Heterotopic Ossification After the Arthroscopic Treatment of Lateral Epicondylitis

Desai, Mihir J.; Ramalingam, Hari; Ruch, David S.

doi:10.1177/1558944716668844

Cited by 8 publications

(13 citation statements)

References 18 publications

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“…To date, there have been 8 case reports on HO after arthroscopic procedures of the elbow. 2,24,32,35,36,51,74,85 Gofton and King 32 reported on a 47-year-old farmer who developed HO anteriorly and posteriorly to the distal humerus after arthroscopic loose body removal. At 4 years postoperatively, the patient underwent an open debridement and capsulectomy for residual stiffness and recurrent locking sensations.…”

Section: Resultsmentioning

confidence: 99%

“…After excision of the mature lesion and anterior capsular release, the patient regained full range of motion and returned to competitive pitching. Desai et al 24 presented a case of HO after arthroscopic debridement of lateral epicondylitis in a former collegiate basketball player. Early HO anterolateral to the lateral epicondyle was found on radiographs 7 weeks postoperatively, and he underwent open HO excision with repair of the common extensor origin 11 weeks later, with a single 700-cGy dose of adjunctive radiation therapy on the day of surgery.…”

Section: Resultsmentioning

confidence: 99%

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Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

Zhou

Gee

Hansen

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Heterotopic ossification (HO) is the formation of bone in soft tissue resultant from inflammatory processes. Lesion formation after arthroscopic procedures is an uncommon but challenging complication. Optimal prophylaxis and management strategies have not been clearly defined. Purpose: To present a scoping review of the pathophysiology, risk factors, diagnostic modalities, prophylaxis recommendations, and current treatment practices concerning HO after arthroscopic management of orthopaedic injuries. Study Design: Scoping review; Level of evidence, 4. Methods: A scoping review via a PubMed search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The search strategy was based on the terms “heterotopic ossification” AND “arthroscopy.” The clinical outcomes review included studies on the arthroscopic management of orthopaedic injuries in which the primary subject matter or a secondary outcome was the development of HO. An analysis of the pathophysiology, diagnostic modalities, and management options was reported. Results: A total of 43 studies (33,065 patients) reported on HO after hip arthroscopy, while 21 (83 patients) collectively reported on HO after arthroscopic procedures to the shoulder, elbow, knee, or ankle; however, management techniques were not standardized. Identified risk factors for HO included male sex and mixed impingement pathology, while intraoperative capsular management was not suggested as a contributing factor. Diagnosis of ossification foci was performed using radiography and computed tomography. The rate of HO after hip arthroscopy procedures approached 46% without prophylaxis, and administration of nonsteroidal anti-inflammatory drugs (NSAIDs) decreased occurrence rates to 4% but carries associated risks. External beam radiation has not been exclusively studied for use after arthroscopic procedures. Conclusion: HO is a known complication after arthroscopic management of orthopaedic injuries. NSAID prophylaxis has been demonstrated to be effective after hip arthroscopy procedures. Patients with persistent symptoms and mature lesions may be indicated for surgical excision, although variability is present in patient-reported outcome scores postoperatively.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

Zhou

Gee

Hansen

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…4) Moderate activity: Clinical trials have shown that joint loosening during inactive ectopic ossification and complete maturation can effectively reduce ossification and help joint activity. Furthermore, in a rabbit model of trauma-induced HO, forced fixation of the animal's body aggravated the occurrence of HO [104]. This finding indicates that after the soft tissue is traumatized and subjected to longterm compression, tissue hypoxia promotes HO due to poor blood circulation.…”

Section: ) Nonsteroidal Anti-inflammatory Drugs (Nsaids)mentioning

confidence: 92%

The hypoxic microenvironment: a driving force for heterotopic ossification progression

2020

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Heterotopic ossification (HO) refers to the formation of bone tissue outside the normal skeletal system. According to its pathogenesis, HO is divided into hereditary HO and acquired HO. There currently lack effective approaches for HO prevention or treatment. A deep understanding of its pathogenesis will provide promising strategies to prevent and treat HO. Studies have shown that the hypoxia-adaptive microenvironment generated after trauma is a potent stimulus of HO. The hypoxic microenvironment enhances the stability of hypoxia-inducible factor-1α (HIF-1α), which regulates a complex network including bone morphogenetic proteins (BMPs), vascular endothelial growth factor (VEGF), and neuropilin-1 (NRP-1), which are implicated in the formation of ectopic bone. In this review, we summarize the current understanding of the triggering role and underlying molecular mechanisms of the hypoxic microenvironment in the initiation and progression of HO, focusing mainly on HIF-1 and it's influenced genes BMP, VEGF, and NRP-1. A better understanding of the role of hypoxia in HO unveils novel therapeutic targets for HO that reduce the local hypoxic microenvironment and inhibit HIF-1α activity.

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“…Anteromedial, anterolateral Complete permanent posterior interosseous nerve palsy (transected) Anterolateral Dumonski et al 9 Severe permanent UN palsy (transected) Proximal medial Sodha et al 10 HO development impeding ROM, required open excision Posterior and posterolateral Park et al 11 Transient radial nerve palsy Proximal anterolateral Gay et al 12 Complete permanent UN palsy (transected) Proximal anteromedial Hughes and Hildebrand 13 HO development impeding ROM, required open incision Dexel et al 14 Transient aseptic subcutaneous emphysema Carafino et al 15 Complete permanent posterior interosseous nerve (PIN) Proximal anterolateral Carafino et al 15 Partial medial nerve (sensory) injury Proximal anteromedial Murphy et al 16 Severe permanent median nerve (MN) palsy (transected) Kinkartz et al 17 Postarthroscopic chondrolysis Mercer et al 18 Radial nerve (RN) palsy (laceration) Proximal anterolateral Desai et al 19 HO Excessive traction, cross-body adduction, lateral positioning and repetitive tourniquet inflation/ deflation should be avoided; management of modifiable risk factors (smoking cessation, diabetes, obesity, HTN); consider chemical prophylaxis in higher risk patients tourniquet time are not uncommon in this setting. 33 Thus, time of tourniquet inflation must be monitored similar to other procedures.…”

Section: References Complications Portalmentioning

confidence: 99%

Complications in Elbow Arthroscopy: Management and Prevention

Batko

Hakakian

Norin

et al. 2022

Sports Medicine and Arthroscopy Review

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With advances in the understanding of elbow anatomy, pathologies of the elbow, arthroscopic instrumentation, and surgical techniques over recent decades, elbow arthroscopy has become a valuable treatment modality for a variety of conditions. Elbow arthroscopy has gained utility for treating problems such as septic arthritis, osteoarthritis, synovitis, osteophyte and loose body excision, contracture release, osteochondral defects, select fractures, instability, and lateral epicondylitis. Accordingly, precise knowledge of the neurovascular anatomy, safe arthroscopic portal placement, indications, and potential complications are required to maximize patient outcomes and assist in educating patients. This comprehensive review provides the reader an understanding of the potential complications associated with arthroscopic procedures of the elbow and to describe strategies for prevention and management.

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Heterotopic Ossification After the Arthroscopic Treatment of Lateral Epicondylitis

Abstract: To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. As the use of elbow arthroscopy continues to grow, there is a need for identification of the risk factors and primary prophylaxis for HO.

Cited by 8 publications

References 18 publications

Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

The hypoxic microenvironment: a driving force for heterotopic ossification progression

Complications in Elbow Arthroscopy: Management and Prevention

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