Minimum 10-year follow-up outcomes of arthroscopic Bankart’s repair with metallic anchors:Reliable results with low redislocation rates

BACKGROUND With stiff competition from alternative albeit more expensive counterparts,it has become important to establish the applicability of metallic anchors for shoulder instability in the modern era.This can be accomplished,in part,by analysing long-term outcomes.AIM To analyse minimum 10-year outcomes from 30 patients following arthroscopic anterior stabilisation using metallic anchors.METHODS Prospectively collected data from arthroscopic Bankart repairs performed using metal anchors during 2007P-2010 were retrospectively analysed in this singlesurgeon study.Comprehensive data collection included historical and clinical findings,dislocation details,operative specifics,and follow-up radiological and clinical findings including shoulder scores.The primary outcomes were patientreported scores(Constant,American Shoulder and Elbow Surgeons[ASES],and Rowe scores)and pain and instability on a visual analogue scale(VAS).RESULTS A 3% recurrence rate of dislocation was noted at the final follow-up.Total constant scores at 10 years postoperatively measured between 76 and 100(mean 89)were significantly better than preoperative scores(mean 62.7).Congruous improvements were also noted in the Rowe and ASES scores and VAS at the 10-year review.CONCLUSION Reliable long-term outcomes with metallic anchors in surgery for shoulder instability can be expected.Our results provide additional evidence of their continued,cost-effective presence in the modern scenario.

Evaluation of Functional and Radiological Outcome of Arthroscopic-Assisted Anatomical Coracoclavicular (CC) and Acromioclavicular (AC) Ligament Reconstruction in Chronic AC Joint Dislocation

Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockwood classification system. Controversies surround grade III injuries, necessitating further classification. Non-operative treatment has shown favorable outcomes, while surgical interventions vary. Anatomical coracoclavicular reconstruction (ACCR) has demonstrated biomechanical advantages over traditional methods. Arthroscopic techniques offer advantages, minimizing deltoid detachment and allowing concurrent pathology identification. This study evaluates the outcomes of arthroscopic-assisted ACCR in chronic AC joint dislocation. Surgical Technique: Arthroscopic-assisted ACCR involves meticulous portal placement, tendon graft harvesting, diagnostic arthroscopy, and coracoid exposure. The clavicle tunnels were made to mimic the conoid and trapezoid ligament positions, using FibreTape#2 loop and Dog Bone Button for correct placement against the coracoid base, and passing the semitendinosus graft through to reconstruct the conoid ligament, reduction done and graft follow through for anatomical reconstruction. Methods: A retrospective cohort study at Hospital Kuala Lumpur analyzed 35 patients undergoing arthroscopic-assisted ACCR for Rockwood grade III - V AC joint dislocations. Inclusion criteria encompassed trauma ≥ 3 weeks prior, no prior shoulder injuries, and ≥12-month follow-up. Functional and radiological assessments utilized ASES scores and coracoclavicular distances, respectively. Statistical analysis employed descriptive statistics and logistic regression. Results: The mean age was 38.9 years (SD 11.26), and 34 of 35 patients were male. Grade IV injuries were predominant (37.1%). Waiting time for surgery averaged 234.9 days. Functional improvement was substantial postoperatively (ASES: 55.5 to 88.9). Radiological outcomes demonstrated reduced coracoclavicular distances and maintained reduction. No significant correlation was observed between injury grade and outcomes. Conclusion: Arthroscopic-assisted ACCR for chronic AC joint dislocation yields significant functional and radiological improvement, irrespective of injury grade. Waiting time for surgery exhibits minor impact on outcomes, emphasizing the procedure’s efficacy. Concomitant injuries do not impede success, highlighting the versatility of this approach in managing shoulder instability. The study contributes valuable insights into the nuanced management of chronic AC joint dislocations and supports the adoption of arthroscopic-assisted ACCR as a viable treatment option.

