Pulmonary embolism is a serious complication after arthroscopy of the knee, about which there is limited information. We have identified the incidence and risk factors for symptomatic pulmonary embolism after arthroscopic procedures on outpatients. The New York State Department of Health Statewide Planning and Research Cooperative System database was used to review arthroscopic procedures of the knee performed on outpatients between 1997 and 2006, and identify those admitted within 90 days of surgery with an associated diagnosis of pulmonary embolism. Potential risk factors included age, gender, complexity of surgery, operating time defined as the total time that the patient was actually in the operating room, history of cancer, comorbidities, and the type of anaesthesia. We identified 374 033 patients who underwent 418 323 outpatient arthroscopies of the knee. There were 117 events of pulmonary embolism (2.8 cases for every 10 000 arthroscopies). Logistic regression analysis showed that age and operating time had significant dose-response increases in risk (p < 0.001) for a subsequent admission with a pulmonary embolism. Female gender was associated with a 1.5-fold increase in risk (p = 0.03), and a history of cancer with a threefold increase (p = 0.05). These risk factors can be used when obtaining informed consent before surgery, to elevate the level of clinical suspicion of pulmonary embolism in patients at risk, and to establish a rationale for prospective studies to test the clinical benefit of thromboprophylaxis in high-risk patients

Objective: Different. Methods: have been proposed to date to achieve the regeneration of hyaline cartilage in osteochondral lesions of the talus (OLT). The aim of this study was to present a new one-step arthroscopic procedure with the use of mesenchimal stem cells (MSC) supported on a collagen scaffold and Platelet Rich Fibrin (PRF). Methods: 14 patients with a diagnosis of OLT underwent this procedure. The MSC were harvested from the posterior iliac crest and concentrated directly in the operating room. An ankle arthroscopy was performed with lesion detection and curettage. The cell concentrate was mixed with a collagen paste as scaffold and with PRF as a pool of growth factors in order to have a final composite to fill the lesion site. Partial weight bearing for 2 months and early ROM was advised postoperatively. Results: According to the American Orthopaedic Foot and Ankle Score (AOFAS) system the patients had a preoperative score of 65.1 (range 35–79), a postoperative of 69.4 (range 61–97) at 6 months and of 83.6 (range 65–100) at 12 months follow up. MRI control at 6 and 12 months showed a progression of the reparative process in the osteochondral lesions. Histological and immuno-hystochemical analysis on a sample biopsed during a control arthroscopy at 12 months confirmed the hyaline quality of the regenerated cartilage. Conclusions: This one-step technique demonstrated to be capable to regenerate hyaline cartilage, with the advantages of a reduced surgical time, lower costs and lower patient’s morbidity

Ankle arthrodesis is the gold standard for treatment of end stage ankle arthritis. We analysed the data of 124 Ankle Arthrodesis (Open Ankle Arthrodesis (OAA) −27; Arthroscopic Ankle Arthrodesis (AAA)- 97) performed between January 2005 and December 2015 by fellowship trained foot and ankle surgeons in a single institution. Based on preoperative deformity (AAA- 28 degree valgus to 26 degrees varus; OAA- 41 degree valgus to 28 degree varus), they were subdivided into 2 groups based upon deformity more than 15 degrees. Union rates, time to union, length of hospital stay and patient related factors like smoking, alcoholism, diabetes, BMI were assessed.

Mean age of patients was 60 years (Range 20 to 82 years)(Male:Female-87:32). Overall fusion rate was 93% in AAA and 89% in OAA (p=0.4). On sub group analysis of influence of preoperative deformity, there was no difference in union rates of AAA versus OAA. 7 patients in AAA and 3 in OAA required further procedures. Average time to union was 13.7 in AAA and 12.5 weeks in OAA (p=0.3). Average hospital stay was 2.6 days in AAA and 3.8 days in OAA (p=0.003). Smoking, alcoholism, Diabetes, BMI did not have any correlation with union rates. Although both AAA and OAA showed good union rates, hospital stay was significantly shorter in AAA. A larger deformity did not adversely affect union rates in AAA. Time to union was higher in AAA though it was statistically insignificant. Lifestyle risk factors did not have cumulative effect on union.

