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(searched for: doi:10.1016/j.arthro.2019.03.045)
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Alessandro Annibaldi, , Matthew Daggett, Alessandro Carrozzo, Daniele Mazza, Leonardo Previ, Giorgio Rossi, Pierfrancesco Orlandi, Andrea Ferretti
Published: 7 September 2022
Journal of experimental orthopaedics, Volume 9, pp 1-8; https://doi.org/10.1186/s40634-022-00528-1

Abstract:
Purpose: In-office needle arthroscopy has been reported as a diagnostic tool for different knee pathologies. In addition, ACL repair has seen a resurgence with the advent of innovative orthopedic devices. The aim of this study was to assess clinical, radiological, and in-office needle arthroscopic findings in 15 adult patients who underwent acute (within 14 days from injury) anterior cruciate ligament (ACL) repair. Methods: Fifteen patients voluntarily participated in the study. A second-look arthroscopy was performed with an in-office needle arthroscopy at an average of 7.2 months after the primary repair. The parameters included in the investigation were the continuity of the anatomical footprint of the repaired ACL, subjective assessment of the ACL tension with the probe, and synovial coverage of the ACL. All patients had a Magnetic Resonance Imaging (MRI) at 6 months after repair and an arthrometric evaluation with the KT-1000. Clinical evaluation with the scores, Tegner Lysholm Knee Scoring Scale (TLKSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) was performed at the final follow-up of 2 years. Moreover, a correlation between the characteristics of ACL appearance at the time of the second look in-office needle arthroscopy, MRI and KT-1000 was performed. Results: The mean TLKSS was 97.86, the mean KOOS was 98.08 and the mean subjective IKDC was 96.71. The objective IKDC was A in 10 patients and B in 5 patients. ACL healing was graded as A in 11 patients and B in 4 patients. Synovial coverage was graded as good in 10 patients and fair in 5 while MRI assessment showed a type I ACL in 10 patients, type II in 4 patients and type III in 1 patient. Conclusion: In-office needle arthroscopy is a reliable tool to assess the condition of a repaired ACL. In addition, ACL repair performed in acute proximal tears demonstrated excellent clinical results.
Sameh A. Labib, Maged Hanna
Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 38, pp 1312-1314; https://doi.org/10.1016/j.arthro.2021.12.006

The publisher has not yet granted permission to display this abstract.
Robert W. Ike, Kenneth C. Kalunian
JCR: Journal of Clinical Rheumatology, Volume 28, pp 177-181; https://doi.org/10.1097/rhu.0000000000001802

Abstract:
Background/Objective Rheumatologists' interest in arthroscopy began before the 1980s, when many era practitioners began to take up the procedure in earnest. Some of the important players in pre–World War II explorations of arthroscopy were rheumatologists, and the father of modern arthroscopy Makei Watanabe counted many rheumatologists among his postwar students, who were publishing about arthroscopic insights into rheumatic conditions in the 1960s and 1970s. We chose to review this evolution to demonstrate the diverging interests of rheumatologists and orthopedists in arthroscopy and emphasize the chances for reconciliation and cooperation. Methods involve our personal recollection and review of the literature. Results Guidelines for the practice of arthroscopy were published by the American Rheumatism Association (now the American College of Rheumatology) 7 years before similar guidelines appeared from the Arthroscopy Association of North America. American rheumatologists ceased arthroscopy when controlled trials showed no effect in osteoarthritis beyond placebo and biologics for synovitis virtually eliminated situations in which synovectomy might be considered. The research potential of arthroscopy has been realized mainly by European rheumatologists, although the ultrasound-guided biopsy is supplanting arthroscopy as means to secure synovium for investigation, despite the advantages of the latter, such as the ability to obtain larger amounts of tissue, select tissue based on macroscopic appearance, sample multiple area in the same joint, and deliver the potentially therapeutic effect of washout. New miniscopes suitable for office use could restore some of the lagging interest in arthroscopy for investigation. Orthopedists have generally been resistant to rheumatologists doing arthroscopy but would not be sharing any turf with rheumatologists using the miniscope. Conclusions We hope that we orthopedists and rheumatologists could be friends as we enter this new phase of arthroscopy as we use the technique for different purposes.
Nathaniel P. Mercer, Arianna L. Gianakos, Daniel J. Kaplan, John F. Dankert, , Jeffrey S. Chen, Christopher A. Colasanti, Eoghan T. Hurley, James W. Stone,
Published: 24 February 2022
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Nathaniel P. Mercer, Alan P. Samsonov, John F. Dankert, Arianna L. Gianakos, Tobias Stornebrink, Rick J. Delmonte, Gino M.M. J. Kerkhoffs,
Published: 8 February 2022
Arthroscopy, Sports Medicine, and Rehabilitation, Volume 4; https://doi.org/10.1016/j.asmr.2021.12.004