Mid-term outcomes of microfragmented adipose tissue plus arthroscopic surgery for knee osteoarthritis:A randomized,activecontrol,multicenter clinical trial

BACKGROUND Osteoarthritis(OA)is the most prevalent form of degenerative whole-joint disease.Before the final option of knee replacement,arthroscopic surgery was the most widely used joint-preserving surgical treatment.Emerging regenerative therapies,such as those involving platelet-rich plasma,mesenchymal stem cells,and microfragmented adipose tissue(MFAT),have been pushed to the forefront of treatment to prevent the progression of OA.Currently,MFAT has been successfully applied to treat different types of orthopedic diseases.AIM To assess the efficacy and safety of MFAT with arthroscopic surgery in patients with knee OA(KOA).METHODS A randomized,multicenter study was conducted between June 2017 and November 2022 in 10 hospitals in Zhejiang,China.Overall,302 patients diagnosed with KOA(Kellgren-Lawrence grades 2-3)were randomized to the MFAT group(n=151,were administered MFAT following arthroscopic surgery),or the control group(n=151,were administered hyaluronic acid following arthroscopic surgery).The study outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,the visual analog scale(VAS)score,the Lequesne index score,the Whole-Organ Magnetic Resonance Imaging Score(WORMS),and safety over a 24-mo period from baseline.RESULTS The changes in the WOMAC score(including the three subscale scores),VAS pain score,and Lequesne index score at the 24-mo mark were significantly different in the MFAT and control groups,as well as when comparing values at the posttreatment visit and those at baseline(P<0.001).The MFAT group consistently demonstrated significant decreases in the WOMAC pain scores and VAS scores at all follow-ups compared to the control group(P<0.05).Furthermore,the WOMAC stiffness score,WOMAC function score,and Lequesne index score differed significantly between the groups at 12 and 24 mo(P<0.05).However,no signicant between-group differences were observed in the WORMS at 24 mo(P=0.367).No serious adverse events occurred in both groups.CONCLUSION The MFAT injection combined with arthroscopic surgery treatment group showed better mid-term clinical outcomes compared to the control group,suggesting its efficacy as a therapeutic approach for patients with KOA.

Application of Tranexamic Acid in Shoulder Arthroscopic Surgery:A Randomised Controlled Trial

Objective To explore the optimal administration route of tranexamic acid(TXA)in shoulder arthroscopic surgery.Methods Patients undergoing arthroscopic rotator cuff repair were randomly divided into four groups:control group(without TXA treatment),intravenous group(TXA was intravenously administered 10 minutes before surgery),irrigation group(TXA was added to the irrigation fluid during subacromial decompression and acromioplasty),and intravenous plus irrigation group(TXA was applied both intravenously and via intra-articular irrigation).The primary outcome was visual clarity assessed with visual analog scale(VAS)score,and the secondary outcomes included irrigation fluid consumption and time to subacromial decompression and acromioplasty procedure.Results There were 134 patients enrolled in the study,including 33 in the control group,35 in the intravenous group,32 in the irrigation group,and 34 in the intravenous plus irrigation group.The median and interquartile range of VAS scores for the intravenous,irrigation,and intravenous plus irrigation groups were 2.70(2.50,2.86)(Z=-3.677,P=0.002),2.67(2.50,2.77)(Z=-3.058,P<0.001),and 2.91(2.75,3.00)(Z=-6.634,P<0.001),respectively,significantly higher than that of the control group[2.44(2.37,2.53)].Moreover,the control group consumed more irrigation fluid than the intravenous group,irrigation group,and intravenous plus irrigation group(all P<0.05).The intravenous plus irrigation group consumed less irrigation fluid than either the intravenous group or the irrigation group(both P<0.001).There was no difference in subacromial decompression and acromioplasty operative time among the four groups.Conclusion TXA applied both topically and systematically can improve intraoperative visual clarity,and the combined application is more effective.

