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ObjectivesTo assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up.DesignMulticentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial.SettingOrthopaedic departments in five public hospitals in Finland.Participants146 adults, mean age 52 years (range 35–65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised.InterventionsAPM or placebo surgery (diagnostic knee arthroscopy).Main outcome measuresWe used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade ≥1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function (Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale).ResultsThere was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade ≥1 of 13%, 95% CI −2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), −1.7 (95% CI −7.7 to 4.3) in WOMET, −2.1 (95% CI −6.8 to 2.6) in Lysholm knee score, and −0.04 (95% CI −0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar.ConclusionsAPM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery.Trial registrationClinicalTrials.gov (NCT01052233 and NCT00549172).

Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.Design Randomised controlled superiority trial.Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway.Participants 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis.Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone.Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months.Results No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval −4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit.Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial’s inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.Trial registration www.clinicaltrials.gov (NCT01002794).

ObjectiveTo assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.MethodsIn this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35–65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out.ResultsIn the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, −4.3; 95% CI, −11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (−3.2; −8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (−0.4; −1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups.ConclusionsIn this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.

Background Anatomical repair of Bankart lesions and restoring the tension of the antero-inferior capsulo-labral complex is the optimum method of surgical treatment with a variety of fixation methods including suture anchors and trans-glenoid sutures. Grand knot technique is a modification of the trans-glenoid sutures technique that can be an alternative to double-loaded suture anchors with a lower cost. We aimed to compare the outcomes and complications of both techniques. Methods This is a randomized controlled study that was conducted on 200 patients with recurrent anterior glenohumeral dislocation, of whom 170 patients completed at least a three-year follow-up period. Arthroscopic Bankart repair using two double-loaded knotted suture anchors was performed in 78 cases (Group A) while repair was done using two trans-glenoid grand knots in other 92 cases (Group B). Patients were evaluated in terms of range of motion, functional scores (Constant, Rowe, and ASES), and complication rate. Results The mean operative time was significantly longer in Group B (87.7 ± 24) minutes compared to Group A (61.2 ± 28.1) minutes ( P  = 0.002). No statistically significant difference was found between both groups regarding postoperative external rotation range of adducted arm, functional scores, and rate of recurrence. Only forward flexion and external rotation of abducted arm were significantly better in Group A ( P  = 0.005 and < 0.001 respectively). Conclusion Trans-glenoid double-loaded grand knot technique is an alternative surgical option for the treatment of Bankart lesions with comparable results to double-loaded anchors regarding the functional outcomes and failure rates. Clinical Trial Registration (Retrospectively registered) Registration number: NCT06394609 28-4-2024.

BackgroundThe management of massive, irreparable rotator cuff tears (RCT) is challenging and associated with high failure rates. There are no current consensus or definitive guidelines concerning the optimal surgical treatment for this devastating condition. This study was designed to confirm the long-term safety and efficacy of the biodegradable inflatable InSpace™ system in patients with massive reparable or irreparable RCTs.MethodsIn this open-label, single arm, prospective study, subjects with massive RCT underwent subacromial implantation with the biodegradable spacer. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Total Constant Score (TCS).ResultsTwenty-four patients were treated and assessed. Four patients had partial tears, and in three of them RC repair was performed. These patients were not included in the efficacy analyses. Of the participating subjects who reached the 5-year follow-up, 84.6% of the patients showed a clinically significant improvement of at least 15 points in their score, while 61.54% showed at least 25 points of improvement. Only 10% of the treated patients showed no improvement or worsening in the shoulder score comparing to their baseline. An overall improvement in the total CS commencing at 3 months and sustained by 6 months through to 5 years of follow-up (P < 0.0001) was demonstrated.ConclusionsWe conclude that in this initial cohort, arthroscopic implantation of InSpace™ system represented an effective alternative to the existing arthroscopic procedures in patients with painful massive RCT refractory to conservative management. Further randomized controlled trials comparing the clinical and functional outcomes after implantation of the InSpace™ device are warranted.

