1,721,022 research outputs found
A study for evaluating the effect of the deltoid-flap repair in massive rotator cuff defects
No full textThe repair of massive cuff defects by direct suture often is impossible. In these cases, a repair by musculo-tendineous flaps (latissimus-dorsi, pectoralis or deltoideus) is required. It was the goal of this study to evaluate the result of delta-flap repair in case of massive cuff defects with a diameter of 5 cm or more. Between 1998 and 2000 for all patients who were suffering from a massive rotator cuff tear more than 5 cm a deltoid transfer was performed. A total of 20 patients (14 male, 6 female; age: 60.9 +/- 8.7 years) were available for a follow-up after 47.2 +/- 8.0 (range, 36 to 60) month. The operation included an arthroscopic evaluation, acromioplasty with resection of the lateral clavicular end, and biceps tenodesis. The cuff defect was repaired by transfer a muscular flap from the anterior part of the deltoid (about 2x6 cm) into the defect. The patients subjectively rated their result-10 excellent, 9 good, and 1 poor. Preoperatively, the Constant amounted 26.3 +/- 5.1 points. At follow-up, the score significantly increased to 74.5 +/- 8.5 points. The acromiohumeral distance increased from 4.9 +/- 1.1 to 9.2 +/- 1.7 mm. In MRI examination of 11 patients all had an intact flap. Two complications (a wound hematoma and a deep infection) did not influence the result. The repair of massive rotator cuff tears by a deltoid transfer produces acceptable clinical and radiological results
The Effect of Conservative Treatment in Symptomatic Midgrade Knee Osteoarthritis. 5-Year-Results of a Retrospective Study and of a Systematic Review
No full textPurpose: This study was performed to evaluate the effect (subjective complaints and conversion to the knee replacement) of a conservative treatment protocol in patients who are suffering from middle-stage knee osteoarthritis. Another goal of this current study was to perform a systematic review of the international literature for a comparison with the own results. Methods: A total of 63 grade III (Kellgren Lawrence Score) patients did undergo conservative treatment of knee osteoarthritis. The evaluation was made at baseline and yearly up to 5 years by using the KOOS (Knee Injury and Osteoarthritis Outcome Score). Results: At baseline the KOOS amounted 99.2 points. At the 1-year control, the score did increased to 134.8 points. This result debased within the 2-year follow-up to 120.3 points. In comparison to the baseline, the 2-year outcome still was significantly better. After 3 years there only was a tendency superior outcome in comparison to the baseline score (KOOS= 115.9). In the 4(th) (KOOS= 93.2 points) and 5(th) (KOOS =81.3 points) year, after initial treatment there was a continuous debasement of the results. A total of 22 patients (34.9%) did undergo a total knee replacement during the follow-up. The mean time for survival was 44.2 (95 %-CI 38.6-49.9) months. The number of studies which reports about middle or long-term reports is rare. We only evaluated 12 studies with reports about a follow-up >12 months. The mean increase of patients complaints in all studies was Random effects = 1.04 (95% CI=0.7-1.4), p <0.001. Conclusion: The conservative treatment of knee osteoarthritis is method of choice in a large number of patients. After 1-2 years, the results debase significantly
The effects of arthroscopic joint debridement in the knee osteoarthritis: results of a meta-analysis
No full textKnee osteoarthritis is one of the most common orthopaedic diseases. Therapeutic options for this disease include conservative treatments and arthroscopic debridement and partial or complete replacement. This meta-analysis aimed to collect and analyse the available information on the effects of arthroscopic joint debridement related to the clinical outcomes, the required conversion to replacement and the factors for patient selection. A search for publications was performed in the PubMed, Cochrane and EMBASE medical databases. The primary search resulted in a total of 1,512 citations. The results from 30 papers were included in this study. The extracted dates were listed in a standardised protocol. The statistical evaluation was performed using Comprehensive Meta-analysis software (V2 Biostat, Englewood, NJ, USA). No randomised study that compared conservative and arthroscopic treatments for knee osteoarthritis was found. Most studies reported middle-term results after arthroscopic operations. The results of these studies showed excellent or good outcomes in more than 60 % of all patients. These results were correlated with a significant increase in the knee scores from baseline to follow-up; the standardised difference in means was 2.3 (CI 95 % 1.5-3.0, p < 0.001). The required conversion rate to replacement increased as the follow-up interval increased. The rates were as follows: 1 year-6.1 % (CI 95 %, 2.1-16.6 %), 2 years-16.8 % (CI 95 %, 10.2-26.3 %), 3 years-21.7 % (CI 95 %, 15.5-29.1 %) and 4 years-34.1 % (CI 95 %, 22.8-47.6 %). The mean survival time was 42.7 (CI 95 %, 14.5-71.1) months. Numerous factors influenced the outcome, including the radiological stage of the osteoarthritis and individual patient factors (e.g. time of history of osteoarthritis, weight and smoking). The local knee findings, such as axial dysalignment, missing effusion and massive crepitus, were also correlated with patient outcome. Arthroscopic joint debridement is a potential and sufficient treatment for knee osteoarthritis in a middle-term time interval. This procedure results in an excellent or good outcome in approximately 60 % of patients in approximately 5 years. Systematic review of studies, Level III
Arthrodesis of the knee after failed infected total knee arthroplasty
No full textInfection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47-81 years) and the mean number of previous surgical procedures was 6 (range: 4-11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2-11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk
A study of effectiveness of knee arthroscopy after knee arthroplasty
