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1.
Purpose
Most tears of the Ligamentum Teres (LT) are diagnosed when treating other hip pathologies. The purpose of this study was to evaluate the outcome of arthroscopic surgery for a unique group of patients with symptomatic isolated Ligamentum Teres rupture of the hip.Methods
The study included 29 patients who suffered from an isolated Ligamentum Teres rupture of the hip and were treated with an arthroscopic debridement from 2003 to 2008. Patients with femoroacetabular impingement or other hip pathologies except Ligamentum Teres tear were excluded. Clinical results were measured preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Non-Arthritic Hip Score (NAHS). The mean age was 25?years (SD?±?11) with a mean follow-up time of 2.5?years (SD?±?1.5).Results
At the last follow-up, the mean MHHS improved from 70 to 86 [mean difference?=?16 (95% CI 4?C27)] and the mean NAHS improved from 64 to 86 [mean difference?=?22 (95% CI 10?C33)]. Five patients have had a second arthroscopic debridement due to symptomatic recurrent tears.Conclusion
Arthroscopic debridement alone of the isolated Ligamentum Teres rupture has a short-term beneficial result in more than 80% of cases. 相似文献2.
Frank McCormick William Slikker III Joshua D. Harris Anil K. Gupta Geoffrey D. Abrams Jonathan Frank Bernard R. Bach Jr Shane J. Nho 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):902-905
Purpose
The purpose of this study is to identify the incidence of capsular defects in patients undergoing revision hip arthroscopy.Methods
A radiographic and anatomical analysis of MR arthrograms of patients undergoing revision arthroscopy was performed to assess for the presence of capsular defect. Intra-operative images and findings were reviewed. Patients with persistent cam and pincer lesions were excluded.Results
From October 2011 to October 2012, 25 patients underwent revision hip arthroscopy surgery, and 9 patients met our inclusion criteria. Within this series, all patients had post-surgical capsular irregularities and seven patients (78 %) had radiographic evidence of capsule and iliofemoral defects on MR arthrogram. Gross capsular defects were confirmed at revision surgery in two patients.Conclusion
The findings of this study demonstrate post-surgical radiographic and anatomical evidence of capsular defects in a select group of patients following hip arthroscopy.Level of evidence
IV. 相似文献3.
Philipp Schuster Markus Geßlein Philipp Mayer Michael Schlumberger Raul Mayr Jörg Richter 《Knee surgery, sports traumatology, arthroscopy》2018,26(10):3029-3038
Purpose
The purpose of this study was to determine the incidence of septic arthritis following arthroscopic posterior cruciate ligament (PCL) and multi-ligament reconstructions, and to evaluate a treatment regime with sequential arthroscopic irrigation and debridement procedures combined with antibiotic therapy that is focused on retention of the graft.Methods
Between 2004 and 2016 a total of 866 PCL reconstructions and multi-ligament reconstructions were performed at our institution (408 isolated PCL reconstructions, 458 combined reconstructions). Medical charts of all cases were retrospectively reviewed with regard to the occurrence of septic complications. These cases were analysed with special focus on clinical management, number of reoperations and if the grafts were retained. Further, microbiological findings, postoperative clinical course and available clinical outcome data were evaluated.Results
Four cases of septic arthritis (0.5%) were identified (follow-up rate 96.5%): two following isolated PCL reconstruction (0.5%), and two following multi-ligament reconstruction (0.4%), respectively. Septic arthritis was successfully treated in all cases with a mean of 2.5?±?2.4 irrigation and debridement procedures (1–6). In one case of isolated PCL reconstruction, the graft was resected within the fifth irrigation and debridement due to septic loosing of the femoral fixation. All other grafts were retained. With regard to the outcome, all patients were subjectively satisfied with good stability (stress radiographs) in cases of retained grafts.Conclusion
Postoperative septic arthritis after arthroscopic PCL and complex knee ligament reconstructions is a rare but serious complication. Arthroscopic graft-retaining treatment is recommended, as it is established in ACL surgery. Graft retention can be expected in the majority of the cases.Level of evidence
Case series, Level 4.4.
