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Blankenburg N, Henkelmann R, Theopold J, Löffler S, Hepp P. Comparison of needle and conventional arthroscopy for visualisation of predefined anatomical structures of the knee joint: a feasibility study in human cadavers and patients. BMC Musculoskelet Disord 2024; 25:212. [PMID: 38475756 DOI: 10.1186/s12891-024-07346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND In terms of the optics used for Knee arthroscopy, a large number of different endoscopes are currently available. However, the use of the 30° optics in knee arthroscopy has been established as the standard procedure for many years. As early as the 1990s, needle arthroscopy was occasionally used as a diagnostic tool. In addition to the development of conventional optics technology in terms of camera and resolution, needle arthroscopes are now available with chip-on-tip image sensor technology. To date, no study has compared the performance of this kind of needle arthroscopy versus standard arthroscopy in the clinical setting in terms of the visibility of anatomical landmarks. In this monocentric prospective feasibility study, our aim was to evaluate predefined anatomical landmarks of the knee joint using needle arthroscopy (0° optics) and conventional knee arthroscopy (30° optics) and compare their performance during knee surgery. METHODS Examinations were performed on eight cadavers and seven patients who required elective knee arthroscopy. Two surgeons independently performed the examinations on these 15 knee joints, so that we were able to compare a total of 30 examinations. The focus was on the anatomical landmarks that could be visualized during a conventional diagnostic knee arthroscopy procedure. The quality of visibility was evaluated using a questionnaire. RESULTS In summary, the average visibility for all the anatomic landmarks was rated 4.98/ 5 for the arthroscopy using 30° optics. For needle arthroscopy, an average score of 4.89/ 5 was obtained. Comparatively, the needle arthroscope showed slightly limited visibility of the retropatellar gliding surface in eight (4.5/ 5 vs. 5/ 5), medial rim of the patella in four (4.85/ 5 vs. 5/ 5), and suprapatellar recess in four (4.83/ 5 vs. 5/ 5) cases. Needle arthroscopy was slightly better at visualizing the posterior horn of the medial meniscus in four knee joints (4.9/ 5 vs. 4.85/ 5). CONCLUSION Needle arthroscopy is a promising technology with advantages in terms of minimally invasive access and good visibility of anatomical landmarks. However, it also highlights some limitations, particularly in cases with challenging anatomy or the need for a wide field of view.
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Affiliation(s)
- Notker Blankenburg
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, Leipzig, 04103, Germany.
| | - Ralf Henkelmann
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, Leipzig, 04103, Germany
| | - Jan Theopold
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, Leipzig, 04103, Germany
| | - Sabine Löffler
- Institute of Anatomy, University of Leipzig, Liebigstraße 13, Leipzig, 04103, Germany
| | - Pierre Hepp
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, Leipzig, 04103, Germany
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Gianakos AL, Kennedy JG. In-Office Needle Arthroscopy: Indications, Surgical Techniques, Tips, and Tricks. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00015. [PMID: 38385718 PMCID: PMC10883628 DOI: 10.5435/jaaosglobal-d-23-00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
In-office needle arthroscopy (IONA) has gained increased attention as a minimally invasive alternative to standard arthroscopy performed in the operating room (OR) setting. IONA uses instrumentation that is markedly smaller in size and diameter making arthroscopy less invasive. Less OR equipment and less OR staff are required resulting in procedures that may be more accessible and less expensive. IONA is typically performed using local intra-articular blocks, thereby reducing the need for regional anesthesia or general anesthesia along with its associated risks. Using a clinic setting rather than an OR reduces the cost and increases the efficiency of the procedure. This article will present the indications for IONA in upper and lower extremity injuries and will describe the best practice office setup. Technical pearls and pitfalls will also be discussed.
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Affiliation(s)
- Arianna L Gianakos
- From the Department of Orthopaedic Surgery, Yale Medicine, Orthopaedics, and Rehabilitation, New Haven, CT (Dr. Gianakos), and the Department of Orthopaedic Surgery, NYU Langone Health, New York, NY (Dr. Kennedy)
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Owusu-Sarpong S, Fariyike B, Colasanti CA, Bi AS, Kirschner N, Neal WH, Azam MT, Stone JW, Kennedy JG. In-Office Nano-Arthroscopy of the Shoulder with Acromioplasty. Arthrosc Tech 2023; 12:e1423-e1428. [PMID: 37654871 PMCID: PMC10466288 DOI: 10.1016/j.eats.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Subacromial decompression with acromioplasty is among the most commonly performed shoulder procedures. The advantages of in-office nano-arthroscopy include the capability of diagnosing and treating subacromial impingement, swifter patient recovery, improved cost-effectiveness, and superior patient satisfaction. The purpose of this technical report is to describe our technique for performing in-office nano-arthroscopy for subacromial decompression (subacromial bursectomy and acromioplasty), with a particular focus on appropriate indications, providing sufficient local anesthesia, optimizing visualization, and discussing the advantages of the in-office setting compared to the operating room.
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Affiliation(s)
| | | | | | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
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Chowdhury A, Gibson C, Nicholls A, MacLeod I, Colaco H. Diagnostic Needle Arthroscopy of the Shoulder: A Validation Study. Orthop J Sports Med 2023; 11:23259671231155885. [PMID: 37576458 PMCID: PMC10413894 DOI: 10.1177/23259671231155885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 08/15/2023] Open
Abstract
Background Diagnostic needle arthroscopy offers an alternative imaging modality to magnetic resonance imaging (MRI) for the diagnosis of intra-articular pathology. Purpose To compare the accuracy of a needle arthroscopy device (Mi-eye2) versus MRI in identifying intra-articular anatomic abnormalities in the glenohumeral joint, with formal arthroscopy as the gold standard. Study Design Cohort study; Level of evidence, 2. Methods A total of 22 patients underwent diagnostic needle arthroscopy of the shoulder, of whom 20 had preoperative MRI scans. A standardized 12-point noninstrumented diagnostic arthroscopy was performed on each patient using the 0° needle arthroscope, followed by a 30°, 4 mm-diameter conventional arthroscope. Intraoperative images were randomized and reviewed by 2 independent blinded fellowship-trained shoulder surgeons for identification of key pathology and anatomic structures. The MRI scans were reviewed by a single musculoskeletal radiologist to identify pathology in the same key areas. Results For the identification of rotator cuff pathology, needle arthroscopy (sensitivity, 0.75; specificity, 1.00) was superior to MRI (sensitivity, 0.75; specificity, 0.75) with an interobserver reliability (κ) of 0.703. For long head of the biceps pathology, needle arthroscopy (sensitivity, 0.67; specificity, 0.95) was superior to MRI (sensitivity, 0.00; specificity, 0.83). It was less accurate for labral (sensitivity, 0.33; specificity, 0.50; κ = 0.522) and articular cartilage pathology (sensitivity, 0.00; specificity, 0.94; κ = 0.353). The number of anatomic structures that could be clearly identified was 8.35 of 12 (69.58%) for needle arthroscopy versus 10.35 of 12 (86.25%) for standard arthroscopy. Conclusion Diagnostic needle arthroscopy was found to be more accurate than MRI for the diagnosis of rotator cuff and long head of the biceps pathology but was less accurate for diagnosing labral and cartilage pathology. Although the field of view of a 0° needle arthroscope is not equivalent to a 30° conventional arthroscope, it presents an alternative with potential for use in an outpatient setting.
