This chapter mainly focuses on medial meniscus posterior root tear which is the point of attention nowadays because it is the common degeneration process and can lead to early-onset osteoarthritis of the knee without treatment. The biomechanics of the medial meniscus root tear is similar to total meniscectomy. Hence, early detection and diagnosis will lead to better outcome. Most cases with medial meniscus root tear also have degenerative change of the knee. Meniscal extrusion is a common finding in magnetic resonance imaging (MRI) which represent impairing of hoop stress function of the meniscus. Patient selection and understanding of the natural history of the disease is a particularly important. Options for the treatment including conservative treatment, surgical treatment such as partial meniscectomy, meniscus root repair, or reduction of meniscal extrusion. Outcome of these treatments are variable depending on the condition of the patients. Long term outcome of surgical treatment revealed lower rate of knee replacement compared with conservative treatment.
Background: Functional or quality of life questionnaires are important tools in clinical investigations. The Lysholm Knee Scoring Scale and Tegner Activity Scale are knee-specific questionnaires that are widely used to assess knee function. Purpose: To translate both questionnaires into Thai and to assess the validity and reliability of the Thai versions of the Lysholm and adjusted Tegner scales. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The Lysholm and Tegner scales were translated into Thai by using the forward-backward translation protocol. Because cultural modifications were made to the sports used to measure activity on the Tegner scale, the authors of this study refer to the Thai version as the “Thai adjusted Tegner scale.” The reliability and validity of the translated scales were evaluated by obtaining the responses of 60 consecutive patients (mean age, 40.5 years; 34 male, 26 female); the patients also completed the Thai version of the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). Criterion validity was tested by correlating the scores from both translated questionnaires with those from the Thai IKDC-SKF, while reliability was assessed by measuring test-retest reliability and internal consistency. Results: The Thai Lysholm scale showed a strong correlation with the Thai IKDC-SKF ( r = 0.89), while the Thai adjusted Tegner scale showed a moderate correlation with the Thai IKDC-SKF ( r = 0.60). The intrarater and test-retest reliability measures were excellent for the Thai Lysholm (intraclass correlation coefficient [ICC], 0.94 and 0.98, respectively) and moderate to good for the Thai adjusted Tegner (ICC, 0.73 and 0.86, respectively). The internal consistency for the Thai Lysholm was acceptable at all the time points (Cronbach alpha, 0.71-0.73). Conclusion: The Thai Lysholm and Thai adjusted Tegner scales adequately retained the characteristics of the original versions. They can be considered reliable instruments for Thai patients with knee-related problems.
HilleSachs lesions are significantly correlated with recurrent anterior shoulder instability. The remplissage procedure is designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterosuperior capsule in patients with off-track HilleSachs lesions. This Technical Note describes an arthroscopic all-inside suture bridge to gain more footprint contact area and tissue compression to improve healing. Moreover, it does not have the necessity of going through the subacromial space to retrieve and tie the sutures. Thus, the procedure reduces the operative time and improves reproducibility.
PurposeSuprascapular nerve (SN) at the spinoglenoid notch is a mobile structure which is vulnerable to iatrogenic injury from screw or guidewire penetration during shoulder surgery such as Latarjet procedure or SLAP/Bankart repairs. The primary objective is to identify the distance between posterior glenoid and SN in different shoulder abduction and rotation. The secondary objective is to identify the distance in standard lateral decubitus position. MethodsNineteen shoulders from 10 Thiel embalmed soft cadavers were used in this study. The dissection of posterior shoulder was done to identify the SN at spinoglenoid notch. The distance between the posterior glenoid rim and the SN was measured. In beach chair position, the SN distance from six combinations of shoulder position was obtained: adduction/90° internal rotation (ADIR), adduction/neutral rotation (ADN), adduction/90° external rotation (ADER), 45° abduction/90° internal rotation (ABIR), 45° abduction/neutral rotation (ABN), 45° abduction/90° external rotation (ABER). Subsequently, the suprascapular nerve distance was measured in standard lateral decubitus position with 10 lbs. longitudinal traction. ResultsIn the beach chair position with the shoulder in adduction, the mean distances between the glenoid and the SN in ADIR, ADN and ADER were 15.0 ± 3.3, 19.3 ± 2.6 and 19.5 ± 3.1 mm, respectively. During shoulder abduction, the mean distances when the shoulder was in ABIR, ABN and ABER were 15.2 ± 3.4, 19.4 ± 3.0 and 19.3 ± 2.6 mm, respectively. The mean distance for the lateral decubitus position was 19.3 ± 2.4 mm. The distance between the glenoid and SN was significantly shorter when the shoulder was positioned in internal rotation than in neutral (p < 0.001) or external rotation (p < 0.001) when compared to the same shoulder abduction position. The lateral decubitus position had comparable SN distance with the shoulder position of abduction/neutral rotation in beach chair position. ConclusionThe SN was closest to posterior glenoid rim if the shoulder was in internal rotation. Therefore, shoulder internal rotation must be avoided during guidewire and cannulated screw placement in the Latarjet procedure and drill bit insertion during anchor placement in SLAP/Bankart repair.
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