OBJECTIVE: To compare clinical efficacy of musculoskeletal ultrasound-guided acupuncture treatment and radiation extracorporeal shock wave therapy in myofascial pain syndrome after rotator cuff suture under shoulder arthroscopy. METHODS: From June 2021 to April 2022, 75 patients with myofascial pain syndrome after rotator cuff suture under shoulder arthroscopy were admitted and divided into musculoskeletal ultrasound group and extracorporeal shock wave group according to different treatment methods. There were 39 patients in musculoskeletal ultrasound group, including 12 males and 27 females, aged from 43 to 77 years old with an average of (56.33±9.45) years old;11 patients on the left side and 28 patients on the right side;the course of disease with a median of 7.00(4.00, 12.00) weeks;acupuncture treatment was performed under the guidance of musculoskeletal ultrasound. There were 36 patients in extracorporeal shock wave group, including 16 males and 20 females, aged from 46 to 72 years old with a median of (58.94±8.94) years old;12 patients on the left side and 24 patients on the right side;the course of disease with an average of 5.50(4.00, 8.00) weeks;extracorporeal shock wave therapy with radiation were performed. Visual analogue scale (VAS) and American shoulder and elbow surgeons score (ASES) were compared between two groups to evaluate improvement of shoulder joint pain and function before treatment and 1, 3, 6, 12, and 24 months after treatment. RESULTS: Both of two groups were followed up for 24 to 27 months with an average of (24.68±0.89) months. No complications such as infection and vascular and nerve injury occurred during follow-up period. At 6 months after treatment, VAS of musculoskeletal ultrasound group (2.00±1.19) was lower than that of extracorporeal shock wave group (3.08±1.02), and the difference was statistically significant (P<0.05). At 1, 3, 12 and 24 months after treatment, there were no statistically significant difference in VAS between two groups (P>0.05). At 3, 6 and 12 months after treatment, ASES scores of musculoskeletal ultrasound group were (77.44±11.56), (86.06±6.11), and (89.44±4.66) respectively, which were higher than those of extracorporeal shock wave group (55.23±12.76), (58.10±10.25), (84.03±7.36), the differences were statistically significant (P<0.05);there were no statistically significant difference in ASES between two groups at 1 and 24 months after treatment(P>0.05). CONCLUSION Musculoskeletal ultrasound-guided acupuncture treatment has advantages of faster pain relief and more rapid improvement of shoulder joint function for myofascial pain syndrome after rotator cuff suture under shoulder arthroscopy compared with radioactive extracorporeal shock wave therapy.
Humans ; Male ; Female ; Middle Aged ; Acupuncture Therapy/methods* ; Adult ; Aged ; Arthroscopy/adverse effects* ; Myofascial Pain Syndromes/etiology* ; Ultrasonography ; Rotator Cuff/surgery*