We conclude that AAA is a reproducible method of treating end stage tibiotalar arthritis irrespective of preoperative deformity and patient related factors.

Aims

This systematic review aimed to summarize the full range of complications reported following ankle arthroscopy and the frequency at which they occur.

Aims

Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy.

Painful conditions of the acromioclavicular (AC) joint are common in South Africa, particularly among sportsmen. These conditions are often treated by open excision of the distal end of the clavicle, but an arthroscopic procedure offers many advantages. From February 1994 to February 2000, we performed 138 procedures. The mean age of patients ({71% men and 29% women) was 29 years (19 to 53). In cases of rotator cuff impingement, arthroscopic acromioplasty was followed by clavicular excision via the subacromial route. With a normal acromion and rotator cuff the AC joint was approached through two superior AC portals, avoiding removal of the AC ligaments. In all cases a standard 3.5-mm arthroscope was placed in one portal for viewing and the mechanical shaver inserted through the other. About 7 mm to 8mm of bone was removed from the clavicle. Patients were in hospital for about a day and 87% were discharged the same day. The mean follow-up time was 34 months (2 months to 4 years). Patient satisfaction was high in 32%, fair in 60% and poor in 8%. Most patients (92%) returned to all previous sports and activities. We concluded that the arthroscopic Mumford procedure is at least as successful as its open equivalent. It can be done as an outpatient procedure and permits a rapid return to activities. Cosmesis is excellent and stability of the AC joint is preserved

Abstract

Background. The purpose of this study was to report functional outcome scores following arthroscopic acetabular chondral procedures using the U.K. Non-Arthroplasty Hip Registry (NAHR). Methods. Data on adult patients who underwent hip arthroscopy between January 2012 and December 2018 was extracted from the NAHR. Patients who underwent femoral sided chondral procedures were excluded. Patients who underwent osteophyte excision or a concurrent extra-articular procedure were also excluded. Cases were then classified according to the acetabular chondral procedure performed – ‘chondroplasty’, ‘microfracture’ or ‘none’ (no chondral procedure recorded). Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 months. Results. A total of 4,978 arthroscopies were identified (chondroplasty 26.4%, microfracture 5.4%, none 68.2%). Patients who underwent microfracture were significantly older (37.9y vs 37.3y) and of higher BMI (26.4 vs 25.8 kg/m2) than patients who underwent chondroplasty. Pre-operative, 6 and 12-month follow-up were available for 77%, 42% and 38% of cases respectively. This registry study found significant clinical improvement in all groups based on arthroscopic chondral procedure following hip arthroscopy. Patients who have microfracture seem to take longer to improve and have lower peak scores as compared with chondroplasty. All groups saw significant (p <0.0001) EQ-5D and iHOT-12 gain compared to pre-operative baseline scores at 6 months which was maintained at 12 months (12 month iHOT-12 gain: chondroplasty = +27.6 (95%CI 25.0 to 30.2), microfracture = +22.6 (95%CI 17.6 to 27.6), none = +25.4 (23.8 to 27.0)). There were no statistically significant between group differences in iHOT-12 gain. Comparing <40y vs >40y age groups, all saw significant improvements in baseline scores maintained up to 12 months however patients over 40y were slower to improve, particularly in microfracture with significantly poorer iHOT-12 gain at 6 months in comparison to patients under 40y but significance was lost by 12 months. Conclusion. Whilst patient selection is crucial (and we acknowledge selection bias as a key limitation), all three chondral procedures were effective at improving patient outcomes for both younger and older patients