Shoulder arthroscopy has become a common procedure, but it is often associated with severe postoperative pain. This study aims to evaluate the analgesic effect of ultrasound-guided coracoid approach brachial plexus block combined with posterior suprascapular nerve block in shoulder arthroscopy. To this end, fifty patients undergoing right shoulder arthroscopy were randomly divided into two groups with 25 patients in each group. Before induction of general anesthesia, patients in the two groups received different nerve blocks. In Group A, participants received ultrasound-guided supraclavicular brachial plexus block with 25 mL 0.3% ropivacaine. In Group B, coracoid approach brachial plexus block and posterior suprascapular nerve block were carried out under ultrasound guidance. M-mode ultrasound was used to measure diaphragm movement before and 30 min after the block, and the presence of hemidiaphragm paralysis was recorded during calm breathing and deep breathing. Pain scores were recorded at 1, 6, 12, 24 and 48 h after surgery. The actual press times of the PCA pump and consumption of sufentanil were also recorded.A total of 45 patients completed this study. The incidence of hemidiaphragm paralysis in Group B was significantly lower than that in Group A under both calm breathing and deep breathing. The two groups displayed similar pain scores at 1, 6, 12, 24 and 48 h after surgery. Compared with supraclavicular brachial plexus block, coracoid approach brachial plexus block combined with posterior suprascapular nerve block can significantly reduce the occurrence of hemidiaphragm paralysis with an equivalent postoperative analgesic effect for shoulder arthroscopy. Therefore, the latter may be beneficial for early postoperative recovery in patients who cannot tolerate hemidiaphragm paralysis. Trial registration: This study was registered in the Chinese Clinical Trial Register (ID ChiCTR2100043069) on 04/02/2021.

Introduction The use of multiple layers of vibril under tourniquet cuffs is common. However, these layers can lead to complications. We designed a special waterproof curtain for use under tourniquet cuffs. Its effects on burns, postoperative pain, and operating room staff satisfaction were evaluated. Materials & methods In this randomized clinical trial, 34 patients underwent arthroscopic surgery of the knee joint in the operating rooms of selected hospitals at Isfahan University of Medical Sciences in 2022 via a simple random method. Even and odd days were divided into two groups: Group A (even days: special tourniquet drape: 17 people) and Group B (odd days: usual layers under the pneumatic tourniquet cuff: 17 people). The degree of pain was evaluated with a visual analog scale (VAS), the severity of burns was evaluated on the basis of a rating from one to four, and the satisfaction of the operating room personnel was evaluated via a standardized questionnaire with 10 questions. Results Pain intensity was lower in Group A than in Group B at all times: immediately after recovery (2.29 ± 0.47 vs. 5.00 ± 0.71, P  < 0.001), during the first eight hours (1.71 ± 0.47 vs. 3.94 ± 0.56, P  < 0.001), during the second eight hours (2.82 ± 0.73 vs. 5.12 ± 0.45, P  < 0.001), and during the third eight hours (1.65 ± 0.61 vs. 3.59 ± 0.62, P  < 0.001). None of the participants in Group A and only one participant (5.9%) in Group B suffered burns, a difference that was not significant ( P  = 0.5). Most of operating room personnel (82.4%) reported a \"high\" level of satisfaction. Conclusion The use of a special tourniquet in arthroscopic surgeries of the knee joint seems to have a positive effect, considering the reduction in postoperative pain and the increase in the level of satisfaction of the operating room personnel.