OBJECTIVE: To investigate the risk factors associated with the development of knee osteoarthritis (OA) following arthroscopic surgery for degenerative lesions of the posterior horn of the medial meniscus. METHODS: Between January 2012 and January 2014, a retrospective analysis was conducted on 506 patients who underwent arthroscopic surgery for degenerative disease of the posterior horn of the medial meniscus. The cohort included 230 males and 276 females, aged from 32 to 58 years old with an average of (46.77±9.02) years old. According to the results of postoperative follow-up, patients were categorized into a knee osteoarthritis(OA) group and a non-OA group. The following parameters were recorded for each subject:gender, medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKA), presence of bone edema on MRI, physical characteristics (including McMurray test results, locking symptoms, and medial knee tenderness points), meniscus protrusion, type of meniscus injury, and free body condition as observed via arthroscopy. Multivariate unconditional Logistic regression analysis was employed to investigate the associated factors influencing the 10-year postoperative incidence of knee osteoarthritis following surgery for degenerative injury of the posterior horn of the medial meniscus. Independent risk factors potentially influencing the development of postoperative OA were identified, and a nomogram-based predictive model for postoperative OA was established. The discriminatory ability and calibration accuracy of the model were assessed using the C-index and Hosmer-Lemeshow goodness-of-fit test, respectively. Furthermore, internal validation was performed using the bootstrap resampling method. RESULTS: Within a 10-year period following arthroscopic surgery, there were 123 patients in the OA group and 383 patients in the non-OA group. Significant differences were observed between two groups with respect to gender (χ²=5.156, P=0.023), MPTA<86.6° (χ²=21.671, P<0.001), varus lower limb alignment( χ²= 80.086, P<0.001). Additionally, meniscus extrusion (χ²=6.371, P=0.012), meniscus transverse tear (χ²=14.573, P<0.001), and bone edema detected on MRI(χ²=9.881, P=0.002) were identified as factors associated with the development of postoperative knee OA. The multifactorial Logistic regression analysis revealed that the lower limb line of force inversion OR=4.324, 95%CI (1.391, 13.443), P=0.011;MPTA <86.6°, OR=2.519, 95%CI (1.150, 5.519), P=0.021;transverse meniscus tear, OR=4.546, 95%CI (1.827, 11.310), P=0.001;meniscus ectropion, OR=5.401, 95%CI (1.992, 14.646), P=0.001;and bone edema manifestation on MRI OR=2.692, 95%CI (1.169, 6.200), P=0.020. They were independent risk factors associated with the development of postoperative OA. The area under the ROC curve predicted by the model was 0.927, 95%CI (0.903, 0.950). The Hosmer-Lemeshow goodness-of-fit test, used to evaluate the accuracy of the model, yielded P=0.689. Additionally, the internally sampled calibration curve demonstrated good consistency with the actual postoperative OA outcomes. CONCLUSION Varus alignment of the lower extremity, MPTA <86.6°, transverse meniscus tear, lateral meniscus injury, and bone marrow edema observed on MRI were independent risk factors for the development of knee osteoarthritis following arthroscopic surgery. Additionally, the prognostic model demonstrated excellent predictive performance.
Humans ; Male ; Female ; Middle Aged ; Arthroscopy/adverse effects* ; Adult ; Retrospective Studies ; Tibial Meniscus Injuries/surgery* ; Osteoarthritis, Knee/epidemiology* ; Risk Factors ; Menisci, Tibial/surgery* ; Incidence ; Postoperative Complications/epidemiology*

OBJECTIVE: To explore risk factors for infections after arthroscopic rotator cuff repair, and improve the under standing for reducing infection. METHODS: Clinical data of 2 591 patients who underwent arthroscopic rotator cuff repair from January 2019 to January 2022 were retrospectively analyzed, including 1 265 males and 1 326 females, aged from 25 to 82 years old with an average age of (51.5±15.6) years old. They were divided into infection group(n=18) and uninfected group(n=2 573) according to whether or not patients had postoperative infection. Gender, age, smoking, diabetes, body mass index, local closure within 1 month before operation, operation time, preventive use of antibiotics, and internal fixation implantation between two groups were recorded. Univariate Logistic regression analysis screened factors associated with infections after arthroscopic rotator cuff repair. Theresultswere entered into the multivariate logistic regression analysis, screening the high risk factors for infections after arthroscopic rotator cuff repair. RESULTS: In 2 591 patients, 18 patients were infected after operation, infection rate was 0.69%. Univariate Logistic regression analysis showed that gender, age, operation time, antibiotic prophylaxis, internal fixation implantation were risk factors for infections after arthroscopic rotator cuff repair. Multivariate Logistic regression analysis showed male(OR=14.227), age≥65 years(OR=34.313), operation time≥2 h (OR=15.616), without antibiotic prophylaxis(OR=4.891), and internal fixation implantation(OR=5.103) were major risk factors for infection after arthroscopic rotator cuff repair(P<0.05). CONCLUSION Male, age≥65 years, operation time≥2 h, without antibiotic prophylaxis and internal fixation implantation were independent risk factors for infection after arthroscopic rotator cuff repair. Early diagnosis and timely treatment should be carried out to reduce the incidence of infection.
Female ; Humans ; Male ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Rotator Cuff ; Rotator Cuff Injuries/surgery* ; Retrospective Studies ; Arthroscopy/adverse effects* ; Risk Factors ; Treatment Outcome

