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Butler JJ, Wingo T, Kennedy JG. Presurgical and Postsurgical MRI Evaluation of Osteochondral Lesions of the Foot and Ankle: A Primer. Clin Podiatr Med Surg 2024; 41:759-773. [PMID: 39237183 DOI: 10.1016/j.cpm.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
The gold standard diagnostic imaging tool for ankle OCLs is magnetic resonance imaging, which allows precise evaluation of the articular cartilage and assessment of the surrounding soft tissue structures. Post-operative morphologic MRI assessment via MOCART scores provide semi-quantitative analysis of the repair tissue, but mixed evidence exists regarding its association with post-operative outcomes. Post-operative biochemical MRIs allow assessment of the collagen network of the articular cartilage via T2-mapping and T2∗ mapping, and assessment of the articular glycosaminoglycan content via delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho mapping and sodium imaging.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York City, NY 10002, USA
| | - Taylor Wingo
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York City, NY 10002, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York City, NY 10002, USA.
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2
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Inoue J, Yasui Y, Sasahara J, Takenaga T, Ha M, Miyamoto W, Kawano H, Murakami H, Yoshida M. Comparison of visibility in needle arthroscopy of the ankle according to surgical experience: A cadaveric study. Foot Ankle Surg 2024; 30:603-607. [PMID: 38762338 DOI: 10.1016/j.fas.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Literature regarding the feasibility of inexperienced surgeons using needle arthroscopy is limited. The present study aimed to clarify the feasibility of performing ankle needle arthroscopy for inexperienced surgeons. METHODS Diagnostic needle arthroscopy was performed for 10 cadaveric ankles by two surgeons with different levels of experience in ankle arthroscopy (inexperienced and expert surgeons). The visibility of arthroscopy was assessed based on a 15-point checklist and compared between surgeons. In addition, iatrogenic articular cartilage injury created by the inexperienced surgeon was investigated. RESULTS The number of visible points was significantly larger for the expert surgeon than for the inexperienced surgeon (14.1 ± 1.0 vs. 13.7 ± 1.0, P = 0.035). The location of cartilage injury was greatest on the medial talar dome when viewing from the anteromedial portal at a rate of 30%. CONCLUSION Ankle needle arthroscopy may be an option for surgeons in the future, however, differences in surgeon experience may impact effective visualization.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopaedic 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 Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Myongsu Ha
- Department of Orthopaedic 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 Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahito Yoshida
- Department of Musculosleletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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3
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Wojtowicz BG, Domzalski M, Lesman J. Needle arthroscopic-assisted repair of tibio-fibular syndesmosis acute injury: A case report. World J Orthop 2024; 15:820-827. [PMID: 39165867 PMCID: PMC11331323 DOI: 10.5312/wjo.v15.i8.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Acute injuries to the tibiofibular syndesmosis, often associated with high ankle sprains or malleolar fractures, require precise diagnosis and treatment to prevent long-term complications. This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries. CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain. Due to significant swelling and poor soft tissue quality, initial management involved external stabilization. Subsequently, needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury. The procedure, performed under spinal anesthesia and fluoroscopic control, included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button. Follow-up assessments showed significant improvement in pain levels, range of motion, and functional scores. At 26 weeks post-procedure, the patient achieved full range of motion and pain-free status. Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries, combining diagnostic and therapeutic capabilities with minimal invasiveness. CONCLUSION This technique may enhance clinical outcomes and reduce recovery times, warranting further investigation and integration into clinical practice.