Arthroscopic sub-acromial decompression (decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically) is a common surgery for subacromial shoulder pain, but its effectiveness is uncertain. We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression. We did a multicentre, randomised, pragmatic, parallel group, placebo-controlled, three-group trial at 32 hospitals in the UK with 51 surgeons. Participants were patients who had subacromial pain for at least 3 months with intact rotator cuff tendons, were eligible for arthroscopic surgery, and had previously completed a non-operative management programme that included exercise therapy and at least one steroid injection. Exclusion criteria included a full-thickness torn rotator cuff. We randomly assigned participants (1:1:1) to arthroscopic subacromial decompression, investigational arthroscopy only, or no treatment (attendance of one reassessment appointment with a specialist shoulder clinician 3 months after study entry, but no intervention). Arthroscopy only was a placebo as the essential surgical element (bone and soft tissue removal) was omitted. We did the randomisation with a computer-generated minimisation system. In the surgical intervention groups, patients were not told which type of surgery they were receiving (to ensure masking). Patients were followed up at 6 months and 1 year after randomisation; surgeons coordinated their waiting lists to schedule surgeries as close as possible to randomisation. The primary outcome was the Oxford Shoulder Score (0 [worst] to 48 [best]) at 6 months, analysed by intention to treat. The sample size calculation was based upon a target difference of 4·5 points (SD 9·0). This trial has been registered at ClinicalTrials.gov, number NCT01623011. Between Sept 14, 2012, and June 16, 2015, we randomly assigned 313 patients to treatment groups (106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment). 24 [23%], 43 [42%], and 12 [12%] of the decompression, arthroscopy only, and no treatment groups, respectively, did not receive their assigned treatment by 6 months. At 6 months, data for the Oxford Shoulder Score were available for 90 patients assigned to decompression, 94 to arthroscopy, and 90 to no treatment. Mean Oxford Shoulder Score did not differ between the two surgical groups at 6 months (decompression mean 32·7 points [SD 11·6] vs arthroscopy mean 34·2 points [9·2]; mean difference −1·3 points (95% CI −3·9 to 1·3, p=0·3141). Both surgical groups showed a small benefit over no treatment (mean 29·4 points [SD 11·9], mean difference vs decompression 2·8 points [95% CI 0·5–5·2], p=0·0186; mean difference vs arthroscopy 4·2 [1·8–6·6], p=0·0014) but these differences were not clinically important. There were six study-related complications that were all frozen shoulders (in two patients in each group). Surgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinically important. Additionally, surgical decompression appeared to offer no extra benefit over arthroscopy only. The difference between the surgical groups and no treatment might be the result of, for instance, a placebo effect or postoperative physiotherapy. The findings question the value of this operation for these indications, and this should be communicated to patients during the shared treatment decision-making process. Arthritis Research UK, the National Institute for Health Research Biomedical Research Centre, and the Royal College of Surgeons (England).

Purpose The aim of the study was to compare the intermediate-term clinical outcomes between lateral ligaments augmentation using suture-tape and modified Broström repair in a selected cohort of patients. The hypothesis of the presented study is that suture-tape augmentation technique has comparable clinical and radiological outcomes with arthroscopic Broström repair technique. Methods Sixty-one consecutive patients with chronic ankle instability were operated between 2012 and 2016 randomized to 2 groups. First group was composed of 31 patients whom were operated using an arthroscopic Broström repair technique (ABR) and second group was composed of 30 Patients whom were operated using arthroscopic lateral ligaments augmentation using suture-tape internal bracing (AST). At the end of total follow-up time, all patients were evaluated clinically using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiological evaluation was performed using anterior drawer and varus stress radiographs with standard Telos device in 150 N. Talar tilt angles and anterior talar translation were measured both preoperatively, 1 year postoperatively and at the final follow-up. Results Preoperative total FAOS scores for ABR and AST groups were 66.2 ± 12 and 67.1 ± 11, respectively. Postoperative Total FAOS scores for ABR and AST groups were 90.6 ± 5.2 and 91.5 ± 7.7, respectively. There was no statistical difference in between 2 groups both pre- and postoperatively (n.s). According to FAAM, sports activity scores of ABR and AST groups were 84.9 ± 14 and 90.4 ± 12 at the final follow-up, which showed that AST group was significantly superior ( p  = 0.02). There were no significant differences in preoperative and postoperative stress radiographs between the two groups. Mean operation time for AST and ABR groups were 35.2 min and 48.6 min, respectively, which shows statistically significantly difference ( p  < 0.05). There was no significant difference in recurrence rate of instability between to operation techniques (n.s). Conclusions Arthroscopic lateral ligament augmentation using suture tape shows comparable clinical outcomes to arthroscopic Broström repair in the treatment of chronic ankle instability at intermediate-term follow-up time. Arthroscopic lateral ligament augmentation using suture tape has a significant superiority in the terms of less operation time and no need for cast or brace immediate after surgery which allows early rehabilitation. It also has a significant superiority in the terms of FAAM scores at sports activity. However, there was no difference during daily life. Level of evidence II.