Complications in arthroscopic surgery of the knee and shoulder

Complete tibial nerve lesion secondary to postoperative popliteal pseudoaneurysm following anterior cruciate ligament arthroscopic reconstruction: A series of two patients

Background

Complications following arthroscopic anterior cruciate ligament reconstruction (ACLR) are rare, but injuries to the popliteal artery can occur. Popliteal pseudoaneurysms are a potential complication and can cause significant morbidity if not diagnosed and treated promptly.

Cases Description

We describe the cases of two patients who developed nerve injuries following arthroscopic ACLR, with subsequent diagnosis of a popliteal pseudoaneurysm. The peroneal nerve recovered spontaneously in both cases, while the tibial nerve was reconstructed using autologous nerve grafting. Satisfying, functional recoveries were observed 24 months postoperatively.

Conclusion

Prompt diagnosis and effective treatment of popliteal pseudoaneurysms are crucial to prevent further complications. However, timely diagnosis can be challenging due to inconsistent clinical presentations and a low index of suspicion. This case report highlights the need for increased awareness of this uncommon complication and provides insights into its pathophysiological mechanisms.

Delayed Presentation of Popliteal Artery Laceration Mimicking Baker Cyst After Arthroscopic Meniscectomy: A Case Report

CASE

We report a case of delayed presentation of popliteal artery laceration after arthroscopic meniscectomy. Three weeks after the procedure, the patient developed severe calf pain, swelling over the popliteal fossa, and foot drop, despite a normal initial postoperative period. Clinical examination and radiological investigations suggested a massive hematoma in the popliteal fossa. A decision was made to explore the popliteal artery and drain the hematoma after consultation with the vascular surgeon. A laceration was noted, and it was repaired.

CONCLUSION

Orthopaedic surgeons should maintain a high index of suspicion regarding the possibility of this postoperative complication, especially after an arthroscopic meniscectomy.

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

Knee arthroscopy is one of the most common surgical procedures in orthopaedics and especially in sports medicine. Portal problems and effusion after knee arthroscopy have been reported. The fluid retention within the joint in knee arthroscopy can affect clinical outcomes, but there is no consensus on portal management. The studies of portal management in knee arthroscopy have mainly addressed wound healing and cosmetic problems. There is insufficient information in the literature about whether the irrigation fluid used in this effusion contributes to the process. This study investigates whether arthroscopic irrigation fluid is retained in the joint and whether portal-closure management has an effect on effusion. In this randomized, prospective study, 91 patients (46 [50.5%] sutured-portal group and 45 [49.5%] open-portal group) were included. Suprapatellar knee-diameter measurement and the number of times the dressing was changed were used to assess intra-articular fluid collection. The visual analog scale (VAS) score, Oxford knee score, and Knee Society score were used to evaluate knee problems. All portal wounds in both groups healed without any problems. Superficial or deep infection was not observed in either group. There was no statistically significant difference in VAS score, Oxford knee scores, and Knee Society scores between groups. Although there was a decrease in the knee diameter of both groups between the early postoperative period and first postoperative day, a statistically significant difference in knee diameter was found, especially in the open-portal group. There was a significant difference between the groups in terms of the number of dressings used in the first 24 hours after surgery. Leaving portals open may be effective in preventing intra-articular fluid retention. We thus advise leaving the arthroscopy portals open with just a simple dressing for selected patients.

A Review of Current Management of Knee Hemarthrosis in the Non-Hemophilic Population

The knee joint is one of the most frequently injured joints in the body, and the resulting injury may often lead to the presence of a bloody effusion, or hemarthrosis. The acute management of this condition can have long-lasting implications, and may ultimately result in the early onset of osteoarthritis in this population. Heme, a breakdown product of erythrocytes, and associated pro-inflammatory mediators, are known to have deleterious interactions with cartilage and synovium. The presence of blood in a joint following injury can precipitate these effects and accelerate the degenerative changes in the joint. Currently, there is no consensus on the optimal management of a traumatic knee joint injury with a hemarthrosis. Nontraumatic hemarthosis, seen most commonly in hemophilia patients, has a set of established guidelines that does not routinely recommend drainage of the joint. This article presents a rationale for joint aspiration to minimize the harmful effects of blood following traumatic hemarthrosis.