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Affiliation(s)
- Blazej G Wojtowicz
- Department of Orthopedy and Trauma, Medical University of Lodz, Lodz 90-549, Lodz, Poland
| | - Marcin Domzalski
- Department of Orthopedy and Trauma, Medical University of Lodz, Lodz 90-549, Lodz, Poland
| | - Jedrzej Lesman
- Department of Orthopedy and Trauma, Medical University of Lodz, Lodz 90-549, Lodz, Poland
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Butler JJ, Randall GW, Schoof L, Roof M, Weiss MB, Gianakos AL, Kennedy JG. Excellent Clinical Outcomes and Rapid Return to Activity Following In-Office Needle Tendoscopy for Chronic Achilles Tendinopathy. Arthrosc Sports Med Rehabil 2024; 6:100937. [PMID: 39006796 PMCID: PMC11240018 DOI: 10.1016/j.asmr.2024.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To assess outcomes following Achilles in-office needle tendoscopy (IONT) for the treatment of chronic Achilles tendinopathy (cAT) at a minimum 12-month follow-up. Methods A retrospective case series was conducted to evaluate patients who underwent Achilles IONT for cAT between January 2019 and December 2022. Inclusion criteria were patients ≥18 years of age and clinical history, physical history, and magnetic resonance imaging findings consistent with cAT who did not respond to a minimum of 3 months of conservative management for which each patient underwent Achilles IONT and had a minimum 12-month follow-up. Clinical outcomes were evaluated using the Victorian Institute of Sport Assessment-Achilles and visual analog scale scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. Results Twelve patients (13 Achilles) with a mean age of 50.9 ± 14.6 years were included in the study. The mean follow-up time was 26.3 ± 6.3 months. The mean Victorian Institute of Sport Assessment-Achilles scores improved from a preoperative score of 35.6 ± 5.9 to a postoperative score of 83.6 ± 14.1 (P < .001). The mean visual analog scale score improved from a preoperative score of 6.6 ± 1.0 to a postoperative score of 1.3 ± 1.7 (P < .001). There were 10 patients (83.3%) who participated in sports activities before the IONT procedure. Within this group, 9 patients (90.0%) returned to play at a mean time of 5.9 ± 2.6 weeks. The mean time to return to work was 4.2 ± 1.2 days. Patients reported an overall positive IONT experience with a mean rating scale of 4.5 ± 0.9. Conclusions This retrospective review demonstrated that Achilles IONT for the treatment of cAT results in significant improvements in subjective clinical outcomes and a low complication rate together with high patient satisfaction scores at short-term follow-up. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Grace W Randall
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Lauren Schoof
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Mackenzie Roof
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Matthew B Weiss
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Arianna L Gianakos
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
- Department of Orthopaedic Surgery, Yale Medicine Orthopaedics and Rehabilitation, New Haven, Connecticut, U.S.A
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
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Fariyike B, Neal WH, Bi AS, Owusu-Sarpong S, Colasanti CA, Kirschner N, Azam MT, Butler JJ, Stone JW, Kennedy JG. In-Office Needle Arthroscopy for Superior Labral Tear Debridement. Arthrosc Tech 2024; 13:102956. [PMID: 38835456 PMCID: PMC11144941 DOI: 10.1016/j.eats.2024.102956] [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: 02/06/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
SLAP tears are a common cause of shoulder pain in overhead athletes. The benefits of in-office nano-arthroscopy include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced health care costs, and improved patient satisfaction. This technique can be particularly advantageous in the management of SLAP tears given that magnetic resonance imaging has poor sensitivity without the use of an invasive arthrogram. The purpose of this technical report is to describe our technique for performing in-office nano-arthroscopy for SLAP tears with special consideration of the technique for obtaining adequate local anesthesia, proper indications, and adequate visualization, as well as the advantages of performing these procedures in the office rather than the operating room.
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Affiliation(s)
- Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | | | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - James J. Butler
- 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
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Stornebrink T, Walinga AB, Stufkens SA, Kerkhoffs GM. Wide-Awake Needle Arthroscopy of the Anterior Ankle: A Standardized Approach. Arthrosc Tech 2024; 13:102901. [PMID: 38690356 PMCID: PMC11056615 DOI: 10.1016/j.eats.2023.102901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024] Open
Abstract
Over the years, possibilities in ankle arthroscopy have evolved from diagnostic inspection to complex interventional procedures. Further innovation may come from needle arthroscopy, which has improved substantially in image quality in recent years and can now be used for interventional procedures as well. We here present a standardized approach to wide-awake needle arthroscopy of the anterior ankle under local anesthesia. As new needle arthroscopic procedures of the ankle arise, this approach serves to help ensure safe, uniform, and beneficial adoption of this emergent technique.
