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The investigation of histological changes in the infrapatellar fat pad due to patellar tendinopathy
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
semitendinosus autograft, and creating two patellar bone sockets and one femoral bone socket anatomically under X-ray control. The center of double-looped semitendinosus tendon was inserted into a femoral bone socket and the two free ends of the graft were pulled into the patellar bone sockets. The graft was fixed with extra-cortical suspension devices. Computed tomographic scans obtained before surgery, three weeks, and one year after surgery were reconstructed into multi-planar reconstruction by using a volume analyzer. An axial slice on the most prominent part of both femoral condyles was selected for analysis of the patellar position. A tangent line passing through the both condyles of the femur was drawn and a perpendicular bisector line between the tangent points was drawn. The patellar position was measured by the distance between the perpendicular bisector line and the lateral edge of the patella. After the image through both the apertures of femoral and patellar tunnels and complete longitudinal images of the femoral tunnel and the patellar tunnel were identified, the lengths of the graft in each locations were measured. The lengths of each proximal and distal half of the graft were calculated by summing these measurements and the total graft length was defined as the sum of the proximal and distal graft length. The patellar positions and the total graft length of the three time points were compared using the Wilcoxon signed rank test. The relationship between the patellar position and the total graft length at a year was evaluated by single linear regression analysis. Results: No patients reported re-dislocation during follow-up. The patellar postions were 38.2 ± 5.4 mm (range, 26.5-50.2) before surgery, 27.8 ± 3.9 mm (range, 22.1-36.9) at three weeks, and 32.0 ± 4.8 mm (range, 24.1-41.6) at one year after surgery, respectively. The total graft length was slightly shortened from 199.3 ± 3.6 mm at three weeks to 195.8 ± 7.2 mm at one year follow-up (P < 0.05)There was a significant correlationship between the total graft length and the position of the patella after MPFL reconstruction (R2¼0.17, P<0.05). Discussion: This study revealed that the patella being reduced immediately after surgery returned to somewhat the lateral position a year after surgery and the length change of the graft was related to the lateral shift. Graft elongation was observed in some cases, but shortening in other cases. The length change pattern depending on patients might be because a difference in tension applied to the graft might affect the process of graft remodeling. Lateral patellar shift after surgery was observed in almost cases, even in cases with graft shortening. This suggested that only the length change of the graft could not explain the lateral patellar shift. Further examination regarding other factors involved in this phenomenon is necessary. Conclusion: The patella shifted more laterally one year than three weeks after MPFL reconstruction. There was a significant correlation between the position of the patella and the length of the graft after MPFL reconstruction. Keywords: the patellar shift, the length of the graft
Knee - Patellofemoral joint disorder EP-087 CURE THE PATELLAR TENDINOPATHY WITH ARTHROSCOPY Wenzhao Chen, Zhizeng Gao. Department of China, The First Affiliated Hospital of Nanchang University, China Method: we cured 7 knees which including 4 male and 2 female . ages 1835 years during 2013.1-2016.5 . in those patients ,a male cured 2 knees . all the patients still complain the painful of knee after conservative treatment ,including rest, Local physiotherapy and Closed therapy. The VAS score were 4-7.All the patients’ knees have Mass calcification , only one Mass calcification near the patella ,others are near tibia. We excision the Mass calcification with arthroscopy ,and fixed 2 of them with PDS-II. Those patients fixed with PDS-II were told to avoid sports for 6 weeks. Result: All patients were followed up for 3 months to 12 months, Compared with the preoperative movement, VAS score of knee pain decreased . Conclusion: arthroscopic minimally invasive treatment is effective way , for patients treated with conservative therapy who with Mass calcification. Keywords: ARTHROSCOPY, Mass calcification, PATELLAR TENDINOPATHY