Introduction We have evaluated the early outcome of arthroscopic excision of the distal clavicle (Mumford procedure) for acromioclavicular joint pathology. Method Forty-one patients with acromioclavicular joint pathology underwent arthroscopic distal clavicle resections between 2002 and 2004. Preoperatively, all patients had acromioclavicular joint tenderness, 90% had a positive horizontal adduction test and 62% had a positive O’Brien’s AC compression test. All provocative signs were abolished on re-examination after acromio-clavicular joint injection. Surgery was indicated with failure of conservative management. Surgery was performed through a subacromial approach to the acromio-clavicular joint, using a Acromionizer (Smith-Nephew Dyonics, Andover, MA) burr through the anterosuperior portal. A supplementary Neviaser portal was used in 9 cases. Patients were clinically assessed at average of 18 months post surgery (range; 9–36). Functional rating was obtained with the Constant Score, WORC score and the Oxford Score. Results. Thirty-five patients (85%) reported none or minimal pain. 81% were negative for provocative AC signs. Internal rotation increased by average of 5 vertebrae levels. The Constant, the WORC and Oxford Scores were improved by 23 points, 674 points and 16 points respectively (p< 0.05). 71% reported good or excellent function by the 3. rd. post-operative month. Conclusion The arthroscopic Mumford procedure effectively treats acromioclavicular joint pathology. The procedure has low associated morbidity and high patient satisfaction

We reviewed 36 patients (39 shoulders) who had undergone arthroscopic Mumford procedure via a two superior portal technique for isolated acromioclavicular joint pain, using the Simple Shoulder Score (SSS) and a subjective outcome questionnaire, which included views about the cosmesis of the scars. The mean age of the 32 men and four women was 36 years (19 to 57) and 14 shoulders were on the dominant side. The mean follow-up was 22.7 months (14 to 47). Twenty-five patients reported a history of trauma, including six rugby injuries and five repetitive injuries sustained while bodybuilding. The mean SSS was 11.5 out of 12. Subjectively 25 shoulders were rated excellent, eight good, two moderate and four poor. In 31 shoulders (79.5%) pain resolved completely. Twenty-five patients considered small scars either very important or extremely important and 33 were either extremely happy or very happy with their scars. Arthroscopic excision of the distal clavicle via superior portals preserves the capsule-ligamentous structures stabilising the acromioclavicular joint. The procedure gives an excellent subjective outcome. Those patients with a poorer subjective outcome were older, with an increased possibility of occult shoulder pathology

Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the subscapularis tendon, the symptoms are usually more severe and the prognosis after surgery must be guarded. Isolated subscapularis tears represent 18% of all rotator cuff tears and arthroscopic repair is a good alternative primary treatment. However, when the tendon is deemed irreparable, tendon transfers are the only option for younger or high-functioning patients. The aim of this review is to describe the indications, biomechanical principles, and outcomes which have been reported for tendon transfers, which are available for the treatment of irreparable subscapularis tears. The best tendon to be transferred remains controversial. Pectoralis major transfer was described more than 30 years ago to treat patients with failed surgery for instability of the shoulder. It has subsequently been used extensively to manage irreparable subscapularis tendon tears in many clinical settings. Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its position in the axial plane – anterior to the rib cage – is clearly different and does not allow it to function as an ideal transfer. Consistent relief of pain and moderate recovery of strength and function have been reported following the use of this transfer. In an attempt to improve on these results, latissimus dorsi tendon transfer was proposed as an alternative and the technique has evolved from an open to an arthroscopic procedure. Satisfactory relief of pain and improvements in functional shoulder scores have recently been reported following its use. Both pectoralis minor and upper trapezius transfers have also been used in these patients, but the outcomes that have been reported do not support their widespread use. Cite this article: Bone Joint J 2024;106-B(9):970–977