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Affiliation(s)
- Tobias Stornebrink
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Alex B. Walinga
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Address correspondence to Gino M.M.J. Kerkhoffs, M.D., Ph.D., Amsterdam UMC, location AMC, department of Orthopedic Surgery, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
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Lei Q, Lin D, Lin K, Huang W, Wu D, Liu Y. Clinical and electromyographic signals analysis about the effect of space-adjustment splint on overerupted maxillary molars. BMC Oral Health 2024; 24:296. [PMID: 38431564 PMCID: PMC10909290 DOI: 10.1186/s12903-024-04039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Overerupted maxillary molars is common in adults, which can lead to insufficient intermaxillary vertical space ,great difficulty in prosthetic reconstruction ,and cause occlusal interference in movements.To reconstruct occlusal function, it is necessary to prepare enough space for prostheses. The aim of the present study was to evaluate the effect of space-adjustment occlusal splint on overerupted maxillary molars by clinical and electromyographic signals analysis. METHODS Eighteen patients with overerupted maxillary molars were selected to wear space-adjustment occlusal splint suppressing overerupted maxillary molars for three months. Satisfaction was assessed by 5-point Likert; intermaxillary vertical space and the teeth transportation distance were measured in models; clinical periodontal status were evaluated by periodontal probing depth (PPT) and bleeding index (BI); electromyographic recordings of the masseter and anterior temporal muscles were monitored by Cranio-Mandibular K7 Evaluation System. RESULTS All the patients were satisfied with the treatment effect (Likert scale ≧ 4). The intermaxillary space in edentulous areas after treatment showed statistically significant increasing when compared with those before treatment. PPT and BI showed no significant difference. No statistically significant differences were found in electromyographic activity of anterior temporal muscles, while a reduction of muscle activity in masseter in the contralateral side were detected in post-treatment evaluations compared with pre-treatment at mandibular rest position. CONCLUSIONS Space-adjustment occlusal splint is an efficient treatment option on overerupted maxillary molars by intruding the maxillary molar to obtain adequate intermaxillary space for prostheses.
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Affiliation(s)
- Qun Lei
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
| | - Dong Lin
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Kaijin Lin
- Fujian Medical University, Fuzhou, China
| | - Wenxiu Huang
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Dong Wu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Yuyu Liu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
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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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Chen X, Huang HQ, Duan XJ. Arthroscopic treatment of ankle impingement syndrome. Chin J Traumatol 2023; 26:311-316. [PMID: 37852876 PMCID: PMC10755808 DOI: 10.1016/j.cjtee.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.
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Affiliation(s)
- Xin Chen
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - He-Qin Huang
- Department of Nuclear Medicine, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China.
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10
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Kirschner N, Owusu-Sarpong S, Neal WH, Fariyike B, Bi AS, Colasanti CA, Azam MT, Gianakos AL, Stone JW, Kennedy JG. In-Office Needle Arthroscopy with Meniscal Repair for Meniscal Lesions of the Knee. Arthrosc Tech 2023; 12:e1821-e1826. [PMID: 37942106 PMCID: PMC10628162 DOI: 10.1016/j.eats.2023.06.013] [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: 02/06/2023] [Accepted: 06/22/2023] [Indexed: 11/10/2023] Open
Abstract
Meniscal injuries are a common cause of knee pain and are often an indication for knee arthroscopy, the most common orthopedic surgical procedure in the United States. In-office needle arthroscopy (IONA) is a described technique with the ability to diagnose and treat meniscal injuries in the office. IONA allows for diagnosis and treatment at a significantly deceased cost, with both quicker patient recovery, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing in-office needle arthroscopy for meniscal injuries of the knee, including 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)
- Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Arianna L. Gianakos
- 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
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11
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Neal WH, Kirschner N, Owusu-Sarpong S, Colasanti CA, Fariyike B, Bi AS, Azam MT, Stone JW, Kennedy JG. In-Office Needle Arthroscopy of the Knee With Lateral Parapatellar Retinacular Release. Arthrosc Tech 2023; 12:e1809-e1813. [PMID: 37942101 PMCID: PMC10628066 DOI: 10.1016/j.eats.2023.06.011] [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: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 11/10/2023] Open
Abstract
The lateral patellofemoral joint, composed of multiple soft-tissue structures, balances the knee by aiding patella tracking, stability, and force distribution. Arthroscopic lateral release is a well-described procedure that addresses patellofemoral knee pain and, in cases with patellar instability, may be combined with medial stabilization. In-office needle arthroscopy is an up-trending technique that simultaneously diagnoses and treats patellofemoral pathology in the office, leading to a quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this Technical Note is to describe in-office needle arthroscopy technique to address patellofemoral pain and lateral patellar mal-tracking, with special consideration for achieving 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)
- William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | | | - Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - James W. Stone
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
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12
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Mayich DJ. Wide-Awake Local Anesthetic No Tourniquet Surgery of the Foot and Ankle. Orthop Clin North Am 2023; 54:471-483. [PMID: 37718086 DOI: 10.1016/j.ocl.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Wide awake local anesthetic no tourniquet (WALANT) surgery of the foot and ankle has the potential to offer safe and effective surgeon-based anesthesia for a significant number of surgeries about the foot and ankle. This has been documented with significant and growing body of literature. WALANT could offer significant advantages with respect to patient experience, per case cost of procedures as well as for improving access for patients to operative resources in a setting of scarcity or restricted access.