103
Knee - Patellofemoral joint disorder EP-171 THE INVESTIGATION OF HISTOLOGICAL CHANGES IN INFRAPATELLAR FAT PAD DUE TO PATELLAR TENDINOPATHY
THE
Takashi Kitagawa 1, 2, Junsuke Nakase 2, Yasushi Takata 2, Kengo Shimozaki 2, Hiroyuki Tsuchiya 2. 1 Department of Rehabilitation, Japanese Red Cross Kanazawa Hospital, Japan; 2 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan Background: Patellar tendinopathy (PT) is primarily a condition of relatively young athletes who participate in sports that require repetitive loading of the patellar tendon. Repetition of jumping and landing or insufficient rest to enable patellar tendon remodeling can induce PT pathology and changes in the knee structure that may cause symptoms such as anterior knee pain. PT is also a troublesome condition of unknown etiology and pathogenesis, characterized by microscopic ruptures with degenerative changes in the distal quadriceps tendon or patellar tendon. It is believed that the pain is related to pathological change of the infrapatellar fat pad (IPFP). The IPFP is an intra-capsular but extrasynovial structure, covered by the synovial membrane posteriorly. The IPFP is thought to occupy dead space in the knee joint, thus maintaining the joint cavity and promoting efficient lubrication. No previous studies have characterized changes to the IPFP in response to PT. In the present study, we aimed to investigate the histological changes in the IPFP tissue resulting from PT. Material: The use of rats for experiments in this study was approved by the animal research ethics committee of the authors’ institution. Eighteen male Wistar rats (9 weeks old) were used in this study. Method: After administering anesthesia, the hairs over the lower limb were shaved and the patellar tendon was located by positioning the knee at 90 degrees. Twenty microliters (0.015 mg/ml in 0.9% saline) of bacterial collagenase I (9 rats, PT group) or saline (9 rats, control group) was injected into the patellar tendon intratendinously using a 30-gauge needle in one limb, while the contralateral limb was left untreated. Free cage activity was allowed after injection. All the animals survived until they were sacrificed. The rats were killed at week 12, and the patellar tendon and the IPFP were harvested for hematoxylin-eosin staining. Images of the hind limbs of each rat were taken at a magnification of 10. We adapted the IPFP histological grading protocol using the histological grading protocols for synovial tissue described by BJ Heard et al. IPFP samples were graded according to 3 general criteria: cellularity, fibrosis, and vascularity. Scores for cellularity were graded from 0 to 3: 0 ¼ scattered cells, 1 ¼ focal clustering, 2 ¼ diffuse increase, and 3 ¼ severe diffuse increase. Scores for fibrosis were graded from 0 to 3: 0 ¼ absent (<10 % of image area), 1 ¼ mild (10e30 % of image area), 2 ¼ moderate (30e60 % of image area), and 3 ¼ severe (>60 % of image area). Scores for vascularity (cross-sections of the vessels of all diameters) were graded from 0 to 3: 0 ¼ no vessels present, 1 ¼ 1e2 vessels, 2 ¼ 3e4 vessels, and 3 ¼ 5 vessels. Finally, total scores were calculated by summation of each of the criterion scores. For statistical analysis, a Shapiro-Wilk test for normality was performed. Due to the lack of normally distributed data, variables were tested with the Mann-Whitney U-tests. The significance was set at P<0.05. Results: Significant differences in cellularity, fibrosis, and vascularity scores were found between the two groups. The mean scores for cellularity were 1.67 in the PT group and 0.44 in the control group (P<0.01). The mean scores for fibrosis were 1.78 in the PT group and 0.67 in the control group (P¼0.013). The mean scores for vascularity were 2.67 in the PT group and 0.89 in the control group (P<0.01). There was also a significant difference in the total score between the PT group and the control group (6.11 and 2.00, respectively; P<0.01). Discussion: The histological findings of the rat IPFP in response to PT have thus been characterized. At 12 weeks following collagenase injection to the patellar tendon, the IPFPs showed significantly greater cellularity, fibrosis, and vascularity. According to a previous study, up-regulated messenger ribonucleic acid (mRNA) expression levels for degenerative proteinases were found in key joint tissues such as the synovium and cartilage after knee surgery. For example, sustained collagen types I and III expression and fibrosis result from the accrual of extracellular matrix components due to excessive synthesis of collagen types I and III, and impaired degradation