Aaron J. Krych Scott A. Kuzma Rudy Kovachevich Joshua L. Hudgens Michael J. Stuart Bruce A. Levy 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):763-767
Purpose
Currently, there is a paucity of literature regarding outcomes after isolated labral debridement. The purpose of this study was to (1) report the reoperation rate following isolated labral debridement, (2) report clinical and functional outcomes after labral debridement with a minimum 2-year follow-up and (3) identify risk factors for worse clinical and functional outcomes. It was hypothesized that inferior outcomes are associated with an increasing Tönnis grade and those with untreated femoral acetabular impingement (FAI).Methods
The records of patients undergoing hip arthroscopy between 1998 and 2005 were reviewed. Patients with labral tears who underwent isolated arthroscopic labral debridement were identified. Kaplan–Meier estimate of failure (defined as subsequent surgery) was performed for all patients. Patients with minimum 2-year follow-up were assessed with Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). Univariate analysis was then performed to assess which factors were associated with worse clinical and functional outcomes.Results
Fifty-nine hips in 57 patients met our inclusion criteria (39 females, 18 males) with a mean age of 46 ± 14 years and mean follow-up of 5 (range 2–14) years. Overall, 45 % of the hips failed for repeat surgery (20 %) or rating for hip function as abnormal or severely abnormal (25 %). Twelve hips (20 %) required subsequent surgical intervention at a mean 23 (range 6–60) months (7 total hip arthroplasties, 2 open revisions, 3 arthroscopic revisions). Of the remaining hips, mean MHHS was 83.4 ± 19.7, mean HOS ADL score was 83.8 ± 21.3 and mean HOS sport score was 70.6 ± 32.9, with 33 of 41 (75 %) reporting normal or nearly normal current level of function. Univariate analysis revealed that hips with untreated bony impingement (p = 0.01) or requiring concomitant chondroplasty (p = 0.03) had inferior clinical outcome scores.Conclusions
Isolated arthroscopic labral debridement for hip labral tears had 45 % combined poor results when strictly defining failure as repeat surgery or abnormal hip rating. Untreated FAI and concomitant chondroplasty were risk factors for inferior outcome. We recommend concomitant treatment for bony impingement lesions and preservation of the labrum whenever possible.Level of evidence
Retrospective case series, Level IV. 相似文献5.
Luciano Rodrigo Peres Raphael Oliveira Marchitto Gustavo Souza Pereira Fabio Seiti Yoshino Miguel de Castro Fernandes Marcelo Hide Matsumoto 《Knee surgery, sports traumatology, arthroscopy》2016,24(10):3155-3162
Purpose
To evaluate the efficacy of treatment and functional recovery of patients diagnosed with septic arthritis of the knee submitted to two surgical techniques: conventional arthrotomy and arthroscopic approach for debridement.Method
In this prospective clinical study, all adult patients diagnosed with knee pyoarthritis in a 15-month period at a philanthropic hospital in Brazil were randomized into two groups: one group submitted to arthrotomy and the other to arthroscopy. The protocols of antibiotic therapy, physical therapy and postoperative assessment were standardized in both groups. Demographic, clinical, functional and laboratorial variables were compared between groups, with a minimum follow-up of 24 months.Results
There was no difference in effectiveness of treatment in both groups, but 2 patients (18.2 %) of the arthrotomy group needed a new approach. The pain was higher in those undergoing treatment by arthrotomy, at 7 and 14 days postoperatively. The return to activities of daily living took an average of 5.7 days for both groups: 7.1 days for the arthrotomy group and 4.3 days for arthroscopy group.Conclusion
It was found that the treatment of knee septic arthritis by both techniques showed similar effectiveness in healing, but the arthroscopy procedure was better than arthrotomy because it has a lower reinfection rate and low initial inflammatory reaction.Level of evidence
Therapeutic studies, Level I.6.
