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Arthroscopic patterns of the poster-medial aspect of the knee joint: classification of the gastrocnemius-semimembranosus gateway and its relationship with Baker's cyst
Full text linkBackground
The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arthroscopic anatomy of the posteromedial aspect varies depending on the angle of the oblique popliteal ligament, the level at which it crosses the medial gastrocnemius tendon, and its relationship with the capsular joint and synovia.
The aim of this paper is to identify possible patterns, and to evaluate their characteristics and their relationship with Baker’s cyst.
Methods
data archived from 185 consecutive arthroscopies were evaluated; an anatomic description and classification was carried out; the percentages of association with BC and the associated pathologies were reported.
Results
The different anatomies were classified into six groups based on the relationship above the medial gastrocnemius tendon, the capsular joint and synovia. The prevalence of Baker’s cyst was 28.3%. The main associated intra-articular pathological condition was the contemporary presence of a meniscal tear and chondropathy.
Conclusion
Exploration of the posterior aspect of the knee must be performed routinely. Knowing the possible anatomy patterns of the posteromedial arthroscopic aspect of the knee joint could help to identify the cyst and its gateway, thus facilitating its treatment
Prelievo dei tendini autologhi per la ricostruzione dei legamenti crociati: tecnica chirurgica
No full textComorbidity-related quality of life in anterior cruciate ligament insufficiency: a cross-sectional study involving 282 candidates for arthroscopic reconstruction
No full textBACKGROUND AND PURPOSE
Comorbidity-adjusted health-related quality of life (HRQoL) in anterior cruciate ligament insufficiency (ACLI) has not been assessed to date. A cross-sectional study was conducted to test the hypothesis that HRQoL in ACLI is comorbidity-related and differs from the Italian norm.
METHODS
282 chronically ACL-insufficient candidates for arthroscopic reconstruction with or without meniscal and/or focal chondral lesions were studied. Knee function was evaluated with IKDC form, HRQoL with SF-36, and associated medical comorbidities with a self-administered questionnaire allowing calculation of a comorbidity index (CI). Patients were stratified according to CI into subgroup A (CI = 0) and subgroup B (CI > 0). The SF-36 profiles in the whole sample and in subgroups A and B were compared with the Italian norm.
RESULTS
Of the 282 patients, 82 had associated comorbidity and 200 did not. Patients with comorbidity were older and had a higher degree of knee laxity than patients without comorbidity. Distinctive SF-36 profiles were obtained after stratification by comorbidity and comparison with the age- and sex-matched norm. The SF-36 profile in subgroup A showed statistically significantly lower scores on the PF, RP, BP, and SF domains while the GH and MH domains were statistically significantly higher than the norm. Subgroup B showed statistically significantly lower scores than the norm for the PF, RP, BP, VT, SF and RE domains.
INTERPRETATION
Comorbidity-related HRQoL in ACL-insufficient candidates for arthroscopic reconstruction showed statistically significant differences from the norm. Comorbid illness acting as confounder should thus be controlled for when reporting SF-36 profiles, in order to avoid selection bias. Our findings may also be used as benchmark data for researchers investigating SF-36 profiles in ACLI
Single-bundle versus double-bundle arthroscopic reconstruction of the anterior cruciate ligament: what does the available evidence suggest?
No full textThe introduction of the
double-bundle technique as a surgical
option for primary anterior cruciate
ligament (ACL) surgery stems
from the hypothesis that replicating
the double-bundle anatomy of the
native ACL improves knee kinematics
by supplying better rotational
control. We performed a systematic
review of the literature comparing
double-bundle with standard
single-bundle reconstruction methods.
One RCT and three quasi-
RCTs with a one- to two-year follow-
up were included in this
review. On the basis of these studies,
ACL reconstruction with a double-
bundle technique leads to less
residual pivot-shift as assessed on
manual and instrumented tests.
Conflicting results exist as to
whether the double-bundle technique
leads to less side-to-side
anterior tibial translation, and no
significant differences were found
regarding proprioception, flexorextensor
peak torque and knee
function as assessed with the
International Knee Documentation
Committee score. On the other
hand, better subjective knee function
was found in one quasi-RCT.
However, there is a lack of correlation
between these kinematic differences
and an as yet unproven clinical
effect. Uncertainties also exist
regarding the mid- and long-term
performances of the ACL reconstructed
with a double-bundle technique.