Arthroscopic approach to the posterior compartment of the knee using a posterior transseptal portal

Arthroscopic surgery of the posterior compartment ofthe knee is difficult when only two anterior portals are used for access because of the inaccessibility of the back of the knee. Since its introduction, the posterior transseptal portal has been widely employed to access lesions in the posterior compartment. However, special care should be taken to avoid neurovascular injuries around the posteromedial, posterolateral, and transseptal portals. Most importantly, popliteal vessel injury should be avoided when creating and using the transseptal portal during surgery. Purpose of the present study is to describe how to avoid the neurovascular injuries during establishing the posterior three portals and to introduce our safer technique to create the transseptal portal. To date, we have performed arthroscopic surgeries via the transseptal portal in the posterior compartments of 161 knees and have not encountered nerve or vascular injury. In our procedure, the posterior septum is perforated with a 1.5-3.0-mm Kirschner wire that is protected by a sheath inserted from the posterolateral portal and monitored from the posteromedial portal to avoid popliteal vessel injury.

Medium-term efficacy of arthroscopic debridement vs conservative treatment for knee osteoarthritis of Kellgren-Lawrence grades I-III

BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis(KOA).Due to the differences in the research subjects,methods,and efficacy evaluation indexes,there are great differences in the surgical efficacy reported in the literature.AIM To compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODS Patients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group,and those who refused surgical treatment were included in a conservative treatment group.Gender,age,body mass index(BMI),side of KOA,American hospital for special surgery knee score(HSS score)before treatment,visual analogue scale(VAS)score during walking and rest before treatment,conservative treatment content,and surgical procedure were recorded.Outpatient visits were conducted at the 1st,3rd,6th,12th,and 24th mo after treatment in the two groups.The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed,and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTS In the conservative treatment group,there were 80 patients with complete followup data,including 20 males and 60 females,aged 58.75±14.66 years old.And in the knee arthroscopic debridement group,there were 98 patients with complete follow-up data,including 24 males and 74 females,aged 59.27±14.48 years old.There was no statistically significant difference in the general data(gender,age,BMI,side of KOA,Kellgren-Lawrence grade distribution,HSS score,and VAS score)between the two groups before treatment.The HSS scores of the conservative treatment group at the 1st,3rd,6th,12th,and 24th mo after treatment were significantly higher than that before treatment(P<0.05).There was no statistical difference in HSS score of the conservative treatment group among the 1st,3rd,6th,12th,and 24th mo(P>0.05).The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery(P<0.05).HSS scores of the knee arthroscopic debridement group at the 3rd,6th,12th,and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery(P<0.05).There were no statistically significant differences in HSS scores at the 3rd,6th,12th,and 24th mo after surgery(P>0.05).HSS scores at the 3rd,6th,12th,and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group(P<0.05).There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up(P>0.05).VAS scores during walking and rest were significantly decreased in both groups,and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group,but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSION Compared with conservative treatment,arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.

The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months （range 12-30 months）. The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation （P〈0. 01）, the total excellent and fine rate was 91.86%. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

Arthroscopic Capsular Release for Frozen Shoulder—Time to Thaw the Delay?