Abstract. Introduction. Transforming outpatient services is a key commitment set out in the NHS Long Term Plan, with particular emphasis on digital solutions to reduce outpatient follow-up (FU) by 25%. This study looks at the potential for removing knee arthroscopy FU by providing a bespoke multimedia report for each individual patient, generated using the Synergy™ Surgeon App (Arthrex). Methodology. Single District Hospital using a 3 Phase study. Phase 1 – Assessment of cost and environmental impact of outpatient follow up appointments. Phase 2 – Bench marking of existing pathways and patient experience. Phase 3 – Qualitative assessment of multimedia report feedback of 30 patients. Results. Phase 1 – Impact per year for Trust in released clinician time 135hrs. Cost avoidance £40-£60k. Reduction of the carbon footprint from reduced FU of 3132 KgCo2e2. Phase 2 – Deep dive on 2019 n. 353 procedures. 1206 outpatient appointments required. Average 1.2 post-operative appointments. Phase 3 – 87% of patients who received the e-op report needed no further FU. This compares to only 25% using a traditional post op discussion after surgery. 94% of patients felt the report aided their recovery. Conclusions. Reducing patient FU appointments is crucial to the future of the NHS. Achieving this whilst simultaneously improving the quality of patient communication is achievable as this study has demonstrated. The potential scalability of this project to be applied other arthroscopic procedures is enormous. The study has demonstrated patients are comfortable with modern technology and feel it enhances their understanding whilst decreasing the need for routine post-op FU

Aims. Tourniquets have potential adverse effects including postoperative thigh pain, likely caused by their ischaemic and possible compressive effects. The aims of this preliminary study were to determine if it is possible to directly measure intramuscular pH in human subjects over time, and to measure the intramuscular pH changes resulting from tourniquet ischaemia in patients undergoing knee arthroscopy. Methods. For patients undergoing short knee arthroscopic procedures, a sterile calibrated pH probe was inserted into the anterior fascial compartment of the leg after skin preparation, but before tourniquet inflation. The limb was elevated for three minutes prior to tourniquet inflation to 250 mmHg or 300 mmHg. Intramuscular pH was recorded at one-second intervals throughout the procedure and for 20 minutes following tourniquet deflation. Probe-related adverse events were recorded. Results. A total of 27 patients were recruited to the study. Mean tourniquet time was 21 minutes (10 to 56). Tourniquet pressure was 300 mmHg for 21 patients and 250 mmHg for six patients. Mean muscle pH prior to tourniquet inflation was 6.80. Muscle pH decreased upon tourniquet inflation, with a steeper fall in the first ten minutes than for the rest of the procedure. Change in muscle pH was significant after five minutes of tourniquet ischaemia (p < 0.001). Mean muscle pH prior to tourniquet release was 6.58 and recovered to 6.75 within 20 minutes following release. No probe related adverse events were recorded. Conclusion. It is possible to directly measure skeletal muscle pH in human subjects over time. Tourniquet ischaemia results in a decrease in human skeletal muscle pH over time during short procedures. Cite this article: Bone Joint Res 2021;10(6):363–369

Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon's visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is a safe alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. One hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p < 0 .001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p < 0 .001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone

Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon's visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is a safe alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. One hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p < 0 .001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p < 0 .001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone

