Search Results (44)

Introduction: The optimal management of hallux sesamoid fracture nonunions remains a subject of ongoing debate, particularly in the context of personalized medicine. This systematic review aimed to synthesize current evidence regarding surgical strategies for this rare but disabling condition. Methods: A comprehensive literature search was conducted in accordance with the PRISMA guidelines. Results: Six studies met the inclusion criteria, encompassing a total of 80 patients. Surgical techniques varied and included open and arthroscopic sesamoidectomy, autologous bone grafting (alone or combined with screw fixation), and percutaneous screw fixation. When reported, outcomes were generally favorable, with union rates ranging from 90.5% to 100% and with consistent postoperative improvements in clinical function. Complication and reoperation rates were both 6.5%. The most frequent reoperation was sesamoidectomy for persistent pain or nonunion, followed by hardware removal. Conclusions: Despite the limited and low-quality evidence, available data suggest that individualized surgical planning can lead to favorable outcomes with low complication rates. Sesamoidectomy remains the most reliable salvage procedure in refractory cases. These findings support a personalized, stepwise approach to treatment—prioritizing sesamoid preservation, when feasible, while reserving excision for symptomatic nonunions. Further studies are needed to validate tailored algorithms and refine patient-specific decision-making in this challenging clinical scenario. Full article

Background: Arthrofibrosis, mixed contracture, and patellofemoral impingement are frequent complications following total knee arthroplasty (TKA), potentially leading to chronic pain and poor recovery of range of motion (ROM). The comprehensive management of these complications remains challenging and controversial. Methods: This study analyzed the outcomes of arthroscopic arthrolysis performed in 27 patients diagnosed with arthrofibrosis, mixed contracture, and patellofemoral impingement post-TKA to evaluate the efficacy of this technique in improving knee function, enhancing ROM, and reducing pain, as assessed by the Knee Society Score (KSS). A total of 27 patients underwent arthroscopic arthrolysis following unsuccessful conservative rehabilitation. The arthroscopic procedure included removal of fibrous adhesions within the suprapatellar pouch, restoration of medial and lateral gutters, and lateral retinacular release of the patella. Intensive physiotherapy and continuous passive motion commenced immediately postoperatively. The mean follow-up period ranged from 24 to 60 months. Pain and functional outcomes were evaluated using KSSs. Results: Clinical improvements were evident in 26 cases, with the Knee Society Score rising from a preoperative average of 48 to 86, and pain scores improving from 30 to 41. Only one patient did not experience positive outcomes following the procedure. Arthroscopic arthrolysis appears beneficial for patients suffering from arthrofibrosis, patellofemoral impingement, and mixed contracture post-TKA, significantly improving clinical pain scores and KSS outcomes. Conclusions: Further research is recommended to refine specialized surgical instruments and enhance arthroscopic arthrolysis techniques. Full article

Hallux valgus (HV) is a common forefoot deformity for which numerous surgical techniques have been proposed, with the Lapidus procedure representing a powerful and durable solution, especially in cases of moderate to severe deformities and first ray hypermobility. Initially described in the early 20th century, the Lapidus procedure involves first tarsometatarsal joint (TMTJ) arthrodesis and has undergone multiple modifications over time to reduce complications such as nonunion, malunion, shortening, and recurrence. The technique offers triplanar correction, addressing axial, sagittal, and coronal deformity components. Despite its proven corrective potential, the procedure remains technically demanding, and no universal consensus exists on the ideal fixation method or postoperative protocol. Recent developments in fixation strategies—including crossed screws, locking plates, intramedullary nails, nitinol staples, external fixation, and arthroscopic approaches—have aimed to improve stability, union rates, and the possibility of earlier weight-bearing. This narrative review provides a comprehensive overview of the Lapidus procedure, focusing on surgical indications, technical variants, fixation methods, clinical outcomes, and complications, with the goal of offering practical guidance for optimizing surgical decision-making in various clinical settings. Full article

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

Meniscoplasty is a common surgical procedure used to treat meniscus tears. During the operation, there are often key challenges such as a limited visual field, a narrow operating space, and difficulties in controlling the resection range. Therefore, this study developed an arthroscopic robotic system with the ability of autonomous meniscus resection to achieve better surgical outcomes. To address the issue of limited visual fields during the operation, this study used the preoperative and intraoperative meniscus point cloud images for surgical navigation and proposed a novel cross-modal point cloud registration framework. After the registration was completed, the robotic system automatically generated a resection path that could maintain the crescent shape of the remaining meniscus based on the improved Rapidly Exploring Random Tree (RRT) path-planning algorithm in this study. Meanwhile, the Remote Center of Motion (RCM) constraint was introduced during the movement of the robot to enhance safety. In this study, the mean squared error of the preoperative–intraoperative meniscus point cloud registration was only 0.1964 mm², which meets the surgical accuracy requirements. We conducted experiments to validate the autonomous operation capabilities of the robot. The robot successfully completed motion-planning and autonomous implementation, thus demonstrating the reliability of the robotic system. Full article