Geoffrey D. Abrams Marc R. Safran Lauren M. Shapiro William J. Maloney Stuart B. Goodman James I. Huddleston Michael J. Bellino Gaetano J. Scuderi 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):768-773
Purpose
To report hip synovial fluid cytokine concentrations in hips with and without radiographic arthritis.Methods
Patients with no arthritis (Tonnis grade 0) and patients with Tonnis grade 2 or greater hip osteoarthritis (OA) were identified from patients undergoing either hip arthroscopy or arthroplasty. Synovial fluid was collected at the time of portal establishment for those undergoing hip arthroscopy and prior to arthrotomy for the arthroplasty group. Analytes included fibronectin–aggrecan complex (FAC) as well as a standard 12 cytokine array. Variables recorded were Tonnis grade, centre-edge angle of Wiberg, as well as labrum and cartilage pathology for the hip arthroscopy cohort. A priori power analysis was conducted, and a Mann–Whitney U test and regression analyses were used with an alpha value of 0.05 set as significant.Results
Thirty-four patients were included (17 arthroplasty, 17 arthroscopy). FAC was the only analyte to show a significant difference between those with and without OA (p < 0.001). FAC had significantly higher concentration in those without radiographic evidence of OA undergoing microfracture versus those not receiving microfracture (p < 0.05).Conclusion
There was a significantly higher FAC concentration in patients without radiographic OA. Additionally, those undergoing microfracture had increased levels of FAC. As FAC is a cartilage breakdown product, no significant amounts may be present in those with OA. In contrast, those undergoing microfracture have focal area(s) of cartilage breakdown. These data suggest that FAC may be useful in predicting cartilage pathology in those patients with hip pain but without radiographic evidence of arthritis.Level of evidence
Diagnostic, Level III. 相似文献7.
Cheng Wang Yee Han Dave Lee Rainer Siebold 《Knee surgery, sports traumatology, arthroscopy》2014,22(9):2136-2144
Purpose
To evaluate the current evidence for the management of septic arthritis after anterior cruciate ligament (ACL) reconstruction, the factors that affect the outcome after treatment and the retention of graft and implants.Methods
A systematic literature search of the PubMed database was performed on septic arthritis after ACL reconstruction. A total of 301 publications were initially identified, and 17 papers were found to fulfil the criteria to be included in the review.Results
There were 196 cases of septic arthritis after ACL reconstruction in over 30,000 ACL reconstructions, making the proportion of infection 0.6 %. Most patients (114/123, 92.6 %) had an acute or subacute infection at an average of 16.8 ± 10.5 days after ACL reconstruction. Coagulase-negative Staphylococci (CNS) was the most common organism (67/147, 45.6 %) followed by Staphylococcus aureus (SA) (35/147, 23.8 %); 86.9 % underwent surgical treatment of which 92.8 % had an average of 1.54 (up to 4) arthroscopic debridements. The group with SA infection had a higher graft removal rate (33.3 %, p = 0.019), a longer antibiotic duration (35.4 days, p = 0.047) and a worse range of flexion (111.5°, p = 0.036) than the CNS group.Conclusions
CNS was the most common organism in septic arthritis after ACL reconstruction followed by SA. For most authors, arthroscopic debridement combined with intravenous antibiotic therapy was the initial treatment of choice. Antibiotic therapy with or without multiple irrigations of the joint is not recommended based on the high failure rates. Delayed diagnosis of more than 7 days or SA infection required a longer duration of antibiotic therapy and increased the likelihood for graft removal and restricted range of motion. Fungal infection and tubercular infection had a high prevalence of late diagnosis and open debridement.Level of evidence
Systematic review, Level IV. 相似文献8.
Alessandro Aprato Narlaka Jayasekera Richard N. Villar 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):932-937
Purpose
This study describes the medium-term results of revision hip arthroscopy.Methods
Patients with persistent hip pain and a positive impingement sign were considered for revision surgery after the exclusion of other causes of groin pain. Seventy-four consecutive patients were prospectively assessed using the modified Harris hip score for a period of 3 years after surgery. Of the 74 patients, 11 had inadequate follow-up data; thus, a total of 63 patients were qualified for the study. The mean age at index surgery was 37 years, comprising 27 males and 36 females.Results
Revision surgery was performed at a mean of 3 years from index surgery. Chondral lesion associated with labral re-injury was the most common finding at revision arthroscopy. In contrast to other authors, however, only 31 % of our patients underwent revision for persistent femoroacetabular impingement. The mean pre-operative mHHS for all 63 patients was 54 (SD 14.5). The mean post-operative mHHS was 53 (SD 14.9) at 6 weeks, 62 (SD 17.5) at 6 months, 63 (SD 16.5) at 1 year, 64 (SD 16.5) at 2 years and 59 (SD 16.5) at 3 years (p = n.s., 0.02, 0.045, 0.039 and n.s., respectively).Conclusions
Revision arthroscopy results in improvement in outcome in the first 3 years after revision surgery with a success rate of 63.4 % at 1 year, falling to 55.6 % by 3 years.Level of evidence