The publisher has not yet granted permission to display this abstract.
John F. Dankert, Nathaniel P. Mercer, Daniel J. Kaplan, Ajay C. Kanakamedala, Jeffrey S. Chen, Christopher A. Colasanti, Eoghan T. Hurley, James W. Stone,
Published: 7 February 2022
The publisher has not yet granted permission to display this abstract.
Tobias Stornebrink, Sjoerd A S Stufkens, Nathaniel P Mercer, John G Kennedy,
Published: 18 January 2022
World Journal of Orthopedics, Volume 13, pp 78-86; https://doi.org/10.5312/wjo.v13.i1.78

Abstract:
Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents. Accuracy and tolerability of this approach in the clinical setting–including patients with end-stage ankle pathology and/or a history of prior surgery–is not known. To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint. This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint. In our center, these injections are used as a last resort prior to extensive surgery. The primary outcome was injection accuracy, which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear arthroscopic view of the joint space. Secondary outcome measures included a patient-reported numeric rating scale (NRS, 0-10) of pain during the procedure and willingness of patients to return for the same procedure. NRS of ankle pain at rest and during walking was collected at baseline and at 2-wk follow-up. Complications were monitored from inclusion up to a 2-wk control visit. We performed 24 inspection-injections. Eleven (46%) participants were male, and mean age was 46.8 ± 14.5 years. Osteoarthritis was the indication for injection in 20 (83%) cases, of which 8 (33%) patients suffered from osteoarthritis Kellgren-Lawrence grade IV, and 10 (42%) patients from Kellgren-Lawrence grade III. An osteochondral defect was the indication for injection in 4 (17%) cases. A history of ankle surgery was present in 14 (58%) participants and a history of multiple ankle surgeries in 11 (46%) participants. It was possible to confirm accuracy in 21 (88%) procedures. The 3 (12%) participants where needle arthroscopy did not reach a clear view of the joint space all suffered from Kellgren-Lawrence grade IV osteoarthritis. Pain during the procedure was reported with a median of 1 [interquartile ranges (IQR): 0–2]. Willingness to return was 100%. Pain in rest decreased from a median NRS of 4 (IQR: 2–7) at baseline to a median of 3 (IQR: 1–5) at follow-up (P< 0.01). Pain during walking decreased from a median NRS of 8 (IQR: 6–9) to a median of 7 (IQR: 4–8) (P< 0.01). Infections or other complications were not encountered. Clinical accuracy and tolerability of bedside needle arthroscopy of the ankle as a delivery system for injectable agents are excellent. Accuracy was 100% in patients without total ventral joint obliteration.
Seong Kee Shin, Do Kyung Lee, Dae Won Shin, Tae Hoon Yum, Jun-Ho Kim
Published: 1 November 2021
Orthopaedic Journal of Sports Medicine, Volume 9; https://doi.org/10.1177/23259671211050616

