Popliteal cysts are characterized by enlargement of the gastrocnemius-semimembranosus bursa. The pathogenesis includes a valvular opening between the knee joint and the bursa, and associated intra-articular pathology may give rise to knee effusion. The mainstay of treatment is conservative. If popliteal cysts are symptomatic, analgesia, aspiration, and steroid injection therapy may be considered, but most recur rapidly. In the past, open excision was an option if they remained symptomatic, but the associated recurrence rate was high. One important reason was that the intraarticular pathology causing the knee effusion was not treated. We present an alternative minimally invasive arthroscopic treatment using dye (methylene blue) directly injected into the cyst, which will leak from the cyst into the joint, to identify the valvular opening. The thickened valve is opened using a basket forceps and then enlarged using a motorized shaver to disrupt the 1-way mechanism between the joint and bursa, as well as to establish an unobstructed freeway connection between them. We also present a safe technique to create a direct posterior portal. Intracystic debridement of the fibrous membrane, nodules, and septa through this portal will decrease the recurrence rate of the popliteal cyst. P opliteal cysts (also termed "Baker cysts") were first described over a century ago by Adams 1 and later by Baker.2 They are most frequently characterized by enlargement of the gastrocnemius-semimembranosus bursa, which is one of several bursae around the knee. Studies of the pathogenesis of popliteal cysts have shown that they are connected to the knee joint by means of a valvular opening.3,4 The presence of a valve, along with the existence of an effusion, creates unidirectional flow of the synovial fluid from the articular cavity to the cyst and is one of the fundamental factors responsible for the appearance and persistence of the cyst.Treatments for popliteal cysts have included conservative approaches or open resection. [5][6][7] Because the cysts are often asymptomatic and resolve spontaneously, many are treated by observation alone. If they are symptomatic, analgesia, aspiration, and steroid injection therapy may be considered, but most recur rapidly. In the past, open excision was an option if they remained symptomatic; however, an associated recurrence rate as high as 42% to 63% has been reported. 6,7 Several studies have reported frequently associated intra-articular pathologies with the cysts and warned of a high recurrence rate if the intra-articular pathologic condition is not addressed. 8-12Arthroscopic intervention is favored over open excision because of the successful outcomes of arthroscopic treatment for conditions associated with popliteal cysts. Arthroscopy is minimally invasive, is associated with a lower amount of risk, directly addresses both intraarticular pathology and the cyst, and allows early aggressive rehabilitation. Recent advances in arthroscopic techniques have been made to effectively address the ...
Purpose and hypothesis: Acromion spur is the extrinsic factor for impingement syndrome and rotator cuff tear. The Rockwood tilt view can be used to evaluate prominence of the anterior acromion, however no study has shown the correlation of findings between the Rockwood tilt view and the arthroscopic finding. Methods: We developed the arthroscopic classification of acromion spur as type 1 flat spur, type 2 bump spur, type 3 heel spur, type 4 keel spur, and type 5 irregular spur. Patients with rotator cuff syndrome who underwent arthroscopic surgery were recruited. Two observers were asked to classify the type of spur from arthroscopic findings and Rockwood tilt views separately in random pattern. The prevalence of supraspinatus tendon tear was also recorded as no tear, partial-thickness tear, and full-thickness tear. Results: The keel spur (33.9%) was the most common finding followed by the heel spur (27.8%). The correlation was high especially for the heel, the keel, and the irregular spur (75.47%, 74.03%, and 72.73%, respectively.) These three types of spurs have a high prevalence of full thickness of supraspinatus tendon tear. Conclusion: The Rockwood tilt view can be used to evaluate the morphology of an acromion spur, especially the at-risk spur that correlates highly with the full-thickness supraspinatus tendon tear. The arthroscopic classification will also be a useful tool to improve communication between the surgeon and the guide for appropriate treatment in a rotator cuff tear patient when encountering the heel, keel, and irregular spur.
Background To study of efficacy of early pelvic circumferential compression device using in patients with suspected pelvic trauma, compared with conventional stepwise approach. Methods Traumatic injury and at least one of the following criteria are required for inclusion: loss of consciousness or a Glasgow coma score (GCS) of less than 13; systolic blood pressure less than 90 mmHg; falling from more than 6 m; injury to several important organs; and a positive pelvic compression test. Patients who satisfied the inclusion criteria for the experimental group were given an early application of a commercial pelvic sling beginning in July 2019. The control group consisted of cases who got the device after clinical or radiological confirmation of a pelvic fracture in the previous year. Gender, age, mechanism of injury, GCS, hospital stay, amount of packed red blood cell transfusion, hematocrit in emergency room, and hematocrit 24 h after application of pelvic binder were all assessed and compared. Results The study had a total of 30 participants, with 15 in each group. The number of packed red blood cell transfusions in the early pelvic binder group (0.80 ± 1.42) is considerably lower than in the control group (2.4 ± 2.32) (P = 0.008), although the hematocrit change is not statistically different between the groups (2.1 VS 0.7) (P = 0.191). The time it took to install a pelvic binder was considerably shorter in the early pelvic binder group (16.40 ± 5.45) than in the control group (40.40 ± 13.64) (P = 0.001). There were no problems associated to soft tissue and skin necrosis in either group of patients. Conclusions The use of the PCCD for 24 h prior to clinical and radiographic confirmation has significantly reduced the rate of packed red blood cell transfusion in any pelvic fracture patient without device-related complications. Trial registration The study was entered into the Thai Clinical Trials Registry (TCTR20210809007).
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