approximately 56.7% of the entire cohort. The mean follow-up was 34.5 months (range, 12-120 months). The modified Harris Hip Score (mHHS) was reported in 9 studies, and at latest follow-up, scores were excellent in 4 studies (range, 90-95) and good in the remaining 5 studies (range, 82.1-89.6). All adolescents also showed significant improvement on the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL), the HOS–Sport-Specific Subscale (HOS-SSS), the physical component of the 12-Item Short Form Health Survey (SF-12P), a visual analog scale for pain (VAS), and both versions of the International Hip Outcome Tool (iHOT-12 and iHOT-33) at latest follow-up ( P < .05). Further, mean improvements reported in all studies surpassed reported values of the minimal clinically important difference and patient acceptable symptomatic state for the mHHS, HOS-ADL, HOS-SSS, and iHOT-33. Finally, the collective return-to-sport rate among athletic adolescents was 84.9%. Conclusion: In the setting of labral tears and femoroacetabular impingement, hip arthroscopic surgery can safely be performed in adolescents and leads to significant functional improvement. Furthermore, athletic adolescents return to sport at high levels after hip arthroscopic surgery.

scholarly journals “Double-Pulley” Dual-Row Technique for Arthroscopic Fixation of Large Bony Bankart Lesion: Minimum 2-Year Follow-up With CT Evaluation

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110292
Author(s):  
Siyi Guo ◽  
Chunyan Jiang
Keyword(s):  
Intraobserver Reliability ◽  
Bankart Lesion ◽  
Reliable Technique ◽  
Bony Bankart Lesion ◽  
Ct Measurements ◽  
Bony Bankart ◽  
Patient Reported ◽  
Arthroscopic Fixation ◽  
The Mean

Background: A “double-pulley” dual-row technique had been applied for arthroscopic fixation of large bony Bankart lesion in which the fragment has a wide base. Purpose: To investigate clinical outcomes and glenoid healing after arthroscopic fixation of bony Bankart lesion using the double-pulley dual-row technique. Study Design: Case series; Level of evidence, 4. Methods: A total of 25 patients were included in this retrospective study. The American Shoulder and Elbow Surgeons (ASES) score, pain visual analog scale (VAS) score, and range of motion of the affected shoulder were assessed. Radiographs and computed tomography (CT) scans (preoperatively, immediately after surgery, and at 1 year postoperatively) were performed to evaluate arthritic changes (Samilson-Prieto classification) and glenoid size. The intraobserver reliability of the CT measurements was analyzed. Results: At a mean follow-up of 3.4 years, the mean ASES and VAS scores were 94.87 ± 5.02 and 0.48 ± 0.59, respectively. Active forward elevation, external rotation with the arm at the side, and internal rotation were 165.80° ± 11.70°, 33.20° ± 8.02°, and T9 (range, T6-S1), respectively. No patient reported a history of redislocation or instability. The intraobserver reliability of the CT measurements was moderate to excellent. The mean preoperative size of the bony fragment was measured as 23.4% ± 7.8% of the glenoid articular surface. The quality of the reduction was judged to be excellent in 13 (52%) cases, good in 8 (32%), and fair in 4 (16%). The mean immediate postoperative glenoid size was 96.8% ± 4.3%, and bone union was found in all cases. There were no significant differences between reconstructed and immediate postoperative glenoid size or between preoperative and final Samilson-Prieto grades. Conclusion: The arthroscopic double-pulley method was a reliable technique for the fixation of large bony Bankart lesions with a wide base. Satisfactory results can be expected regarding the restoration of the glenoid morphology and stability of the shoulder. High healing rate and good shoulder function can be achieved. No radiological evidence of cartilage damage caused by suture abrasion was found at 2- to 5-year follow-up.

scholarly journals Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

2018 ◽  
Vol 21 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Julio D. Montejo ◽  
Joaquin Q. Camara-Quintana ◽  
Daniel Duran ◽  
Jeannine M. Rockefeller ◽  
Sierra B. Conine ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Pediatric Patients ◽  
Lumbar Disc ◽  
Low Back ◽  
Duration Of Symptoms ◽  
Patient Reported ◽  
The Mean

OBJECTIVELumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.METHODSTwelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.RESULTSThe mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).CONCLUSIONSTo the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.

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