Abstract:
Background: Anterior cruciate ligament reconstruction (ACLR) is often performed on an outpatient basis; thus, effective pain management is essential to improving patient satisfaction and function. Local infiltration analgesia (LIA) and femoral nerve block (FNB) have been commonly used for pain management in ACLR. However, the comparative efficacy and safety between the 2 techniques remains a topic of controversy. Purpose: To compare pain reduction, opioid consumption, and side effects of LIA and FNB after ACLR. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed to identify studies comparing pain on the visual analog scale (a 100-mm scale), total morphine-equivalent consumption, and side effects between the 2 techniques after ACLR at the early postoperative period. The LIA was categorized into intra-articular injection and periarticular injection, and subgroup analyses were performed comparing either intra-articular injection or periarticular injection with FNB. Two reviewers performed study selection, risk-of-bias assessment, and data extraction. Results: A total of 10 studies were included in this systematic review and meta-analysis. In terms of VAS pain scores, our pooled analysis indicated that FNB was significantly more effective at 2 hours postoperatively compared with LIA (mean difference, 8.19 [95% confidence interval (CI), 0.75 to 15.63]; P = .03), with no significant difference between the 2 techniques at 4, 8, and 12 hours postoperatively; however, LIA was significantly more effective at 24 hours postoperatively compared with FNB (mean difference, 5.61 [95% CI, −10.43 to −0.79]; P = .02). Moreover, periarticular injection showed a significant improved VAS pain score compared with FNB at 24 hours postoperatively (mean difference, 11.44 [95% CI, −20.08 to −2.80]; P = .009), and the improvement reached the threshold of minimal clinically important difference of 9.9. Total morphine-equivalent consumption showed no difference between the 2 techniques, and side effects were unable to be quantified for the meta-analysis because of a lack of data. Conclusion: Compared with FNB, LIA was not as effective at 2 hours, comparable within 12 hours, and significantly more effective at 24 hours postoperatively for reducing pain after ACLR. Total morphine-equivalent consumption showed no significant differences between the 2 techniques.
Christopher A. Colasanti, Nathaniel P. Mercer, Jeremie V. Garcia, Gino M.M. J. Kerkhoffs,
Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 38, pp 1302-1311; https://doi.org/10.1016/j.arthro.2021.09.016

The publisher has not yet granted permission to display this abstract.
Alex C. DiBartola, Alan Rogers, , Michael V. Knopp,
Published: 14 September 2021
Arthroscopy, Sports Medicine, and Rehabilitation, Volume 3; https://doi.org/10.1016/j.asmr.2021.08.003

The publisher has not yet granted permission to display this abstract.
Tobias Stornebrink, Robbert A.H.E. van Dijck, Dirk Douven,
Published: 28 August 2021
Arthroscopy techniques, Volume 10; https://doi.org/10.1016/j.eats.2021.05.020

The publisher has not yet granted permission to display this abstract.
Tobias Stornebrink, Stein J. Janssen, Arthur J. Kievit, Nathaniel P. Mercer, John. G. Kennedy, Sjoerd A. S. Stufkens, Gino M. M. J. Kerkhoffs
Published: 24 August 2021
Journal of experimental orthopaedics, Volume 8, pp 1-7; https://doi.org/10.1186/s40634-021-00384-5

Abstract:
Purpose To assess the feasibility of needle arthroscopy for management of suspected bacterial arthritis in native joints. Methods During a pilot period, patients presenting with symptoms suggestive of native joint bacterial arthritis were eligible for initial management with needle arthroscopy. Procedures were performed in the operating theatre or at the patient bedside in the emergency department or inpatient ward. As our primary outcome measure, it was assessed whether needle arthroscopic lavage resulted in a clear joint. In addition, the need for conversion to standard arthroscopy or arthrotomy, the need for conversion from local to general anaesthesia, complications and the need for additional surgical intervention at follow-up during admission were recorded. Results Eleven joints in 10 patients (four males, age range 35 – 77) were managed with needle arthroscopy. Needle arthroscopic lavage resulted in a clear joint in all cases. Conversion to standard arthroscopy or arthrotomy was not needed. Seven procedures were performed at the patient bedside using local anaesthesia. These procedures were well tolerated and conversion to general or spinal anaesthesia was not required. There were no procedure complications. One patient received multiple needle arthroscopic lavages. No further surgical interventions beside the initial needle arthroscopic lavage were required for successful management in other cases. Conclusions Needle arthroscopy can be a feasible tool in the initial management of complaints suggestive for native joint bacterial arthritis, providing an effective, quick and well-tolerable intervention in the operating theatre or at the patient bedside, with the potential to relief health systems from need for scarce operating theatre time.
Robert W. Ike, Kenneth C. Kalunian
International Journal of Rheumatic Diseases, Volume 24, pp 1235-1246; https://doi.org/10.1111/1756-185x.14184