Background and Objectives: Distal radius fractures (DRFs) are among the most common fractures globally, with a lifetime incidence of around 9%. They typically present in two age peaks: high-impact trauma in patients under 40 and low-energy trauma in those over 40. Intra-articular DRFs are classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, influencing the treatment approach. Surgical management, particularly open reduction and internal fixation (ORIF) using volar plate osteosynthesis, is considered the gold standard. This study aims to compare the treatment costs of fluoroscopy-assisted ORIF and arthroscopy-assisted ORIF for intra-articular DRF. The analysis includes surgical procedure costs, material expenses, and operating time to evaluate the cost-effectiveness of both methods, considering reimbursement within the German healthcare system. Materials and Methods: A retrospective, monocentric study was conducted at Ludwig-Maximilians-University (LMU) Hospital, a supraregional hand trauma center in southern Germany. Patients with DRFs requiring ORIF were treated either with fluoroscopy or arthroscopic assistance. Group 1 included patients treated by the Department of Hand Surgery (Plastic Surgery), subdivided into Group 1a (arthroscopy-assisted) and Group 1b (fluoroscopy-only). Group 2 comprised patients treated by Orthopaedics and Trauma Surgery (fluoroscopy-only). Costs associated with surgical procedures, including materials, operating time, and postoperative care, were analyzed. Results: A total of 43 DRFs were treated. Group 1 consisted of 17 cases, with an average age of 49.6 years (SD = 19.4) and a 64% majority of female patients. Of these, 10 cases were treated with arthroscopy-assisted ORIF (Group 1a) and 7 with fluoroscopy-only ORIF (Group 1b). In Group 1a, the average age was 53.9 years (SD = 16.3) with 60% female and 40% male patients, while in Group 1b, the average age was 43.6 years (SD = 23.1) with 71.4% female patients. Group 2 included 25 cases, with an average age of 54.2 years (SD = 21.0) and a distribution of 64% female and 36% male patients. There was no significant difference in age and gender distribution within the groups and subgroups (p > 0.05). The mean procedure time was longer for arthroscopically assisted ORIF (111.5 min) compared to fluoroscopy-only ORIF (80.1 min), and even longer compared to Group 2 (65.0 min). Material costs were slightly higher in Group 1. Total costs for Group 1 averaged EUR 4906.58, with subgroup costs of EUR 5448.24 for arthroscopy-assisted and EUR 4132.80 for fluoroscopy-only. In comparison, Group 2 costs averaged EUR 3344.08. Conclusions: Intra-articular DRFs with severely displaced fragments or concomitant injuries benefit from arthroscopically assisted fracture treatment. While material costs do not significantly differ between arthroscopically assisted and fluoroscopy-only treatments, the significantly longer procedure time for arthroscopy-assisted ORIF results in the largest cost component. Despite this, reimbursement through the DRG system remains fixed and does not account for the increased operative duration or complexity of arthroscopic procedures. Our findings demonstrate that DRF treatment, regardless of the method used, is either not or only marginally cost-covering under the current German reimbursement structure. In the context of the ongoing shift towards outpatient hand surgery, including the management of DRF, adequate reimbursement rates are necessary to ensure the economic viability of DRF management, particularly for complex intra-articular fractures requiring arthroscopic assistance. Full article

Background: Cartilaginous exostoses of the scapula are rare and can cause symptoms such as pain and mechanical crepitus due to scapulothoracic bursitis. While open surgical resection remains the standard approach, it is associated with significant tissue disruption and longer rehabilitation. This technical note presents a minimally invasive arthroscopic technique for excising scapular exostoses. Methods: We report the case of a 22-year-old female patient with a symptomatic ventral scapular exostosis. After confirmation of a benign lesion, the exostosis was excised en bloc under continuous arthroscopic guidance. The surgical procedure, including patient positioning, portal placement, instrumentation, and specimen removal, is described in detail. Results: The lesion was successfully excised as a single piece for histopathological analysis. The patient experienced no intra- or postoperative complications. Postoperative rehabilitation included early passive motion, and full recovery was achieved within six weeks. At 24-month follow-up, the patient remained pain-free with complete restoration of shoulder function and no evidence of recurrence. Conclusions: Arthroscopic excision of scapular exostoses offers a viable alternative to open surgery. The technique minimizes soft tissue trauma, supports faster recovery, and may be safely performed in experienced hands with appropriate preoperative planning and imaging. Full article