IV. 相似文献9.
S. Clifton Willimon Karen K. Briggs Marc J. Philippon 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):822-825
Purpose
The purpose of this study was to evaluate possible risk factors for symptomatic adhesions after hip arthroscopy.Methods
Data were analysed from hip arthroscopies performed between 2005 and 2009. Only primary hip arthroscopies were included. Data collected included demographics, primary treatment, rehabilitation, revision surgery, and presence of adhesions at revision.Results
One thousand two hundred and sixty-four hips in patients 18 years or older underwent primary hip arthroscopy during the defined period. Eight underwent revision hip arthroscopy by a different surgeon. Patients under 30 years of age were 5.9 times more likely to be in the adhesion group [95 % CI 3.1–11.5]. Patients who underwent microfracture were 3.1 times less likely to have adhesions compared to patients who did not [95 % CI 1.1–8.2]. Patients who did not receive circumduction therapy were 4.1 times more likely to have adhesions compared to those who performed circumduction exercises [95 % CI 1.25–11.0].Conclusion
Risk factors for adhesions following hip arthroscopy identified were age under 30, modified Harris Hip score under 50, no microfracture performed, and rehabilitation without circumduction.Level of evidence
IV. 相似文献10.
Philipp Schuster Markus Geßlein Michael Schlumberger Philipp Mayer Hermann Josef Bail Jörg Richter 《Knee surgery, sports traumatology, arthroscopy》2018,26(8):2289-2296
Purpose
No systematic studies on optimal treatment of postoperative septic arthritis following arthroscopic meniscus repair are available. The purpose of this study was to retrospectively evaluate the fate of repaired menisci in cases of postoperative septic arthritis, with treatment for infection focused on arthroscopic irrigation and debridement (I&D) and intention to maintain the meniscus.Methods
Data of two sports orthopedics centers of the last 10 years were pooled (approximately 25,000 arthroscopic procedures of the knee). All cases of septic arthritis following arthroscopic meniscus repair were identified. These cases were retrospectively evaluated with regard to clinical course and management, especially the number of necessary I&Ds, if eradication was achieved, and if the repaired meniscus was retained or a partial resection was necessary (‘early failure’). Patients with initially maintained meniscus repairs were contacted if further meniscus surgery was performed in further follow-up (‘late failure’).Results
20 patients with 23 repaired menisci were included. In 65% (13 cases), a concomitant anterior cruciate ligament reconstruction was performed. A mean of 2.0?±?1.0 (1–4) arthroscopic I&Ds were performed in the treatment of septic arthritis. In two cases, additional open surgery was performed (after outside-in sutures). Eradication was achieved in all cases. Four repaired menisci (17.4%) showed loosened fixation or substantial degradation and were consequently partially resected within treatment for septic arthritis (early failures). The follow-up rate for the 19 initially maintained menisci was 94.7% after 3.0?±?2.2 years (median 2.8, 0.4–7.8). Three of these underwent further partial resection (13.0%). Cumulative 3-year survival rate (Kaplan–Meier method) of all repairs was 70.7% (95% CI 50.3–91.1%), and for the subgroup of initially maintained menisci 85.6% (95% CI 67.0–100.0%), respectively.Conclusion
Septic arthritis following meniscus repair can be successfully treated with (sequential) arthroscopic I&Ds. There is a considerable rate of early failures, however, in a mid-term follow-up the failure rate of initially retained menisci is low and comparable to what we know from the literature for cases without infection. Therefore, it is generally recommended to try to save the repaired menisci in these cases.Level of evidence
IV, therapeutic case series.11.