Introduction: Frozen shoulder is a common condition that affects the working population. Current management regimes are variable nationwide and the evidence base on which to base these decisions is poor. The longevity and severity of symptoms often result in great economic burden, both to health services and in terms of absence from work. Early surgical intervention with arthroscopic capsular release may result in improved symptoms and earlier return to both work and leisure activities. Aims: The aim of our prospective cohort study was to investigate whether early intervention with arthroscopic capsular release resulted in improvement of symptoms and whether this would in turn provide overall economic benefit to society. Methods: Patients diagnosed with frozen shoulder at an elective orthopaedic specialist shoulder clinic were recruited prospectively. Data were gathered by way of questionnaire to ascertain the demographic information of the patient as well as their previous treatment in the primary care setting and absence from work. Initial Oxford Shoulder Score (OSS) was also calculated: Arthroscopic capsular release was then performed and further data gathered at four-week post-operative follow-up. Economic impact of delay to treatment and cost of intervention were calculated using government data from the national tariff which cost different forms of treatment. Statistical analysis was then performed on the results. Results: Twenty five patients were recruited. Mean results were: Age of patients: 53.5 years, duration of symptoms prior to intervention: 35.2 weeks, days absent from work: 31.5, number of previous physiotherapy sessions: 7.2, number of steroid injections: 1.3. Mean pre-operative OSS was 37.4 (range 27 - 58, SD 7.4). Mean post-operative OSS was 15.9 (range 12 - 22, SD 2.3), P 0.01. Mean improvement in OSS was 21.5 (range 12 - 38, SD 7.1). The cost of non-operative treatment per patient including absence from work to the point of surgical intervention was ￡3954. The overall cost of arthroscopic capsular release per patient was ￡1861, a difference of ￡2093. There were no surgical complications. Conclusion: Arthroscopic capsular release improved shoulder function on OSS within four weeks. This is significantly shorter than the natural history of frozen shoulder. The overall cost of arthroscopic capsular release is significantly less than the cost of treating the patients non-operatively up to the point of surgical intervention. Early surgical intervention may improve symptoms quickly and reduce economic burden of the disease. A randomised controlled trial comparing early with late intervention would further elucidate potential benefits.

Clinical Results of Arthroscopic Rotator Cuff Repair with a Tape-Attached Anchor

Objective: The purpose of this study was to evaluate the clinical results of arthroscopic rotator cuff repair with a tape-attached anchor: The HEALICOILRG with ULTRATAPE. We hypothesised that performing arthroscopic rotator cuff repair with tape-attached anchors would result in better clinical outcomes and reduce the retear rate compared with conventional suture anchors. Methods: We included 83 patients treated by arthroscopic rotator cuff repair with a minimum 1-year follow-up. We divided them into two groups: Use of the HEALICOILRG with ULTRATAPE (group T: 41 shoulders;mean patient age, 64.3 years) and use of the conventional suture anchor (group S: 42 shoulders;mean patient age, 68.9 years). We compared the University of California Los Angeles scores, Japanese Orthopaedic Association scores, range of motion, and retear rate between the two groups. The Student t test and chi-square test were used in statistical analyses. Results: At the 1-year postoperative follow-up, both groups showed improvement in the average University of California Los Angeles score, Japanese Orthopaedic Association score, and range of motion, although no significant difference was found in the retear rate between the two groups. Conclusions: Results of arthroscopic rotator cuff repair with the HEALICOILRG with ULTRATAPE were generally good. However, our results could not demonstrate efficacy of the HEALICOILRG with ULTRATAPE. Further detailed studies are needed to determine its treatment result.

Controversial role of arthroscopic meniscectomy of the knee: A review

The role of arthroscopic partial meniscectomy(APM) in reducing pain and improving function in patients with meniscal tears remains controversial. Five recent highquality randomized controlled trials(RCTs) compared non-operative management of meniscal tears to APM, with four showing no difference and one demonstrating superiority of APM. In this review, we examined the strengths and weaknesses of each of these RCTs, with particular attention to the occurrence of inadvertent biases. We also completed a quantitative analysis that compares treatment successes in each treatment arm, considering crossovers as treatment failures. Our analysis revealed that each study was an excellent attempt to compare APM with non-surgical treatment but suffered from selection, performance, detection, and/or transfer biases that reduce confidence in its conclusions. While the RCT remains the methodological gold standard for establishing treatment efficacy, the use of an RCT design does not in itself ensure internal or external validity. Furthermore, under our alternative analysis of treatment successes, two studies had significantly more treatment successes in the APM arm than the non-operative arm although original intention-totreat analyses showed no difference between these two groups. Crossovers remain an important problem in surgical trials with no perfect analytical solution. With the studies available at present, no conclusion can be drawn concerning the optimal treatment modality for meniscal tears. Further work that minimizes significant biases and crossovers and incorporates sub-group and cost-benefit analyses may clarify therapeutic indications.

