Arthroscopy

Definition

Mid-substance calcification of the rotator cuff

- part of a metaplasia secondary to hypoxia

Aetiology

2 groups of patients

Epidemiology

Traumatic initial cause in 95%

M:F 2:1

Age of initial dislocation inversely related to recurrence rate

- patients younger than 20 have a redislocation rate of 90%

- between 20 - 40 years, redislocation rate of 60%

- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)

Anatomy & Stability

1. Passive Stabilisers

Position

1.  Lateral decubitus

- stabilise patient with beanbag or lateral rests

- apply skin traction to forearm

- place traction pole at foot of table opposite surgeon

- suspend arm with 10 lb weight

- abduction 60°

- forward flexion of 20°

- tilt top shoulder posteriorly 30° so that glenoid is parallel wwith bed

- mark bony landmark

- prep & free drape

Indications

1. Removal Loose body

2. Excison of osteophytes

- coronoid

- olecranon

- aiming to improve ROM / prevent impingement

Non Operative Management

Options / ELM POPI

Education

Lifestyle Management

- weight loss

- reduce sport

Physiotherapy

Orthotics

- walking stick

- braces

Pharmaceuticals

- NSAIDS

- acetominophen

- glucosamine

Injections

- cortisone

- hyaluronic acid

Definition

Osteochondritis Dissecans

- separation of avascular fragment of bone & cartilage

Epidemiology

M : F = 2:1

Mean age 18 years

- can present as young as 9

4:1000

Anatomy

Developmental Anatomy

Knee joint first appears as a mesenchymal cleft at 8 weeks gestation

- ACL and PCL separate entities by week 10