Recurrent anterior shoulder instability (RASI) is related to progressive bone loss on the glenoid and on the humeral head. Bone deficit magnitude is a well-recognized predictor of recurrence of instability after an arthroscopic Bankart surgery, but the best way to measure it is unknown. In this study, we want to determine which measurement method is the best predictor of recurrence of instability and function. For 10 years now, all patients undergoing surgery for RASI in 4 centers are included in a prospective study: the LUXE cohort. Patients with a pre-operative CT-scan and a minimum of 1-year follow-up were included. ISIS score was used to stratify patients. WOSI and Quick-Dash questionnaires were used to characterise function. Bone defects were assessed using the Clock method, the Glenoid Ratio, the Humeral Ratio, the Glenoid Track method and the angle of engagement in the axial plane. A total of 262 patients are now included in the LUXE study. One hundred and three patients met the inclusion criteria for analysis with a majority of male (79%) and a mean age is 28 years old. The median number of dislocations prior to surgery was 6. Seventy patients had an arthroscopic Bankart repair and 33 patients underwent an open Latarjet procedure. The ISIS score for these groups were of 2.7 and 4.8 respectively (p<0.001). The mean bone defect on the glenoid was of 1h51 with the Clock method (range: 0h-4h48; SD=1h46) and of 9% for the glenoid ratio (0–37%, 10%). On the humeral side, the bone defect was of 1h59 (0h-4h08; 0h49) for the Humeral clock method, 15% (0–36%; 6%) with the ratio method and 71 degrees of external rotation (SD=30 degrees) with the angle of engagement measurement. On the combined evaluations, 53 patients presented an off-track lesion, with mean combined hours of 3h53 (SD= 2h13). The greatest correlation obtained was between the glenoid ratio and the glenoid clock method (r=0.919, p<0.001). Eighteen patients had a recurrence of shoulder dislocation after the initial surgery, leading to a recurrence rate of 23% in arthroscopic surgery versus six percent after a Latarjet (OR= 4.6, p=0.034). No bone defect was correlated to Latarjet failure. For the arthroscopic group, the risk of recurrence was related to a smaller angle of engagement of the Hill-Sachs (p=0.05), a smaller Humeral clock measurement (p=0.034) and a longer follow-up (p=0.006). No glenoid or combined measurements were correlated with arthroscopic procedure failure. Recurrence of dislocation was associated to worst function according to the WOSI (1036 vs 573, p=0.002) and DASH (32 vs 15, p=0.03). Even with lower ISIS score, arthroscopic procedures are still leading to high risk of recurrence in this “all comer” consecutive cohort study AND it is related to humeral side parameters. Recurrence is also affecting daily function and creating higher anxiety related to the shoulder

Abstract. Objectives. The study aims to determine whether an arthroscopic ligament reconstruction is necessary to relieve clinical ankle instability symptoms in patients with an MRI scan showing medial or lateral ligament tear. Methods. This was a single centre retrospective case series study of 25 patients with ankle instability and ligament tear on MRI scan who had undergone arthroscopic procedures from January 2015 to December 2018. Patients were followed up for an average period of 3 years postoperatively to check for any recurrence of symptoms. Results. Of the 25 patients, 23 had ATFL tear on MRI scan, and 2 had deltoid ligament tear. Examination under anaesthesia was stable in 13 patients and unstable in 12 patients. The majority of the patients (76%) had a simple arthroscopic ankle debridement and no ligament repair. Six patients needed Brostrom repair. Conclusions. Our study has shown that in patients with MRI proven ligament tear and clinical instability, a ligament reconstruction was unnecessary in most patients. The instability symptoms of patients were relieved by simple ankle arthroscopic debridement

Malnutrition is an important consideration during the perioperative period and albumin is the most common laboratory surrogate for nutritional status. The purpose of this study is to identify if preoperative serum albumin measurements are predictive of infection following arthroscopic procedures. Patients undergoing knee, shoulder or hip arthroscopy between 2006–2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with an arthroscopic current procedural terminology code and a preoperative serum albumin measurement were included. Patients with a history of prior infection, including a non-clean wound class, pre-existing wound infection or systemic sepsis were excluded. Independent t-tests where used to compare albumin values in patients with and without the occurrence of a postoperative infection. Pre-operative albumin levels were subsequently evaluated as predictors of infection with logistic regression models. There were 31,906 patients who met the inclusion criteria. The average age was 55.7 years (standard deviation (SD) 14.62) and average BMI was 31.7 (SD 7.21). The most prevalent comorbidities were hypertension (49.2%), diabetes (18.4%) and smoking history (16.9%). The average preoperative albumin was 4.18 (SD 0.42). There were 45 cases of superficial infection (0.14%), 10 cases of wound dehiscence (0.03%), 17 cases of deep infection (0.05%), 27 cases of septic arthritis or other organ space infection (0.08%) and 95 cases of any infection (0.30%). The preoperative albumin levels for patients who developed septic arthritis (mean difference (MD) 0.20, 95% CI, 0.038, 0.35, P = 0.015) or any infection (MD 0.14, 95% CI 0.05, 0.22, P = 0.002) were significantly lower than the normal population. Additionally, disseminated cancer, Hispanic race, inpatient status and smoking history were significant independent risk factors for infection, while female sex and increasing albumin were protective towards developing any infection. Rates of all infections were found to increase exponentially with decreasing albumin. The relative risk of infection with an albumin of 2 was 3.46 (95% CI, 2.74–4.38) when compared to a normal albumin of 4. For each albumin increase of 0.69, the odds of developing any infection decreases by a factor of 0.52. This study suggests that preoperative serum albumin is an independent predictor of septic arthritis and all infection following elective arthroscopic procedures. Although the effect of albumin on infection is modest, malnutrition may represent a modifiable risk factor with regard to preventing infection following arthroscopy