Luke Spencer-Gardner Joseph J. Eischen Bruce A. Levy Rafael J. Sierra William M. Engasser Aaron J. Krych 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):848-859
Purpose
Recent advancements in the understanding of hip biomechanics have led to the development of techniques to remove bony impingement and repair and/or preserve the labrum during hip arthroscopy. Although much attention in the literature is devoted to diagnosis and treatment, there is little information about post-operative rehabilitation. Therefore, the purpose of this review is to (1) provide a five-phase rehabilitation protocol following arthroscopic treatment for FAI and (2) report clinical and functional outcomes of patients following this protocol at minimum 1-year follow-up, in order to provide the surgeon and therapist with a protocol that is supported by clinical data.Methods
All consecutive patients undergoing hip arthroscopy and subsequent five-phase rehabilitation protocol at a single institution from 1 April 2011 to 1 April 2012 were analysed. Inclusion criteria were as follows: no prior ipsilateral hip surgery, completion of the five-phase rehabilitation protocol, minimum 1-year follow-up, and documented outcome scores. Prospective outcomes were assessed with modified Harris hip score (MHHS) and hip outcome score (HOS).Results
Fifty-two patients (19 male and 33 female) met the inclusion criteria with a median age of 42 (range 16–59) years. Mean MHHS, HOS-ADL, and HOS-sport scores at a mean 12.5 (range 12–15) months were 80.1 ± 19.9 (0–100), 83.6 ± 19.2 (13.2–100), and 70.3 ± 27.0 (0–100), respectively.Conclusion
This five-phase rehabilitation programme provides a framework where progression from surgery to increasing post-operative activity level can take place in a predictable manner. Patients following this rehabilitation protocol after hip arthroscopy demonstrated satisfactory clinical and functional outcomes, validating its implementation.Level of evidence
Case series, Level IV. 相似文献12.
Mikael Sansone Mattias Ahldén Pall Jonasson Christoffer Thomeé Leif Swärd Adad Baranto Jón Karlsson Roland Thomeé 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):774-780
Purpose
Hip arthroscopy is a rapidly expanding field in orthopaedics. Indications and surgical procedures are increasing. Although several studies report favourable clinical outcomes, further scientific evidence is needed for every aspect of this area. Accordingly, a registry for hip arthroscopy was developed. The purpose of this study is to describe the development of the registry and present its baseline data.Methods
A Scandinavian expert group agreed to use a set of functional outcome scores for the evaluation of hip arthroscopy patients. They were the international hip outcome tool-12, hip and groin outcome score, EQ-5D, hip-specific activity level scale and visual analogue scale for overall hip function. These scores were validated and culturally adapted to Swedish. A database was created for web-based, self-administered questionnaires. Perioperative data were also collected.Results
The process leading to the registry is reported. Baseline data from the first 606 patients collected during a 14-month period are presented. The preferred surgical technique is presented. The mean operation time was 69 (SD 14) minutes. In 333 procedures, mixed cam and pincer pathology were addressed, compared with 223 procedures with the treatment of isolated cam pathology. Outpatient surgery was performed in all patients.Conclusion
The baseline data in this study can be used as reference values for future scientific work from this registry. Knowledge of the process leading to the development of the registry could be useful to other researchers planning similar work.Level of evidence
IV. 相似文献13.
M. Kowalczuk M. Bhandari F. Farrokhyar I. Wong M. Chahal S. Neely R. Gandhi O. R. Ayeni 《Knee surgery, sports traumatology, arthroscopy》2013,21(7):1669-1675
Purpose
The use of hip arthroscopy to address injuries and conditions about the hip is becoming more widespread. There are several narrative reviews regarding complications of hip arthroscopy but a systematic review is currently lacking. The primary goal of this study is to determine the complication rate associated with hip arthroscopy in the literature.Methods
A search of the EMBASE and Ovid Medline databases was performed to identify articles published between 1 January 2000 and 25 November 2011 that reported a complication rate after hip arthroscopy. Appropriate inclusion and exclusion criteria were applied to identify articles, and a meta-analysis was performed to determine an overall complication rate. Complications were divided into major and minor.Results
A total of 66 papers (n = 6,962 hip arthroscopies) were identified and deemed appropriate for analysis. The overall complication rate was found to be 4.0 % (95 % CI 2.9–5.2 %). Of the 287 complications identified in the literature, 20 were deemed major constituting a rate of 0.3 %.Conclusions
Hip arthroscopy appears to be safe. The vast majority of complications are minor in nature. Prospective trials looking at the complications of hip arthroscopy would aid in identifying prognostic factors.Level of evidence
Systematic review and meta-analysis, Level III. 相似文献14.
