BACKGROUND Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents.Accuracy and tolerability of this approach in the clinical setting–includi...BACKGROUND Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents.Accuracy and tolerability of this approach in the clinical setting–including patients with end-stage ankle pathology and/or a history of prior surgery–is not known.AIM To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint.METHODS This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint.In our center,these injections are used as a last resort prior to extensive surgery.The primary outcome was injection accuracy,which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear arthroscopic view of the joint space.Secondary outcome measures included a patientreported numeric rating scale(NRS,0-10)of pain during the procedure and willingness of patients to return for the same procedure.NRS of ankle pain at rest and during walking was collected at baseline and at 2-wk follow-up.Complications were monitored from inclusion up to a 2-wk control visit.RESULTS We performed 24 inspection-injections.Eleven(46%)participants were male,and mean age was 46.8±14.5 years.Osteoarthritis was the indication for injection in 20(83%)cases,of which 8(33%)patients suffered from osteoarthritis Kellgren-Lawrence grade IV,and 10(42%)patients from Kellgren-Lawrence grade III.An osteochondral defect was the indication for injection in 4(17%)cases.A history of ankle surgery was present in 14(58%)participants and a history of multiple ankle surgeries in 11(46%)participants.It was possible to confirm accuracy in 21(88%)procedures.The 3(12%)participants where needle arthroscopy did not reach a clear view of the joint space all suffered from Kellgren-Lawrence grade IV osteoarthritis.Pain during the procedure was reported with a median of 1[interquartile ranges(IQR):0–2].Willingness to return was 100%.Pain in rest decreased from a median NRS of 4(IQR:2–7)at baseline to a median of 3(IQR:1–5)at follow-up(P<0.01).Pain during walking decreased from a median NRS of 8(IQR:6–9)to a median of 7(IQR:4–8)(P<0.01).Infections or other complications were not encountered.CONCLUSION Clinical accuracy and tolerability of bedside needle arthroscopy of the ankle as a delivery system for injectable agents are excellent.Accuracy was 100%in patients without total ventral joint obliteration.展开更多
<strong>Introduction:</strong> Purpose to study prevalence of the intraarticular chondral lesion in the malleolar fracture by using ankle arthroscopy to fully understand the severity and complexity of the ...<strong>Introduction:</strong> Purpose to study prevalence of the intraarticular chondral lesion in the malleolar fracture by using ankle arthroscopy to fully understand the severity and complexity of the injury. <strong>Methods:</strong> Cross sectional study of 32 patients diagnosed with ankle fracture and undergone open reduction and internal fixation with arthroscopic assessment performed stimultaneously. The mechanism of injury, patterns of injury and intraarticular chondral injury were documented. <strong>Results:</strong> Mean age was 38 years (SD = 14.1, range 18 - 68 years). Eighteen were female and 14 were male. Fifteen involved syndesmostic distruption, 22 had Danis-Weber B injury and 16 had supination external rotation (SER). Ten (31.2%) had positive intraoperative cartilage injury. Significant correlation between the Lauge-Hansen classifications with positive findings with 6 had SER, 2 had pronation adduction and 2 had pronation external rotation.<strong> Conclusion: </strong>The prevalence of chondral injury in ankle fracture was quite high and may leads to poor outcome. Arthroscopy procedure allow surgeon to assess intraarticular surface and reduction of the ankle fracture which prompt further intervention that may improve the clinical outcomes and prognosis of the patients.展开更多
文摘BACKGROUND Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents.Accuracy and tolerability of this approach in the clinical setting–including patients with end-stage ankle pathology and/or a history of prior surgery–is not known.AIM To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint.METHODS This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint.In our center,these injections are used as a last resort prior to extensive surgery.The primary outcome was injection accuracy,which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear arthroscopic view of the joint space.Secondary outcome measures included a patientreported numeric rating scale(NRS,0-10)of pain during the procedure and willingness of patients to return for the same procedure.NRS of ankle pain at rest and during walking was collected at baseline and at 2-wk follow-up.Complications were monitored from inclusion up to a 2-wk control visit.RESULTS We performed 24 inspection-injections.Eleven(46%)participants were male,and mean age was 46.8±14.5 years.Osteoarthritis was the indication for injection in 20(83%)cases,of which 8(33%)patients suffered from osteoarthritis Kellgren-Lawrence grade IV,and 10(42%)patients from Kellgren-Lawrence grade III.An osteochondral defect was the indication for injection in 4(17%)cases.A history of ankle surgery was present in 14(58%)participants and a history of multiple ankle surgeries in 11(46%)participants.It was possible to confirm accuracy in 21(88%)procedures.The 3(12%)participants where needle arthroscopy did not reach a clear view of the joint space all suffered from Kellgren-Lawrence grade IV osteoarthritis.Pain during the procedure was reported with a median of 1[interquartile ranges(IQR):0–2].Willingness to return was 100%.Pain in rest decreased from a median NRS of 4(IQR:2–7)at baseline to a median of 3(IQR:1–5)at follow-up(P<0.01).Pain during walking decreased from a median NRS of 8(IQR:6–9)to a median of 7(IQR:4–8)(P<0.01).Infections or other complications were not encountered.CONCLUSION Clinical accuracy and tolerability of bedside needle arthroscopy of the ankle as a delivery system for injectable agents are excellent.Accuracy was 100%in patients without total ventral joint obliteration.
文摘<strong>Introduction:</strong> Purpose to study prevalence of the intraarticular chondral lesion in the malleolar fracture by using ankle arthroscopy to fully understand the severity and complexity of the injury. <strong>Methods:</strong> Cross sectional study of 32 patients diagnosed with ankle fracture and undergone open reduction and internal fixation with arthroscopic assessment performed stimultaneously. The mechanism of injury, patterns of injury and intraarticular chondral injury were documented. <strong>Results:</strong> Mean age was 38 years (SD = 14.1, range 18 - 68 years). Eighteen were female and 14 were male. Fifteen involved syndesmostic distruption, 22 had Danis-Weber B injury and 16 had supination external rotation (SER). Ten (31.2%) had positive intraoperative cartilage injury. Significant correlation between the Lauge-Hansen classifications with positive findings with 6 had SER, 2 had pronation adduction and 2 had pronation external rotation.<strong> Conclusion: </strong>The prevalence of chondral injury in ankle fracture was quite high and may leads to poor outcome. Arthroscopy procedure allow surgeon to assess intraarticular surface and reduction of the ankle fracture which prompt further intervention that may improve the clinical outcomes and prognosis of the patients.
