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Mathew Davis, David Brooks, William Bryceson
A 53-year-old woman underwent arthroscopic ankle debridement for posttraumatic arthrofibrosis 2 years following a bimalleolar ankle fracture. Twelve months postarthroscopy, the patient returned to physical therapy with a 2-week history of pain and prominent swelling to her anterior ankle. Urgent follow-up was arranged with an orthopaedic surgeon, who ordered a radiograph and magnetic resonance imaging, which demonstrated a large heterogeneous mass. Doppler ultrasound was also ordered and confirmed the mass to be a pseudo-aneurysm of the anterior tibial artery...
January 2017: Journal of Orthopaedic and Sports Physical Therapy
Ronald E Delanois, Chukwuweike Gwam, Jaydev B Mistry, Morad Chughtai, Melbin Thomas, Prathik P Mudaliar, Anton Khlopas, Vidur Tangri, Michael A Mont
INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic agent that can be used to reduce blood loss in total knee arthroplasty (TKA) patients. Due to its thrombogenic properties, intravenous (IV) TXA is contraindicated in patients who have an increased risk of arterial or venous thrombosis. For such patients, intraarticular (IA) TXA may be a safe alternative. In this study, we compare: 1) complication rates; 2) intraoperative blood loss; and 3) need for transfusion in TKA patients who received IA TXA versus patients who used IV TXA...
December 16, 2016: Surgical Technology International
Hermann O Mayr, Christian M Brandt, Thomas Weig, Manuel Koehne, Anke Bernstein, Norbert P Suedkamp, Robert Hube, Amelie Stoehr
PURPOSE: The current study was conducted to evaluate the long-term clinical and radiological outcomes after arthroscopic arthrolysis for arthrofibrosis after anterior cruciate ligament reconstruction (ACLR). METHODS: All patients treated with arthrolysis between 1990 and 1998 were included. Indication was arthrofibrosis in at least one knee compartment or a cyclops syndrome limiting range of motion (ROM) by > 5° of extension deficit and 15° of flexion deficit...
October 24, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Emilie M Flament, Keith R Berend, Jason M Hurst, Michael J Morris, Joanne B Adams, Adolph V Lombardi
BACKGROUND: In past decades, polyethylene wear was a major cause of failure in total knee arthroplasty (TKA). Polyethylene for use in arthroplasty has been vastly improved in recent years, with improved materials as well as manufacturing and sterilization processes. Testing has shown that infusion of vitamin E prevents oxidative degradation of polyethylene without remelting, allowing the material to maintain mechanical properties and wear resistance over time. The purpose of this study is to review the early result of patients undergoing primary TKA with vitamin E antioxidant-infused polyethylene inserts...
October 26, 2016: Surgical Technology International
J Jiang, N L Leong, U Khalique, T M Phan, K M Lyons, J V Luck
INTRODUCTION: Joint haemorrhage is the principal clinical manifestation of haemophilia frequently leading to advanced arthropathy and arthrofibrosis, resulting in severe disability. The degree and prevalence of arthrofibrosis in hemophilic arthropathy is more severe than in other forms of arthropathy. Expression of connective tissue growth factor (CTGF) has been linked to many fibrotic diseases, but has not been studied in the context of haemophilic arthropathy. AIM: We aim to compare synovial tissues histologically from haemophilia and osteoarthritis patients with advanced arthropathy in order to compare expression of proteins that are possibly aetiologic in the development of arthrofibrosis...
November 2016: Haemophilia: the Official Journal of the World Federation of Hemophilia
Timothy J Ewald, Justin A Walker, Eric Alexander Lewallen, William H Trousdale, Michael J Yaszemski, Arlen D Hanssen, Bernard F Morrey, Andre J van Wijnen, Joaquin Sanchez-Sotelo, Mark E Morrey, Matthew P Abdel
Implantable biomaterials supporting extended release of pharmacologic agents may permit localized intra-articular delivery of drugs that modulate the fibrotic response to injuries and surgery. Oligo[Poly (ethylene glycol)] Fumarate (OPF) is an attractive organic carrier, but its safety profile within synovial joints remains unclear. Here, we assessed the safety of OPF sponges using a validated in vivo model of knee arthrofibrosis. A cohort of 102 rabbits was divided into 5 groups: arthrotomy only (24), arthrotomy with OPF scaffold placement (24), surgically induced contracture (24), surgically induced contracture with OPF scaffold placement (24), and control without any surgical intervention (6)...