OBJECTIVE: To explore clinical effect of arthroscopic meniscus tear strapping suture by rotator cuff suture threader. METHODS: Forty patients with meniscus tear injury admitted from July 2015 to May 2019, including 27 males and 13 females, aged from 20 to 55 years old with an average of (36.0±1.4) years old. Menisci laceration was sutured with rotator cuff suture thread under arthroscopy. Postoperative complication was observed, Lysholm knee joint score before and after operation at 12 months were used to evaluate clinical effects, visual analogue scale (VAS) and range of knee flexion and extension were applied to evaluate recovery of pain and function. RESULTS: All patients were followed up from 12 to 15 months with an average of (12.6±0.7) months.No complication such as joint effusion, suture failure occurred. Two patients occurred mild pain after activity without clinical physical abnormality, and 1 patient manifested moderate pain with joint space tenderness, the other rest without abnormal. Lysholm knee joint score was increased from (49.55±1.21) preoperatively to (98.95±0.42) at 12 months after operation, VAS score decreased from (5.18±0.78)preoperatively to (1.03±0.77) at 12 months after operation, and range of knee joint flexion and extension activity increased from (50.63±9.20)°preoperatively to (130.38±4.99)°after operation, and there were statistical differences in Lysholm knee joint score, VAS and range of knee joint flexion and extension activity ( CONCLUSION Arthroscopic strapping suture by rotator cuff suture threading device applies to most meniscus injuries, including medial meniscus posterior horn tears, lateral meniscus body tears and lateral meniscus posterior horn tears. This technique meets the need of full-internal meniscus suture without specialmeniscus suture, and has advantages of convenient operation, less complications and good postoperative function.
Adult ; Arthroscopy ; Female ; Humans ; Male ; Menisci, Tibial/surgery* ; Middle Aged ; Rotator Cuff ; Rotator Cuff Injuries/surgery* ; Suture Techniques ; Sutures/adverse effects* ; Tibial Meniscus Injuries/surgery* ; Treatment Outcome ; Young Adult

BACKGROUND: Heterotopic ossification (HO) is a known complication of hip arthroscopy. We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome. METHODS: A retrospective study was conducted on 242 patients (140 men and 102 women, mean age: 36.2 ± 9.5 years) who underwent hip arthroscopy for femoroacetabular impingement (FAI) between January 2016 and January 2018. The average follow-up period was 22.88 ± 11.74 months (range: 11-34 months). Thirteen (5.37%) cases of HO (six men and seven women, five left hips and eight right hips; mean age: 37.5 ± 4.7 years) were observed. Among them, four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO. Monthly follow-up was conducted. Visual analog scale (VAS), modified Harris Hip Score (mHHS), and non-Arthritis Hip Score (NAHS) were evaluated and compared between HO and non-HO patients. Independent sample t test, Mann-Whitney U test and the Chi-square test were used for inter-group comparisons. HO degree was evaluated using Brooker classification. Symptoms and function were evaluated before and after revision. RESULTS: A total of 242 patients were involved in this study. Thirteen cases (5.4%) had imaging evidence of HO. Nine (9/13) were classified as Brooker stage I, three (3/13) Brooker stage II, and one (1/13) Brooker stage III. HO was detected by ultrasonography as early as 3 weeks after operation. After primary surgery, the mHHS of the HO group and non-HO group increased by 13.00 (8.50, 25.50) and 24.00 (14.00, 34.50) points (Z = -1.80, P = 0.08), NAHS increased by 18.00 (9.50, 31.50) and 26.00 (13.50, 36.00) points (Z = -1.34, P = 0.18), and VAS decreased by 3.00 (2.00, 4.00) and 4.00 (3.00, 4.50) points (Z = -1.55, P = 0.12). Average follow-up time after revision was 9.00 ± 2.94 months; mHHS increased by 34.75 points (t = -55.23, P < 0.01) and NAHS by 28.75 points (t = -6.03, P < 0.01), and VAS decreased by 4 points (t = 9.80, P < 0.01). HO and non-HO patients were similar for demographic and surgical data, and clinical and functional scores. CONCLUSION HO incidence after arthroscopic treatment of FAI is similar to that found in previous studies. Most HO have no effect on clinical symptoms. Patients who undergo revision HO resection show improvement in pain and joint function.
Adult ; Arthroscopy ; adverse effects ; Female ; Femoracetabular Impingement ; surgery ; Hip Joint ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; diagnosis ; etiology ; Retrospective Studies ; Treatment Outcome