Arthroscopic shoulder surgery has undergone significant advancements over the past decades, transitioning from a primarily diagnostic tool to a comprehensive therapeutic approach. Technological innovations and refined surgical techniques have expanded the indications for arthroscopy, allowing minimally invasive management of shoulder instability and rotator cuff pathology. Methods: This narrative review explores the historical evolution, current trends, and future perspectives in arthroscopic shoulder surgery. Results: Key advancements in shoulder instability management include the evolution of the arthroscopic Bankart repair, the introduction of the remplissage technique for Hill–Sachs lesions, and the development of arthroscopic Latarjet procedures. Additionally, novel techniques such as Dynamic Anterior Stabilization (DAS) and bone block procedures have emerged as promising solutions for complex instability cases. In rotator cuff repair, innovations such as the suture-bridge double-row technique, superior capsular reconstruction (SCR), and biological augmentation strategies, including dermal allografts and bioinductive patches, have contributed to improving tendon healing and functional outcomes. The role of biologic augmentation, including biceps tendon autografts and subacromial bursa augmentation, is also gaining traction in enhancing repair durability. Conclusions: As arthroscopic techniques continue to evolve, the integration of biologic solutions and patient-specific surgical planning will likely define the future of shoulder surgery. This review provides a comprehensive assessment of current state-of-the-art techniques and discusses their clinical implications, with a focus on optimizing patient outcomes and minimizing surgical failure rates. Full article

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent synovial inflammation, leading to joint destruction and disability. Synovectomy, the surgical removal of inflamed synovial tissue, is performed when pharmacological treatments are insufficient. This study compares the clinical efficacy, systemic inflammatory response, and cost-effectiveness of minimally invasive arthroscopic synovectomy versus traditional open synovectomy in RA patients. Methods: A comparative observational study was conducted on 53 RA patients undergoing either arthroscopic (n = 30) or open synovectomy (n = 23) at “Pius Brînzeu” Timișoara County Emergency Clinical Hospital over nine years. Clinical outcomes, including pain relief (VAS), functional improvement (HAQ), complication rates, and recovery times, were assessed at baseline, 1, 3, 6, and 12 months postoperatively. Systemic inflammatory markers (CRP, IL-6, TNF-α, ESR, and fibrinogen) were measured preoperatively, at 48 h and 30 days postoperatively. A cost-effectiveness analysis evaluated direct and indirect healthcare costs. Results: Arthroscopic synovectomy demonstrated significantly faster pain reduction and functional recovery within the first three months (p < 0.001), shorter hospital stays (3.1 vs. 6.4 days, p < 0.001), and quicker returns to daily activities (14.5 vs. 22.3 days, p < 0.001) compared to open synovectomy. Inflammatory markers were significantly lower postoperatively in the arthroscopic group (p < 0.01), indicating reduced systemic inflammation. Complication rates were markedly lower in the arthroscopic group (26.66% vs. 82.60%, p < 0.001). Despite higher procedural costs, arthroscopic synovectomy proved more cost-effective due to reduced hospitalization and faster recovery. Conclusions: Arthroscopic synovectomy offers superior early postoperative outcomes, reduced systemic inflammation, and greater cost-effectiveness compared to open synovectomy, with comparable long-term joint stability. These findings support its preference as the surgical technique of choice for RA patients requiring synovectomy. Full article

Background/Objectives: Multiligament knee injuries, involving damage to multiple stabilizing structures, present a significant challenge in orthopedic surgery, often resulting in knee instability and compromised function. While anatomic ligament reconstruction has been traditionally advocated, non-anatomic techniques may provide effective alternatives, particularly for patients with moderate functional demands who do not require high-level athletic performance. Material and methods: In this study, we assessed the outcomes of a non-anatomic, hybrid surgical approach involving combined arthroscopic and open non-anatomic ligament reconstruction in 60 patients with multiligament knee injuries. Using simplified reconstruction methods for the medial collateral ligament (MCL) and lateral collateral ligament (LCL), we tailored the procedures to the needs of active, non-professional patients. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) Questionnaire, Lysholm Knee Scoring Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: Postoperative improvements were significant, with the total IKDC score increasing from a median of 39.1 preoperatively to 75.9 postoperatively, Lysholm from 61.0 to 87.0, and KOOS from 47.6 to 85.7 (p < 0.01). The results demonstrated significant improvements across all scoring systems, with enhanced knee stability, reduced pain, and better quality of life. Conclusions: These findings support the feasibility of non-anatomic reconstructions as a practical solution for patients seeking a return to daily activities and recreational sports without the complexity of full anatomic reconstruction. Full article