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Affiliation(s)
- D Joshua Mayich
- Stanton Territorial Hospital, 548 Byrne Road, Yellowknife, NT, Canada.
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Dahmen J, Indino C, D’Ambrosi R, Usuelli FG. Needle Arthroscopic Subchondroplasty With Adipose-Derived Stem Cell Augmentation for the Treatment of Osteochondral Lesions of the Talus. Arthrosc Tech 2023; 12:e1649-e1656. [PMID: 37942119 PMCID: PMC10627869 DOI: 10.1016/j.eats.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/27/2023] [Indexed: 11/10/2023] Open
Abstract
Needle arthroscopy has enjoyed a tremendous growth concerning the quality of intraoperative images due to technical innovation, resulting in innovative possibilities concerning concomitant minimally invasive procedures and treatment of osteochondral lesions of the talus (OLT). These lesions have increasingly been receiving scientific attention in the orthopaedic (sports) medicine field, and, as such, the quality of evidence-based treatment for them has developed substantially. Treatment of OLTs-and specifically subchondroplasty. OLTs may also be suitable for needle arthroscopic interventions. The purpose of the present technical note is, therefore, to present an all-arthroscopic needle arthroscopic technique, including subchondroplasty with adipose-derived stem cells augmentation for osteochondral lesions of the talus.
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Affiliation(s)
- Jari Dahmen
- University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports, International Olympic Committee Research Center, Amsterdam, The Netherlands
| | - Cristian Indino
- Ortopedia della Caviglia e del Piede, Humanitas S. Pio X, Milano, Italia
| | - Riccardo D’Ambrosi
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Galeazzi–Sant’Ambrogio, Milano, Italia
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano, Italia
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14
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Colasanti CA, Azam MT, Bi AS, Fariyike B, Kirschner N, Neal WH, Owusu-Sarpong S, Stone JW, Kennedy JG. Reproducible and Effective Biceps Tenodesis Method Utilizing In-Office Nano-Arthroscopy. Arthrosc Tech 2023; 12:e1797-e1802. [PMID: 37942114 PMCID: PMC10628057 DOI: 10.1016/j.eats.2023.06.009] [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: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 11/10/2023] Open
Abstract
Biceps tendinopathy is a common cause of chronic anterior shoulder pain characterized by altered joint mechanics with considerable deficits in range of motion secondary to pain. The benefits of in-office nano-arthroscopy (IONA) include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing IONA for biceps tendinopathy (biceps tenotomy/biceps tenodesis), with special consideration 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)
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - William H.E. Neal
- 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
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15
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Butler JJ, Wingo T, Kennedy JG. Presurgical and Postsurgical MRI Evaluation of Osteochondral Lesions of the Foot and Ankle: A Primer. Foot Ankle Clin 2023; 28:603-617. [PMID: 37536821 DOI: 10.1016/j.fcl.2023.04.010] [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] [Indexed: 08/05/2023]
Abstract
The gold standard diagnostic imaging tool for ankle OCLs is magnetic resonance imaging, which allows precise evaluation of the articular cartilage and assessment of the surrounding soft tissue structures. Post-operative morphologic MRI assessment via MOCART scores provide semi-quantitative analysis of the repair tissue, but mixed evidence exists regarding its association with post-operative outcomes. Post-operative biochemical MRIs allow assessment of the collagen network of the articular cartilage via T2-mapping and T2∗ mapping, and assessment of the articular glycosaminoglycan content via delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho mapping and sodium imaging.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York City, NY 10002, USA
| | - Taylor Wingo
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York City, NY 10002, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York City, NY 10002, USA.
