Outcome evaluation after Achilles tendon ruptures : A review of the literature

The optimal treatment and the best rehabilitation protocol after an acute Achilles tendon rupture (ATR) remain a matter of controversy in orthopaedic and sports medicine. The use of validated injury-specific outcome instruments is the only way to clarify these issues, in order to ensure that patients receive the best possible treatment. This article describes the most commonly reported outcome measures used to assess patients treated for ATR. On the basis of the available evidence, the Achilles tendon total Rupture score (ATRs) is the most appropriate outcome measure for evaluating the management of acute ATR

Improved visualization of the 70° arthroscope in the treatment of talar osteochondral defects

Osteochondral defects (OCDs) of the talus are a common cause of residual pain after ankle injuries. When conservative treatment fails, arthroscopic debridement combined with drilling/microfracturing of the lesion (bone marrow stimulation [BMS] procedures) has been shown to provide good to excellent outcomes. Not uncommonly, talar OCDs involve the borders of the talar dome. These uncontained lesions are sometimes difficult to visualize with the 30\ub0 arthroscope, with potential negative effect on the clinical outcome of an arthroscopic BMS procedure. The use of the 70\ub0 arthroscope has been described for a multitude of common knee, shoulder, elbow, and hip procedures. The purpose of this article is to show the usefulness of the 70\ub0 arthroscope in arthroscopic BMS procedures, pointing out which kinds of talar OCDs can benefit most from its use

Advantages of 70\ub0 arthroscope in management of ECRB tendinopathy

Lateral epicondylitis requires a challenging therapeutic management even for expert surgeons. With the failure of conservative treatment, the physician should consider a surgical choice. The purpose of the surgical procedure is to excise the degenerated tissue of extensor carpi radialis brevis tendon. This article describes the arthroscopic release, performed under direct visualization with a 70\ub0 scope; the aim is to encourage the use of this type of lens, versus the traditional 30\ub0 one. The patient is positioned in a modified lateral decubitus. After joint distension, a diagnostic arthroscopy of the posterior compartment is performed as first step. Then, an anterior compartment arthroscopic evaluation, a subsequent antero-lateral capsulectomy, and extensor carpi radialis brevis tendon exposition are performed with a 30\ub0 view. At this point, the 70\ub0 lens is switched and the tendon release is performed under direct control. The 70\ub0 lens allows a safer procedure, but requires a dedicated learning curve

Erratum to: Evidence-based indications for hindfoot endoscopy

The author would like to correct the following errors in the online publication of the article: In the \u201cHindfoot periarticular area\u201d section, under the sub-heading \u201cPosterior ankle impingement\u201d, the seventh and eighth paragraph should read as: The AOFAS score was the most frequently used clinical outcome score; where used, cumulative results showed average post-operative score of 90.6 points [1, 2, 11, 22, 24, 27, 32, 42, 50, 56, 64, 68] and pre- to post-operative increase by an average of 24.0 points [1, 2, 24, 27, 32, 42, 50, 56, 64]. Six studies reported results of isolated os trigonum excision in 99 ankles [2, 18, 22, 24, 33, 46]: the pre- to postoperative increase in AOFAS was available for 22 patients and reached 33.7 points [2, 24], while pre- to post-operative VAS decrease was available for 62 patients and was >6 points [18, 24, 33]. In the \u201cArticular joint spaces\u201d section, under the subheading \u201cSubtalar joint articular space\u201d, the first paragraph should read as follows: Osteoarthritis Level of evidence IV and V Degenerative changes of the subtalar joint are reported in the literature as indications for hindfoot endoscopy in prone position, eitherby means of talocalcaneal arthrodesis [3-5, 10, 29, 30, 38,39, 57] or arthroscopic osteophyte resection and debridement [39, 42]. Seven retrospective case series adequately documented the clinical results of 73 procedures of posterior arthroscopic subtalar arthrodesis (PASTA) [3, 4, 10, 29, 30, 38, 57]. Over these studies, post-traumatic or primary osteoarthritis were the preoperative indications for PASTA in more than 90 % of the cases. In five cases, subtalar arthropathy was related to a tarsal coalition [3, 4]. Five of the seven series evaluated post-operative clinical outcome with the AOFAS score: the cumulative results showed average post-operative score by 80.3 points and pre- to postoperative increase by an average of 40.4 points [3, 4, 29, 38, 57] The original article has been updated accordingly

Complications associated with arthroscopic rotator cuff repair : a literature review

The aim of this literature review was to report complications associated with arthroscopic rotator cuff repair (RCR). A computerized search of articles published between 200 and 2009 was performed using MEDLINE and PubMed. We included clinical studies (Level 1-4): (a) investigating patients with rotator cuff tears, managed by a completely arthroscopic RCR technique; (b) reported data about complications. Data about arthroscopic-assisted techniques were excluded. Articles that meet criteria inclusion were analytically examined. Complications were classified into general complications and specific complications related to arthroscopic RCR. We found 414 complications in 2,890 patients; most of them were specific complications related to arthroscopic RCR. Re-rupture was the most frequently encountered complication: re-tear rate ranged between 11.4 and 94%. Stiffness and hardwarerelated complications were observed in 74 and 12 patients, respectively. Eleven less common complications were also reported: 5 neurovascular, 3 septic, 2 thromboembolic events, and 1 anesthesiological complication. This review stated that arthroscopic RCR is a low-risk surgical procedure. Anatomical failure of the repair is the most common complication encountered in the literature

Long-term outcome after arthroscopic rotator cuff treatment

Purpose Arthroscopic techniques have become the gold standard in the operative management of several pathologic conditions of the shoulder. The purpose of this systematic review was to present the long-term outcomes following arthroscopic treatment of rotator cuff pathology. Methods A comprehensive literature review was performed to identify studies reporting clinical or structural results of arthroscopic rotator cuff repairs (ARCRs) at least 5 years after surgery. Results Ten articles were selected, which described 483 procedures. Study type, surgical approaches, complications, evidences of structural integrity of the repaired lesions, preoperative and postoperative functional scores are identified, analyzed and discussed. Satisfactory results are presented by all authors, and significant postoperative improvement is reported by all the studies with available preoperative data; 16 of 483 cases were re-operated. Conclusion Although high-level evidences are lacking, ARCR appears to be an effective and safe option to treat the symptoms of rotator cuff tears and to provide successful clinical results durable with time. Current evidences are insufficient to clearly define the relationship between structural integrity of repaired cuffs and long-term clinical outcome. The available data do not allow to draw conclusions regarding the long-term superiority of double-row versus single-row repairs. Level of evidence Review of level II, III and IV studies, Level IV. \ua9 2014 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)