Manar A. Bessar Hanan A. Hassan Wesam A. Mokhtar 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(4):971-975
Aim
The aim of this study is to evaluate the role of high resolution ultrasonography (HRUS) of the hip in premature neonates admitted to the neonatal intensive care unit (NICU) in diagnosis of septic hip arthritis.Patients and methods
This prospective study was done for twenty premature neonates having clinical and laboratory findings compatible with the diagnosis of acute septic arthritis. They were subjected to HRUS of the hip as well as US-guided aspiration and analysis of synovial fluid.Results
Hip ultrasonography showed synovial fluid containing echoes in twelve patients and was clear in six patients. Joint capsule was thickened in fourteen patients. Seventeen patients had sonographic features of septic arthritis. The sensitivity of HRUS was 93.8%, specificity 50%, positive predictive value 88.2%, negative predictive value 66.7% and the accuracy was 85%.Conclusion
HRUS is beneficial in early diagnosis of septic hip arthritis in premature neonates admitted to the NICU. It is an easy, available and rapid procedure. 相似文献15.
Patrícia Martins e Souza Bruno Lobo Brandão Eduardo Brown Geraldo Motta Martim Monteiro Edson Marchiori 《Skeletal radiology》2014,43(8):1085-1092
Objective
To investigate the accuracy of conventional magnetic resonance imaging (MRI) in determining the severity of glenoid bone loss in patients with anterior shoulder dislocation by comparing the results with arthroscopic measurements.Subjects and methods
Institutional review board approval and written consent from all patients were obtained. Thirty-six consecutive patients (29 men, seven women; mean age, 34.5 [range, 18–55] years) with recurrent anterior shoulder dislocation (≥3 dislocations; mean, 37.9; range, 3–200) and suspected glenoid bone loss underwent shoulder MRI before arthroscopy (mean interval, 28.5 [range, 9–73] days). Assessments of glenoid bone loss by MRI (using the best-fit circle area method) and arthroscopy were compared. Inter- and intrareader reproducibility of MRI-derived measurements was evaluated using arthroscopy as a comparative standard.Results
Glenoid bone loss was evident on MRI and during arthroscopy in all patients. Inter- and intrareader correlations of MRI-derived measurements were excellent (intraclass correlation coefficient?=?0.80–0.82; r?=?0.81–0.86). The first and second observers’ measurements showed strong (r?=?0.76) and moderate (r?=?0.69) interreader correlation, respectively, with arthroscopic measurements.Conclusions
Conventional MRI can be used to measure glenoid bone loss, particularly when employed by an experienced musculoskeletal radiologist. 相似文献16.
Guillaume Bierry Ambrose J. Huang Connie Y. Chang Martin Torriani Miriam A. Bredella 《Skeletal radiology》2012,41(12):1509-1516
Introduction
The purpose of this study was to report the MRI findings that can be encountered in successfully treated bacterial septic arthritis.Materials and methods
The study included 12 patients (8 male and 4 female; mean age 38?years, range 9–85) with 13 proven cases of bacterial septic arthritis. The joints involved were hip (n?=?3), knee (n?=?3), shoulder (n?=?2), sacroiliac (n?=?2), ankle (n?=?1), wrist (n?=?1), and elbow (n?=?1). MRI examinations following surgical debridement and at initiation of antibiotic therapy and after successful treatment were compared for changes in effusion, synovium, bone, and periarticular soft tissues. Imaging findings were correlated with microbiological and clinical findings.Results
Joint effusions were present in all joints at baseline and regressed significantly at follow-up MRI (p?=?0.001). Abscesses were present in 5 cases (38?%), and their sizes decreased significantly at follow-up (p?=?0.001). Synovial enhancement and thickening were observed in all joints at both baseline and follow-up MRI. Myositis/cellulitis was present in 10 cases (77?%) at baseline and in 8 cases (62?%) at follow-up MRI. Bone marrow edema was present in 10 joints (77?%) at baseline and persisted in 8 joints (62?%). Bone erosions were found in 8 joints (62?%) and persisted at follow-up MRI in all cases.Conclusion
The sizes of joint effusions and abscesses appear to be the factors with the most potential for monitoring therapy for septic arthritis, since both decreased significantly following successful treatment. Synovial thickening and enhancement, periarticular myositis/cellulitis, and bone marrow edema can persist even after resolution of the infection. 相似文献17.