September 27, 2016: Tissue Engineering. Part C, Methods
Stacey M Cornelson, Alicia M Yochum, Norman W Kettner
OBJECTIVE: This case report describes magnetic resonance imaging (MRI) and diagnostic ultrasound (US) findings for a patient with arthrofibrosis related to a complication of anterior cruciate ligament (ACL) reconstruction. CLINICAL FEATURES: A 25-year old man presented with right knee pain and loss of extension 5 years after ACL reconstruction. MRI and sonographic examination revealed a soft tissue mass anterolateral to the ACL graft consistent with a cyclops lesion...
September 2016: Journal of Chiropractic Medicine
Sean T Grambart
Arthroscopy of the ankle is used in the treatment and diagnosis of a spectrum of intra-articular pathology including soft tissue and osseous impingement, osteochondral lesions, arthrofibrosis, and synovitis. To help identify the correct pathology, imaging techniques are often used to aid the surgeon in diagnosing pathology and determining best treatment options. This article discusses the use of imaging in various ankle pathologies.
October 2016: Clinics in Podiatric Medicine and Surgery
Tyler J Brolin, Ryan P Mulligan, Frederick M Azar, Thomas W Throckmorton
BACKGROUND: Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. METHODS: Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations...
August 31, 2016: Journal of Shoulder and Elbow Surgery
Eric Hohn, Nirav K Pandya
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is one of several surgical procedures used to treat patellofemoral instability. Use of allograft tissue can preserve autogenous tissue and may be preferable in patients with connective tissue disorders or ligamentous laxity. Although there are successful reports in adults, it is unclear if the use of allograft tissue in MPFL reconstruction can restore patellofemoral stability in children and adolescents. QUESTIONS/PURPOSES: (1) Does allograft tissue in MPFL reconstruction in pediatric and adolescent patients restore patellar stability? (2) What complications were associated with allograft MPFL reconstructions in children and adolescents? METHODS: Between June 2012 and August 2015, one surgeon (NKP) performed 26 MPFL reconstructions in 23 patients with gracilis allograft for traumatic patellar instability...
September 2, 2016: Clinical Orthopaedics and related Research
Martin W Roche, Tsun Yee Law, Jacob J Triplet, Zachary S Hubbard, Jennifer Kurowicki, Sam Rosas
BACKGROUND: It is well established that diabetic patients undergoing total knee arthroplasty (TKA) are more susceptible to infection, problematic wound healing, and overall higher complication rates. However, a paucity in current literature exists. The purpose of this study was to determine the effect of hypoglycemia on TKA revision (rTKA) incidence by analyzing a national private payer database for procedures performed between 2007 and 2015 Q1 Q2. METHODS: A retrospective review of a national private payer database within the PearlDiver Supercomputer application for patients undergoing TKA with blood glucose levels from 20 to 219 mg/mL, in 10-mg/mL increments, was conducted...
July 25, 2016: Journal of Arthroplasty
Pedro Debieux, Carlos E S Franciozi, Mário Lenza, Marcel Jun Tamaoki, Robert A Magnussen, Flávio Faloppa, João Carlos Belloti
BACKGROUND: Anterior cruciate ligament (ACL) tears are frequently treated with surgical reconstruction with grafts, frequently patella tendon or hamstrings. Interference screws are often used to secure the graft in bone tunnels in the femur and tibia. This review examines whether bioabsorbable interference screws give better results than metal interference screws when used for graft fixation in ACL reconstruction. OBJECTIVES: To assess the effects (benefits and harms) of bioabsorbable versus metallic interference screws for graft fixation in ACL reconstruction...
July 24, 2016: Cochrane Database of Systematic Reviews
A Ateschrang, S Döbele, T Freude, U Stöckle, S Schröter, T M Kraus
BACKGROUND: There is an on-going discussion whether to operatively treat combined grade II and III lesions of the medial collateral ligament (MCL) with anterior cruciate ligament (ACL) in the acute phase rather than conservative treatment of the MCL lesion with a delayed unitary ACL replacement. Another issue is the question how to technically address these MCL lesions. The aim of this study was, therefore, to analyze the results of simultaneous ACL replacement (hamstrings) in a single-bundle technique with a simultaneous MCL ligament bracing procedure...
