In a randomised prospective study, 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning. Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning. The patients were evaluated clinically and radiologically at follow-up of 24 months. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and modified Mayo wrist score were used at 3, 9, 12 and 24 months postoperatively. In the arthroscopically- and fluoroscopically-assisted group, triangular fibrocartilage complex tears were found in 12 patients (60%), complete or incomplete scapholunate ligament tears in nine (45%), and lunotriquetral ligament tears in four (20%). They were treated either arthroscopically or by open operation. Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination, extension and flexion at all time points than those who had fluoroscopically-assisted surgery. The mean DASH scores were similar for both groups at 24 months, whereas the difference in the mean modified Mayo wrist scores remained statistically significant.

Although the groups are small, it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome. Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome.

Aim: The purpose of this study was to evaluate the success and complication rate of endoscopic carpal tunnel release (ECTR) using the Chow technique in a large series of patients. Methods: Between September 1897 and February 2001, 2402 hands in 1698 patients underwent ECTRusing the Chow technique. The mean age of the patients was 51 years (14–96). The diagnosis of CTS was based on clinical symptoms and nerve conduction velocity test. Patients were evaluated by physical examination or interviewed by telephone for the current status of their hands. Patients were asked to report about any symptoms following surgery, including numbness, tingling, night pain, weakness and if present the severity of them. The return to work status was followed in 1156 patients. Results: The average follow-up was 6 years and 10 months (range 4 to 161 months). The average operating time was 8 minutes (ranged 5 to 27). A total of 2284 (95%) hands were completely asymptomatic or had very minor problems after ECTR. There were 26 complications, including perioperative (neurapraxias) and late (failed cases, recurrences, infections) complications. The overall complication rate was 1.1% but no serious complications were occurred in this series. Ninety percent of non-workerñs compensation patients and 60% of workerñs compensation patients return to work within 4 weeks. Conclusions: This study suggests that ECTR for carpal tunnel syndrome is a reliable procedure with a high success rate. Furthermore, the technique was found to be safe and iatrogenic complications can be avoided with meticulous surgical technique.

Aim: The purpose of this study was to evaluate the results of arthroscopic capsular release in patients with primary adhesive capsulitis of the glenohumeral joint. Methods: Twenty-eight shoulders in 27 patients with adhesive capsulitis of the glenohumeral joint were treated with manipulation and arthroscopic capsular release. Their average age was 54.5 years (range, 39–67). During surgery, synovectomy and a combined anterior, posterior and inferior arthroscopic release using electrocautery or laser was performed. Range of motion and evaluation with the Constant score before and after surgery was performed in all patients. Results: The mean follow-up was 32 months (24–63). The mean Constant score significantly improved from 44.6 (28–52) preoperatively to 86.3 (73–52) postoperatively (p< 0.001, paired t-test). Range of motion for all planes significantly improved. Abduction improved from 72° preoperatively to 165° postoperatively; Internal rotation improved from 13° to 60° and external rotation from 10° to 75°. Subjectively all patients had remarkably less pain, and there were no complications. Conclusions: Our study suggest that arthroscopic treatment of primary adhesive capsulitis with capsular release is an effective and reliable method for restoring a painless motion of the glenohumeral joint.

Aim: The aim of this prospective study was to evaluate the results of arthroscopic treatment of chondral and osteochondral lesions of the knee with osteochondral autogenous transplantation (OAT). Methods: Thirty patients with symtomatic cartilage lesions of the femoral condyles were treated with OAT. Inclusion criteria were full thickness femoral condyle defects between 1 and 3 cm in diameter. Grafts were harvested from the superior intercondylar notch and press þt into holes drilled into the defect starting adjacent to the articular cartilage margin. All patients were evaluated both pre and postop with the Lysholm score, IKDC Form and radiological assessment. Second look arthroscopy was offered to all patients independently of their symptoms. Results: The mean follow-up was 44.7 months. The mean Lysholm score signiþcantly improved from 43.6 pre-operatively to 87.5 postoperatively (p< 0.001, paired t-test) with excellent and good results in 25 (83.3%) patients. Using the IKDC assessment 26 (86.6%) of the patients reported their knee as being normal or nearly normal. Repeat arthroscopies have been done in 9 (30%) patients. Seven of these demonstrated complete healing and two partial healing. The histological examination ascertained the presence of viable chondrocytes and normal hyaline cartilage in the completely healed cases. Conclusions: Our study suggest that arthroscopic OAT is an effective method for treating chondral defects of the femoral condyles in selected cases. However, further studies with long-term follow-up are needed to determine if the transplanted area will maintain functional and structural integrity over time.

Introduction: The aim of this study was to evaluate the anterior knee symptoms after anterior cruciate ligament reconstruction (ACL) using either pateller tendon (PT) or hamstring tendon (HS) autograft.

Materials and Methods: 45 patients undergoing primary ACL reconstruction were randomized to have a PT (23 patients) or a doubled HS (22 patients). Patients were reviewed after 3, 6, and 9 months. Patients were examined for knee pain and sensory changes in the anterior aspect of the knee, the ability for kneeling and sensitivity of the surgical incision.