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Affiliation(s)
- Alex Chowdhury
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | | | - Alex Nicholls
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Iain MacLeod
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Henry Colaco
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
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Schaver AL, Lash JG, MacAskill ML, Taylor S, Hewett TE, Jasko JJ, Argintar EH, Lavender CD. Partial meniscectomy using needle arthroscopy associated with significantly less pain and improved patient reported outcomes at two weeks after surgery: A comparison to standard knee arthroscopy. J Orthop 2023; 41:63-66. [PMID: 37538832 PMCID: PMC10393789 DOI: 10.1016/j.jor.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023] Open
Abstract
Purpose to compare immediate post-operative pain and patient-reported outcomes (PROs) after partial meniscectomy with needle (NA) vs. standard (SA) arthroscopy technique. Methods A retrospective review of a consecutive series of patients who underwent partial meniscectomy before and after adoption of a needle arthroscopic technique was performed. Meniscus repairs, root repairs, and those with ligamentous injuries were excluded. Total milligram morphine equivalents (MMEs) consumed, Visual analog scale (VAS) pain, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were compared pre-operatively and at 2 and 6-weeks postoperatively. Univariate analysis was used to compare results. Results Nineteen patients were in each group (NA: 10 females, SA: 11 females). Mean ± SD age (NA 42.8 ± 8.4 vs. SA 47.6 ± 10.4 years, p = 0.13) and body mass index (NA 31.4 ± 5.6 vs. SA 35.1 ± 5.4 m/kg2, p = 0.06) were not significantly different. Seventeen (89%) patients in both groups had medial meniscus tears of the posterior horn. Preoperative Outerbridge score was significantly greater in the SA group (3.4 vs. 1.8, p = 0.002); however, preoperative VAS pain (NA 6.1 ± 1.7 vs. SA 6.1 ± 1.8, p = 0.98) and KOOS pain (NA 44 ± 17% vs. SA 37 ± 12.5%, p = 0.20) were similar. Amount of arthroscopic fluid used was significantly greater in the SA vs. NA group (1.4 ± 0.7 vs. 0.5 ± 0.3 L, p < 0.0001), but tourniquet time was equivalent (NA 20 ± 6 vs.16 ± 6 min, p = 0.11). VAS pain scores (NA 1.0 ± 1.1 vs. SA 2.6 ± 1.5, p = 0.0014), KOOS pain (NA 79 ± 15% vs. 58 ± 19%, p = 0.0006), and Quality of Life (QOL) scores (NA 70 ± 22% vs. SA 43 ± 24%, p = 0.001) were significantly better at 2-weeks post-op in the N group. By 6 weeks post-op, all PROs including VAS pain and KOOS scores were similar between groups. Conclusions Adoption of a needle arthroscopic technique for partial meniscectomy was associated with significantly improved VAS and KOOS pain scores two-weeks post-operatively. Differences were not sustained at 6 weeks after surgery. Level of evidence III, Retrospective Comparison Study.
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Affiliation(s)
- Andrew L. Schaver
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Jonathan G. Lash
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Micah L. MacAskill
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Shane Taylor
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Timothy E. Hewett
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - John J. Jasko
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Evan H. Argintar
- MedStar Orthopaedic Institute, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
| | - Chad D. Lavender
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
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Inoue J, Yasui Y, Sasahara J, Takenaga T, Wakabayashi K, Nozaki M, Kobayashi M, Ha M, Fukushima H, Kato J, Miyamoto W, Kawano H, Murakami H, Yoshida M. Comparison of Visibility and Risk of Neurovascular Tissue Injury Between Portals in Needle Arthroscopy of the Anterior Ankle Joint: A Cadaveric Study. Orthop J Sports Med 2023; 11:23259671231174477. [PMID: 37332532 PMCID: PMC10273784 DOI: 10.1177/23259671231174477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background For needle arthroscopy with 0° viewing, the visible range of intra-articular structures and the difference between portals remain unknown, as do the risks for neurovascular tissue at each portal. Purpose To clarify the visibility and safety of needle arthroscopy. Study Design Descriptive laboratory study. Methods Ten cadaveric ankle specimens were used. A needle arthroscope with a 1.9-mm diameter was inserted from 4 portals (anteromedial [AM], anterolateral [AL], medial midline [MM], and anterocentral [AC]). Visibility was assessed using a 15-point ankle arthroscopy checklist. In addition, the ankles were dissected to measure the distance between each portal and neurovascular tissues. The visibility of the ankle joint was compared between portals. Results The success rate of visibility in the deltoid ligament and the tip of the medial malleolus was 100% from the AM, MM, and AC portals and 10% from the AL portal, with significant differences between the portals (P < .01). The visibility success rates in the origin of the anterior talofibular ligament and the tip of the lateral malleolus were 20% for the AM portal, 90% for the MM and AC portals, and 100% for the AL portal, with significant differences between the portals (P < .01). All other points of the ankle joint were visualized from all the portals with a 100% success rate. The AC portal was in contact with the anterior neurovascular bundle in 4 of the 10 specimens. Conclusion When needle arthroscopy was performed from the AM or AL portal, the site opposite to the portal in the ankle joint was difficult to visualize. Conversely, most points of the ankle joint could be visualized from the MM and AC portals. Care should be taken when creating an AC portal because of its proximity to the anterior neurovascular bundle. Clinical Relevance The present study provides information regarding which portal should be selected to perform needle arthroscopy in the ankle joint, which will be beneficial for management of ankle injuries.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Jun Sasahara
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Kenjiro Wakabayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Myongsu Ha
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Hiroaki Fukushima
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Jiro Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahito Yoshida
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Burt J, Smith V, Gee CW, Clarke JV, Hall AJ. The role of outpatient needle arthroscopy in the diagnosis and management of musculoskeletal complaints: A systematic review of the Arthrex NanoScope. Knee 2023; 42:246-257. [PMID: 37105012 DOI: 10.1016/j.knee.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The aim was to review the literature regarding needle arthroscopy using the Arthrex NanoScope system and evaluate: (1) the diagnostic indications, utility, and efficacy compared to conventional methods, and (2) the therapeutic indications, safety, and reported outcomes. METHODS Searches of three databases (MEDLINE, Embase and PubMed) were conducted in November 2021 using MeSH terms: 'needle arthroscopy', 'human', 'in office arthroscopy', 'needle arthroscope', 'nanoscopic', 'surgery', 'nanoscope' and 'percutaneous arthroscopy'. The included studies were catalogued, quality-assessed using Methodological Index for Non-Randomised Studies (MINORS), and analysed using the Cochrane data collection templates for randomised control trials (RCT) and non-randomised control trials (non-RCT). The majority of studies were non-numerical and were examined using qualitative analysis. RESULTS The search yielded 314 studies, 22 of which were included for analysis. MINORS assessment was applicable to four studies. Mean MINORS was 10.7/16 with the most frequent limitations being lack of unbiased endpoint or sample size calculation. The level of evidence ranged from level IV-V. Diagnostic and therapeutic indications were described in relation to the: knee (n = 10); shoulder (n = 6); foot/ankle (n = 3); elbow (n = 2), and miscellaneous (n = 1). CONCLUSIONS Needle arthroscopy can augment the diagnostic process in patients presenting with musculoskeletal complaints, and may provide benefits in terms of diagnostic accuracy, cost efficiency, timeliness of investigation, and a visually impactful patient-centred consultation. Therapeutic interventions are reported by a small number of pioneer groups who report some benefits over conventional arthroscopy. The available literature remains small and of low quality, and more evidence is needed with regards to patient selection, efficacy, safety, and cost. LEVEL OF EVIDENCE Level V (based on the weakest study included in the Systematic Review).