September 2016: Archives of Orthopaedic and Trauma Surgery
Huan Xu, Jinhe Ying
OBJECTIVE: The aim of this study was to introduce the results of a novel mini-invasive operative technique comprising mini-incision release, "pie-crusting" lengthening of the quadriceps extensor, and arthroscopic lysis in severe arthrofibrotic knees. METHODS: From 2010 to 2014, 17 patients (12 males and 5 females with a mean age of 44 years (range, 19-62 years)) with severely arthrofibrotic knees were treated with this operative technique. The mean follow-up duration was 23 months...
August 2016: Acta Orthopaedica et Traumatologica Turcica
Ping Shang, Hai-Xiao Liu, Yu Zhang, En-Xing Xue, Xiao-Yun Pan
PURPOSE: In this article, a mini-invasive technique is described, which consists of arthroscopic adhesiolysis and quadriceps pie-crusting lengthening basing on pre-operative sonographic examination. Sonographic diagnostic value of quadriceps tendon fibrosis is also evaluated. METHODS: Pre-operative sonographic examination was performed to make an accurate location diagnosis of quadriceps fibrosis. After arthroscopic adhesiolysis, percutaneous pie-crusting release was performed basing on preoperative sonographic examination...
August 2016: Injury
M Gabl, R Arora, A S Klauser, Gernot Schmidle
PURPOSE: The purpose of this study was to assess characteristics of radiocarpal arthrofibrosis after intra-articular distal radius fractures (DRF). PATIENTS AND METHODS: In this study 20 patients who underwent wrist arthroscopy at the time of implant removal after volar plating for intra-articular DRF were included retrospectively. The direction of fibrous tissue formation (FTF) and its rigidity were investigated. The findings were correlated to the course of intraarticular fracture lines seen in the preoperative CT, patient age and AO fracture types...
August 2016: Archives of Orthopaedic and Trauma Surgery
Wesley G Lackey, Merrill A Ritter, Michael E Berend, Robert A Malinzak, Philip M Faris, John B Meding
Revision total knee arthroplasty (TKA) is becoming increasingly common as the population ages and the number of existing primary TKAs continues to increase. Revision TKA systems use a greater range of component modularity than primary TKA systems, including stems, augments, and varying levels of constraint. The purpose of this study was to retrospectively review the authors' institution's use of one specific revision knee implant system and its midterm results. The Vanguard SSK Revision Knee System (Biomet, Warsaw, Indiana) was implanted 297 times in 272 patients between 2005 and 2013...
September 1, 2016: Orthopedics
R Michalik, B Rath, H-R Springorum, C Lüring, M Tingart
BACKGROUND: Anterior knee pain is one of the most common complications after total knee arthroplasty. An incidence of up to 30 % has been reported in peer-reviewed studies. TARGET: The purpose of this study was to systematically review the literature and to identify determinants that have been analyzed with regard to anterior knee pain. CAUSES: Patient- and knee-specific characteristics, prosthetic designs and operative techniques are addressed as well as functional and neurologic determinants...
May 2016: Der Orthopäde
F Wilken, I J Banke, M Hauschild, S Winkler, K Schott, M Rudert, R V Eisenhart-Rothe
BACKGROUND: The reconstruction of the extensor mechanism around the knee is an essential part of tumorresection and tumor arthroplasty in orthopaedic oncology for functional rehabilitation of quality of life and daily activities. OBJECTIVES: Operative procedures, treatment options and management of complications with reconstruction of the extensor mechanism after tumor resection around the knee depend on the type of arthroplasty. MATERIALS AND METHODS: Description of the different treatment option for extensor deficiency divided into infra- and suprapatellar modalities...
May 2016: Der Orthopäde
Anagha P Parkar, Andrea Alcalá-Galiano
Posterior cruciate ligament (PCL) ruptures are not common, but reconstruction is increasing because PCL-deficient knees are prone to develop osteoarthritis. Preoperative MRI may confirm a total or partial disruption of PCL fibers. An overstretched PCL is often mistaken for an intact PCL while the knee is functionally PCL deficient, resulting in false-negative MRI reports. Posterior translation of the medial condyle is a useful indirect sign on imaging. Preoperative stress radiographs are used to quantify the degree of PCL deficiency, and posterior translation determines whether to treat conservatively or with surgery...
February 2016: Seminars in Musculoskeletal Radiology
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