Project description:Osteoid osteoma is a benign tumor that can cause significant pain and disability. Excision of the tumor can be accomplished with open surgery or, as advocated in recent years, with computed tomography (CT)-guided radiofrequency ablation. In this article, a unique arthroscopic approach to excise an osteoid osteoma of the talus is presented. This was possible by relying on a clear intra-articular prominent osteophyte, which was used as a landmark to indicate tumor location in accordance with preoperative CT views. This technique enabled excision of the tumor with concomitant arthroscopic decompression of the osteophyte, which contributed to symptoms of anterior ankle impingement.
Project description:New technologies in additive manufacturing and patient-specific CT-based custom implant designs make it possible for previously unimaginable salvage and limb-sparing operations a practical reality. This study presents the design and fabrication of a lattice-structured implant for talus replacement surgery. Our primary case involved a young adult patient who had sustained severe damage to the talus, resulting in avascular necrosis and subsequent bone collapse. This condition caused persistent and debilitating pain, leading the medical team to consider amputation of the left foot at the ankle level as a last resort. Instead, we proposed a Ti6Al4V-based patient-specific implant with lattice structure specifically designed for pan-talar fusion. Finite element simulation is conducted to estimate its performance. To ensure its mechanical integrity, uniaxial compression experiments were conducted. The implant was produced using selective laser melting technology, which allowed for precise and accurate construction of the unique lattice structure. The patient underwent regular monitoring for a period of 24 months. At 2-years follow-up the patient successfully returned to activities without complication. The patient's functional status was improved, limb shortening was minimized.
Project description:Avascular necrosis of the femoral head arises due to inadequate blood supply to the femoral head, leading to cell death, fracture, and eventually collapse. The disease often begins as asymptomatic but can present with pain, stiffness, and limited range of motion in later phases. These symptoms cause disability, predominantly in young to middle-aged individuals. Both conservative and operative treatment modalities have been used depending on the progression of the disease. Timely surgical intervention is essential to enhance outcomes and avert stress fractures, subchondral collapse, and secondary hip arthritis. This technical note presents an arthroscopic approach to core decompression for the minimally invasive management of avascular necrosis of the femoral head.
Project description:Avascular necrosis (AVN) of the hip is a devastating disease that affects middle-aged adults with poor outcomes if not treated in its early stages. In recent years, subchondroplasty with calcium phosphate solution has shown promising results. Concomitant intra-articular pathologies, including femoroacetabular impingement and chondral lesions, have been described in hips affected by AVN. These should be addressed at the time of surgery to lower the risk of failure. In this Technical Note, we describe an arthroscopic approach to femoral head subchondroplasty with precollapse lesion in AVN affected hip, combined with labral reconstruction and acetabular chondral treatment.
Project description:Avascular necrosis of the femoral head (AVNFH) is a debilitating disease that requires early intervention to prevent subchondral collapse and irreversible damage leading to premature hip replacement. Patients presenting with AVNFH can have concomitant intra-articular pathology, including femoroacetabular impingement (FAI), that contributes to their hip pain and dysfunction. It is important to restore the native hip anatomy in addition to providing revascularization of necrotic areas to reduce pain, improve function, and maximize efforts to preserve the joint. The purpose of this Technical Note is to describe our preferred arthroscopic approach to core decompression through the femoral neck in combination with femoral osteoplasty to address AVNFH and FAI in a single-staged and minimally invasive procedure. Technique Video Video 1 Before standard hip arthroscopy, bone marrow aspirate concentrate harvest is performed using the ipsilateral posterior superior iliac spine, with the contralateral side being used if more aspirate is needed. The patient is placed in the modified supine position. Anterolateral and midanterior portals are placed. An interportal capsulotomy is performed followed by a diagnostic arthroscopy to identify any intra-articular pathology. After any necessary central compartment work and osteoplasty of the femoral neck are performed, the focus is changed to the area of avascular necrosis of the femoral head for the core decompression. The femoral head can be distracted with traction, and the area of avascular necrosis (AVN) is verified to be viable tissue with a 3 mm–long hip probe placed in the central defect. Bleeding may be verified on the periphery of the defect. Additionally, the lateral epiphyseal blood vessels can be visualized to be intact, and blood flow can be appreciated by pulse visualization or with a Doppler ultrasound probe. Core decompression is then performed with a 1.5 mm JuggerKnot drill in a retrograde fashion to decompress the area from the femoral neck to the site of the lesion within the femoral head. Fluoroscopy can be used to confirm the trajectory and depth of the drill into the area of AVN. Multiple passes are made with the drill, and bleeding is noted with the passes after arthroscopic fluid is turned off. The number of passes is variable with the objective of stimulating bleeding throughout the defect; typically this is between 5 and 10. The shaver is used to create a suction effect to illustrate that blood is coming through the drill holes. A key aspect of this technique is the creation of a relatively large number of small-diameter tunnels rather than 1 large-diameter tunnel, with the primary aim of stimulating blood flow more diffusely throughout the area of necrosis and avoiding the creation of an unnecessarily large cortical defect. The concentrated bone marrow aspirate collected earlier is then injected into these drill holes. Last, capsular closure is performed.