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Affiliation(s)
- J Burt
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - V Smith
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - C W Gee
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Glasgow, Glasgow, UK. https://twitter.com/@ChrisGeeOrtho
| | - J V Clarke
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Strathclyde, Glasgow, UK
| | - A J Hall
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Edinburgh, Edinburgh, UK. https://twitter.com/@andrewhallortho
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Munn D, Burt J, Gee CW, Mclaren CK, Clarke JV, Hall AJ. Moving orthopaedic procedures out of the operating theatre:Outpatient needle arthroscopy can reduce cost & waste, and increase inpatient capacity compared to conventional knee arthroscopy. Knee 2023; 42:143-152. [PMID: 37001331 DOI: 10.1016/j.knee.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/04/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Needle arthroscopy (NA) is an emerging technique that could streamline pathways, facilitate timely care, and reduce service burden. The primary aim was to assess the practical and economic viability of an outpatient NA service. Secondary aims were to assess the relative costs and benefits compared to a conventional arthroscopy (CA) service. METHODS This service feasibility study was conducted between 2021-2022 in a high-volume national treatment centre. A NA pathway was established for patients with chronic soft tissue pathology or early degenerative knee disease. The pathway was evaluated in terms of: i) cost; ii) efficiency, and iii) waste production, and an assessment was conducted of the patient-related and service-related effects. RESULTS The cost of the NA pathway was £1555.20 per patient, compared to £2,351.53 for CA. Time to management was 45 days for NA versus 180 days for CA. The NA pathway involved two hospital attendances, whereas CA required a minimum of three. NA cases produced 1.4 kg of non-recyclable waste compared to 5.0 kg produced by CA. For every two cases managed by NA instead of CA, capacity for one additional obligate-inpatient procedure was created. CONCLUSIONS The NA pathway offers a technically and economically viable approach for the management of refractory knee symptoms in the context of chronic soft tissue or early degenerative disease. NA placed less demand on hospital resources, produced two-thirds less non-recyclable waste, and is amenable to a one-stop clinic approach. Clinical studies focused on objective and patient-reported outcome measures are required to assess clinical efficacy.
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Affiliation(s)
- D Munn
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - J Burt
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK. https://twitter.com/GJOrthopaedics
| | - C W Gee
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Glasgow, Glasgow, UK. https://twitter.com/ChrisGeeOrtho
| | | | - J V Clarke
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Glasgow, Glasgow, UK
| | - A J Hall
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Edinburgh, Edinburgh, UK. https://twitter.com/andrewhallortho
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Muacevic A, Adler JR, Campbell H, Bi AS, Lin CC, Struhl S. Needle Arthroscopy Demonstrates High Sensitivity and Specificity for Diagnosing Intra-Articular Shoulder and Knee Pathology. Cureus 2022; 14:e33189. [PMID: 36726892 PMCID: PMC9886505 DOI: 10.7759/cureus.33189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Needle arthroscopy has been introduced in recent years as an alternative to magnetic resonance imaging (MRI) for the evaluation of knee and shoulder conditions. It has continued to evolve at a rapid rate with newer generation models making in-office integration simple. As MRI can sometimes prove inconclusive, it is worthwhile to consider these alternative options for evaluating musculoskeletal pathology as a primary diagnostic tool. Purpose: The purpose of this study is to evaluate the specificity and sensitivity of needle arthroscopy in diagnosing intra-articular shoulder and knee pathology in a small case series of patients who ultimately underwent surgical arthroscopy. METHODS A retrospective, single-centre, single-surgeon, cohort study was performed over a three-year period from August 2018 to June 2021. During this time, diagnostic needle arthroscopy was performed on patients with suspected shoulder or knee pathology based on MRI findings and clinical exams. These patients subsequently underwent standard surgical arthroscopy. RESULTS Thirty-four patients were included in the study. There were 35 joints included, 25 shoulders and 10 knees, with a mean age of 41.88 +/- 11.32 years and BMI of 29.33 +/- 6.27 in the shoulder group and a mean age of 45.5 +/- 14.54 and BMI of 31.5 +/- 4.94 in the knee group. When evaluating shoulder pathologies, needle arthroscopy showed a sensitivity of 0.93 for rotator cuff tears, 1.00 for labral tears and 1.00 for loose bodies. Needle arthroscopy for the shoulder was found to be 100% specific for all shoulder pathologies. Needle arthroscopy for the knee was found to have a 1.00 sensitivity for detecting chondral defects and 0.80 sensitivity for meniscal tears. There were once again no false positive needle arthroscopy findings amongst the knee group. CONCLUSION Needle arthroscopy is an accurate diagnostic tool for the evaluation of intra-articular knee and shoulder musculoskeletal pathology. It can provide a potential solution for MRI-derived diagnostic inaccuracies that can lead to missed pathologies or unindicated procedures. It is less invasive than surgical arthroscopy and should be considered a useful tool in the armamentarium of orthopedic surgeons.
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Trang G, Del Sol SR, Jenkins S, Bryant S, Gardner B, Chakrabarti MO, McGahan PJ, Chen JL. Evaluation of Osteochondral Allograft Transplant Using In-Office Needle Arthroscopy. Arthrosc Tech 2022; 11:e2243-e2248. [PMID: 36632378 PMCID: PMC9827059 DOI: 10.1016/j.eats.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
In-office needle arthroscopy (IONA) has been available in various iterations for decades. Studies have described it as comparable if not superior to magnetic resonance imaging for identifying intra-articular pathology with associated cost savings per patient. A new IONA system has been brought to market with a modernized user interface and disposable handpieces offering the opportunity to address intra-articular pathology. This article outlines the use of this IONA system for the postoperative evaluation of an osteochondral allograft transplant.
