Open versus arthroscopic release for lateral patellar compression syndrome: a randomized-controlled trial

Introduction Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence, and patellar instability with 2 years of follow-up. Materials and methods 80 patients, age (21–49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features and MRI. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2, 6 weeks, 6, 12, and 24 months after surgery. Results There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P < 0.001). There is significantly better functional outcome at 2 years of follow-up with arthroscopic release (P = 0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group of open release. Conclusion Both open and arthroscopic lateral release for patients with isolated lateral patellar compression syndrome can be effective surgical procedures, but arthroscopic release can achieve better functional outcome. Trial registration: NCT, NCT04130412. Retrospectively registered on 3rd of June, 2020 at ClinicalTrials.gov.

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

Open Versus Arthroscopic Release for Lateral Patellar Compression Syndrome: A Randomized Controlled Trial

Background: Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum, which can be treated by surgical release of tight retinaculum after failure of conservative measures. Surgical release can be done by open or arthroscopic procedures. There was no randomized control trial to compare between these two procedures in considering of functional outcome and complications. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence and patellar instability with 2 years of follow up. Methods: 80 patients, age (21-49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release after diagnostic arthroscopy. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features, MRI and diagnostic arthroscopy and they had failure of conservative measures of quadriceps strengthening and analgesics for 6 months. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2 weeks, 6 weeks, 6 months, 12 months and 24 months after surgery. Results: There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P<0.001). There is significantly better functional outcome at 2 years of follow up with the arthroscopic release (P=0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group that was treated by open release. There are 2 patients develop hemarthrosis in arthroscopic group and one patient develop superficial wound infection in the group of open release. There is no significant difference in the postoperative complications between two groups. Conclusion: Both open and arthroscopic lateral release for patients with lateral patellar compression syndrome (without instability, limb malalignment or dysplasia) are effective surgical procedures but arthroscopic release can achieve better functional outcome than open release with less risk of development of post-operative patellar instability.Trial registration: NCT, NCT04130412. Registered 15 October 2019 -Retrospectively registered, https://www.clinicaltrials.gov/NCT04130412

Open Versus Arthroscopic Release for Lateral Patellar Compression Syndrome: A Randomized Control Trial

Background: Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum, which can be treated by surgical release of tight retinaculum after failure of conservative measures. Surgical release can be done by open or arthroscopic procedures. There was no randomized control trial to compare between these two procedures in considering of functional outcome and complications. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence and patellar instability with 2 years of follow up. Methods: 80 patients, age (21-49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release after diagnostic arthroscopy. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features, MRI and diagnostic arthroscopy and they had failure of conservative measures of quadriceps strengthening and analgesics for 6 months. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2 weeks, 6 weeks, 6 months, 12 months and 24 months after surgery.Results: There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P<0.001). There is significantly better functional outcome at 2 years of follow up with the arthroscopic release (P=0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group that was treated by open release. There are 2 patients develop hemarthrosis in arthroscopic group and one patient develop superficial wound infection in the group of open release. There is no significant difference in the postoperative complications between two groups.Conclusion: Both open and arthroscopic lateral release for patients with lateral patellar compression syndrome (without instability, limb malalignment or dysplasia) are effective surgical procedures but arthroscopic release can achieve better functional outcome than open release with less risk of development of post-operative patellar instability.Trial registration: NCT, NCT04130412. Registered 15 October 2019 -Retrospectively registered, https://www.clinicaltrials.gov/NCT04130412

Trigger Finger? Just Shoot!

Trigger finger is a common condition usually curable by a safe, simple corticosteroid injection. Trigger finger results from a stenotic A1 pulley that has lost its gliding surface producing friction and nodular change in the tendon. This results in pain and tenderness to palpation of the A1 pulley, progressing to catching and then locking. Splinting for 6 to 9 weeks produces gradual improvement in most patients as does a quick steroid injection with the latter resulting in resolution of pain in days and resolution of catching or locking in a few weeks. Percutaneous or open release should be reserved for injection failures particularly those at high risk for continued injection failure including diabetics and those with multiple trigger fingers. We present a step-by-step method for injection with illustrations to encourage primary care providers to offer this easily performed procedure to their patients.