No full textPurpose: The purpose of this study was to investigate the outcome of arthroscopy in painful knee arthroplasty without evidence of infection, fracture, wear, and component loosening or malposition that had been refractory to conservative treatment. In addition, a literature review of 498 cases (MEDLINE 1966 to 2002) was performed. Type of Study: Case series. Methods: From 1997 to 2000, 27 patients (20 women, 7 men) had undergone arthroscopies because of poor results following total knee arthroplasty. Before the operation, the patients had suffered symptoms for an average of 11 months (range, 3 to 41 months). The average onset of symptoms after knee arthroplasty was 26 months (range, 3 to 59 months). The average patient age was 70 years (range, 42 to 81 years) and the average follow-up was 34 months (range, 24 to 52 months). At the initial operation, 19 patients had received total condylar surface replacement and 8 had received hemireplacement. Patients were evaluated using the Knee Society rating system. A review of the literature was performed by initial identification of the articles from a MEDLINE database followed by the use of cross references. Results: All of the patients were available for follow-up. Eighteen of the 27 procedures resulted in an improvement in the patient's knee score. The average Knee Society ratings increased from 71 points before arthroscopy to 85 at follow-up for the knee score. The average functional scores were 69 and 83 points, respectively. The Knee Society pain score improved from 32 to 41 points. Nine patients underwent a subsequent open revision after arthroscopic diagnosis or treatment. Operative diagnoses included arthrofibrosis, impinging hypertrophic synovitis, impinging posterior cruciate ligament stump, prosthesis loosening or wear, symptomatic pseudomeniscus, an infrapatellar spur, and meniscal rupture. There was 1 infection as a complication associated with the arthroscopic procedure. Conclusions: Arthroscopic treatment of painful knee arthroplasty provides reliable expectations for improvement in function, decrease in pain, and improvement in knee scores for most patients. Level of Evidence: Level IV, Case Series
The Effect of Arthroscopic Debridement and Conservative Treatment in Knee Osteoarthritis Results of a 5-Year Follow-Up and Literature Review
No full textPurpose: This study is aimed to compare the effects of arthroscopic joint debridement over a 5-year period in a clearly defined patient population (only grade III knee osteoarthritis, history <2 years). Material and Methods: A total of 96 patients (50 male and 46 female) underwent arthroscopic knee debridement for knee OA. The main criteria for inclusion were osteoarthritis grade III (Kellgren-Lawrence score) and a maximal history of 2 years. Results: The subjective complaints and the knee-related quality of life were estimated by the KOOS (knee injury and osteoarthritis outcome score). The score increased significantly within the 1 to 3 rd year post operation. After this interval the mean points of the score declined. But after 5 years the KOOS was higher in comparison to the baseline dates. Patients who had undergone conservative treatment at baseline had a significantly different KOOS than patients in the arthroscopy group. Over time, patients in the arthroscopy group had fewer complaints than patients in the conservative treatment group. In both groups, the results decreased over time. A total of 17 patients (17.2 %) needed a conversion to total endoprothetic replacement. The mean time-interval between index operation and conversion was 56.6 (95 % CI 54.4 - 58.4) months. Conclusions: In middle stages of knee OA, arthroscopic joint debridement can effectively reduce subjective complaints. Because this treatment does not stop the process of OA, the improvements decrease over time
Arthroscopic electrothermal shrinkage of chronic posterolateral elbow instability - Good or moderate outcome in 21 patients followed for an average of 2.5 years
No full textBackground The lateral collateral ligament complex is the key structure involved in recurrent elbow instability. Treatment is surgical, by repair or reconstruction of the lateral collateral ligament complex. We evaluated the effect of arthroscopic electrothermal shrinkage for treatment of chronic posterolateral rotator elbow instability. Methods 21 patients, median age 32 (24-50) years, suffering from chronic lateral elbow instability underwent arthroscopic electrothermal ligament shrinkage with a bipolar shrinkage probe. All patients were available for follow-up after median 30 (848) months. Results No complications were seen. The Morrey score increased from 40 to 77 points. The result was moderate (50-80 points) in 10 patients, and in the other patients a good result was achieved (80-95 points). The manual stress radiography showed a mean lateral joint opening of 13 (8-18) mm preoperatively. During follow-up, it decreased to 2 (14) mm. Interpretation Our findings suggest that arthroscopic bipolar ligament shrinkage is sufficient for the treatment of chronic posterolateral rotator elbow instability
How valid is the arthroscopic diagnosis of cartilage lesions? Results of an opinion survey among highly experienced arthroscopic surgeons
No full textIn general, arthroscopy is considered the "gold standard" for the evaluation of cartilage lesions. In this multicenter survey, we ascertained the general opinion of surgeons regarding arthroscopic cartilage diagnoses. A total of 301 highly experienced arthroscopists (instructors of the AGA, the German-speaking society of arthroscopy) were contacted in writing with a request to complete the survey. The data from 105 respondents (34.8% of those contacted) were used for the investigation. In the grading of the cartilage lesions, the Outerbridge classification was most frequently used (n = 87), followed by the ICRS protocol (n = 8) and the Insall score (n = 3). The majority (61%) of the arthroscopic surgeons felt that differentiation between healthy cartilage and low-grade cartilage lesions was simple. For differentiation between grade I and grade II lesions, and for differentiation between grade II and grade III lesions, 41.9 and 51.4%, respectively, thought that there was a "need for improvement". In the case of grade IV lesions, 70.5% of the surgeons thought that the diagnosis was valid. The respondents also judged the utility of incorporating objective measurements (e.g., intraoperative biomechanical tests): 13.3% (n = 14) responded that such measurements would be "very useful" and 61.9% (n = 65) responded that they would be "somewhat useful". Among surgeons, arthroscopy was not perceived to be as reliable as a "gold standard" for the diagnosis of cartilage lesions. The majority of experienced arthroscopists felt unsure of the results in general, or at least in some cases. A universal and definitive grading system for lesions appears to be needed. For questionable cases, measurement devices are needed for objective cartilage grading
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