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Affiliation(s)
- Garrett Trang
- The University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA,Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA,Address correspondence to Garrett Trang, B.S., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, USA
| | - Shane Rayos Del Sol
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sarah Jenkins
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
| | - Stewart Bryant
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
| | - Brandon Gardner
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
| | | | - Patrick J. McGahan
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
| | - James L. Chen
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
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11
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Bradsell H, Lencioni A, Shinsako K, Frank RM. In-Office Diagnostic Needle Arthroscopy Using the NanoScope™ Arthroscopy System. Arthrosc Tech 2022; 11:e1923-e1927. [PMID: 36457377 PMCID: PMC9705598 DOI: 10.1016/j.eats.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
Diagnostic needle arthroscopy performed in office is a safe and cost-effective method for accurate evaluation of intra-articular pathology, improving clinical decision making. This minimally invasive approach is an effective alternative to traditional diagnostic techniques of diagnostic surgical arthroscopy and magnetic resonance imaging (MRI). Needle arthroscopy is considered low-risk, with an extremely low complication rate when performed with appropriate technique and indications. The purpose of this article is to describe an approach to an in-office diagnostic procedure using a needle arthroscopy system.
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Affiliation(s)
| | | | | | - Rachel M. Frank
- Address correspondence to Rachel M. Frank, M.D., University of Colorado School of Medicine, 12631 E 17th Ave., Mail Stop B202, Aurora, CO 80045, USA.
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Annibaldi A, Monaco E, Daggett M, Carrozzo A, Mazza D, Previ L, Rossi G, Orlandi P, Ferretti A. In-office needle arthroscopic assessment after primary ACL repair: short-term results in 15 patients. J Exp Orthop 2022; 9:89. [PMID: 36070161 PMCID: PMC9452609 DOI: 10.1186/s40634-022-00528-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose In-office needle arthroscopy has been reported as a diagnostic tool for different knee pathologies. In addition, ACL repair has seen a resurgence with the advent of innovative orthopedic devices. The aim of this study was to assess clinical, radiological, and in-office needle arthroscopic findings in 15 adult patients who underwent acute (within 14 days from injury) anterior cruciate ligament (ACL) repair. Methods Fifteen patients voluntarily participated in the study. A second-look arthroscopy was performed with an in-office needle arthroscopy at an average of 7.2 months after the primary repair. The parameters included in the investigation were the continuity of the anatomical footprint of the repaired ACL, subjective assessment of the ACL tension with the probe, and synovial coverage of the ACL. All patients had a Magnetic Resonance Imaging (MRI) at 6 months after repair and an arthrometric evaluation with the KT-1000. Clinical evaluation with the scores, Tegner Lysholm Knee Scoring Scale (TLKSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) was performed at the final follow-up of 2 years. Moreover, a correlation between the characteristics of ACL appearance at the time of the second look in-office needle arthroscopy, MRI and KT-1000 was performed. Results The mean TLKSS was 97.86, the mean KOOS was 98.08 and the mean subjective IKDC was 96.71. The objective IKDC was A in 10 patients and B in 5 patients. ACL healing was graded as A in 11 patients and B in 4 patients. Synovial coverage was graded as good in 10 patients and fair in 5 while MRI assessment showed a type I ACL in 10 patients, type II in 4 patients and type III in 1 patient. Conclusion In-office needle arthroscopy is a reliable tool to assess the condition of a repaired ACL. In addition, ACL repair performed in acute proximal tears demonstrated excellent clinical results.
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Affiliation(s)
| | - Edoardo Monaco
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy.
| | | | | | - Daniele Mazza
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Leonardo Previ
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Giorgio Rossi
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | | | - Andrea Ferretti
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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13
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Arrigoni F, Mazzoleni MG, Calvisi V, Masciocchi C. In-Office Needle Arthroscopy (IONA): may a traditionally orthopedic procedure enter the portfolio of interventional radiology? Radiol Med 2022; 127:784-787. [DOI: 10.1007/s11547-022-01497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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Colasanti CA, Mercer NP, Garcia JV, Kerkhoffs GMMJ, Kennedy JG. In-Office Needle Arthroscopy for the Treatment of Anterior Ankle Impingement Yields High Patient Satisfaction With High Rates of Return to Work and Sport. Arthroscopy 2022; 38:1302-1311. [PMID: 34571184 DOI: 10.1016/j.arthro.2021.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of in-office needle arthroscopy (IONA) for the treatment of anterior ankle impingement in the office setting and also evaluate patient experience of the IONA procedure. METHODS A prospectively collected database of 31 patients undergoing IONA for the treatment of anterior ankle impingement between January 2019 and January 2021 was retrospectively reviewed. Inclusion criteria for this study were patients ≥18 years of age, clinical history, physical examination, radiographic imaging, and magnetic resonance imaging findings consistent with anterior ankle impingement for which each patient underwent IONA and had a minimum of 12-month follow-up. Clinical outcomes were evaluated using the following methods preoperatively and at final follow-up: the Foot and Ankle Outcome Scores (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity domains. A 5-point Likert scale regarding patient satisfaction with their IONA procedure was evaluated at final follow-up. Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores. RESULTS In total, 31 patients were included in this study, including 18 male and 13 female, with a mean age of 41.7 ± 15.5 years (range, 17-69 years) and mean body mass index of 27.3 ± 5.7 (range, 19.37-41.5). The mean follow-up time was 15.5 ± 4.9 months. The mean postoperative FAOS-reported symptoms, pain, daily activities, sports activities, and quality of life were 79.4 ± 11.9, 82.9 ± 15.3, 83.5 ± 15.4, 71.9 ± 18.5 and 64.3 ± 21.4 at final follow-up respectively. Minimal clinically important difference was achieved by 84% of patients for FAOS pain, 77% for FAOS symptoms, 75% for FAOS Quality of Life, 74% for FAOS sports, 65% for PROMIS Pain Interference, 61% for FAOS Activities of Daily Living, and 42% for PROMIS Pain Intensity. Lastly, 29 patients (94 %) expressed willingness to undergo the same procedure again. CONCLUSIONS The current study demonstrates that IONA treatment of anterior ankle impingement results in significant pain reduction, a low complication rate and excellent patient reported outcomes with high rates of return to work/sport. Additionally, IONA for anterior ankle impingement leads to high patient satisfaction with a significant willingness to undergo the same procedure again. LEVEL OF EVIDENCE IV, Case series study.
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Affiliation(s)
| | | | - Jeremie V Garcia
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee
| | - John G Kennedy
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY.
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15
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Colasanti CA, Kaplan DJ, Chen JS, Kanakamedala A, Dankert JF, Hurley ET, Mercer NP, Stone JW, Kennedy JG. In-Office Needle Arthroscopy for Anterior Ankle Impingement. Arthrosc Tech 2022; 11:e327-e331. [PMID: 35256971 PMCID: PMC8897558 DOI: 10.1016/j.eats.2021.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/28/2021] [Indexed: 02/03/2023] Open
Abstract
Anterior ankle impingement is a common cause of chronic ankle pain characterized by altered joint mechanics with considerable deficits in range of motion. The benefits of in-office nano arthroscopy (IONA) include the ability to diagnosis and treat anterior ankle impingement, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing in-office nano arthroscopy for anterior ankle impingement, with special consideration of the technique for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.
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Affiliation(s)
| | - Daniel J. Kaplan
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Jeffrey S. Chen
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Ajay Kanakamedala
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - John F. Dankert
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Eoghan T. Hurley
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Nathaniel P. Mercer
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A.,Address correspondence to John G. Kennedy, M.D., NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17th St., New York, NY, 10010, U.S.A.
