Arthroscopic Treatment of Iatrogenic Slipped Capital Femoral Epiphysis Screw Impingement and Associated Hip Pathology

Background: Screw impingement is an infrequently reported sequelae following in situ pinning of a slipped capital femoral epiphysis, but it may result in significant bony and chondrolabral degeneration. Hip arthroscopy may offer the advantage of screw removal in a minimally invasive manner under direct visualization, as well as providing the opportunity for management of concomitant hip pathology. Indications: A healthy, active 27-year-old woman with right hip dysfunction secondary to screw impingement and concomitant chondrolabral pathology following previous in situ pinning of a slipped capital femoral epiphysis. Technique Description: The patient elected to undergo arthroscopic removal of hardware, osteochondroplasty, and management of hip labrum pathology. After the screw was localized, a 2.8-mm pin was inserted down the cannulated center of the screw to prevent intraarticular displacement during removal. The screw and washer were removed intact, and femoroplasty was performed to remove the reactive bone and resolve the cam-type impingement. Acetabuloplasty was then performed to remove pincer-type impingement and provide an appropriate rim of bone for labral reconstruction. The pathologic labrum was then debrided and reconstructed with a semitendinosus allograft. Results: There were no immediate complications following surgery. Surgical management led to resolution of the patient’s mechanical symptoms and provided pain relief, which allowed return to prior baseline level of function. Discussion/Conclusion: Symptomatic screws that impinge the osteochondral and soft tissue anatomy of the hip require removal. Historically, these screws have been removed by open, mini-open, or percutaneous techniques. This case demonstrates the advantages of arthroscopic removal, as it affords the surgeon the ability to perform a dynamic examination, safely remove the screw, and directly visualize and manage concomitant hip pathology that may not be otherwise be recognizable. Further studies will be required to determine the ability of this technique to more clearly illustrate long-term improvement in function and prevention of the development of osteoarthritis.

Arthroscopic removal of multiple foreign bodies in the knee: A case report

We report the uncommon case of knee arthroscopic removal of multiple bullet pellets. A 25-year-old male professional footballer was admitted with left knee swelling, pain, and limitation of movement following a gunshot injury. Radiographs revealed multiple pellets in and around the left knee, each measuring about 5 mm in diameter. There were several pellets in the subcutaneous, intramuscular, and intra-articular parts of the left knee. The pellets were metallic, contraindicating magnetic resonance imaging to assess intra articular structures. He was booked for an urgent knee arthroscopy and the pellets were retrieved, and the other vital intra articular structures were examined. Three 5 mm diameter spherical bullet pellets were removed from the joint cavity. The synovial membrane was debrided, and the knee lavaged. Recovery was satisfactory with no complications. The patient was discharged to physiotherapy and followed up at 3 and 6 months after surgery. Foreign bodies in the knee are not uncommon; however, the presence of multiple bullet pellets is rare, especially in the index case of a sportsman. Its removal can be challenging, even arthroscopically. Such a procedure can result in severe complications, such as infections and joint deformities. The decision to use the arthroscopic approach requires careful deliberation regarding the status of the patient vis-a-vis the available skill and experience of the managing team.

Giant Melon seed Bodies in Painless Shoulder Swelling

Melon seed bodies are a non-specific manifestation of chronic synovial inflammation associated with various arthritides such as tubercular, rheumatoid, and seronegative arthritis. Characteristic magnetic resonance imaging (MRI) appearance of these bodies differentiates them from other differential diagnoses (such as synovial chondromatosis and pigmented villonodular synovitis). Ultrasonography and MRI, in combination with clinical and laboratory details, can suggest the possible etiology. Medical management of the underlying cause, along with arthroscopic removal of pathognomonic bodies, is the preferred treatment.

Intra-articular fibrous bands at the tibiotalar joint: diagnosis and outcomes of arthroscopic removal in 4 ankles

The authors retrieved the records of 4 patients that exhibited unusual structural anomalies or pathologies, notably the presence of a fibrous band at the anterior aspect of the tibiotalar joint, observed during arthroscopic exploration or treatment between January and December 2019. Only 1 patient had surgical antecedents on the ipsilateral ankle (extra-articular tenodesis 10 years earlier). The remaining 3 patients had no surgical antecedents on the ipsilateral ankle. The fibrous band was removed in all patients during arthroscopic Brostöm procedure or exploration. For the first 3 patients, the intra-articular fibrous band was not observed prior to arthroscopy by either the senior surgeon or radiologist on any of the images (2 MRIs and 1 CTA), but retrospective inspection confirmed that the intra-articular fibrous band was present but had been overlooked.At a follow-up of 22.3 ± 5.0 months (range, 15–26), all patients reported a decrease in pVAS (− 5.0 ± 2.6, range, 2–8), and an improvement in AOFAS (51.0 ± 17.7, range, 26–65), EFAS (14.5 ± 8.7, range, 6–23) and EFAS sport (8.0 ± 5.3, range, 2–10).This case report corroborates the findings of an earlier discovery of an intra-articular fibrous band in 4 ankles, with more detailed information for clinical and radiologic diagnosis, as well as outcomes of arthroscopic removal. Clinicians should beware of such foreign bodies in the ankle, particularly in patients with history of sprains, and consider arthroscopic removal in cases with persistent pain and/or functional impairment.

Acute Arthroscopic Removal of a Bullet Embedded in the Glenoid: A Case Report

Introduction: Retained bullets in joint spaces have been shown to cause both mechanical and chemical damage to the joint surfaces, leading to the risk of arthritis if untreated. Case Report: A case of arthroscopic treatment for a gunshot to the shoulder with a retained bullet embedded in the glenoid is presented. The patient presented with multiple gunshots to his back and extremities, including gunshot to the left leg with popliteal vein injury, gunshot to the back with lumbar level laminar fractures and acute spinal cord injury, and gunshot to the left shoulder with a retained bullet in the posterior superior glenoid. Conclusion: Shoulder arthroscopy can be successfully employed to retrieve larger embedded bullet or foreign body with the help of tools such as laparoscopic graspers. Even with significant glenoid bone defect, the stability of the shoulder joint does not get compromised if the bone defects are located posterosuperiorly. Keywords: Retained bullet, shoulder arthroscopy, gunshot, glenoid bone defect, humeral head fracture.