Results: At the last follow-up in the PT group 4 patients (17%) had anterior knee pain, knee-walking test was impossible for 4 patients (17%), 3 patients (13%) reported to have surgical incision sensitivity and 4 patients (17%) had numbness in the skin area supplied by the infrapatellar branch of the saphenous nerve. In the HS group, 2 patients (9%) had anterior knee pain, knee-walking test was impossible for 2 patients (9%), 2 patients (9%) reported to have surgical incision sensitivity and 10 patients (45%) had numbness in the skin area supplied by the infrapatellar branch of the saphe-nous nerve. There was a statistical significant difference (p< 0.05) regarding the sensory changes in the anterior aspect of the knee.

Conclusions: Harvesting of the PT or HS autograft for ACL reconstruction is associated with a low rate of anterior knee symptoms. Sensory changes following HS harvesting is significantly higher. However, this does not appear to be of great clinical importance without limitation of activities.

The aim of this prospective study is to investigate the effectiveness of a new method for arthroscopic all-inside meniscus repair (Clearfix meniscal screw system-Innovasive Devices Inc.).This system consists of delivery cannulae,screw implants and a screw driver.After tear debridement a screw is located on the driver and passed through the cannula to the insertion site, holding the two sides of the tear together under linear compression.In this study, 46 patients (48 repairs)are included, mean age 32,7 years,with a follow-up ranging from 6 to 48 months (average 18,8 months).Only longitudinal lesions in the red/red zone or red/white areas were repaired. Ligament stabilizing procedures were done in 39 patients (84,8%) who had ACL deficient knees,.Thirty-four (71%) injuries were considered chronic (injury to repair time more than 4 weeks) and 14 (29%) injuries were considered acute (injury to repair time less than 4 weeks).The evaluation of the results was based on the clinical examination,the “OAK ” knee evaluation scheme and the MRI.Criteria for clinical success included absence of joimt line tenderness, swelling and a negative Mc Murray test.Thirteen out of 48 repairs (27%) were considered as failures according to the above mentioned criteria.The average time for the procedure was 8 minutes.Postoperatively there were no complications directly associated with the device.Magnetic resonance imaging, however,showed a persisting grade III and IV lesion in 72,8% of the patients (n=35) according to Reicher classification.

Though the system offers two main advantages,that is the absence of serious complications and the reduced operative time, the failure rate in this study is quite high. This clinical study is in agreement with the recent experimental studies referring to the limited pull-out strength of this device.

Purpose: purpose of this study is the evaluation of three techniques of arthroscopic meniscal repair: inside-out, outside-in – all inside.

Materials and Method: from January 2002 to January 2003 were admitted 31 patients, (32 meniscal tears) that were underwent to arthroscopic meniscal repair. The patients 24 men and 6 women had mean of age 26.7 years. By the 32 ruptures the 8 were treated with the technique outside-in (group A), 9 with the technique inside-out (group B) and 15 with the technique all inside (group C). Preoperatively and postoperatively the patients were evaluated with the Lysholm score, the McMarray score and the pain of joint line

Results: The average follow-up for group A was 14 months, for group B 11 months and for the group C 12 months. Preoperatively 7 patients of group A had pain of joint line, 6 McMarray testn+ and the Lysholm score was 57. Preoperatively 9 patients of group B had pain of joint line, 5 McMarray test + and the Lysholm score were 46. Preoperatively 13 patients of group C had pain of joint line, 9 McMarray test + and the Lysholm score was 69. Postoperatively none of the patients of group A have pain of joint line, none have McMarray test + and the Lysholm score was 94. Postoperatively none of the patients of group B have pain of joint line, none have McMarray test + and the Lysholm score was 97. Postoperatively 4 patients of group C have joint line pain, 5 McMarray test+ and the Lysholm score was 88.

Conclusions: Despite the small differences that were observed between the three groups the total results of meniscal repair are encouraging. Needs longer time of follow-up of this patients in order to it is realised if the technique of all inside it falls short if it is compared with two others techniques as they show our precocious results.

Introduction: Regional anaesthesia is used recently more often in minor and intermediate orthopaedic procedures. This study evaluates regional anaesthesia in knee arthroscopy.

Patients and Method: From September 2002 to February 2003, sixty three patients had knee arthroscopy by regional blockade, (mean age 28, 3 years). Thirty ml Ropivacaine 5% and 10 ml Lidocaine 2% were used to block sciatic and femoral nerve with nerve stimulator help.

Results: They were realized 31 meniscectomies, 8 meniscal repairs, 6 primary ACL reconstructions, 2 ACL revisions, 5 chondroplasties, 6 lateral releases, 2 Fulkerson osteotomies, 4 plica removals, 2 adhesionlysis, 2 localized villonodular synovitis, one total synovectomy and one arthroscopic removal prepatellar bursa. There was no complication concerning the nerve blockade. Two of 8 ACL patients required general anesthesia and one had sedation during the procedure. Sedation also was necessary in three patients with lateral release and two meniscal repairs. The remaining 55 patients were tolerated the arthroscopic procedure without any additional help. All patients hospitalized less than 24 hours except patients with ACL reconstruction. They needed 1, 2 analgesic pills per person. The cost for the anesthetic procedure was 40 euros.

Conclusion: Regional anesthesia has the advantage of avoiding the complications of general anesthesia, is of low cost and well bearable from the majority of patients. It offers prolonged postoperative analgesia and has no complications.