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16
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Lavender C, Flores K, Patel T, Berdis G, Blickenstaff B. Nanoscopic Medial Meniscus Repair. Arthrosc Tech 2021; 10:e1943-e1947. [PMID: 34401237 PMCID: PMC8355508 DOI: 10.1016/j.eats.2021.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic meniscus repair is one of the commonly used arthroscopic surgical procedures. Open treatment was the standard for meniscus repairs and recently arthroscopic all-inside treatment has become popular. Novel and more minimally invasive techniques to common arthroscopic procedures are paving the foundation to better patient outcomes. With the use of the NanoScope and nanoinstruments, we continue to develop new minimally invasive diagnostic and treatment techniques that do not require standard portals. The nanoscopic medial meniscus repair technique described here uses a less-invasive approach to a meniscus repair.
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Affiliation(s)
- Chad Lavender
- Chad Lavender Marshall University Orthopaedic Surgery Sports Medicine,Address correspondence to Chad Lavender, M.D., Chad Lavender Marshall University Orthopaedic Surgery Sports Medicine, Marshall University, 300 Corporate Center Dr., Scott Depot, WV 25560.
| | | | - Tyag Patel
- Marshall University, Scott Depot, West Virginia, U.S.A
| | - Galen Berdis
- Marshall University, Scott Depot, West Virginia, U.S.A
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17
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Wagner ER, Woodmass JM, Zimmer ZR, Welp KM, Chang MJ, Prete AM, Farley KX, Warner JJP. Needle Diagnostic Arthroscopy and Magnetic Resonance Imaging of the Shoulder Have Comparable Accuracy With Surgical Arthroscopy: A Prospective Clinical Trial. Arthroscopy 2021; 37:2090-2098. [PMID: 33798653 DOI: 10.1016/j.arthro.2021.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/21/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the accuracy, sensitivity, and specificity of a minimally invasive needle arthroscopy device and magnetic resonance imaging (MRI) compared with diagnostic arthroscopy, the gold standard in diagnosing intra-articular shoulder pathologies. METHODS This was a prospective, blinded clinical trial over 6 months on 50 patients with shoulder pathology requiring arthroscopy. Patients were eligible if they had an MRI and consented for surgical arthroscopy. Patients were excluded if they didn't consent. Each underwent a clinical evaluation, MRI, needle arthroscopy, and surgical arthroscopy. Videos and images were blindly reviewed postoperatively. Analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value, Cohen's kappa agreement coefficient, and the McNemar test. RESULTS Needle arthroscopy had similar accuracy to MRI in diagnosing intra-articular shoulder pathologies when both were compared with the gold standard of diagnostic arthroscopy. It had high specificities and PPV for certain rotator cuff tears, biceps pathology, and anterior labral tears. When compared with the gold standard, specificity of needle arthroscopy for diagnosing rotator cuff tear and cartilage lesions was 1.00 and 0.97 and 0.72 and 0.86 for MRIs, respectively. Sensitivity of needle arthroscopy for rotator cuff and cartilage lesions was 0.89 and 0.74, respectively, lower than MRI. For most intra-articular pathologies, needle arthroscopy was at least equally accurate to MRI at diagnosing intra-articular shoulder pathologies, with similar or high kappa statistics when correlated with surgical arthroscopic findings. CONCLUSIONS Needle arthroscopy is a promising diagnostic modality for intra-articular shoulder pathologies. It had comparable accuracy with MRI for diagnosing articular cartilage, labrum, rotator cuff, and biceps pathology. Across all pathologies, needle arthroscopy had better ability to "rule in" a diagnosis (high specificities and PPV), but slightly worse ability to "rule out" a diagnosis (lower sensitivities and negative predictive value) compared with MRI. LEVEL OF EVIDENCE Level II, Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard).
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Affiliation(s)
- Eric R Wagner
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Jarret M Woodmass
- Section of Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zachary R Zimmer
- Shoulder Service, Massachusetts General Hospital, Department of Orthopedic Surgery, Boston Shoulder Institute, Boston, Massachusetts, U.S.A
| | - Kathryn M Welp
- Shoulder Service, Massachusetts General Hospital, Department of Orthopedic Surgery, Boston Shoulder Institute, Boston, Massachusetts, U.S.A
| | - Michelle J Chang
- Shoulder Service, Massachusetts General Hospital, Department of Orthopedic Surgery, Boston Shoulder Institute, Boston, Massachusetts, U.S.A
| | - Alexander M Prete
- Shoulder Service, Massachusetts General Hospital, Department of Orthopedic Surgery, Boston Shoulder Institute, Boston, Massachusetts, U.S.A
| | - Kevin X Farley
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Jon J P Warner
- Shoulder Service, Massachusetts General Hospital, Department of Orthopedic Surgery, Boston Shoulder Institute, Boston, Massachusetts, U.S.A..
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Lavender C. Editorial Commentary: Indications for Needle Arthroscopy as an Alternative to Magnetic Resonance Imaging: More to the Picture Than Meets the Eye. Arthroscopy 2021; 37:2099-2101. [PMID: 34226002 DOI: 10.1016/j.arthro.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
Needle arthroscopy (using a 1- to 1.9-mm diameter arthroscope) is not new, and new interest is a result of the expense and inconvenience of magnetic resonance imaging (MRI), including time out of work, prolonged diagnostic dilemmas, and finite advanced imaging resources. Improvements in the image quality with the modern needle arthroscope have made it a viable option for use as a diagnostic tool in the operative setting, and eventually, if surgeons are able to create strict criteria for proper diagnostic use of the needle arthroscope, it may become an excellent tool for in-office use despite financial or legal hurdles. Specific clinical scenarios for use of an diagnostic needle arthroscopy instead of an MRI (and typically immediately followed by therapeutic arthroscopy in the same setting) include (1) a patient with a clinically obvious meniscus tear with a locked knee, (2) a patient with an outdated but previously positive MRI with recurrent injury such as a recurrent shoulder or patella dislocations, (3) a patient who is ineligible for an MRI such as those with pacemakers or spinal implants who have clear and obvious clinical findings to suggest intra-articular pathology, and (4) a patient who is over the age of 50 years with positive rotator cuff testing after a shoulder dislocation in which I have a high degree of suspicion of a rotator cuff tear. In the future, we envision using multiple needle arthroscopes to provide simultaneous views from different angles during surgery and giving ourselves a 360° view. I envision an operating room in the future with multiple small needle scopes in joint and multiple viewing monitors providing a new 3-dimensional world of arthroscopy.