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16
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Bi AS, Colasanti CA, Kirschner N, Neal WH, Owusu-Sarpong S, Fariyike B, Azam MT, Stone JW, Kennedy JG. In-Office Needle Arthroscopy With Cartilage Allograft Extracellular Matrix Application for Cartilage Lesions of the Knee. Arthrosc Tech 2023; 12:e1507-e1513. [PMID: 37780651 PMCID: PMC10533680 DOI: 10.1016/j.eats.2023.04.023] [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: 02/06/2023] [Accepted: 04/18/2023] [Indexed: 10/03/2023] Open
Abstract
Chondral and osteochondral lesions of the knee are a common cause of pain, mechanical symptoms, and swelling for patients. The benefits of in-office needle arthroscopy (IONA) include the ability to diagnose and treat chondral or osteochondral lesions in the office, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical note is to describe the technique for performing in-office needle arthroscopy for chondral or osteochondral contained lesions of the knee, 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)
- Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | - Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Mohammad T. Azam
- 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
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17
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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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18
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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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19
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Walinga AB, Dahmen J, Stornebrink T, Kerkhoffs GM. Needle Arthroscopic Inspection and Treatment of (Osteo)chondral Lesions of the Ankle in Unstable Syndesmotic Injuries Treated With Suture Button Fixation: A Standardized Approach. Arthrosc Tech 2023; 12:e1121-e1126. [PMID: 37533909 PMCID: PMC10390839 DOI: 10.1016/j.eats.2023.02.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/25/2023] [Indexed: 08/04/2023] Open
Abstract
Both acute and chronic syndesmotic injuries are associated with (osteo)chondral lesions of the ankle in at least 1 out of 5 patients. Having a common denominator of an acute traumatic injury being external rotation and forced dorsiflexion, the injury of a combined unstable syndesmotic injury and a potentially present concomitant (osteo)chondral lesion to the ankle warrants a thorough diagnostic and interventional approach. Furthermore, early diagnosis may prevent further damage to the joint through lifestyle changes and increase the chances of successful conservative or surgical treatment, potentially reducing the progression toward end-stage osteoarthritis. Consequently, technological advances and financial considerations have led to the development of a minimally invasive needle arthroscopic inspection and treatment of concomitant (osteo)chondral injuries of the ankle in the combined treatment of unstable syndesmotic injuries with suture button fixation. The present Technical Note describes this innovative minimally invasive assessment and concomitant treatment technique.
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Affiliation(s)
- Alex B. Walinga
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS) international Olympic Committee (IOC) Research Center, Amsterdam, The Netherlands
| | - Jari Dahmen
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS) international Olympic Committee (IOC) Research Center, Amsterdam, The Netherlands
| | - Tobias Stornebrink
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS) international Olympic Committee (IOC) Research Center, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS) international Olympic Committee (IOC) Research Center, Amsterdam, The Netherlands
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20
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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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21
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Butler JJ, Brash AI, Azam MT, DeClouette B, Kennedy JG. The Role of Needle Arthroscopy in the Assessment and Treatment of Ankle Sprains. Foot Ankle Clin 2023; 28:345-354. [PMID: 37137628 DOI: 10.1016/j.fcl.2023.01.005] [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] [Indexed: 05/05/2023]
Abstract
Lateral ankle ligament complex injuries are most commonly managed nonoperatively. If no improvements have been made following conservative management, surgical intervention is warranted. Concerns have been raised regarding complication rates following open and traditional arthroscopic anatomical repair. In-office needle arthroscopic anterior talo-fibular ligament repair provides a minimally invasive arthroscopic approach to the diagnosis and treatment of chronic lateral ankle instability. The limited soft tissue trauma facilitates rapid return to daily and sporting activities making this an attractive alternative approach to lateral ankle ligament complex injuries.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Andrew I Brash
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Mohammad T Azam
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Brittany DeClouette
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA.