Outcomes after arthroscopic repair of rotator cuff tears in the setting of mild to moderate glenohumeral osteoarthritis

BACKGROUND Rotator cuff pathology is a very common source of shoulder pain.Similarly,osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms.Surgical management can be indicated for both pathologies,however,outcomes data is limited when examining rotator cuff repair(RCR) in the setting of glenohumeral arthritis(GHOA).Thus,this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017.Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity.Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis.Patients included had a minimum two year follow-up.Rate of conversion to total shoulder arthroplasty,complication rates following initial surgery,and patient-reported outcome measures were collected.RESULTS A total of 142 patients were included.The number of patients that required total shoulder arthroplasty within two years after index surgery was low.2/71(2.8%) patients with GHOA,and 1/71(1.4%) without GHOA.Following rotator cuff repair,both groups showed favorable patientreported outcomes.CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.

Adjunctive platelet-rich plasma and hyaluronic acid injection after arthroscopic debridement in Kellgren-Lawrence grade 3 and 4 knee osteoarthritis

BACKGROUND Osteoarthritis(OA)is the most common cause of pain and disability,predominantly affecting the knee.The current management of knee OA falls short of completely stopping disease progression,particularly in Kellgren-Lawrence(KL)grade 3 and 4 knee OA.As such,joint replacement is often recommended,although only 15%-33%of candidates accept it.Alternative therapeutic options are still needed to prevent the progression of joint damage and delay the need for knee arthroplasty.AIM To investigate the effect of adjunctive platelet rich plasma(PRP)and hyaluronic acid(HA)after arthroscopic debridement in KL grade 3 and 4 knee OA.METHODS This retrospective cohort study used the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score and WOMAC sub-scores(pain,stiffness,and function)to assess 21 patients,grouped according to medical record data of treatment received:Arthroscopic debridement(n=7);arthroscopic debridement with PRP(n=7);or arthroscopic debridement with HA(n=7).WOMAC scores and sub-scores at baseline and at 3 mo and 5 mo posttreatment were recorded.The three-group data were statistically analyzed using the tests of paired t,one-way analysis of variance,and post hoc least significant difference.RESULTS All three treatment groups showed significant improvements in WOMAC score and sub-scores from before treatment to 3 mo and 5 mo after treatment.However,the arthroscopic debridement with PRP treatment group,in particular,showed a significantly lower WOMAC pain score than the group who received arthroscopic debridement alone at 5 mo after the procedure(P=0.03).CONCLUSION Compared to arthroscopic debridement alone,adjunctive PRP after arthroscopic debridement significantly lessened the patients’pain symptom.

Role of biomechanical assessment in rotator cuff tear repair: Arthroscopic vs mini-open approach

BACKGROUND Rotator cuff(RC)tears are one of the most frequent pathologies within the shoulder girdle.Hand dominance and older age are associated with RC tears.Two different surgical procedures,the mini-open(MO)and all-arthroscopic(AA)approach,represented the standard of treatment.AIM To compare the clinical and biomechanical outcomes of two surgical techniques(AA vs MO procedure)performed to address the painful shoulder syndrome with partial or total supraspinatus tendon tear.METHODS Eighty-eight participants,50 following RC repair with AA and 38 with MO approach,were recruited in the present cross-sectional case-control study(ORTHO-SHOULDER,Prot.0054602).All patients underwent postoperative clinical evaluation for pain(Visual analogic scale),impairment,and disability(disability of the arm,shoulder,and hand)and limitation in daily activity(Constant-Murley score).Patients’shoulder mobility was also assessed in our Laboratory of Functional Movement through a wearable inertial sensor and surface electromyography to monitor kinematics and muscle activity during the movement on the frontal(abduction/adduction)and sagittal(flexion-extension)planes.RESULTS No statistically significant differences between the two procedures were observed in either main clinical score or range of motion.A significant increase in velocity during the movement execution and a higher contribution of upper trapezius muscles were found in the AA group compared with MO patients.CONCLUSION In terms of clinical scores,our findings were in line with previous results.However,the use of technology-based assessment of shoulder mobility has revealed significant differences between the two techniques in terms of mean velocity and pattern of muscle activation.