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Liu J, Farr J, Ramos O, Voigt J, Amin N. Workers' Societal Costs After Knee and Shoulder Injuries and Diagnosis with In-Office Arthroscopy or Delayed MRI: A Cost-Minimization Analysis. JB JS Open Access 2021; 6:e20.00151. [PMID: 34136739 PMCID: PMC8202550 DOI: 10.2106/jbjs.oa.20.00151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The goal of this study was to evaluate the societal costs of using in-office diagnostic arthroscopy (IDA) compared with magnetic resonance imaging (MRI) for the diagnosis of intra-articular knee and shoulder pathology in employed patients receiving Workers' Compensation or disability coverage. The prevalence is estimated at 260,000 total cases per year. METHODS A cost-minimization analysis of IDA compared with MRI was conducted. Direct costs (in 2018 U.S. dollars) were calculated from private reimbursement amounts and Medicare. Indirect costs were estimated from a societal perspective including effects of delayed surgical procedures on the ability to work, lost income, Workers' Compensation or disability coverage, and absenteeism. Four regions were selected: Boston, Massachusetts; Detroit, Michigan; Denver, Colorado; and San Bernadino, California. Sensitivity analyses were performed using TreeAge Pro 2019 software. The base assumption was that it would take approximately 4 weeks for a diagnosis with MRI and 0 weeks for a diagnosis with IDA. RESULTS Direct costs to determine a knee diagnosis with IDA were $556 less expensive (California) to $470 more expensive (Massachusetts) than MRI. Assuming a 4-week wait, societal costs (indirect and direct) for knee diagnosis were anywhere from $7,852 (Denver) to $11,227 (Boston) less using IDA. Direct costs were similar for shoulder pathology. In order for MRI to be the less costly option, the MRI and the follow-up visit to the physician would need to occur directly after consultation. Under Medicare, direct costs were similar for both the knee and shoulder when comparing IDA and MRI. Including indirect costs resulted in IDA being the less costly option. CONCLUSIONS The use of IDA instead of MRI for the diagnosis of knee and shoulder pathology reduced costs. The potential savings to society were approximately $7,852 to $11,227 per operative patient and were dependent on scheduling and follow-up using MRI and on Workers' Compensation. LEVEL OF EVIDENCE Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California
| | - Jack Farr
- Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Indianapolis, Indiana
| | - Omar Ramos
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California
| | - Jeff Voigt
- Medical Device Consultants of Ridgewood, LLC, Ridgewood, New Jersey
| | - Nirav Amin
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California
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Daggett MC, Busch K, Ferretti A, Monaco E, Bruni G, Saithna A. Percutaneous Anterior Cruciate Ligament Repair With Needle Arthroscopy and Biological Augmentation. Arthrosc Tech 2021; 10:e289-e295. [PMID: 33680758 PMCID: PMC7917016 DOI: 10.1016/j.eats.2020.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 10/08/2020] [Indexed: 02/03/2023] Open
Abstract
Recent advancements in orthopaedic devices have instilled a renewed interest in repair of the anterior cruciate ligament. Biological augmentation of the repair has also recently been investigated with the hopes of improving repair outcomes and improving biological healing. The advent of needle arthroscopy allows for potentially decreased recovery times and potentially reduced complication rates compared with traditional arthroscopy. The purpose of this article is to present a percutaneous technique to repair the anterior cruciate ligament with suture tape augmentation while also augmenting with the biological byproducts from the native effusion using needle arthroscopy.
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Affiliation(s)
- Matthew C. Daggett
- Address correspondence to Matthew C. Daggett, D.O., M.B.A., 2000 SE Blue Pkwy, Ste 230, Lee's Summit, MO 64063, U.S.A.
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21
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Peters M, Gilmer B, Kassam HF. Diagnostic and Therapeutic Elbow Arthroscopy Using Small-Bore Needle Arthroscopy. Arthrosc Tech 2020; 9:e1703-e1708. [PMID: 33294329 PMCID: PMC7695593 DOI: 10.1016/j.eats.2020.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/11/2020] [Indexed: 02/03/2023] Open
Abstract
Needle arthroscopy may provide several potential advantages over standard arthroscopy. The smaller camera size and weight allows for a minimally invasive and percutaneous approach with decreased fluid use. As resolution and image quality improve, the potential to expand clinical use for therapeutic applications becomes possible. One promising use is in elbow arthroscopy. Difference in the technology, such as a zero-degree optic and less-rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy and therapeutic procedures. This manuscript introduces the authors' approach to diagnostic needle arthroscopy of the anterior and posterior elbow compartments and placement of therapeutic instrumentation. This technique could theoretically decrease the risk of iatrogenic neurovascular injuries, reduce postoperative swelling and pain due to decreased fluid use, and potentially lead to faster recovery.
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Affiliation(s)
| | | | - Hafiz F. Kassam
- Address correspondence to Hafiz F. Kassam, M.D., Department of Orthopedic Surgery, Sutter Health, 470 Plumas Blvd., Yuba City, CA 95991, U.S.A.
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Shafi N, Lang SD, Kassam H, Gilmer BB. Diagnostic and Therapeutic Shoulder Arthroscopy Using a Small-Bore Needle Arthroscope. Arthrosc Tech 2020; 9:e1087-e1093. [PMID: 32874887 PMCID: PMC7451705 DOI: 10.1016/j.eats.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/06/2020] [Indexed: 02/03/2023] Open
Abstract
As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. Smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased use of arthroscopic fluid. Differences in the technology, such as a 0° optic and less rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy as well as modified approaches to therapeutic procedures. This article introduces our preferred approach to diagnostic arthroscopy of the glenohumeral joint and subacromial space with needle arthroscopy and small-bore instruments. This technique could increase efficiency and decrease operative time with certain arthroscopic procedures, and it may improve patient outcomes.
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Affiliation(s)
- Noah Shafi
- University of Nevada, Reno, School of Medicine, Reno, Nevada, U.S.A
| | - Sarah D. Lang
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
| | | | - Brian B. Gilmer
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A.,Address correspondence to Brian B. Gilmer, M.D., F.A.B.O.S., 85 Sierra Park Rd, PO Box 660, Mammoth Lakes, CA 93546, U.S.A.
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Daggett M, Tucker T, Monaco E, Redler A, Pettegrew J, Bruni G, Saithna A. Partial Medial Meniscectomy Using Needle Arthroscopy and a Standardized Local Anesthetic Protocol. Arthrosc Tech 2020; 9:e593-e598. [PMID: 32489831 PMCID: PMC7253716 DOI: 10.1016/j.eats.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/03/2020] [Indexed: 02/03/2023] Open
Abstract
Needle arthroscopic procedures of the knee offer potential advantages over standard arthroscopic procedures. The small size of the instruments allows for surgery without the use of a scalpel or suture, potentially decreased recovery times, and potentially reduced complication rates compared with traditional arthroscopy. In some patients, the procedure can be performed without the use of either general anesthesia or sedation. The purpose of this article is to provide a standardized technique guide for needle arthroscopic partial medial meniscectomy under local anesthesia.