Abstract:
Conditions prompting physicians and surgeons first adapting endoscopes to peer into joints were mainly the sort of synovial conditions that would concern today's rheumatologists. Rheumatologists were among the pre-World War II pioneers developing and documenting arthroscopy. The post-War father of modern arthroscopy, Watanabe, found rheumatologists among his early students, who took back the technique to their home countries, teaching orthopedists and rheumatologists alike. Rheumatologists described and analyzed the intra-articular features of their common diseases in the ’60s and ’70s. A groundswell of interest from academic rheumatologists in adapting arthroscopy grew considerably in the ’90s with development of “needle scopes” that could be used in an office setting. Rheumatologists helped conduct the very trials the findings of which reduced demand for their arthroscopic services by questioning the efficacy of arthroscopic debridement in osteoarthritis (OA) and also developing biological compounds that greatly reduced the call for any resective intervention in inflammatory arthropathies. The arthroscope has proven an excellent tool for viewing and sampling synovium and continues to serve this purpose at several international research centers. While cartilage is now imaged mainly by magnetic resonance imaging, some OA features – such as a high prevalence of visible calcinosis – beg further arthroscopy-directed investigation. A new generation of “needle scopes” with far superior optics awaits future investigators, should they develop interest.
, Otwock Mirai Clinic
Journal of Ultrasonography, Volume 21; https://doi.org/10.15557/jou.2021.0029

Abstract:
In the reported case of acute grade 3 anterior cruciate ligament injury, clinical examination and magnetic resonance imaging findings were in conflict, leading to confusion. Ultimately, dynamic ultrasound imaging proved to be the decisive test. The article describes the steps taken to reach the diagnosis. In addition, possible future diagnostic improvements are discussed. Dynamic ultrasound imaging, performed as part of the physical examination, is a valuable supplement to medical documentation. It provides appreciable diagnostic performance for the detection of anterior cruciate ligament insufficiency. Physical examination combined with magnetic resonance imaging, even though they represent the current diagnostic standard, have their limitations.
, Chad Lavender
Published: 29 April 2021
The publisher has not yet granted permission to display this abstract.
Michael A. Ewing, ,
Published: 1 March 2021
The Journal of Knee Surgery, Volume 34, pp 599-604; https://doi.org/10.1055/s-0041-1725176

Abstract:
Posterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.
, Kyle Busch, Andrea Ferretti, Edoardo Monaco, Giorgio Bruni, Adnan Saithna
Published: 16 January 2021
Arthroscopy techniques, Volume 10; https://doi.org/10.1016/j.eats.2020.10.006

The publisher has not yet granted permission to display this abstract.
Robert W Ike, William J Arnold, Kenneth C Kalunian
Published: 1 December 2020
Journal: Rheumatology
Rheumatology, Volume 60, pp 518-528; https://doi.org/10.1093/rheumatology/keaa560

Abstract:
The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to inspect joints to assess synovial conditions that concern rheumatologists. Rheumatologists were among the pioneers developing arthroscopy. Students of the father of modern arthroscopy, Watanabe, included rheumatologists, who taught others once home. Rheumatologists assessed the intra-articular features of their common diseases in the 60s and 70s. Improvements in instrumentation and efforts by a few orthopaedists adapted a number of common joint surgical procedures for arthroscopy. Interest from rheumatologists in arthroscopy grew in the 90s with ‘needle scopes’ used in an office setting. Rheumatologists conducting the first prospective questioning arthroscopic debridement in OA and developing biological compounds reduced the call for arthroscopic interventions. The arthroscope has proven an excellent tool for viewing and sampling synovium, which continues to at several international centres. Some OA features—such as calcinosis—beg further arthroscopic investigation. A new generation of ‘needle scopes’ with far superior optics awaits future investigators.
, Do Kyung Lee,
Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 37, pp 1337-1352; https://doi.org/10.1016/j.arthro.2020.11.031