Concepts in glenoid tracking and treatment strategies of glenoid bone loss are well established. Initial observations in our practice in Singapore showed few patients with major bone loss requiring glenoid reconstructions. This led us to investigate the incidence of and the extent of bone loss in our patients with shoulder instability. Our study revealed bony Bankart lesions were seen in 46% of our patients but glenoid bone loss measured only 6–10% of the glenoid surface. In the same study we found that arthroscopic labral repair with capsular plication and Mason-Ellen suturing (Hybrid technique) was sufficient to stabilise patients with bipolar bone defects and minor glenoid bone loss. This led us to develop the concept of minor bone loss and a new algorithm. Our algorithm and strategies to deal with major bone loss will also be discussed, and techniques & outcomes of Arthroscopic Bony Bankart repair, Arthroscopic Glenoid Reconstruction and Arthroscopic Remplissage procedures will be shown

Introduction and Objective. Postoperative pain control in shoulder surgery is challenging even in arthroscopic procedures. Acute postoperative pain can last up to 48hrs despite using multimodal analgesia. Different techniques have been used to control acute pain following shoulder surgery. The most common technique currently used in shoulder surgery at the elective orthopaedic centre in Leeds is a combination of general anaesthetic (GA) and interscalene block (ISB). ISB maybe very effective, however, carries many risks and potential side effects such as brachial plexus injury and paralysis of the vagus and laryngeal recurrent nerves as well as cervical sympathetic nerve and pneumothorax. ISB can also be associated with higher incidence of neurological deficit compared to other peripheral nerve blocks; up to 14% at 10 days in some cases. As such we decided to examine the use of ISB for achieving pain control in our elective unit. Materials and Methods. A prospective consecutive series of 217 patients undergoing shoulder surgery were studied. These were grouped into 10 groups. All procedures were arthroscopic apart from shoulder arthroplasty procedures such as hemiarthroplasty and total shoulder replacements (TSRs). The choice of regional anaesthesia was ISB with GA as standard practice. Visual analogue scores (VAS) at 0hrs, 1hr, 2hrs, 4hrs and 6hrs; and total opiates intake were recorded. A one-way single factor ANOVA was used as preferred statistical analytical method to determine whether there is a difference in VAS scores and total opiates intake amongst the groups. Postoperative analgesics were used for pain relief, although these were not standardised. Results. In total shoulder replacement group, although the RSR group used more morphine on average compared to the ASR group (Mean morphine intake 6.5mg vs 3mg), this was not statistically significant (F<Fcrit; p value= 0.19). When comparing all the arthroplasty groups, the difference in mean morphine intake was also statistically not significant (F<Fcrit; p value=0.24). However, when comparing all 10 groups’ morphine intake there was a statistically significant difference amongst these groups (F>F crit; p value=0.03). Interestingly, there was a statistically significant difference in VAS at 0hrs (F>Fcrit p value=0.01); 1hrs (F>Fcrit; p value=0.00), and at 6hrs (F>Fcrit; p value=0.02) when comparing all 10 groups. Conclusions. ISB is an effective technique in achieving pain control in shoulder surgery; however, there are still variations in analgesic needs amongst groups and the use of alternative techniques should be thus explored. A future prospective study looking at acute pain for a longer period of time after shoulder surgery would explore the effectiveness of ISB in achieving pain control consistent with rehabilitation requirements