Arthroscopic Subacromial Decompression for Small and Medium Size Tears of Rotator Cuff without Tendon Repair

According to our previous clinical impression, we hypothesized that patients who had symptomatic rotator cuff tendon tear in a diamemter below 3 cm would benefit from arthroscopic subacromial decompression only, without the need for the repair of the thorn tendon. From 1998 to 2003, 160 patients (168 shoulders) had arthroscopic subacromial decompression for impingement syndrome with a torn rotator cuff without repairing the tear of the cuffs (120 males and 40 females). The average patient age was 64 years and the average follow up was 30 months. At follow up, 96 patients (60%) had full recovery;55 patients (35%) had residual low grade shoulder pain on effort and 7 patients (5%) had poor outcome. In the last group of patients with unsatisfactory outcome, the postoperative Constant score was only 64 points. In 95% of patients, the average Constant score values raised from average preoperative value of 62 to postoperative average score of 82. According to these results, there is an indication that in patients in the seventh decade of life or older with symptomatic rotator cuff tear, pain relief and good shoulder function can be achieved by more conservative approach of subacromial decompression alone, providing a clear diagnosis that the diameter of the tear in the supraspinatus and infraspinatus tendons is below 3 cm.

Analgesic effects of low -dose trama dol after arthroscopic knee surgery

Objective To investigate analgesic effect of i ntra -articular low -dose tramadol a fter arthroscopic knee surgery.Methods60patients undergoing arthroscopic k nee surgery under lumbar anesthesia were randomly divided into intra -ar ticular injection of tramadol(TJ group),mulscle injection of tramadol(TM)and saline control group.Vision analog scoring was conducted under exte nsion of knee joint 8h and24h after drugs administration.Follow -up was done to observe unwanted e ffects 48h after surgery.Results Score of TJ group was significantly lower than those of other groups(P <0.05).No unwanted effects were found.Conclusion Intra -articular tramadol in low -dose could relieve operative pain.

Open versus Arthroscopic Treatment of Post-Traumatic Stiff Elbow

Thirty three patients with post-traumatic stiff elbow were divided into two groups. The first group included 18 patients with an average age of 31.05 years treated by open arthrolysis. The second included 15 patients with an average age of 31.66 years treated by arthroscopic method. The results were evaluated using the Mayo clinic score and DASH score for elbow function. In the open group, after an average period of follow-up 19.33 months, the average range of flexion-extension movement improved from 51.11° to 103.94°. The average Mayo clinic score improved from 63.38 to 92.83 and the average DASH score improved from 68.1 to 40.23. There were 13 cases (72.22%) excellent, 4 cases (22.22%) good and 1 case (5.55%) with the poor result. In the arthroscopic group, after an average period of follow-up 17.73 months, the average range of flexion-extension movement improved from 59.46° to 101.53°. The average Mayo clinic score improved from 62.93 to 92.73 and the average DASH score improved from 69.25 to 46.4. There were 10 cases (66.66%) excellent, 3 cases (20%) good and 2 cases (13.33%) with the poor result. Both open and arthro-scopic treatment can be effective in treatment of post-traumatic stiff elbow. Arthroscopic treatment is associated with less post-operative pain and morbidity. However, open treatment provides better range of motion and marked improvement of elbow function.