Project description:Avascular necrosis (AVN) of the femoral head is a progressive disease affecting young adults that results in collapse of the femoral head and subsequent degenerative joint disease. Although precollapse stages of AVN can be successfully treated with core decompression, making the diagnosis is often difficult given alternative sources of hip pain in this age group. We propose that arthroscopic-assisted core decompression of the femoral head offers an effective method of addressing AVN of the femoral head as well as coexistent hip disorders in the same operation. This article describes in detail the technique used to perform an arthroscopic-assisted core decompression of the femoral head, and a companion video demonstrating the procedure is included. Our experience suggests that arthroscopic-assisted core decompression can be used as an alternative to open core decompression, while simultaneously addressing other sources of hip pain, with successful outcomes.
Project description:Os subfibulare is an ossicle at the tip of the lateral malleolus. The ossicle is sometimes symptomatic and presents with local pain or lateral ankle instability. The purpose of this Technical Note is to describe the details of arthroscopic stabilization of the os subfibulare. It is indicated for symptomatic mechanical lateral ankle instability resulting from an unstable os subfibulare. The technique has the advantages of minimally invasive surgery, evaluation and treatment of concomitant ankle pathology, and preservation of integrity of the anterior talofibular ligament.
Project description:Fractures of the lateral process of the talus are uncommon and often overlooked. Typically, they are found in adult snowboarders. We report the case of an 11-year-old male soccer player who complained of lateral ankle pain after an inversion injury 6 months earlier. He did not respond to conservative treatment and thus underwent arthroscopic excision of fragments of the talar lateral process. The ankle was approached through standard medial and anterolateral portals. A 2.7-mm-diameter 30° arthroscope was used. Soft tissues around the talus were cleared with a motorized shaver, and the lateral aspect of the talar process was then visualized. The lateral process presented as an osseous overgrowth, and a loose body was impinged between the talus and the calcaneus. The osseous overgrowth was resected piece by piece with a punch, and the loose body was removed en block. The patient returned to soccer 5 weeks after the operation. This case exemplifies 2 important points: (1) This type of fracture can develop even in children and not only in snowboarders. (2) Arthroscopic excision of talar lateral process fragments can be accomplished easily, and return to sports can be achieved in a relatively short time.
Project description:Large chondral lesions of the humeral head are often treated with total shoulder arthroplasty, but this may not be an ideal option for young, active patients. Humeral head resurfacing is another option, which better preserves the native biomechanics. This article and the accompanying video present the surgical technique of partial humeral head resurfacing, which further preserves the remaining healthy cartilage. It is described for a chondral lesion due to avascular necrosis, but the method has been successfully used to treat chondral lesions from a broad range of causes.
Project description:The osteonecrotic area of steroid-induced avascular necrosis of the femoral head (SANFH) is a hypoxic microenvironment that leads to apoptosis of transplanted bone marrow mesenchymal stem cells (BMSCs). However, the underlying mechanism remains unclear. Here, we explore the mechanism of hypoxic-induced apoptosis of BMSCs, and use the mechanism to improve the transplantation efficacy of BMSCs. Our results show that the long non-coding RNA AABR07053481 (LncAABR07053481) is downregulated in BMSCs and closely related to the degree of hypoxia. Overexpression of LncAABR07053481 could increase the survival rate of BMSCs. Further exploration of the downstream target gene indicates that LncAABR07053481 acts as a molecular "sponge" of miR-664-2-5p to relieve the silencing effect of miR-664-2-5p on the target gene Notch1. Importantly, the survival rate of BMSCs overexpressing LncAABR07053481 is significantly improved after transplantation, and the repair effect of BMSCs in the osteonecrotic area is also improved. This study reveal the mechanism by which LncAABR07053481 inhibits hypoxia-induced apoptosis of BMSCs by regulating the miR-664-2-5p/Notch1 pathway and its therapeutic effect on SANFH.