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22
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Duenes ML, Azam MT, Butler JJ, Weiss MB, Kennedy JG. In-Office Needle Arthroscopy for the Foot and Ankle. Arthroscopy 2023; 39:1129-1130. [PMID: 37019528 DOI: 10.1016/j.arthro.2023.01.005] [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: 10/27/2022] [Accepted: 01/10/2023] [Indexed: 04/07/2023]
Abstract
In-office needle arthroscopy (IONA) has been a readily available tool dating back to the 1990s, primarily for diagnostic purposes. This technique was not fully accepted and implemented because of significant limitations with the image quality and lack of instrumentation available to simultaneously treat the identified pathologies. However, recent advancements in IONA technology have made it possible to perform arthroscopic procedures under local anesthesia in the office setting, which once required a full operating suite. IONA has revolutionized how we treat foot and ankle pathologies in our practice. IONA allows the patient to be an active participant in the procedure and provides an interactive experience. IONA can be used to treat a range of foot and ankle pathologies, including anterior ankle impingement, posterior ankle impingement, osteochondral lesions of the ankle joint, hallux rigidus, lateral ankle ligament repair, and tendoscopic treatment of Achilles, peroneal, and posterior tibial tendon disorders. Excellent outcomes with regard to subjective clinical outcomes, return to play times, and complications have been reported following IONA for these pathologies.
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Affiliation(s)
- Matthew L Duenes
- From Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Mohammad T Azam
- From Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - James J Butler
- From Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Matthew B Weiss
- From Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - John G Kennedy
- From Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A..
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23
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Azam MT, Butler JJ, Duenes ML, McAllister TW, Walls RC, Gianakos AL, Kennedy JG. Advances in Cartilage Repair. Orthop Clin North Am 2023; 54:227-236. [PMID: 36894294 DOI: 10.1016/j.ocl.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Osteochondral lesions of the ankle joint are typically associated with a traumatic etiology and present with ankle pain and swelling. Conservative management yields unsatisfactory results because of the poor healing capacity of the articular cartilage. Smaller lesions (<100 mm2 or <10 mm) can be treated with less invasive procedures such as arthroscopic debridement, anterograde drilling, scaffold-based therapies, and augmentation with biological adjuvants. For patients with large lesions (>100 mm2 or >10 mm), cystic lesions, uncontained lesions, or patients who have failed prior bone marrow stimulation, management with autologous osteochondral transplantation is indicated.
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Affiliation(s)
- Mohammad T Azam
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, USA
| | - James J Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, USA
| | - Matthew L Duenes
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, USA
| | - Thomas W McAllister
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, USA; University of Cambrdige School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Raymond C Walls
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, USA
| | - Arianna L Gianakos
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, USA.
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24
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Pujol O, Sallent A, Salom J, Duarri G, Maled I, Busquets R. ORIF Assisted by Open Subtalar Small Joint Arthroscopy for Intra-articular Displaced Calcaneus Fractures. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231163822. [PMID: 36968811 PMCID: PMC10034289 DOI: 10.1177/24730114231163822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Affiliation(s)
- Oriol Pujol
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
- Oriol Pujol, MD, Foot and Ankle Unit,
Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat
Autònoma de Barcelona, Pg. Vall d’Hebron 119-129, Barcelona, 08035, Spain.
| | - Andrea Sallent
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Juan Salom
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Gemma Duarri
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Ignacio Maled
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Rosa Busquets
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
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25
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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: 2] [Impact Index Per Article: 1.0] [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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26
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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: 5] [Impact Index Per Article: 2.5] [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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Walinga AB, Stornebrink T, Janssen SJ, Dalmau-Pastor M, Kievit AJ, Kerkhoffs GM. Needle Arthroscopy for Bacterial Arthritis of a Native Joint: Surgical Technique for the Shoulder, Elbow, Wrist, Knee, and Ankle Under Local Anesthesia. Arthrosc Tech 2022; 11:e1641-e1648. [PMID: 36185111 PMCID: PMC9520080 DOI: 10.1016/j.eats.2022.05.011] [Citation(s) in RCA: 6] [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: 04/09/2022] [Accepted: 05/20/2022] [Indexed: 02/03/2023] Open
Abstract
Suspected bacterial arthritis of a native joint requires urgent management to control potential life-threatening sepsis and limit cartilage damage. Diagnosing bacterial arthritis is often challenging and relies on diagnostic tests with low accuracy. A high threshold for surgery poses a risk of undertreatment, whereas a low threshold for surgery could lead to overtreatment with unnecessary invasive and costly procedures. Surgical lavage through arthroscopy or arthrotomy is generally considered standard treatment. Nowadays, needle arthroscopy provides an alternative and potentially less-invasive approach that can safely lower the surgical threshold. Needle arthroscopy can be performed directly upon presentation at the patient's bedside, as it is well tolerated under local anesthesia. Therefore, this Technical Note presents a stepwise guideline for performing standardized needle arthroscopic lavage in patients with (suspected) bacterial arthritis of the shoulder, elbow, wrist, knee, and ankle.
