Dataset Information

Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement.

ABSTRACT:

Purpose

To investigate the short-term clinical outcomes and satisfaction for the first set of patients at our institution receiving in-office needle arthroscopy (IONA) for the treatment of posterior ankle impingement syndrome (PAIS).

Methods

A retrospective cohort study was conducted to evaluate patients who underwent IONA for PAIS between January 2019 and January 2021. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System Pain Interference, and Pain Intensity scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. The Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores.

Results

Ten patients (4 male and 6 female) with a mean age of 41.9 ± 15.5 years (range, 24-66 years) were included in the study. The mean follow-up time was 13.3 ± 2.9 months (range, 11-17 months). All mean preoperative FAOS scores demonstrated improvement after IONA, including FAOS symptoms (71.48 ± 10.3 to 80.3 ± 12.6), pain (69.3 ± 11.0 to 78.2 ± 13.9), activities of daily living (61.7 ± 8.8 to 77.93 ± 11.4), sports activities (55.6 ± 12.7 to 76.0 ± 13.6), and quality of life (46.6 ± 9.2 to 71.1 ± 12.1). There were 7 patients who participated in sports activities before the IONA procedure. Within this group, all patients returned to play at a median time of 4.1 weeks (range, 1-14 weeks). The median time to return to work was 3.4 ± 5.3 days. Patients reported an overall positive IONA experience with a mean rating scale of 9.5 ± 1.5 (range, 5-10).

Conclusions

The current study demonstrates that IONA treatment of PAIS results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes. In addition, IONA for PAIS leads to high patient satisfaction with a significant willingness to undergo the same procedure again.

Level of evidence

IV, therapeutic case series.

SUBMITTER: Mercer NP

PROVIDER: S-EPMC9042901 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement.

Mercer Nathaniel P NP Samsonov Alan P AP Dankert John F JF Gianakos Arianna L AL Stornebrink Tobias T Delmonte Rick J RJ Kerkhoffs Gino M M J GMMJ Kennedy John G JG

Arthroscopy, sports medicine, and rehabilitation 20220208 2

<h4>Purpose</h4>To investigate the short-term clinical outcomes and satisfaction for the first set of patients at our institution receiving in-office needle arthroscopy (IONA) for the treatment of posterior ankle impingement syndrome (PAIS).<h4>Methods</h4>A retrospective cohort study was conducted to evaluate patients who underwent IONA for PAIS between January 2019 and January 2021. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Mea ...[more]

PMID: 35494297

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Project description:Diagnostic needle arthroscopy performed in office is a safe and cost-effective method for accurate evaluation of intra-articular pathology, improving clinical decision making. This minimally invasive approach is an effective alternative to traditional diagnostic techniques of diagnostic surgical arthroscopy and magnetic resonance imaging (MRI). Needle arthroscopy is considered low-risk, with an extremely low complication rate when performed with appropriate technique and indications. The purpose of this article is to describe an approach to an in-office diagnostic procedure using a needle arthroscopy system. Technique Video Video 1 Standard arthroscopic approach to the left knee via anterolateral and anteromedial portals. Place the patient in a supine or sitting position, with the left knee at ∼90°, and sterilely prep the left knee. Anesthetize the anterolateral and anteromedial standard portal sites with ∼15 cc of local anesthetic (1% lidocaine with epinephrine and 0.5% Marcaine without epinephrine) on a 25-gauge needle, creating a wheel. Next, insufflate the joint via the anterolateral portal using 20 cc of .25% Marcaine without epinephrine on a 20-gauge needle. After an additional re-prep of the knee with chlorohexidine, wait about 5 minutes, and then place sterile blue drapes at the proximal tibia and distal femur to create a sterile field. Introduce the 2.2-mm inflow NanoScope™ (Arthrex) sheath with the sharp trocar into the anterolateral portal, which is the primary viewing portal, and withdraw the trocar, and then attach the one-way stop valve to the sheath. Insert the 1.9-mm NanoScope™ (Arthrex) needle arthroscopy system, which is approximately one-third of the size of a standard arthroscopy camera. Connect a 30-cc syringe of sterile 0.9% normal saline to the NanoScope™ (Arthrex) via the one-way stop valve, open the valve, and use all 30 cc to insufflate the joint. This is followed by connecting another 30 cc of sterile saline to the one-way stop valve to inject as needed, while performing a standard diagnostic left knee arthroscopy to identify and assess any intraarticular pathology. In this particular patient, a medial femoral condyle defect is identified. If needed, a 2.0-mm NanoProbe (Arthrex) or other NanoSope™ (Arthrex) instrumentation can be used for both diagnostic and therapeutic treatment. This is inserted into the anteromedial portal, which is the accessory portal. If possible, have an assistant available to provide valgus stress or assist in patient knee positioning, as the arthroscopy is being performed. At the conclusion of the standard diagnostic needle arthroscopy, aspirate as much fluid off the knee as possible through the NanoSope™ (Arthrex), while it remains inserted in the anterolateral portal. Remove the scope and resolve any bleeding by applying pressure with sterile gauze. Apply Steri-Strips to the percutaneous portal sites, followed by gauze and an ACE wrap. The patient may ambulate immediately afterward. Post-procedure antibiotics may be considered