Iatrogenic Medial Collateral Ligament Injury by Valgus Stress During Arthroscopic Surgery of the Knee

PURPOSE

To evaluate the radiographic and clinical follow-up results of iatrogenic medial collateral ligament (MCL) injuries caused by valgus stress during arthroscopic surgery of the knee.

METHODS

This study retrospectively evaluated 15 knees in 15 patients (8 female and 7 male patients), with a mean age of 58 years (range, 45-66 years), with iatrogenic MCL injuries caused by valgus stress during arthroscopic surgery of the knee. All patients were treated conservatively without an immobilizer or brace. The mean follow-up period was 24 months (range, 18-51 months). Evaluations included magnetic resonance imaging immediately postoperatively, as well as physical examinations and valgus stress radiographs (at 0° and 30° of knee flexion) 6 weeks after surgery and at final follow-up.

RESULTS

Postoperative magnetic resonance imaging in all patients showed increased signal intensity, swelling, and partial loss of continuity at the meniscofemoral portion of the MCL. Physical examination showed mild tenderness in only 1 patient after 6 weeks and none at final follow-up. Valgus stress tests and valgus stress radiographs showed no significant differences between the injured and uninjured knees at 6 weeks postoperatively and at final follow-up (P > .05).

CONCLUSIONS

Iatrogenic MCL injuries during arthroscopic knee surgery could be treated successfully without a splint or brace.

LEVEL OF EVIDENCE

Level IV, prognostic case series.

Relationship Between the Middle Genicular Artery and the Posterior Structures of the Knee: A Cadaveric Study

Background:

The middle genicular artery (MGA) is responsible for the blood supply to the cruciate ligaments and synovial tissue. Traumatic sports injuries and surgical procedures (open and arthroscopic) can cause vascular damage. Little attention has been devoted to establish safe parameters for the MGA.

Purpose:

To investigate the anatomy of the MGA and its relation to the posterior structures of the knees, mainly the posterior capsule and femoral condyles, and to establish safe parameters to avoid harming the MGA.

Study Design:

Descriptive laboratory study.

Methods:

Dissection of the MGA was performed in 16 fresh, unpaired adult human cadaveric knees with no macroscopic degenerative or traumatic changes and no previous surgeries. The specimens were meticulously evaluated with emphasis on preservation of the MGA. The distances from the MGA to the medial and lateral femoral condyles were measured. The Mann-Whitney test was used for statistical analysis.

Results:

In all specimens, the MGA emerged from the anterior aspect of the popliteal artery, distal to the superior genicular arteries, and had a short distal trajectory toward the posterior capsule where it entered proximal to the oblique popliteal ligament. The artery lay in the midportion between the condyles. The distance between the posterior aspect of the tibia and the point of entry of the MGA into the posterior joint capsule was 23.8 ± 7.3 mm (range, 14.72-35.68 mm). There was no correlation between an individual’s height and the distance of the entrance point of the MGA into the posterior joint capsule to the posterior superior corner of the tibia.

Conclusion:

The middle genicular artery lies in the midportion between the medial and lateral femoral condyles.

Clinical Relevance:

This knowledge is important for the preservation of the blood supply during posterior knee surgical procedures and to settle a secure distance between the posterior aspect of the tibia and the MGA input. This could decrease and prevent iatrogenic vascular injury risk to the MGA.

Iatrogenic nerve injuries during shoulder surgery

INTRODUCTION

The current literature indicates that neurologic injuries during shoulder surgery occur infrequently and result in little if any morbidity. The purpose of this study was to review one institution's experience treating patients with iatrogenic nerve injuries after shoulder surgery.

METHODS

A retrospective review of the records of patients evaluated in a brachial plexus specialty clinic from 2000 to 2010 identified twenty-six patients with iatrogenic nerve injury secondary to shoulder surgery. The records were reviewed to determine the operative procedure, time to presentation, findings on physical examination, treatment, and outcome.

