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Moses MJ, Lorentz NA, Azad A, Paksima N. Needle Arthroscopy Versus Conventional Arthroscopy in the Evaluation of Carpal Pathology: A Comparative Study. Hand (N Y) 2024:15589447241265982. [PMID: 39077809 DOI: 10.1177/15589447241265982] [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: 07/31/2024]
Abstract
BACKGROUND The needle scope is a less invasive intervention to evaluate carpal pathology. We hypothesize that there is no difference in the evaluation and diagnostic capability of the needle scope versus the conventional wrist arthroscope. METHODS Twenty patients indicated for wrist arthroscopy were prospectively enrolled. Prior to insertion of the 2.7-mm arthroscope, the needle scope evaluated for synovitis; cartilage damage (location and modified Outerbridge classification); integrity of the volar, scapholunate (SL), and lunotriquetral ligaments; and the triangular fibrocartilage complex (TFCC). Following needle scope evaluation, the surgeon completed a survey regarding the visualization and diagnosis. The 2.7-mm arthroscope was then inserted, and the surgeon completed the second portion of the survey. Statistical analysis was then completed to determine statistical significance. RESULTS Twelve patients were female (60%), and the mean age was 39.8 years (±11.8 years). Eleven patients underwent arthroscopy for TFCC pathology, 4 patients for SL tearing, and 5 patients for extensive synovitis. There was no difference between the needle scope and wrist arthroscopy diagnosis. There was no difference between radiocarpal and midcarpal visualization. Surgeon-rated ease of use and diagnostic confidence were the same between two groups. The needle scope was better able to visualize the scapho-trapezium-trapezoid and carpometacarpal joints; however, the image was of marginally decreased quality. CONCLUSION In this study, there was no difference between radiocarpal or midcarpal visualization and surgeon-rated ease of use, while diagnostic confidence was the same between two groups. LEVEL OF EVIDENCE II (prospective cohort study)-Diagnostic.
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Affiliation(s)
| | | | - Ali Azad
- NYU Langone Medical Center, New York, USA
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2
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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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3
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Evers JS, Kim SE, Johnson MD, Lazarus MA. Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture. Vet Surg 2023; 52:820-826. [PMID: 35560359 DOI: 10.1111/vsu.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the accuracy of needle arthroscopy (NA) for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture (CCLR). STUDY DESIGN Prospective clinical trial. ANIMALS Twenty-six client-owned dogs. METHODS Dogs with CCLR and scheduled to undergo tibial plateau leveling osteotomy were recruited for the study. Needle arthroscopy was performed by an experienced surgeon; the same dog subsequently underwent standard arthroscopy (SA) by another experienced surgeon who was blinded to the NA findings. The SA arthroscopy findings were used as the gold standard. Arthroscopy time, visibility of the menisci, ability to probe the menisci, and the presence of meniscal tears were recorded for both arthroscopies. The degree of lameness before and after NA was subjectively quantified. RESULTS The sensitivity and specificity to diagnose medial meniscal tears with NA was 95% and 100%, respectively. Visibility of the menisci was lower (P < .01), probing of the lateral meniscus was harder (P = .0017), and procedure time was shorter (P = .073) with NA when compared to SA. The lameness scores did not differ before and after NA (P = .25). CONCLUSION Needle arthroscopy could be performed rapidly with low morbidity, and had high accuracy for detecting medial meniscal tears in dogs with CCLR. CLINICAL SIGNIFICANCE Needle arthroscopy is a promising minimally invasive technique for diagnosing medial meniscal tears in dogs with CCLR.