Olufemi R. Ayeni Forough Farrokhyar Sarah Crouch Kevin Chan Sheila Sprague Mohit Bhandari 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):801-805
Purpose
Diagnostic hip injections are often used to confirm intra-articular pathology prior to arthroscopic treatment for femoroacetabular impingement (FAI). However, little is known whether the type of response correlates with the post-operative functional outcomes. The purpose of this study is to document the ability of a diagnostic hip injection to predict short-term functional outcomes following arthroscopic surgical management.Methods
A prospective cohort of 52 patients diagnosed with FAI who had an intra-articular hip injection prior to arthroscopic surgery was evaluated. A pain diary was used during the 2 weeks after hip injection to document response. In addition, the modified Harris Hip Score (mHHS) was administered preoperatively and 6 months post-operatively to assess functional outcomes. The relationship between response to an intra-articular hip injection and mHHS scores 6 months after FAI surgery was evaluated.Results
Overall, 42 of 52 (81 %) patients diagnosed with FAI achieved pain relief from the hip injection. Outcomes according to mHHS scores improved significantly at the 6-month follow-up visit (19 points, 95 % CI 15–24, p = 0.001). The therapeutic utility of the hip injection suggested that lack of pain relief predicted a lack of functional improvement following arthroscopic surgery.Conclusion
In this study, the data suggests that a positive response from an intra-articular hip injection is not a strong predictor of short-term functional outcomes following arthroscopic management of FAI. However, a negative response from an intra-articular hip injection may predict a higher likelihood of having a negative result from surgery.Level of evidence
Level II. 相似文献18.
Purpose
Trochlear dysplasia is an important aetiological factor for the development of patellofemoral instability (PFI). The aim of the study was to identify the arthroscopic morphology of trochlear dysplasia that can be helpful when planning operative treatment for PFI.Methods
Magnetic resonance imaging (MRI) scans and strict lateral radiographs of 46 patients treated for PFI were assigned according to Dejour and matched with arthroscopic views from the lateral superior arthroscopic portal. On arthroscopy, signs of trochlear dysplasia were identified and classified into two types. Intra- and inter-observer agreements of the arthroscopic evaluation were assessed.Results
Arthroscopically, 2 major types of trochlear dysplasia could be distinguished. Type I shows a flat trochlear groove with an elevated trochlear floor in relation to the anterior femoral cortex. In type II, the proximal trochlea was convex with a lateral trochlear bump. Arthroscopic evaluation was not consistent with the Dejour’s radiographic and axial MRI classification. Arthroscopic grading showed excellent intra- and inter-observer agreements (81–92 %).Conclusion
Arthroscopic evaluation can give additional information about the severity of trochlear dysplasia. This additional information can be used as an aid in decision making for the treatment of PFI.Level of evidence
II. 相似文献19.
Objective
Significant differences between magnetic resonance imaging reports and intraoperative findings at the time of hip arthroscopy were documented in our practice. We sought to examine the accuracy of radiological reporting of hip pathology based on the training level of the reporting radiologist.Materials and methods
A retrospective review of hip arthroscopies carried out between July 2008 and June 2009 identified 61 cases where original MRI scans had been reported by general community radiologists. These scans were then reviewed by musculoskeletal specialist radiologists who were blinded to both the original report and the surgical findings. Accuracy of both subsets of radiologists was compared to arthroscopic findings with regard to labral, acetabular, femoral and impingement lesions.Results
Musculoskeletal radiologists performed better than community radiologists in terms of overall accuracy. Accuracy rates for MSK radiologists were 85, 79, 59, and 82% for labral, acetabular chondrosis, and femoral chondrosis and impingement lesions, respectively. Whereas accuracy rates for community radiologists were 70, 28, 52, and 59% (p values?=?0.08, <0.001, 0.59, <0.001). Accuracy was significantly improved for both groups of radiologists when MR arthrograms were reviewed rather than conventional MRIs.Conclusions
This study establishes the relationship between accuracy of reporting and the training level of the performing radiologists. 相似文献20.
Hyong-Nyun Kim Yoo-Jung Park Gab-Lae Kim Yong-Wook Park 《Knee surgery, sports traumatology, arthroscopy》2013,21(6):1427-1433