RESULTS

The average age was forty-three years (range, seventeen to seventy-two years), and the average delay prior to referral was 5.4 months (range, one to fifteen months). Seven nerve injuries resulted from open procedures done to treat instability; nine, from arthroscopic surgery; four, from total shoulder arthroplasty; and six, from a combined open and arthroscopic operation. The injury occurred at the level of the brachial plexus in thirteen patients and at a terminal nerve branch in thirteen. Fifteen patients (58%) did not recover nerve function after observation and required surgical management. A structural nerve injury (laceration or suture entrapment) occurred in nine patients (35%), including eight of the thirteen who presented with a terminal nerve branch injury and one of the thirteen who presented with an injury at the level of the brachial plexus.

CONCLUSIONS

Nerve injuries occurring during shoulder surgery can produce severe morbidity and may require surgical management. Injuries at the level of a peripheral nerve are more likely to be surgically treatable than injuries of the brachial plexus. A high index of suspicion and early referral and evaluation should be considered when evaluating patients with iatrogenic neurologic deficits after shoulder surgery.

Embolisation for vascular injuries complicating elective orthopaedic surgery

OBJECTIVES

The study aims to present the indications and emphasise the role of embolisation for vascular injuries in orthopaedic surgery.

METHODS

Thirty-one patients with vascular injuries complicating elective orthopaedic surgery had embolisation from 2003 to 2010. N-2-butyl cyano-acrylate (NBCA) was used as embolic agent in 28 patients, gelatin sponge in three and coil embolisation in addition to NBCA or gelatin sponge in two patients. The mean follow-up period was 37 months (range, 4-96 months).

RESULTS

The most common orthopaedic operations associated with vascular injuries amenable to embolisation were hip-joint procedures; and the most common injuries were arterial tears of branch vessels or non-critical axial vessels, most commonly of the superior glutaeal artery. In all cases, angiography showed the bleeding point, and a single embolisation session effectively stopped bleeding. Embolisation-related complications were not observed.

CONCLUSIONS

Embolisation should be considered the treatment of choice for vascular injuries of branch vessels or non-critical axial vessels following elective orthopaedic surgery because of the advantages of minimally invasive therapy and the lack of complications.

False aneurysm at the origin of the anterior tibial artery after opening wedge osteotomy

We report the case of a false aneurysm at the origin of the anterior tibial artery complicating upper tibial osteotomy. The proximally located lesion compressed the posterior tibial nerve, and despite successful decompression, the patient suffers from probably irreversible neurologic after-effects. Even though it is rare, this complication must be considered when faced with leg pain consecutive to upper tibial osteotomy without deep venous thrombosis.

Pseudoaneurisma de artéria genicular após cirurgia artroscópica de joelho: Relato de dois casos

A artroscopia do joelho é considerado um procedimento cirúrgico muito seguro, com um número relativamente pequeno de complicações. Relatamos o caso de dois pacientes do sexo masculino que foram submetidos à artroscopia de joelho (para meniscectomia parcial e reconstrução do ligamento cruzado anterior com parafuso transverso femoral e interferência tibial) que desenvolveram um pseudoaneurisma de artéria genicular superior lateral após o procedimento. A ultrassonografia com Doppler realizou o diagnóstico e os pacientes foram tratados cirurgicamente com ligadura arterial. Um paciente apresentou extenso hematoma na coxa e foi necessária reposição volêmica. Estes casos exemplificam uma complicação vascular rara, nem sempre benigna, em uma cirurgia minimamente invasiva do joelho.

Traumatic lesions of internal saphenous nerve and branches

OBJECTIVE

To show a rare lesion that sometimes simulates vascular disorder of the lower extremities.

METHOD

Three patients were operated and the follow-up period was eight months, the surgical technique was neurotomy of the infrapatellar and descendent branches.

RESULTS

In two cases there were almost total pain resolution, and in other case improvement only.

CONCLUSION

Surgical treatment yields good results in this type of internal saphenous nerve lesion, and could be useful as an alternative to conservative treatment.

