Biomedical subjects
Publications and source records attributed to G J Schonholtz.
The purpose of this article is to present the fourth case report of bilateral discoid medial menisci. A previously unreported anomaly of the tibial plateaus associated with the discoid menisci was also present bilaterally. The patient was treated successfully by excision of the central anomalous discoid portion of the menisci, using arthroscopic techniques.
This paper is a retrospective study of 27 women with carpal tunnel syndrome (39 hands) who underwent a new endoscopic operative procedure utilizing the Universal Subcutaneous Endoscope system developed by the lead author. Operations on 199 hands were performed under local anesthesia on an outpatient basis. The etiology was considered idiopathic in all cases. Complete preoperative and postoperative clinical and electrophysiologic data were analyzed in 39 hands. The follow-up period ranged from 12 to 45.8 months (mean, 18.3 months). Symptoms of sensory disturbances disappeared in an average of 20 weeks in all patients. Electrophysiologic studies showed definite improvement when compared with preoperative studies. No complications were recorded. Clinical and electrophysiologic results showed that the less-invasive management of carpal tunnel syndrome by endoscopy is safe and effective.
We developed a new operative procedure of coracoacromial ligament release for shoulder impingement syndrome. The operative procedure was confirmed by cadaveric studies and applied to clinical cases in 40 shoulders of 37 patients who suffered from shoulder impingement without bony abnormalities. The subacromial space was observed under local anesthesia using the Universal Subcutaneous Endoscope (USE) system on an outpatient basis. A popping phenomenon was observed between the coracoacromial ligament and the greater tuberosity of the humerus, which was covered by the rotator cuff, and the coracoacromial ligament was resected with a rongeur under endoscopic visualization in all shoulders. Resection of the coracoacromial ligament relieved the impingement and clinical signs, as in open or arthroscopic resection of the coracoacromial ligament. Resection of the coracoacromial ligament using the USE system is a safe and less-stressful surgical invasion than open or standard arthroscopic resection of the coracoacromial ligament.
Ankle arthroscopy has evolved over the past decade as a diagnostic and an operative modality. Forty ankle arthroscopies were performed by the senior author (G.J.S.) for osteochondral fractures, chronic sprains unresponsive to conservative treatment, posttraumatic osteoarthritis, adhesions, locking, instability, synovitis, and ankle disability of undetermined cause. Thirty cases with at least 24 months of follow-up were reviewed. Complications occurred in two patients: reflex sympathetic dystrophy and a fibular fracture. Postoperatively, the patients were rated clinically as having 13% excellent, 60% good, 17% fair, and 10% poor results. However, 95% of the patients stated that they would undergo the same operation again if needed. Results were significantly better in those patients who had chondral or osteochondral defects as the diagnosis, and in noncompensation cases.
Arthroscopic debridement is a valuable alternative procedure in the management of osteoarthritis of the knee joint. Although palliative in nature, in many instances it yields permanent relief in the low-demand knee of the elderly. It is especially valuable in young individuals who have not yet reached the ideal age for reconstruction. The procedure is a demanding one, requiring considerable arthroscopic skills. Sclerotic lesions, synovitis, loose bodies, osteophytes, chondromalacia, and degenerative tears of menisci are encountered often in various combinations and must be addressed judiciously and completely. The procedure simplifies rehabilitation, and the risk/benefit ratio is very favorable.
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From October 1977 through January 1984, 2,330 arthroscopic procedures of the knee were performed by one of the authors (G.J.S.). Among these procedures, 35 lateral retinacular releases were performed through minimal, lateral incisions. Twenty-two knees in 22 patients were available for follow-up evaluation, and these cases were reviewed retrospectively. The average age of the patients at the time of surgery was 22.6 years. The average follow-up period was 48 months. The patients were divided into three subgroups on the basis of their preoperative diagnosis. Group I (eight knees) had a history of patellar dislocations; group II (seven knees) had recurrent patellar subluxation, identified by history and physical and radiographic examinations; and group III (seven knees) had patellar pain without a history of dislocations or subluxation and with no symptoms of instability. All of these patients underwent diagnostic arthroscopy and lateral retinacular release, as well as arthroscopic treatment of associated pathology. Postoperatively and at the time of followup, all patients were evaluated for pain, function and patellar instability. In 15 patients with a history of patellar dislocation or subluxation, 67% were found to have had significant improvement in their symptoms, which was borne out by the findings during physical examination. None was worse following treatment. Among the seven patients with no history of patellar dislocation or subluxation, only one of the seven had a satisfactory result. Based upon the findings of this study, it was concluded that arthroscopic lateral retinacular release is a reasonable, initial step in the surgical treatment of patellar dislocation or subluxation, resistant to conservative treatment. Its efficacy in cases of recalcitrant patellar pain without a history of instability is doubtful.
Moraxella osloensis pyarthrosis of the knee joint is an unusual infection. The diagnosis can be quite difficult since the organism is fastidious in its growth characteristics. This case report presents an adult with M. osloensis sepsis of the knee, which could only be diagnosed by arthroscopic synovial biopsy and culture. Moreover, arthroscopy played a critical role in the definitive therapy.
Following failure of conservative treatment, arthroscopic chondroplasty was performed on 41 knees in 40 patients with chondromalacia of the patella as the only lesion. Within a follow-up period averaging 40 months, results were excellent in 10%, good in 39%, fair in 44% and poor in 7%. Seventy-eight percent of patients were subjectively satisfied with their surgery. Age or sex of the patients, grade of the lesion, and duration of the symptoms prior to surgery did not correlate with the final result. The method is considered safe since the few complications recorded were minor and did not affect the end result. Arthroscopic chondroplasty of the patella for chondromalacia patella has proved to be as satisfactory as or superior to more radical surgical approaches; however, conservative care should be the initial and primary method of treatment for this disease.
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Contamination of operative wounds during surgery occurs primarily through contact and secondarily through the airborne route. Inspection and maintenance of air-handling equipment is essential, with special reference to air intakes, filters, humidifiers, and exhaust systems. Doors should remain closed to maintain positive pressure. Surgical attire for all personnel must provide for complete coverage of hair and arms. Intensive interim cleaning of all horizontal sufaces between operations is essential. The infection rate is proportional to the duration of the operation and the number of personnel in the room, and inversely proportional to the air changes per hour.
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