104
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
of these proteins. In a previous study, transforming growth factor (TGF)-b1 expression was shown to increase in rats with PT. TGF-b1 contributes to the control of cellular proliferation and a vast number of other cellular activities including fibrosis and wound healing; hence, the IPFP cellularity and fibrosis was demonstrated in the PT group. TGF-b1 is also known to play a role in angiogenesis, thereby contributing to the observed vascularization of the IPFP. Either an investigation of the mRNA expression levels for molecules in inflammation or an immunohistochemistry analysis of the IPFP blood vessel epithelial cells should be performed, in order to clarify the etiology of IPFP degeneration in patients with PT. Conclusion: Histological changes from inflammation are observed in IPFP tissue due to PT. Keywords: patellar tendinopathy, infrapatellar fat pad, histological changes, inflammation, rats, cellularity, fibrosis, vascularity
Arthroscopy others EP-264 CLINICAL APPLICATION OF ARTHROSCOPIC TECHNIQUES IN THE DIAGNOSES AND TREATMENTS TO COMPLICATED DISEASES OF HIP JOINT Chen Gang, Mao Yunhe, Zhang Zhong, Li Jian, Li Jian. Department of Orthopaedics And Sports Medicine, West China Hospital, Sichuan University, China Objective: To explore the application and surgical techniques of arthroscopy in the diagnoses and treatments to complicated diseases of hip joint. Method: A total of 11 patients with hip joint pain of undefined causes between January 2013 and December 2015 in single center were retrospectively studied. The patient-specific factors were analyzed, including gender, side, onset age, history of trauma, physical examination results and radiology imaging. We analyzed operation findings and pathological sections, preoperative and postoperative sings, symptoms and function of the hip joint were also compared. Result: 5 of the patients were male and 6 were female. According to the operation findings and pathological sections, 4 of them were diagnosed with villonodular synovitis, 3 were synovial chondroma, 3 were labrum acetabulare injury and 1 synovium giant cell tumor. All of the diagnoses were confirmed, 9 of the patients gained short-termed postoperative symptom improvements, and the other 2 patients’ symptoms were relieved after comprehensive treatments. Conclusion: For patients with complicated hip joint pain, arthroscopic techniques can determine the cause of the disease more rapidly and provide more effective treatments comparing with open surgeries, it is worthy of promotion and application for its minimal surgical injury and satisfying postoperative rehabilitation. Keywords: Hip joint, arthroscopy, synovitis
Arthroscopy others EP-265 VENOUS THROMBOEMBOLIC EVENTS AFTER ARTHROSCOPIC KNEE SURGERY: A CURRENT REVIEW OF RISK FACTORS AND THROMBOPROPHYLAXIS Xiaoxu Wang, Xue Xia. Department of Joint Surgery, The Second Affiliated Hospital of University of South China, China Background: Arthroscopic knee surgery (AKS) is currently the most common orthopedic procedure, which has increased by 50% in the past decade, with more than 3 million operations each year worldwide. The venous thromboembolic events (VTEs), including the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE), are viewed as a relatively rare complication following AKS with the frequency of this procedures, however, the potential outcome can be life-threatening. Literature-based date on the risks and prophylaxis are limited and controversial, the purpose of this comprehensive review is to put existing knowledge about VTEs after AKS in order, to raise more concern about establishing individual assessment criteria of high risk patients and to help