Variations in serum electrolyte concentrations and renal function after therapeutic hip arthroscopy: a pilot study

PURPOSE

The purpose of this study was to analyze changes in serum electrolyte concentration and renal function after hip arthroscopy.

METHODS

We studied 10 consecutive patients (4 men and 6 women; median age, 30.5 years [range, 20 to 50 years]) undergoing hip arthroscopy. Operating time, traction time, and perfusion volume of lactated Ringer solution (in milliliters) were recorded. Preoperative and postoperative levels of sodium (Na(+)), potassium (K(+)), cloride (Cl(-)), calcium (Ca(2+)), magnesium (Mg(2+)), phosphorous (P), creatinine, and blood urea nitrogen (BUN) were compared.

RESULTS

The median operating time was 80 minutes (range, 60 to 150 minutes). The median perfusion volume of lactated Ringer solution was 15,000 mL (range, 6,000 to 30,000 mL). The median traction time was 37.5 minutes (range, 30 to 105 minutes). None of the patients had postoperative complications develop. With a mean decrease of 0.84 +/- 0.68 mg/dL, only serum calcium levels were found to decrease significantly (P = .01). There was a mean decrease of 1.50 +/- 2.07 mEq/L in sodium concentrations (P = .06). Hip arthroscopy was associated with a mean postoperative decrease in creatinine and BUN concentrations of 0.05 +/- 0.06 mg/dL (P = .19) and 9.84 +/- 10.36 mg/dL (P = .13), respectively. Although the mean decrease in BUN concentration was important, this was not shown to be significant. No correlations were found between operating time, perfusion volume, and postoperative changes.

CONCLUSIONS

Lengthy therapeutic hip arthroscopy under high intra-articular pressure has only a minimal effect on electrolyte balance and renal function. We therefore conclude that performing routine preoperative and postoperative blood analysis of electrolyte concentrations and renal function is unnecessary.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery: A case report

Arthroscopic shoulder surgery has become a common and routine procedure because it provides several advantages for the diagnosis and therapy of shoulder injuries. However, shoulder arthroscopy is not a technique that's void of complications. We describe here a unique case of a patient who experienced pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery, and this surgery was done under general anesthesia.

Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device

PURPOSE

We sought to evaluate the functional and radiographic outcome of osteochondral lesions involving the femoral condyle that were arthroscopically repaired via a bioabsorbable fixation device made of self-reinforced poly-L-lactic acid.

METHODS

A retrospective clinical and radiographic evaluation of 9 patients (8 male and 1 female) with a mean age of 18 years at the time of surgery was carried out. Of these patients, 8 were diagnosed with osteochondritis dissecans and 1 had a traumatic chondral fracture. All patients underwent arthroscopic repair of a discrete osteochondral lesion involving the femoral condyle with a bioabsorbable fixation implant. All patients were evaluated at a mean of 33 months postoperatively. All patients had preoperative magnetic resonance imaging (MRI) documenting the integrity and location of the fragment. Patients were evaluated at follow-up with a physical examination, Lysholm questionnaire, and repeated MRI with specific cartilage pulse sequencing.

RESULTS

At surgery, the mean size of the fragment was 2 x 2 cm. A mean of 4 nails was used in each case (range, 2 to 10). All patients were treated with a postoperative rehabilitation protocol of non-weight-bearing for a minimum of 6 weeks. The mean postoperative Lysholm score was 94 (range, 78 to 100). The outcomes were excellent in 7 patients, good in 1, and fair in 1. After surgery, MRI evaluation of the osteochondral lesion and overlying cartilage was graded as healed in 7 patients and of questionable integrity in 2.