Glenoid and humeral bone loss is associated with a high incidence of recurrent shoulder instability and failure of arthroscopic stabilization procedures. However, the radiographic evaluation of bony Bankart and Hill–Sachs injuries continues to pose a diagnostic challenge, and a universally accepted optimal method of measurement is lacking. The purpose of this review is to summarize the advantages and disadvantages of various techniques and imaging modalities available for measuring glenoid bone loss in shoulder instability, including conventional roentgenography, 2-dimensional and 3-dimensional computed tomography (CT), and magnetic resonance imaging (MRI). We also review the concepts of engaging “on-track” and “off-track” Hill–Sachs lesions. Finally, we highlight the clinical importance of obtaining accurate determinations of bone loss by the various methods available, as it can affect surgical decision making and the appropriate procedure required to ensure shoulder stability is adequately restored. Full article

Background: The treatment of patients affected by recurrent anterior shoulder instability has received more attention in the last ten years, focusing on the management of bone loss, which is crucial in predicting postoperative recurrence risk. Recently, various bone grafting techniques and different fixation methods have been developed to preserve native anatomy and reduce complications. Nowadays, glenoid bone reconstruction is usually carried out via the Latarjet procedure or free bone block technique. While the Latarjet procedure has traditionally been considered the best option, the bone block has been demonstrated to be a successful procedure. Even though the indication to perform a free bone block or a Latarjet procedure may be given preoperatively, in cases where the choice between the two procedures is unclear, the decision can be made intraoperatively, given the possibility to switch from one to another. This technical note aims to outline our techniques for the arthroscopic Latarjet procedure and the arthroscopic free bone block, as well as discuss the indications, benefits and downsides of each procedure. Technical tips and tricks are provided. Methods: A step-by-step thorough description of bone block and Latarjet procedures is provided, as well as a comparison of advantages and disadvantages of each technique and tips to avoid complications. Respective indications are discussed. Results: Both the procedures have benefits and downsides. The arthroscopic Latarjet procedure is the most effective in addressing anterior shoulder instability, but is more elaborate, has a shallow learning curve and can have a high complication rate. The bone block technique is an anatomic procedure with a shorter learning curve but has fewer indications. Conclusion: The Latarjet is currently considered the gold standard for glenoid bone grafting. The bone block technique can allegedly be seen as being “in the middle” of the soft tissue repair and Latarjet procedures. Many factors should be considered when choosing the right surgical technique, and treatment plans must be customized for each patient. More studies with long-term follow-up are needed to evaluate the efficacy of arthroscopic bone grafting procedures in various subtypes of patients based on bipolar bone loss assessment and individual risk factors. Full article

Background/Objectives: Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon’s arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Methods: Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. Results: A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. Conclusions: The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology. Full article

Cartilage repair techniques for chondral defects in the hip are crucial for treating conditions like femoroacetabular impingement, developmental dysplasia, and osteonecrosis, especially in young patients to delay the progression of osteoarthritis. This study aims to present age and sex distributions and trends in hip-preserving surgeries in Germany from 2006 to 2022, analyzing 116,179 procedures using the German OPS coding system. The procedures were categorized into three groups: debridement, refixation, and regeneration. Arthroscopy was more common than arthrotomy (98,916 vs. 17,263). Males underwent more procedures than females (63,771 vs. 52,408). Debridement had a monomodal age distribution peaking at 43.42 years, while refixation and regeneration exhibited bimodal patterns. Regenerative procedures were primarily performed on younger patients (average 27.73 years). A Joinpoint analysis showed an initial increase in procedures, peaking around 2013, followed by a decline. Arthroscopic procedures peaked at approximately 9000 in 2013, whereas arthrotomies peaked at around 1200 after 2014. The decline in procedures post-2013 may reflect refined surgical indications and a shift towards outpatient settings. These findings underscore the trend towards minimally invasive, scaffold-based treatments, with regenerative techniques showing promising outcomes in younger patients. Future research should focus on prospective comparative studies and cost–benefit analyses to guide clinical decision-making. Full article

Current treatments for medial meniscus lesions in association with CCL ruptures have shown disappointing long-term outcomes. Meniscal suturing may improve the outcome, but their clinical application remains limited. This study aims to assess the practicability of a minimally invasive DNT to facilitate meniscal suturing in dogs. Ten stifles of eight client-owned dogs with arthroscopically confirmed CCL disease and medial meniscal tears in the abaxial third of the meniscus were included. The described suture technique was applied under joint distraction using the Titan joint distractor. Surgical stabilization of all stifles was then accomplished via an X-Porous TTA procedure. The DNT allowed for the precise placement of meniscal sutures. Minor intraoperative complications included reduced arthroscopic visibility (n = 2) and suture breakage during its passage through the meniscus (n = 3). No complications related to the meniscal sutures were noted throughout the six-month follow-up period. The described DNT proved to be a viable and effective method for suturing lesions of the caudal horn of the medial meniscus, provided there is adequate visualization during the procedure. Appropriate stifle stabilization postoperatively is mandatory for protecting the suture and avoiding concomitant meniscal lesions due to joint instability. Full article