Arthroscopic surgery for synovial chondroma of the subacromial bursa with non-traumatic shoulder subluxation complications:Two case reports

BACKGROUND Synovial chondromatosis is a disease originating from the synovium and characterized by the presence of metaplastic cartilaginous nodules in synovial cavities.The exact prevalence of synovial chondromatosis remains unknown,and the involvement of the shoulder joint is very rare.Synovial chondromatosis accompanied by subluxation of the humeral head without a history of trauma is rarely encountered,and to our knowledge,no published reports describe this condition.CASE SUMMARY We present two cases of synovial chondromatosis in the shoulder joint,accompanied by subluxation of the humeral head,in two arthroscopically managed adult patients.We performed arthroscopic labrum fixation and removal of the loose body from the shoulder joint.To identify primary and secondary categories,pathological analysis was arranged.Clinical and radiographic evaluations at the 1-mo follow-up were satisfactory.CONCLUSION The biomechanical function of the shoulder joint requires attention,especially following the detection of loose bodies,as observed with synovial chondroma occurring in rare sites.Arthroscopic management is successful in patients with synovial chondromatosis combined with shoulder subluxation.

Effects of different positions on rehabilitation after rotator cuff repair under shoulder arthroscopy

Objective Shoulder arthroscopic rotator cuff tear repair is currently the main treatment for full-thickness rotator cuff tears,and postoperative rehabilitation training is essential.However,pain and limitation of activity during the rehabilitation process will lead to poor results.Hence,identifying rehabilitation approaches is crucial.This study aimed to compare patient's rehabilitation outcomes and experience between rehabilitation in the supine position and in the standing position.Methods This prospective study included patients diagnosed with full-thickness rotator cuff tears who underwent shoulder arthroscopic double-row rivet repair at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from March 2019 to September 2021.The patients were randomly assigned to the standing rehabilitation exercise group(group A)and the supine rehabilitation exercise group(group B).All patients were followed up for 6 months to record and compare the visual analog scale(VAS)scores,shoulder range of motion,and rehabilitation compliance.Results Altogether,86 patients participated in the study,of whom 79 patients completed the 6-month follow-up.Groups A and B had 39 and 40 patients,respectively.Before operation,the VAS score,forward flexion and extension angle,and abduction angle were comparable between groups A and B.After operation,the patients in groups A and B all experienced a significant improvement in the VAS score,forward flexion and extension angle,and abduction angle(p<0.05).In addition,patients in group B had better VAS score(4.58±0.87 vs.5.21±1.13,p=0.0068;2.15±0.66 vs.2.51±0.51,p=0.0078;0.78±0.86 vs.1.33±0.81,p=0.0015),forward flexion and extension angle(109.30±2.87°vs.102.33±3.74°,p=0.0001;109.53±3.39°vs.104.18±2.76°,p=0.0001;125.22±6.05°vs.117.59±2.27°,p=0.0001),and abduction angle(91.78±2.77°vs.82.92±2.12°,p=0.0001;91.62±2.78°vs.82.82±1.45°,p=0.0001;109.48±3.37°vs.100.10±2.94°,p=0.0001)at 2 wk,6 wk and 6 m postoperatively.Conclusion After 6 months of follow-up,the patients who performed rehabilitation exercises in the supine position achieved better rehabilitation outcomes than those who performed rehabilitation exercises while standing.

Anterior glenohumeral instability:Current review with technical pearls and pitfalls of arthroscopic soft-tissue stabilization

The glenohumeral joint(GHJ)allows for a wide range of motion,but is also particularly vulnerable to episodes of instability.Anterior GHJ instability is especially frequent among young,athletic populations during contact sporting events.Many first time dislocators can be managed non-operatively with a period of immobilization and rehabilitation,however certain patient populations are at higher risk for recurrent instability and may require surgical intervention for adequate stabilization.Determination of the optimal treatment strategy should be made on a case-by-case basis while weighing both patient specific factors and injury patterns(i.e.,bone loss).The purpose of this review is to describe the relevant anatomical stabilizers of the GHJ,risk factors for recurrent instability including bony lesions,indications for arthroscopic vs open surgical management,clinical history and physical examination techniques,imaging modalities,and pearls/pitfalls of arthroscopic soft-tissue stabilization for anterior glenohumeral instability.