guide future individualization of prophylactic treatment. Materials: Screened articles regarding VTEs and AKS between March7, 2006 to December3, 2016. Methods: The PubMed and MEDLINE datebases were searched between March7, 2006 to December3, 2016, with the key terms “venous thromboembolism,” “VTE,” “deep vein thrombosis,” “DVT,” “pulmonary embolism,” “PE,” “venous thromboembolism events,” “arthroscopic knee surgery,” and “knee arthroscopy”, produced 113 hits. First stage screening of titles and abstracts to exclude 56 irrelevant articles. And then, commentaries, opinions and cases reports about patients with heritable thrombophilias. Finally, articles about VTE and AKS in review included case report of VTEs after AKS, studies reporting the incidence of VTEs, articles attempting to identified the high risk factors and researches conducted to confirm the efficiency of pharmacologic thromboprophylaxis. Results: Concluded literatures regarding the risk factors of VTEs after ASK are retrospective studies, using symptomatic VTEs and imaging-confirmed cases as primary outcome measures. R.A.Van adrichem et al. found a strongly increased risk for patients with ligament reconstruction and for patients with additional acquired or genetic risk factors, such as oral contraceptives, factor V Leiden, factor II G 20210A mutation, or non-O blood type. Aaron et al. selected a case-control methodology to identify potential risk factors with 12595 AKS cases, finding an incidence of 0.30% for DVT, 0.06% for PE, and 0.34% for VTEs overall. Factors associated with risk of symptomatic postoperation VTEs included a history of malignancy, a history of VTEs, or the presence of more than 2 classic risk factors for VTEs. And researchers also confirmed the concept of “classic risk factors” described by Delis et al. in 2001, including age older than 65 years, body mass index(BMI) greater than 30 kg/m2, smoking, oral contraception or hormone replacement therapy, and chronic venous insufficiency. Jourdan et al. confirmed high altitude was an independent risk factor for VTEs after AKS, which was similar to another retrospective review conducted by Jared et al, finding the incidence of VTE at low-elevation was 0.13%, and at a high-elevation was 0.49%, the relative risk of developing a VTE was 3.8 times higher at high elevation. And Jourdan et al. also conducted a cohort study including 13358 patients to investigate the relationship between tobacco use and rates of complication after anterior cruciate ligament reconstruction, identifying that the rate of VTE was also significantly higher in patients who use tobacco (1.0%) compared with matched controls (0.5%) and suggesting that tobacco use should be included as a patient-related risk factor for postoperative VTE after primary ACL reconstruction when considering the use of thromboprophylaxis. Camporese et al. demonstrated a statistically significant reduction of the relative risks of VTEs after AKS with use of LMWH and better than graduated compression stockings. L.Munoa et al. conducted a randomized control study to confirm rivaroxaban is as efficient and safe as bemiparin. I.David et al. demonstrated efficiency of prevention of VTEs after AKS in a low risk population with aspirin, excluding patient who has classic risk factors. There are no difference in the development of complications between the aspirin group and control group from the above study, the use of aspirin in a low-risk population is not warranted. Contrary to Camporese et al, a latest study conducted by Raymond et al. Researchers carried out a randomized trail with 1543 patients, and rate of VTEs occurred in LMWH treatment group was 0.7%, while 0.4% in the control group, showing that LMWH was not effective in preventing symptomatic VTE in the 8 days after AKS. Discussion: The relatively high incidence of VTEs after specific surgery procedures has been extensively studied and has led to the development of comprehensive guidelines for postoperative prophylaxis, and the group model works well for procedures such as lip or knee arthroplasty. Similar guidelines have not been established for patients undergoing AKS due to the reported low incidence of VTEs. However, the individual model including patient-specific risk factors and medical or surgical interventionspecific risk factors such as type of surgical procedure, anesthesia, elevation, is more appropriate to guide stratification of thromboprophylaxis for higher risk patients. Whether thromboprophylaxis should be given routinely in patients with high risk factors undergoing AKS is controversial now, and risk prediction and tailored thromboprophylactic strategies for high risk patients should be a topic for further research. Conclusion: VTEs is regarded as a rare complication of AKS, while the outcome can be catastrophic for patients with thromboembolic complications, because the millions of knee arthroscopies performed each year.