Project description:PurposeTo evaluate network integrity for diagnostic testing and patient follow-up comparing in-office needle arthroscopy and outpatient advanced diagnostic imaging for intra-articular pathology.MethodsA retrospective chart review was performed to identify patients who were indicated for either in-office needle arthroscopy (IONA) or outpatient advanced diagnostic imaging (OADI). Current Procedural Terminology (CPT) codes 29870 and 29805 with place of service modifier 11 were used to identify patients who underwent IONA of the knee and shoulder, respectively, between January 2020 and March 2023. CPT codes 73721-3 and 73221-3 were utilized to identify patients indicated for outpatient advanced magnetic resonance imaging of the knee or shoulder. All patients who were indicated for the procedure and denied by the insurance were identified and recorded. Inclusion criteria consisted of patients older than 18 years with suspected intra-articular pathology who had failed conservative treatment. Exclusion criteria included patients younger than 18 years, non-English speaking, or those who failed to follow up due to death. The location of where the imaging was performed was recorded (within the health system vs an unaffiliated center). Additionally, patient follow-up with the provider after the diagnostic testing was indicated was recorded.ResultsTwo separate groups of 100 consecutive patients who were indicated for IONA or OADI were identified and retrospectively chart reviewed. Ninety-four percent of the IONA patients underwent the procedure after it was indicated within the physician office. Sixty-eight percent underwent the procedure the day they were indicated for the procedure. All 94 patients were deemed to have a follow-up with a definitive plan of care after the procedure. Eighty-seven percent of the OADI patients completed their ordered testing. Sixty-two percent (54/87) of the patients had the study performed at one of the primary hospital-affiliated imaging centers. Thirty-eight percent of the studies (33/87) were deemed to have leaked from the system. Of the 87 patients who had the imaging performed, 79% (69/87) had a definitive treatment plan rendered with the lead author (S.M.) based on the imaging results. Twenty-one percent (18/87) of the patients who underwent imaging did not follow up with the treating provider or show for a scheduled follow-up appointment. Nineteen percent (13/69) of the patients who had a definite treatment plan rendered did not come into the office for their results but requested and received them over the phone from the provider. The IONA cohort demonstrated statistically significant (P < .001) network integrity in terms of location of service remaining within the system compared to the OADI group. Furthermore, patient follow-up for definitive treatment plans after IONA was also higher (P < .001) than in the OADI group.ConclusionsIONA results in greater network integrity and patient follow-up compared to conventional imaging.Clinical relevanceIn-office needle arthroscopy performed for the diagnosis of intra-articular pathology may offer a valuable clinical diagnostic tool while providing a meaningful avenue for network integrity and patient retention.

Dataset Information

Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement.

Purpose

Methods

Results

Conclusions

Level of evidence

Publications

Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement.

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