Transverse incision advantages for total knee arthroplasty

Background If a transverse incision can be safely used for total knee arthroplasty (TKA), decreases in scar formation, reduced injury of the infrapatellar branch of the saphenous nerve and improved kneeling motion will be observed. Methods We evaluated 95 patients (101 knees) on whom primary TKA was performed with follow-up of more than 2 years. A longitudinal incision was used for the first 40 knees and a transverse incision for the remaining 61 knees. Operation time, blood loss, complications and Knee Society Score were evaluated. Wound lengths, widths and the Manchester Scar Scale (MSS) were measured 1 year after the surgery. Further examination evaluated sensory disturbances and whether kneeling was possible. Results The complication rate in both groups was almost the same. The wound lengths measured at a 90° kneeflexed position were about 15 cm with no significant difference between the groups. The average width measured at a maximum area was significantly smaller in the transverse group than in the longitudinal group. MSS of the transverse group was also significantly lower than that of the longitudinal group. Sensory disturbance was found to be significantly smaller in the transverse group than in the longitudinal group both in subjective and objective evaluation at 1 year after surgery. When a transverse incision was used, the direction of the incision corresponded to the running direction of the saphenous nerve, and thus, we were able to reduce sensory disturbances on the distal lateral side of the knee joint. The transverse group (70.4%) performed significantly better than the longitudinal group (40.6%) at kneeling motion. Conclusions We showed that making a transverse incision is a safe method, resulting in a reduction of scar formation and less dysfunction of the infrapatellar branch of the saphenous nerve, and improvement of kneeling motion. © The Japanese Orthopaedic Association 2011

Arthroscopic observation was useful to detect loosening of the femoral component of unicompartmental knee arthroplasty in a recurrent hemoarthrosis

A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA) is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy demonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis was ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then, hemarthrosis has not recurred

Arthroscopic-Assisted Pectoralis Minor Transfer for Irreparable Anterosuperior Massive Rotator Cuff Tear

An irreparable anterosuperior massive rotator cuff tear with an irreparable subscapularis tear is not common; however, once symptomatic, it would become a challenging situation. Tendon transfer is a choice and the pectoralis major is a commonly selected graft source. However, there are theoretical concerns over its use: high invasiveness and low reproducibility, different force vector from the subscapularis, unsuitability for the arthroscopic modification, and difficulty in conversion to the reverse shoulder arthroplasty due to adhesions and scar formation in the anterior shoulder. Recently, open pectoralis minor transfer has been advocated as an alternative reconstruction option. We describe an arthroscopic-assisted technique of pectoralis minor transfer for irreparable anterosuperior massive rotator cuff tear

Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging

A Case Report of Isolated Cuboid Nutcracker Fracture

Isolated cuboid fractures are very rare, since they typically occur in combination with midfoot fractures or dislocations. A 61-year-old man presented at our hospital with pain and swelling on the outside of his right foot. The lateral column of his right foot was shortened by approximately 6.5 mm on X-ray. CT showed displacement of the joint surface between the cuboid and the fourth metatarsal, with a 3.5 mm depression. An MRI revealed no other injuries. Based on these findings, we diagnosed the patient with an isolated nutcracker fracture of the cuboid. Using a 1.9 mm arthroscope, we examined the Lisfranc joint. Then the depressed fragments were elevated until the regular joint line was restored. A bone biopsy needle was then used to fill in the large defect with artificial bone. In this case, we did not plate the fracture. Six months after surgery, patient could walk without pain. We report a very rare case of isolated nutcracker fracture of the cuboid. In addition, we suggest our new treatment plan of this fracture