Arthroscopy ; adverse effects ; instrumentation ; methods ; Diagnostic Equipment ; adverse effects ; microbiology ; Disinfection ; methods ; Equipment Failure ; Humans ; Materials Testing ; methods ; Orthopedic Equipment ; adverse effects ; microbiology ; Postoperative Complications ; etiology ; prevention & control

An unusual grayish brown discoloration of the synovium was found during a knee arthroscopy of a 72-year-old man. He also had similar pigmentation affecting the skin on the legs, arms, hands, and face. It was found he had been taking 400 mg of amiodarone hydrochloride daily for last 7 years. Amiodarone is known to cause a slate grey pigmentation of skin and cornea, but we believe this is the first report of amiodarone-induced pigmentation of the synovium. The arthroscopist should be aware of the possibility of drug-related synovial pigmentation and include this in differential diagnosis.
Aged ; Amiodarone/*adverse effects/therapeutic use ; Anti-Arrhythmia Agents/*adverse effects/therapeutic use ; Arrhythmias, Cardiac/complications/drug therapy ; Arthroscopy ; Diagnosis, Differential ; Humans ; Knee Joint/surgery ; Male ; Pigmentation Disorders/*chemically induced/*diagnosis ; Skin/pathology ; Synovial Membrane/*pathology

Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome.
Adult ; Arthroscopy/*adverse effects ; *Compartment Syndromes ; Humans ; Knee Injuries/*surgery ; Male ; *Postoperative Complications ; Turkey ; *Wounds, Gunshot

BACKGROUND: This study aimed to evaluate the clinical and radiological outcomes of arthroscopic bioabsorbable screw fixation in osteochondritis dissecans (OCD) in adolescent patients with unstable lesions causing pain. METHODS: The study included 11 patients (10 males and 1 female) with OCD who underwent arthroscopic bioabsorbable screw fixation between July 2007 and February 2014 and were available for follow-up for more than 12 months. The mean age at diagnosis was 16.3 years (range, 11 to 19 years), and the average follow-up period was 51 months (range, 12 to 91 months). Clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, and International Knee Documentation Committee (IKDC) score measured before surgery and at follow-up. Functional evaluation was made using the Tegner activity scale. Magnetic resonance imaging (MRI) and second-look arthroscopy were performed at the 12-month follow-up. RESULTS: Between the preoperative assessment and follow-up, improvements were seen in the KOOS (range, 44.9 to 88.1), Lysholm knee score (range, 32.6 to 82.8), and IKDC score (range, 40.8 to 85.6). The Tegner activity scale also improved from 2.8 to 6.1. Based on postoperative MRI, there were eight Dipaola grade I cases and three grade II cases. No complications due to fixation failure developed in any case. Second-look arthroscopy at 12 months postoperatively revealed that the lesion was covered with cartilage in all cases. CONCLUSIONS: For unstable OCD lesions causing pain in adolescents, arthroscopic bioabsorbable screw fixation provided favorable outcomes with reduced pain and restoration of movement. Therefore, it should be considered as an effective treatment for OCD.
*Absorbable Implants ; Adolescent ; Adult ; Arthroscopy/adverse effects/*instrumentation/methods ; *Bone Screws ; Child ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Osteochondritis Dissecans/*diagnostic imaging/*surgery ; Range of Motion, Articular ; Treatment Outcome ; Young Adult

PURPOSE: The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. MATERIALS AND METHODS: Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. RESULTS: The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1+/-2.0 in the zolpidem group and 3.3+/-2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. CONCLUSION: The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.
Adult ; Analgesia/*methods ; Analgesics/*therapeutic use ; Arthroscopy/*adverse effects ; Female ; Humans ; Hypnotics and Sedatives/*therapeutic use ; Male ; Middle Aged ; Pain Management ; Pain Measurement ; Pain, Postoperative/drug therapy/etiology/*prevention & control ; Postoperative Period ; Prospective Studies ; Pyridines/*therapeutic use ; Rotator Cuff/injuries/*surgery ; Sleep/drug effects ; Treatment Outcome ; Visual Analog Scale