Jack M. Bert

The arthroscopic treatment of unicompartmental gonarthrosis ; a five-year follow-up study of abrasion arthroplasty plus arthroscopic debridement and arthroscopic debridement alone

A retrospective review with a mean follow-up time of 60 months was performed on 126 patients who had treatment of unicompartmental gonarthrosis with either abrasion arthroplasty plus arthroscopic debridement or arthroscopic debridement alone. Fifty-nine patients had abrasion arthroplasty and arthroscopic debridement, and 67 patients had arthroscopic debridement alone. All patient had stage II Ahlbäck changes roentgenographically, as well as Outerbridge stage IV changes arthroscopically in the involved compartment. All the knees were evaluated postoperatively at a minimum of 60 months, utilizing The Hospital For Special Surgery Knee Scoring System. In the group treated with abrasion arthroplasty, 51% had good to excellent results, 16% had fair results, and 33% had poor results. The conditions of ten of the patients who had poor results actually became worse subsequent to their abrasion arthroplasty. In the group that had arthroscopic debridement, 66% had good to excellent results, 13% had fair results, and 21% had poor results. The conditions of 12 of the patients who had poor results actually became worse subsequent to the arthroscopic debridement.

Abandoning Microfracture of the Knee: Has the Time Come?

Marrow stimulation has been performed for more than 45 years beginning with the simple drilling of bony surfaces, burring or abrading the sclerotic lesion, and more recently using awls to penetrate eburnated bone to promote blood flow to the bony surface. Multiple authors have promoted these procedures as helpful, but others have confirmed only short-term relief with destruction of the subchondral surface. Unfortunately, proponents do not compare their marrow stimulation results to a control group that had debridement alone. A recent study confirmed that microfracture (MF) is equivalent to debridement and does not affect the subchondral bone, which therefore does not reduce the success rates of future surgery subsequent to MF. This brief review summarizes some of the factual data showing that marrow stimulation may not offer any improvement over debridement alone and that, in fact, MF results in significant destruction to the subchondral bone.

Effect of various irrigating fluids on the ultrastructure of articular cartilage

The effect of five different irrigating fluids on the ultrastructure of articular cartilage was studied utilizing the scanning electron microscope. Gross histologic studies have shown no significant difference amongst commonly used irrigating fluids on the surface or matrix composition of articular cartilage. Recent in vivo and in vitro biochemical studies, in addition, have shown no significant deleterious effects of irrigating fluids on articular cartilage composition. This study was prospectively undertaken to assess the effect of irrigating fluids on the ultrastructure of articular cartilage. When comparing five irrigating solutions utilizing the scanning electron microscope, specimens irrigated with 1.5% glycine seemed to show a more consistently smooth appearance. Ultrastructural changes were noted with the other four irrigating solutions tested.

Use of an electrocautery loop probe for arthroscopic meniscectomy: A five-year experience with results, indications, and complications

Between 1984 and 1990, 952 patients had arthroscopic meniscectomies with a specially designed electrocautery loop probe. In all but 250 patients, 1.5% glycine was used as the nonconductive irrigating solution. Ninety-five patients had repeat arthroscopic procedures at a minimum of 6 months after their original procedure. Biopsies of the meniscal remnants were obtained in 21 patients. In all 21, there was no evidence of thermal damage in the area of the previous arthroscopic meniscal electrosurgery. In less than 4% of the patients, articular surface injuries occurred at the time of the original meniscectomy. Careful records were kept outlining the areas of contact damage with the exposed wire of the electrocautery loop probe. At repeat arthroscopies in 17 patients 9 months to 4 years after the initial procedure, there was no apparent evidence of significant permanent damage to the articular surface in the area of the original thermal injury. The electrocautery loop probe was effective for efficient resection of simple and complex tears of the medial or lateral meniscus.

Interscalene Block for Shoulder Surgery in Physician-Owned Community Ambulatory Surgery Centers

PURPOSEnTo retrospectively report on a series of patients who had interscalene block regional anesthesia performed for outpatient open and arthroscopic shoulder surgical procedures in a community-based ambulatory surgery center setting.nnnMETHODSnWe reviewed the cases of 1,945 patients who had interscalene block regional anesthesia performed during an 8-year period.nnnRESULTSnThe complication rate was 0.63%, with all complications occurring in the immediate postoperative period, none of which were permanent.nnnCONCLUSIONSnWith an expert, experienced anesthesia team, the interscalene block can be a safe method (temporary complication rate, 0.63%) of intraoperative anesthesia and perioperative analgesia for outpatient open and arthroscopic shoulder surgery in physician-owned ambulatory surgery centers.nnnLEVEL OF EVIDENCEnLevel IV, therapeutic case series.

Editorial Commentary: Knee Meniscus and Hip Labrum: The Dilemma of Degenerative Tears

The dilemma for orthopaedic surgeons attempting to solve the problem of treating a knee meniscal tear in an older patient has always been whether or not a conservative approach is of value and if a surgical approach will provide benefit to the patient. Today, the same might be said of hip labral tears. Physical therapy is a wonderful tool to strengthen muscles, but it does not correct underlying pathology, which is often the source of joint pain. In an older patient with a symptomatic internal derangement, it is important for surgeons and payers to recognize that a simple outpatient surgical procedure often can improve that patients symptoms.