Abstract:
Purpose To quantify the increased detection rate of lateral hinge fractures (LHFs) owing to additional computed tomography (CT), determine factors associated with LHF, and compare radiologic and clinical outcomes of LHF following medial opening wedge high tibial osteotomy (MOW-HTO). Methods The MEDLINE, Embase, Cochrane Library, and Web of Science databases were systematically searched to identify studies reporting the incidence of LHF detected using additional CT, showing radiologic factors, or comparing radiologic and clinical outcomes between LHFs and non-LHFs after MOW-HTO. Subgroup analyses were performed to compare stable and unstable LHF. Two reviewers performed the study screening, risk of bias assessment, and data extraction processes. Results Eleven studies were included in this review. The weighted estimate of apparent incidence of LHF in the pooled studies was 24.8%. The weighted estimate of incidence was increased by 9.9% owing to the use of CT detection, which indicated approximately 40 percent of total diagnosed LHF was missed on plain radiographs or fluoroscopy. The pooled mean opening gap distance was ranged from 11.40 to 12.60mm in the LHF group and ranged from 9.80 to 11.12 in the non-LHF group, and mean difference of opening gap distance was significantly larger in the LHF (95% CI, 0.64–1.84; P< .0001). However, no significant differences in correction loss, bone union duration, and clinical outcomes were observed between the LHF and non-LHF groups. Subgroup analyses showed no significant difference between stable and unstable LHF. Conclusion Postoperative CT evaluations increase the detection rate of LHF compared with plain radiography alone. Furthermore, the opening gap distance was larger in the LHF group than in the non-LHF group, suggesting the need for attention when opening a wedge by more than 11.4 mm. However, the consequences of LHFs following MOW-HTO were not major concerns when proper management was provided.
Matthew Peters, Brian Gilmer,
Published: 13 November 2020
Arthroscopy techniques, Volume 9; https://doi.org/10.1016/j.eats.2020.07.013

Abstract:
Needle arthroscopy may provide several potential advantages over standard arthroscopy. The smaller camera size and weight allows for a minimally invasive and percutaneous approach with decreased fluid use. As resolution and image quality improve, the potential to expand clinical use for therapeutic applications becomes possible. One promising use is in elbow arthroscopy. Difference in the technology, such as a zero-degree optic and less-rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy and therapeutic procedures. This manuscript introduces the authors' approach to diagnostic needle arthroscopy of the anterior and posterior elbow compartments and placement of therapeutic instrumentation. This technique could theoretically decrease the risk of iatrogenic neurovascular injuries, reduce postoperative swelling and pain due to decreased fluid use, and potentially lead to faster recovery.
Bo Yuan, Yin Zhao, Shengyuan Zhou, Zhiwei Wang, , Lianshun Jia
Published: 9 August 2020
Archives of orthopaedic and trauma surgery, Volume 141, pp 1863-1876; https://doi.org/10.1007/s00402-020-03572-7

The publisher has not yet granted permission to display this abstract.
Noah Shafi, Sarah D. Lang, Hafiz Kassam,
Published: 1 August 2020
Arthroscopy techniques, Volume 9; https://doi.org/10.1016/j.eats.2020.04.007

Abstract:
As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. Smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased use of arthroscopic fluid. Differences in the technology, such as a 0° optic and less rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy as well as modified approaches to therapeutic procedures. This article introduces our preferred approach to diagnostic arthroscopy of the glenohumeral joint and subacromial space with needle arthroscopy and small-bore instruments. This technique could increase efficiency and decrease operative time with certain arthroscopic procedures, and it may improve patient outcomes.
Matt Daggett, Tyler Tucker, Edoardo Monaco, Andrea Redler, Johnathan Pettegrew, Giorgio Bruni,
Published: 1 May 2020
Arthroscopy techniques, Volume 9; https://doi.org/10.1016/j.eats.2020.01.010

Tobias Stornebrink, J. Nienke Altink, Daniel Appelt, Coen A. Wijdicks, Sjoerd A. S. Stufkens,
Published: 17 February 2020
Knee Surgery, Sports Traumatology, Arthroscopy, Volume 28, pp 3080-3086; https://doi.org/10.1007/s00167-020-05889-7

Abstract:
Purpose: Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage. Methods: A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed. Results: All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage. Conclusion: 2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.
Comment
Louis F. McIntyre
Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 35, pp 2722-2723; https://doi.org/10.1016/j.arthro.2019.06.032

Abstract:
In-office needle arthroscopy (IONA) has been around for many years, and technological improvements in image fidelity, patient convenience and access to care, and medical economics have resulted in renewed interest in this diagnostic tool. Patients could be well served by an immediate diagnosis of their joint pathology at the initial office encounter. A limitation of the current literature is that for research purposes, studies comparing IONA with diagnostic surgical arthroscopy and/or magnetic resonance imaging have been performed in the operating room-not the office setting. In addition, IONA is limited to intra-articular evaluation. IONA has been shown to be accurate and cost-effective, and future adoption of this modality seems promising.
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