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Affiliation(s)
- Matt Daggett
- Kansas City University, Kansas City, Missouri, U.S.A
| | - Tyler Tucker
- Kansas City University, Kansas City, Missouri, U.S.A
| | - Edoardo Monaco
- Sant’Andrea Hospital, University of Rome La Sapienza, Roma, Italy
| | - Andrea Redler
- Sant’Andrea Hospital, University of Rome La Sapienza, Roma, Italy
| | | | - Giorgio Bruni
- Sant’Andrea Hospital, University of Rome La Sapienza, Roma, Italy
| | - Adnan Saithna
- Kansas City University, Kansas City, Missouri, U.S.A
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Quinn R, Lang SD, Gilmer BB. Diagnostic Needle Arthroscopy and Partial Medial Meniscectomy Using Small Bore Needle Arthroscopy. Arthrosc Tech 2020; 9:e645-e650. [PMID: 32489839 PMCID: PMC7253772 DOI: 10.1016/j.eats.2020.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/14/2020] [Indexed: 02/03/2023] Open
Abstract
As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. The smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased arthroscopic fluid use. Differences in the technology, such as a 0-degree optic and less rigid instrumentation necessitate a novel technique to accommodate thorough diagnostic arthroscopy as well as new approaches to therapeutic procedures. This manuscript introduces our preferred approach to diagnostic arthroscopy and partial medial meniscectomy with NA and small-bore instruments. The minimally invasive nature of this technology may decrease postoperative pain and improve return of comfort and function.
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Affiliation(s)
| | | | - Brian B. Gilmer
- Address correspondence to Brian Gilmer, M.D., Mammoth Orthopedic Institute, Mammoth Hospital, 85 Sierra Park Rd. PO Box 660, Mammoth Lakes, CA 93546 U.S.A.
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Daggett MC, Stepanovich B, Geraghty B, Meyers A, Whetstone J, Saithna A. Office-Based Needle Arthroscopy: A Standardized Diagnostic Approach to the Shoulder. Arthrosc Tech 2020; 9:e521-e525. [PMID: 32368473 PMCID: PMC7189211 DOI: 10.1016/j.eats.2019.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/09/2019] [Indexed: 02/03/2023] Open
Abstract
In-office needle arthroscopy offers the potential advantage of reduced injury to intervention time, without the need for advanced imaging. It is particularly appropriate for those with contraindications to advanced imaging and also may reduce the risk of incorrect diagnoses in those situations in which imaging is associated with low sensitivity/specificity. The purpose of this article is to provide a standardized diagnostic approach to needle arthroscopy of the shoulder.
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Affiliation(s)
- Matthew C. Daggett
- Address correspondence to Dr. Matthew Daggett, 2000 SE Blue Pkwy Suite 230, Lee’s Summit, MO 64063.
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Stornebrink T, Stufkens SAS, Appelt D, Wijdicks CA, Kerkhoffs GMMJ. 2-Mm Diameter Operative Tendoscopy of the Tibialis Posterior, Peroneal, and Achilles Tendons: A Cadaveric Study. Foot Ankle Int 2020; 41:473-478. [PMID: 31868013 PMCID: PMC7160745 DOI: 10.1177/1071100719895504] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Technical innovation now offers the possibility of 2-mm-diameter operative tendoscopy with disposable arthroscopes and tablet-like control units. The promises of new technology should be critically scrutinized. Therefore, this study assessed whether 2-mm-diameter operative tendoscopy of the tibialis posterior, peroneal, and Achilles tendons was safe and effective in a cadaveric model. METHODS A 2-mm-diameter arthroscopic system was used to perform a tendoscopic procedure in 10 nonpaired, fresh-frozen, human ankles. Standard tendoscopic portals were utilized. Visual examination and operative reach with tailored tendoscopic instruments within the tendon sheaths were recorded and documented. Adhesiolysis and vincula resections were performed. After dissection, distances between portal tracts and neurovascular structures were measured and the tendons were inspected for signs of iatrogenic damage. RESULTS The entire tendon sheath and tendon of the tibialis posterior, peroneus brevis, and Achilles tendons were visualized and reached with tailored operative instruments. The proximal part of the peroneus longus tendon was visible and reachable from proximally up to the cuboid bone distally. Adhesiolysis and vincula resections were successfully performed in all specimens. The mean distances between portal tracts and local neurovascular structures ranged between 9.4 and 19.2 mm and there were no cases of contact. None of the tendons showed signs of iatrogenic damage. CONCLUSION Two-millimeter-diameter operative tendoscopy provided safe and effective visualization and operative reach of the tibialis posterior, peroneal, and Achilles tendons. CLINICAL RELEVANCE Compared with current practice, 2-mm-diameter operative tendoscopy has the potential to make tendoscopy around the ankle less invasive and more accessible. Diagnostic, interventional, and second-look procedures might be performed at substantially reduced risk, time, and costs.
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Affiliation(s)
- Tobias Stornebrink
- Department of Orthopedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands,Academic Center for Evidence Based
Sports Medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center,
Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A. S. Stufkens
- Department of Orthopedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands,Academic Center for Evidence Based
Sports Medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center,
Amsterdam UMC, Amsterdam, The Netherlands
| | - Daniel Appelt
- Department of Orthopedic Research,
Arthrex GmbH, Munich, Bayern, Germany
| | - Coen A. Wijdicks
- Department of Orthopedic Research,
Arthrex GmbH, Munich, Bayern, Germany
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands,Academic Center for Evidence Based
Sports Medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center,
Amsterdam UMC, Amsterdam, The Netherlands,Gino M. M. J. Kerkhoffs, MD, PhD, Department
of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC,
University of Amsterdam, Meibergdreef 9, Room K1-207, Amsterdam, 1105 AZ, The
Netherlands.
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Abstract
Knee arthroscopy has evolved greatly from its inception in the twentieth century. Of the many arthroscopic knee surgeries, meniscectomy is the most commonly performed. Arthroscopic meniscectomy is the most common orthopaedic surgical procedure performed in the United States. We continue to develop more minimally invasive procedures, and the NanoScope has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and with the use of nanoinstruments, we can perform treatments as well as diagnostic arthroscopy without incisions. This technique provides an updated incisionless option to perform a partial medial meniscectomy.
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McIntyre LF. Editorial Commentary: What You See Is What You Get-Is In-Office Needle Arthroscopy Ready for Prime Time? Arthroscopy 2019; 35:2722-2723. [PMID: 31500760 DOI: 10.1016/j.arthro.2019.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 02/02/2023]
Abstract
In-office needle arthroscopy (IONA) has been around for many years, and technological improvements in image fidelity, patient convenience and access to care, and medical economics have resulted in renewed interest in this diagnostic tool. Patients could be well served by an immediate diagnosis of their joint pathology at the initial office encounter. A limitation of the current literature is that for research purposes, studies comparing IONA with diagnostic surgical arthroscopy and/or magnetic resonance imaging have been performed in the operating room-not the office setting. In addition, IONA is limited to intra-articular evaluation. IONA has been shown to be accurate and cost-effective, and future adoption of this modality seems promising.
