Endo-arthroscopically assisted surgery of selected orthopaedic conditions: Technique and results.

Abstract

The minimally invasive and arthroscopically assisted surgery is a new therapeutic resource in the surgical treatment of degenerative and prosthetic orthopaedic pathology; in the field of neoplastic one it is just dawning. In this work the AA. report the technique and results of the arthroscopically assisted percutaneous arthrodesis of the ankle and of the arthroscopically assisted percutaneous curettage of epiphyseal chondroblastoma (E.C.) and osteoid osteoma (O.O.) of skeleton.

From 1992 to 2002 they treated 12 selected cases: 4 affected by E.C., 3 located at proximal tibia and 1 at proximal humerus, in patients aged from 13 to 16 years and evaluated at a follow-up ranging from 7 to 3 years, with a 75% of good results; 4 affected by osteoid osteoma of proximal femur (2) and tibia (2), in patients aged from 13 to 18 years, evaluated at a follow-up ranging from 12 to 3 years with very good results (75%); 4 cases of ankle’ painful stiffness, with 1 case of severe weightbearing instability, in patients aged from 17 to 75 years, evaluated at final bone fusion, radiographically observed at a average of 3.2-month follow-up from operation. All cases were treated by MIS criteria under accurate radiographic and CT-3D pre-operative planning, endoscopic (trans-osseous tunnels) and/or arthroscopic (ankle arthrodesis) continuous assistance under fluoroscopy. Two cases received cortico-cancellous bone autografts. All neoplastic cases had histologic confirmation by excision biopsy. They report 2 cases of failure, 1 in the E.C. series (25%) and 1 among the O.O. (25%), respectively at 6 and 12 months from the operation. In conclusion the authors report good results in 75% of cases together with very good aestheticism, well accepted by patients, and with articular function not minimally altered by the technique.