Comparison between the single-
bundle and double-bundle techniques
should be expanded to cover
unresolved issues such as the rate
of complications from a more challenging
surgical technique, the risk
of complicating revision surgery
due to the presence of two tunnels,
and the cost-effectiveness of a procedure
with a higher consumption
of fixation devices. The doublebundle
technique should be further
investigated by experienced knee
surgeons in studies with higher
methodological quality
The Anatomical Variants of the Gateway to the Gastrocnemio-Semimembranosus Bursa in the Posteromedial Region of the Knee: An Arthroscopic Classification and Their Relationship with Baker's Cysts
No full textArthroscopic anatomic repair of bankart lesion in rugby players
No full textRecent studies have reported equivalent outcomes of arthroscopic and open shoulder stabilization. However, surgical strategy for shoulder instability is a challenging and controversial problem for surgeons that have to treat collision sport athletes. In fact, only few studies support the arthroscopic surgery for this group of patients. The aim of this study is to evaluate the outcome of arthroscopic stabilization in a homogenous population of professional young athletes practicing in high-level collision sport. We treated 22 consecutive professional rugby players, with a mean age of 23.6 years, affected by traumatic anterior shoulder instability. All patients underwent arthroscopic Bankart repair with bone suture-anchors. Exclusion criteria were: failed previous shoulder surgery, atraumatic, multidirectional or posterior instability, bone defects greater than 20% of the anterior-inferior glenoid, engaging Hill-Sachs, rotator cuff tears, capsular-ligament avulsion on the humeral side (HAGL). Patients were evaluated according to Constant score, Rowe score and Visual Analogue Scale (VAS) for discomfort and handicap. The mean follow-up was 40.7 months (range, 6 to 87 months). All patients except one were able to return at the same previous sports level at 5 to 6 months postoperatively. Re-dislocation occurred in 3 players for high impact trauma during competition or training. Our results confirm that, also in the collision sport patients, anatomic arthroscopic Bankart repair is a good option for the treatment of traumatic anterior instability without associated lesions
Breakage of a znn nail in an active elderly female: A case report and literature review
No full textTrochanteric fractures are common in elderly patients with osteoporosis and are surgically treated to facilitate early rehabilitation and to prevent lodging-related comorbidities. Nonunion and hardware breakage of intertrochanteric hip fractures is a relatively rare occurrence resulting from an incorrect surgical procedure. We present a case of ZNN nail breakage caused by fatigue of an unstable trochanteric fracture in a very active elderly female. An 84 year-old woman was treated with a long, pertrochanteric femoral nail. Six months after surgery, she returned to the emergency department due to the ruptured nail. The patient underwent hemiarthroplasty with a stem revision and, after removing the nail, was stabilized with a trochanteric gripping plate and rims. Long-term results assessed with the Harris Hip Score and the Oxford Hip Score were excellent. The patient’s quality of life improved greatly. Our experience confirms that total hip hemiarthroplasty is a satisfactory revision procedure after failed treatment of an intertrochanteric fracture in elderly patients with poor bone stock and high functional demands in daily activities
Spontaneous Compartment Syndrome in a patient with Diabetes and Statins assumption: a case report
No full textCompartment syndrome is a condition characterized by pressure increasing in the inextensible muscular compartments that leads to a decrease of capillary perfusion with consequent ischemic lesions of the logia elements. The authors report a case of an unusual compartment syndrome with spontaneous onset in a patient with type II diabetes and chronic therapy with statins (Atorvastatin). The condition was successfully treated by a fasciotomy and medical support. The importance of a correct anamnesis and a high level of suspicion is emphasized
Comparative evaluation of meniscal pathology: MRI vs arthroscopy
No full textThe meniscal pathology of the knee is one of the clinical realities the orthopedic surgeon must daily confront with. The diagnosis is generally both clinical and instrumental; among the different diagnostic imaging techniques, Magnetic Resonance Imaging (MRI) appears to be the most accurate method regarding sensitivity and specificity for the study of meniscal fibrocartilages and articular cartilage. In an attempt to clarify the roles of MRI and diagnostic knee arthroscopy, we performed a retrospective comparative study of the two methods to assess their sensitivity and specificity in the diagnosis of meniscal pathology. We evaluated 105 consecutive patients with a clinical diagnosis of intra-articular knee pathology who were subjected to MRI examination and subsequently to surgical arthroscopy, recording on a graphic card the surgical and radiographic findings expressed by a blinded expert radiologist. Comparison of MRI and arthroscopy data showed, for the internal meniscus, values of 98.5% sensitivity, 94.7% specificity and 93.8% "K" index for MRI compared to arthroscopy, and of 90%, 98.6% and 90.5% for the external meniscus. These results allow us to state that the diagnostic capacity of MRI appears to be very high and therefore crucial in the planning of the correct surgical treatment of individual patients, thanks to its ability to highlight even small changes affecting intra-articular structures
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