CONCLUSIONS

This report documents the efficacy of a bioabsorbable nail to internally fix osteochondral lesions. It supports the use of MRI for both preoperative planning and postoperative assessment of fragment healing.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Transarterial embolization of an inferior genicular artery pseudoaneurysm with arteriovenous fistula after arthroscopy

Arthroscopic meniscectomy of the knee is generally a safe and effective procedure with a low rate of vascular complications. We report here on a unique case of a 55-year-old man with a lateral inferior genicular artery pseudoaneurysm and a concomitant arteriovenous fistula that developed after arthroscopic meniscectomy; this was successfully treated with selective angiographic embolization. This case illustrates the effectiveness of an endovascular approach as a minimally invasive treatment for this uncommon complication that occurs after an arthroscopic procedure.

Arthroscopically assisted medial reefing without routine lateral release for patellar instability

BACKGROUND

Patellofemoral instability in patients with normal alignment has been effectively treated with medial reefing procedures and a lateral release. Recent research suggests that a lateral release may not be necessary in patients without excessive patellar tilt.

HYPOTHESIS

Arthroscopically assisted medial reefing without lateral release is as effective as techniques with a lateral release reported in the literature.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Twenty-four patients (25 knees) were observed for an average of 60 months. Preoperatively, patients underwent a history, physical examination, and radiographic evaluation. At follow-up, a physical examination and radiographic evaluation were repeated. Preoperative and postoperative Lysholm and Tegner scores were calculated. A subjective questionnaire was also completed. Comparative statistics were used for the preoperative and postoperative scores (P < .05).

RESULTS

Ninety-six percent (24/25) were satisfied with their results, and all patients would have the same procedure performed again. Subjective symptom scores improved significantly. Lysholm knee scores improved from an average of 54 to 91 (P < .001). Tegner activity level improved from an average of 3.3 to 6.2 (P < .001). Significant improvement was seen in patellar mobility, apprehension, and patellofemoral tenderness with compression. Range of motion, muscle atrophy, and tilt did not change significantly. Congruence angles improved from 4.4 degrees to -2.5 degrees (P = .009), lateral patellofemoral angles improved from 5.5 degrees to 8.7 degrees (P = .011), and lateral patellar displacement improved from 2.0 to 0.2 mm (P < .044). There were no recurrent dislocations or subluxations.

CONCLUSION

Arthroscopically assisted medial reefing, without lateral release, is an effective treatment for patients with recurrent patellofemoral instability and normal alignment.

Clostridium infections associated with musculoskeletal-tissue allografts

BACKGROUND

Allografts are commonly used in orthopedic reconstructive surgery. In 2001, approximately 875,000 musculoskeletal allografts were distributed by U.S. tissue banks. After the death from Clostridium sordellii sepsis of a 23-year-old man who had received a contaminated allograft from a tissue bank (Tissue Bank A), the Centers for Disease Control and Prevention initiated an investigation, including enhanced case finding, of the methods used for the recovery, processing, and testing of tissue.

METHODS

A case of allograft-associated clostridium infection was defined as a culture-proven infection of a surgical site within one year after allograft implantation, from January 1998 to March 2002. We traced tissues to tissue banks that recovered and processed these tissues. We also estimated the rates of and risk ratios for clostridium infections for tissues processed by the implicated tissue bank and reviewed processing and testing methods used by various tissue banks.

RESULTS

Fourteen patients were identified, all of whom had received allografts processed by Tissue Bank A. The rates of clostridium infection were 0.12 percent among patients who received sports-medicine tissues (i.e., tendons, femoral condyles, menisci) from Tissue Bank A and 0.36 percent among those who received femoral condyles in particular. The risk-ratio estimates for clostridium infections from tissues processed by Tissue Bank A, as compared with those from other tissue banks, were infinite (P<0.001) for musculoskeletal allografts, sports-medicine tissues, or tendons. Because Tissue Bank A cultured tissues only after treating them with a nonsporicidal antimicrobial solution, some test results were probably false negatives. Tissues from implicated donors were released despite the isolation of clostridium or bowel flora from other anatomical sites or reports of infections in other recipients.

CONCLUSIONS

Clostridium infections were traced to allograft implantation. We provide interim recommendations to enhance tissue-transplantation safety. Tissue banks should validate processes and culture methods. Sterilization methods that do not adversely affect the functioning of transplanted tissue are needed to prevent allograft-related infections.