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Zhang K, Crum RJ, Samuelsson K, Cadet E, Ayeni OR, de Sa D. In-Office Needle Arthroscopy: A Systematic Review of Indications and Clinical Utility. Arthroscopy 2019; 35:2709-2721. [PMID: 31416656 DOI: 10.1016/j.arthro.2019.03.045] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This review explores the current literature regarding both the clinical indications and utility of minimally invasive in-office needle arthroscopy (IONA) relative to conventional imaging modalities. METHODS In compliance with R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched in July 2018, in addition to the conference abstract databases of 5 prominent meetings between 2013 and 2018, for studies using IONA for diagnostic purposes. Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS Among 932 conference abstracts and 369 studies identified, 11 publications involving 404 patients (395 knees and 9 shoulders) were included, with 9 clinical studies and 2 cost analyses. The median Methodological Index for Non-Randomized Studies (MINORS) score was 9 for noncomparative and 23 for comparative studies. Among the 9 clinical studies, IONA had a superior sensitivity, specificity, positive predictive value, and negative predictive value to magnetic resonance imaging (MRI) in the evaluation of knee osteoarthritis, anterior cruciate ligament insufficiency, and meniscal tears. IONA was comparable or inferior to MRI in the same parameters for the diagnosis of osteochondral defects and rotator cuff tears. In the 2 cost analyses, IONA had lower costs when used in place of MRI for treatment algorithms involving medial meniscal tears and rotator cuff tears but not lateral meniscal tears. CONCLUSIONS IONA holds potential for cost savings and improved diagnostic accuracy relative to MRI, primarily for intra-articular meniscal, ligamentous, and chondral defects of the knee. However, its current indications for use in other joints are limited to rotator cuff tears in the shoulder, making its diagnostic value in other joints much more limited. The current quality and breadth of evidence are significantly lacking, with numerous practical shortcomings. To improve acceptance of IONA, priority should be placed on establishing defined protocols, indications, contraindications, and patient perspectives for the procedure. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Kailai Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Raphael J Crum
- Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | | | - Edwin Cadet
- Raleigh Orthopaedic Clinic, Raleigh, North Carolina, U.S.A
| | | | - Darren de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
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McMillan S, Chhabra A, Hassebrock JD, Ford E, Amin NH. Risks and Complications Associated With Intra-articular Arthroscopy of the Knee and Shoulder in an Office Setting. Orthop J Sports Med 2019; 7:2325967119869846. [PMID: 31632993 PMCID: PMC6767734 DOI: 10.1177/2325967119869846] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Classically, arthroscopy has been considered one of the diagnostic gold standards for assessing intra-articular knee and shoulder abnormality. PURPOSE To assess the risks associated with in-office needle arthroscopy. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective case series analysis was performed by evaluating consecutive diagnostic needle arthroscopies performed by 13 physicians at 13 independent institutions. The findings of both major and minor complications were reported by each of the 13 surgeons based on office documentation. The data were analyzed as a lump sum of both knee and shoulder cases and then subdivided and examined separately. The patients' ages ranged from 14 to 78 years, and no statistical difference was noted between the numbers of men and women. A major complication was defined as infection, chondral toxicity, or the need for alternative treatment at an urgent care or emergency room secondary to the procedure. Minor complications were defined as a vasovagal event, pain that persisted after 24 hours, or the need for crutches or sling postprocedure. RESULTS Of the 1419 cases, no major complications were reported. The overall rate of vasovagal events was 1.9% for all procedures (1.6% in knees, 3% in shoulders). Persistent pain longer than 24 hours postprocedure was reported in 0.3% of cases. No patient required crutches or a sling. Postarthroscopy magnetic resonance imaging was needed in 1.4% of cases. No device failures were reported. CONCLUSION Previous literature has evaluated the efficacy, sensitivity, and specificity of in-office diagnostic arthroscopy, and this study validates needle arthroscopy as safe in the office setting, with minimal risk of major or minor complications.
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Affiliation(s)
- Sean McMillan
- Department of Orthopedics, Lourdes Health Systems, Burlington, New Jersey, USA
| | - Anikar Chhabra
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Elizabeth Ford
- Department of Orthopedics, Lourdes Health Systems, Burlington, New Jersey, USA
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Amin N, McIntyre L, Carter T, Xerogeanes J, Voigt J. Cost-Effectiveness Analysis of Needle Arthroscopy Versus Magnetic Resonance Imaging in the Diagnosis and Treatment of Meniscal Tears of the Knee. Arthroscopy 2019; 35:554-562.e13. [PMID: 30712631 DOI: 10.1016/j.arthro.2018.09.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether needle arthroscopy (NA) compared with magnetic resonance imaging (MRI) in the diagnosis and treatment of meniscal tears is cost-effective when evaluated over a 2-year period via patient-reported outcomes. The hypothesis is that improved diagnostic accuracy with NA would lead to less costly care and similar outcomes. METHODS A Markov model/decision tree analysis was performed using TreeAge Pro 2017 software. Patients were evaluated for degenerative and traumatic damage to the lateral/medial meniscus. Assumed sensitivities and specificities were derived from the medical literature. The direct costs for care were derived from the 2017 Medicare fee schedule and from private payer reimbursement rates. Costs for care included procedures performed for false-positive findings and for care for false-negative findings. Effectiveness was examined using the global knee injury and osteoarthritis outcome score (KOOS). Patients were evaluated over 2 years for costs and outcomes, including complications. Dominance and incremental cost-effectiveness were evaluated, and 1- to 2-way sensitivity analysis was performed to determine those variables that had the greatest effect. The consolidated economics evaluation and reporting standards checklist for reporting economic evaluations was used. RESULTS NA was less costly and had similar KOOS versus MRI for both the medial/lateral meniscus with private pay. Costs were less for both Medicare and private pay for medial meniscus, $780 to $1,862, and lateral meniscus, $314 to $1,256, respectively. CONCLUSIONS Based on the reported MRI incidence of false positives with the medial meniscus and false negatives with the lateral meniscus and based on assumed standards of care, more costly care is provided when using MRI compared with NA. Outcomes were similar with NA compared with MRI. LEVEL OF EVIDENCE Level II, economic and decision analysis.
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Affiliation(s)
- Nirav Amin
- Department of Orthopedic Surgery, Loma Linda University School of Medicine, Loma Linda, California
| | - Louis McIntyre
- Northwell Health Physician Partners Orthopaedic Institute, Tarrytown, New York
| | | | - John Xerogeanes
- Emory Orthopaedics and Spine Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey Voigt
- Medical Device Consultants of Ridgewood, Ridgewood, New Jersey, U.S.A..
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Cooper DE. Editorial Commentary: The Desire to Take a Look: Surgeons and Patients Must Weigh the Benefits and Costs of In-Office Needle Arthroscopy Versus Magnetic Resonance Imaging. Arthroscopy 2018; 34:2436-2437. [PMID: 30077266 DOI: 10.1016/j.arthro.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 02/02/2023]
Abstract
There has always been a need for a more accurate diagnosis than the history and clinical examination allow. This was the very foundation for the evolution of the field of radiology and arthroscopic surgery. Before 1972, the imaging option (arthrography) was invasive and of limited use; therefore, arthroscopic surgery, as a much more accurate diagnostic tool, became widely accepted over time, even though it was more invasive. We should remember that this was not without a high degree of controversy and scorn. Today, we have technology that allows us to perform in-office diagnostic arthroscopy with a needle-size arthroscope under local anesthesia. We also have modern high-resolution magnetic resonance imaging. Both have merits, clear indications, and clear contraindications. Both have advantages and disadvantages and costs, and neither offers treatment.
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