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Affiliation(s)
- Johanna S Evers
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Stanley E Kim
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Matthew D Johnson
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Matthew A Lazarus
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
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Abbas A, Shah A, Lex JR, Abouali J, Toor J. In-office needle arthroscopy is a cost-effective alternative for operating room diversion in medial meniscectomy: a financial analysis. J Orthop Surg Res 2023; 18:435. [PMID: 37322494 DOI: 10.1186/s13018-023-03866-7] [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: 02/21/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In-office needle arthroscopy (IONA) has been described as a diagnostic alternative to magnetic resonance imaging (MRI) for intra-articular pathology. However, few studies have analyzed its impact on cost and wait times when used as a therapeutic intervention. The purpose of this study was to investigate the impact on cost and wait times associated with offering IONA for partial medial meniscectomy as an alternative to traditional operating room (OR) arthroscopy for patients with irreparable medial meniscus tears on MRI. METHODS Two models were created comparing the existing care pathway (current state) to a proposed future state utilizing IONA. Data sources were accounting data from an academically affiliated hospital in Canada and supplemented with literature values. A Monte Carlo simulation combined with DuPont analysis running 10,000 simulations was conducted to calculate the revenue, expenses, profits, and effect on surgical waitlists (i.e., throughput) between the states. Sensitivity analyses examined the influence of patient preference and revision rates on profit and throughput. Two-sample Student's t test was performed (p < .05). RESULTS An average of 198 (standard deviation (SD) 31) patients underwent arthroscopic meniscectomy or repair each year from 2016 to 2020. The IONA revision rate was calculated as 20.3%. Compared to the current state, annual expenses in the IONA pathway were significantly reduced ($266,912.68 versus $281,415.23, p < .0001), while improving throughput by 21.2% (3.54%). Sensitivity analysis revealed 10% of patients need to select IONA over traditional OR arthroscopy with the revision rate remaining below 40% for the proposed state profit to be higher than the current state. CONCLUSIONS IONA is a cost-effective alternative to traditional OR arthroscopy in patients undergoing partial medial meniscectomy. The next steps are to assess patients' perceptions of IONA as an alternative to traditional OR arthroscopy, and to carry out clinical trials to determine the efficacy, patient-reported outcome metrics, and complications of IONA.
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Affiliation(s)
- Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street Room 508-A, Toronto, ON, M5T 1P5, Canada
| | - Ajay Shah
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street Room 508-A, Toronto, ON, M5T 1P5, Canada
| | - Johnathan R Lex
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street Room 508-A, Toronto, ON, M5T 1P5, Canada
| | - Jihad Abouali
- Division of Orthopaedic Surgery, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, ON, M4C 3E7, Canada
| | - Jay Toor
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street Room 508-A, Toronto, ON, M5T 1P5, Canada.
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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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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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Stornebrink T, van Dijck RA, Douven D, Kerkhoffs GM. Needle Arthroscopic All-Inside Repair of Meniscal Tears Under Local Anesthesia. Arthrosc Tech 2021; 10:e2173-e2180. [PMID: 34504758 PMCID: PMC8417447 DOI: 10.1016/j.eats.2021.05.020] [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: 03/08/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023] Open
Abstract
Needle arthroscopy has experienced a substantial increase in image quality due to technical innovation, which has brought needle arthroscopic interventional possibilities along. Repair of meniscal tears is gaining popularity relative to meniscectomy and may be such a procedure that is suitable for needle arthroscopy. We here present a needle arthroscopic technique for all-inside repair of meniscal tears in the red zone and red-white zone. With the use of local anesthesia only, the procedure is easy to perform for the surgeon and well-tolerable for the patient. Compared with conventional approaches to meniscal repair, needle arthroscopy may result in improved patient experience, decreased soft-tissue trauma, speedier recovery, and less need for personnel and hospital facilities. Combined, the advantages may lead to decreased overall costs as well.
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Affiliation(s)
- Tobias Stornebrink
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, 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 UMC, Amsterdam, The Netherlands,Bergman Clinics, Breda, The Netherlands
| | | | | | - Gino M.M.J. Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, 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 UMC, Amsterdam, The Netherlands,Address correspondence to Prof. Gino Kerkhoffs, M.D., Ph.D., Amsterdam UMC, location AMC, Department of Orthopedic Surgery, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
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