Neurovascular complications of knee arthroscopy

During the last 3 decades, arthroscopy has revolutionized the way knee surgery is performed. The indications and the applications of arthroscopic procedures in the knee joint have enormously increased with the improvement in surgical technique and advent of new arthroscopic equipment. The use of arthroscopic techniques has led to a significant decrease in morbidity for the patient with intraarticular abnormalities, in terms of both diagnosis and surgical correction. Even though knee arthroscopy is a minimally invasive procedure with relatively low morbidity, it is not without risk of complications, of which neurovascular complications are among the most serious and devastating. The reported incidence of neurovascular complication is low, but it may be underestimated. Many neurovascular complications that occur are preventable with a thorough understanding of neurovascular anatomy, good preoperative and intraoperative planning, and attention to the details of basic techniques and the equipment used for the procedure. It is imperative that the surgeon who is performing arthroscopy be aware of these neurovascular complications, recognize them as early as possible, and initiate further evaluation and treatment as expeditiously as possible. In this article, the causes, management, prevention, and medicolegal implications of neurovascular complications of knee arthroscopy are reviewed.

That bloody knee! Dealing with an organized hemarthrosis

The decision to manage an organized hemarthrosis conservatively or surgically is difficult and still controversial, especially in the postoperative patient compared with the trauma patient. We describe a cheap, effective, and readily available technique for the surgeon who elects for a surgical solution to this problem using a Karman catheter (Rocket Medical PLC, Watford, UK) during arthroscopy to complete an irrigation and vacuum circuit.

Usefulness of 99Tcm-MDP knee SPET for pre-arthroscopic evaluation of patients with internal derangements of the knee

The aim of this study was to ascertain whether knee SPET can localize lesion sites in patients with internal derangements of the knee. We performed knee SPET as a pre-arthroscopic examination in 63 consecutive patients. SPET imaging was performed with a triple-headed SPET camera 4 h after the injection of 99Tcm-methylene diphosphonate. Arthroscopic diagnoses were as follows: 28 medial meniscus injuries, 24 lateral meniscus injuries, 31 anterior cruciate ligament (ACL) injuries, three posterior cruciate ligament injuries and one medial collateral ligament injury. Of 30 patients with crescent-shaped increased activity at the medial tibial plateau, 22 had medial meniscus injuries (positive predictive value: PPV 73%); of 17 patients with crescent-shaped activity at the lateral tibial plateau, 13 had lateral meniscus injuries (PPV 76%). Of 18 patients with increased activity at ACL attachment sites (primary sign), 17 had ACL injuries (PPV 94%). Of 27 patients with increased activity at bone impaction sites of ACL injury (secondary sign), 22 had ACL injuries (PPV 81%). Of 32 patients who had either a primary or secondary sign, 26 had ACL injuries (PPV 81%). We conclude that knee SPET is very useful in the management of internal derangements of the knee, particularly in determining the need for arthroscopy by localizing lesion sites.

Hospital outcomes research in Germany: results from a retrospective survey among sickness fund beneficiaries

OBJECTIVES

The authors assess the feasibility of using retrospective, indication-specific patient surveys to conduct hospital outcomes research in Germany. Surgical outcome and patient satisfaction were examined in patients who underwent common elective surgical procedures.

METHODS

Using the International Classification of Diseases Ninth Revision coding available in the Schwäbisch Gmünd health insurance data base, all patients for a defined period of time with one of the three following diagnoses were selected and questioned retrospectively using an indication-specific survey instrument: (1) varicose veins of the lower extremity; (2) nasal septum deviation; and (3) inner knee joint damage limited to patients undergoing arthroscopic meniscus repair. Survey content focused on preoperative conditions, pre- and postoperative symptoms, postoperative complications, the nature and duration of postoperative follow-up, and satisfaction with surgical outcome.

RESULTS

Significant postoperative improvement of preoperative symptoms was found for all three groups. Complete freedom from symptoms was found in 29.7% of patients treated for varicose veins, 24.1% of patients with meniscus repair, and in only 10.6% of patients with nasal septum deviation. Multivariate analyses indicated that postoperative impairment was the decisive variable governing patient satisfaction for all three groups.