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Affiliation(s)
- Alex B. Walinga
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands,Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Amsterdam, The Netherlands,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands,Address correspondence to Alex B. Walinga, Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Tobias Stornebrink
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands,Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Amsterdam, The Netherlands,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Stein J. Janssen
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands,Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Amsterdam, The Netherlands,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, The University of Barcelona, Barcelona, Spain,MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Arthur J. Kievit
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands,Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Amsterdam, The Netherlands,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Gino M.MJ. Kerkhoffs
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands,Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Amsterdam, The Netherlands,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
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28
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Needle arthroscopy in anatomical reconstruction of the lateral ankle: a report of three cases with a parallel comparison to the standard arthroscopy procedure. J Exp Orthop 2022; 9:75. [PMID: 35907091 PMCID: PMC9339066 DOI: 10.1186/s40634-022-00510-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study evaluates the use of the needle arthroscopy in anatomical reconstruction of the lateral ankle. We hypothesized that the needle arthroscopy would allow anatomical reconstruction to be performed under arthroscopy. Methods Three patients underwent treatment of chronic ankle instability. The comparative procedure was performed in the following four steps: 1) anteromedial articular exploration (medial/lateral gutter/anterior chamber/syndesmosis); 2)creation of the talar tunnel via the anteromedial arthroscopic approach; 3) anterolateral fibular tunneling; and 4) positioning of the graft by the anteromedial arthroscopic approach. For each of these steps, the planned procedure using the needle arthroscope was compared to the standard arthroscope. For each step, the planned procedure using the needle arthroscopy was compared to the standard arthroscope and the act was classified based on level of difficulty: facilitated, similar, complicated and impossible. Results The exploration of the medial and lateral gutter, the creation of the tunnel of the talus and graft positioning were not accomplished using the needle arthroscope. While the syndesmosis visualization was facilitated by the needle arthroscope in comparison to the standard arthroscope. Conclusion The anatomical reconstruction of the lateral ankle, using the needle arthroscopy-only approach, was impossible in all three cases, regarding: ankle joint exploration, creation of the tunnel of the talus and graft positioning. The needle arthroscope should not be considered as a "mini arthroscope" but as a new tool with which it is necessary to rethink procedures to take advantage of the benefits of this instrument.
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Labib SA, Hanna M. Editorial Commentary: In-Office Needle Ankle Arthroscopy May Be Better, Simpler, and Less Expensive. Arthroscopy 2022; 38:1312-1314. [PMID: 35369927 DOI: 10.1016/j.arthro.2021.12.006] [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: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
Orthopaedic surgeons have always been on the cutting edge of innovation in health care delivery and technology. In turn, the orthopaedic device industry has responded with new products that deliver better quality at competitive prices. Numerous examples of collaboration exist such as in outpatient joint replacement and minimally invasive orthopaedic procedures. In-office needle arthroscopy (IONA) for knees and ankles has been in existence since the 1990s but was hampered by poor image quality and a cumbersome-to-use technology. Now with improved technology for IONA, ankle IONA allows adequate visualization of all pertinent ankle joint structures, allowing reach of 96% of the talus surface and 85% of the tibia plafond, and may show greater accuracy than preoperative magnetic resonance imaging. The majority of cost of an arthroscopy episode of care may reside with the "facility" fee charged for the use of an operating room, personnel, and related equipment. Surgeons and their patients pay higher fees to use hospital or outpatient centers, sometimes with increased inefficiency or more adverse events. IONA may allow orthopaedic surgeons to deliver better services at a reduced cost for ankle arthroscopy.
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30
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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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