CONCLUSIONS

The use of retrospective, indication-specific patient surveys constitutes a time-efficient, cost-effective, and patient-focused option for the systematic acquisition and evaluation of health outcomes in Germany. This methodology holds promise for international and domestic efforts to demonstrate the consequences of restructuring activities in the inpatient sector.

Arthroscopic repair of glenolabral injuries with an absorbable fixation device

In view of potential problems with metallic implants around the shoulder a bioabsorbable tact has been used in arthroscopic repair of labral lesions in the shoulder joint. We report on a consecutive series of 70 patients (71 shoulders) who had arthroscopic stabilization of Bankart lesions, SLAP lesions, and other labral detachments with the Suretac device. Minimum follow-up time was 12 months (range 12 to 27 months). Clinical outcome was assessed with the Constant score. The recurrence of dislocation or subluxation in the 42 unstable shoulders was 12% (5 of 42), and in 78% (33 of 42) the Constant score was rated good or excellent. The recurrence of dislocation in true anteroinferior dislocators was 3.2% (1 of 31). A total of 82.3% (14 of 17) of patients with SLAP repairs were rated good or excellent, and 53% (9 of 17) returned to their preinjury level of sporting activities. Eight (67%) of 12 patients with labral detachments other than Bankart and SLAP lesions were rated good or excellent, and 64% (7 of 11) returned fully to sports.

Osteochondritis dissecans of the patella: arthroscopic fixation with bioabsorbable pins

Osteochondritis dissecans of the patella is a relatively rare condition. Surgical treatment has been recommended for those patients who fail conservative treatment, or who present with mechanical symptoms or loose bodies. In an attempt to preserve the patellofemoral articulation, we describe a new technique to arthroscopically fix osteochondritic lesions of the patella using bioabsorbable pins. This technique avoids the morbidity of a formal arthrotomy as well as the complications associated with metallic hardware.

Pseudoaneurysm of the descending genicular artery after arthroscopic meniscectomy: report of a case

Vascular injuries in the arthroscopic meniscectomy of the knee are uncommon. A case of pseudoaneurysm of the descending genicular artery in a 39-year-old man, after medial arthroscopic meniscectomy, is reported. The pseudoaneurysm was simple to diagnose with computed tomographic scan and angiography, and treatment was successful surgical resection.

Late follow-up results of operative ankle arthroscopy in patients under local anaesthesia

The purpose of this study was to evaluate our long-term results of operative ankle arthroscopy in local anaesthesia, without tourniquet and antibiotic prophylaxis, and to see whether we could produce the same results other investigators had published using general anaesthesia. Between 1987 and 1992, 51 operative ankle arthroscopies were performed--all as out-patient procedures. Thirty-six patients had local anaesthesia, 7 had general anaesthesia, one had spinal anaesthesia and one had epidural anaesthesia. No prophylactic antibiotics were given. Indications for surgery were the same for patients who had local anaesthesia as for those who had the other types of anaesthesia. Nineteen patients had partial synovectomies, 8 had removals of osteophytes, 7 had debridements of osteochondral fractures, 6 had debridements of mild degenerative osteoarthritis, 3 had loose bodies and 2 had septic arthritis. After a mean of 3 years (range 1-8) the patients were sent a questionnaire. They were asked to rate activity level, pain, swelling, and limb stiffness on a four-grade scale pre- and postoperatively and to rate their total subjective improvement. They were also asked if they would undergo the same procedure again knowing the outcome of the procedure. Forty-five patients (88%) were available for follow-up. Thirty-four patients (76%) were improved, 10 remained unchanged, and one became worse after surgery. No correlation existed between preoperative symptom duration, sex, trauma, type of anaesthesia, postoperative diagnosis or type of surgical procedure. Minor complications occurred in 11% of patients. Eighty-four percent of the patients said they would undergo the same procedure again. The type of anaesthesia used did not influence this decision.(ABSTRACT TRUNCATED AT 250 WORDS)