semitendinosus autograft, and creating two patellar bone sockets and one femoral bone socket anatomically under X-ray control. The center of double-looped semitendinosus tendon was inserted into a femoral bone socket and the two free ends of the graft were pulled into the patellar bone sockets. The graft was fixed with extra-cortical suspension devices. Computed tomographic scans obtained before surgery, three weeks, and one year after surgery were reconstructed into multi-planar reconstruction by using a volume analyzer. An axial slice on the most prominent part of both femoral condyles was selected for analysis of the patellar position. A tangent line passing through the both condyles of the femur was drawn and a perpendicular bisector line between the tangent points was drawn. The patellar position was measured by the distance between the perpendicular bisector line and the lateral edge of the patella. After the image through both the apertures of femoral and patellar tunnels and complete longitudinal images of the femoral tunnel and the patellar tunnel were identified, the lengths of the graft in each locations were measured. The lengths of each proximal and distal half of the graft were calculated by summing these measurements and the total graft length was defined as the sum of the proximal and distal graft length. The patellar positions and the total graft length of the three time points were compared using the Wilcoxon signed rank test. The relationship between the patellar position and the total graft length at a year was evaluated by single linear regression analysis. Results: No patients reported re-dislocation during follow-up. The patellar postions were 38.2 ± 5.4 mm (range, 26.5-50.2) before surgery, 27.8 ± 3.9 mm (range, 22.1-36.9) at three weeks, and 32.0 ± 4.8 mm (range, 24.1-41.6) at one year after surgery, respectively. The total graft length was slightly shortened from 199.3 ± 3.6 mm at three weeks to 195.8 ± 7.2 mm at one year follow-up (P < 0.05)There was a significant correlationship between the total graft length and the position of the patella after MPFL reconstruction (R2¼0.17, P<0.05). Discussion: This study revealed that the patella being reduced immediately after surgery returned to somewhat the lateral position a year after surgery and the length change of the graft was related to the lateral shift. Graft elongation was observed in some cases, but shortening in other cases. The length change pattern depending on patients might be because a difference in tension applied to the graft might affect the process of graft remodeling. Lateral patellar shift after surgery was observed in almost cases, even in cases with graft shortening. This suggested that only the length change of the graft could not explain the lateral patellar shift. Further examination regarding other factors involved in this phenomenon is necessary. Conclusion: The patella shifted more laterally one year than three weeks after MPFL reconstruction. There was a significant correlation between the position of the patella and the length of the graft after MPFL reconstruction. Keywords: the patellar shift, the length of the graft
Knee - Patellofemoral joint disorder EP-087 CURE THE PATELLAR TENDINOPATHY WITH ARTHROSCOPY Wenzhao Chen, Zhizeng Gao. Department of China, The First Affiliated Hospital of Nanchang University, China Method: we cured 7 knees which including 4 male and 2 female . ages 1835 years during 2013.1-2016.5 . in those patients ,a male cured 2 knees . all the patients still complain the painful of knee after conservative treatment ,including rest, Local physiotherapy and Closed therapy. The VAS score were 4-7.All the patients’ knees have Mass calcification , only one Mass calcification near the patella ,others are near tibia. We excision the Mass calcification with arthroscopy ,and fixed 2 of them with PDS-II. Those patients fixed with PDS-II were told to avoid sports for 6 weeks. Result: All patients were followed up for 3 months to 12 months, Compared with the preoperative movement, VAS score of knee pain decreased . Conclusion: arthroscopic minimally invasive treatment is effective way , for patients treated with conservative therapy who with Mass calcification. Keywords: ARTHROSCOPY, Mass calcification, PATELLAR TENDINOPATHY
103
Knee - Patellofemoral joint disorder EP-171 THE INVESTIGATION OF HISTOLOGICAL CHANGES IN INFRAPATELLAR FAT PAD DUE TO PATELLAR TENDINOPATHY
THE
Takashi Kitagawa 1, 2, Junsuke Nakase 2, Yasushi Takata 2, Kengo Shimozaki 2, Hiroyuki Tsuchiya 2. 1 Department of Rehabilitation, Japanese Red Cross Kanazawa Hospital, Japan; 2 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan Background: Patellar tendinopathy (PT) is primarily a condition of relatively young athletes who participate in sports that require repetitive loading of the patellar tendon. Repetition of jumping and landing or insufficient rest to enable patellar tendon remodeling can induce PT pathology and changes in the knee structure that may cause symptoms such as anterior knee pain. PT is also a troublesome condition of unknown etiology and pathogenesis, characterized by microscopic ruptures with degenerative changes in the distal quadriceps tendon or patellar tendon. It is believed that the pain is related to pathological change of the infrapatellar fat pad (IPFP). The IPFP is an intra-capsular but extrasynovial structure, covered by the synovial membrane posteriorly. The IPFP is thought to occupy dead space in the knee joint, thus maintaining the joint cavity and promoting efficient lubrication. No previous studies have characterized changes to the IPFP in response to PT. In the present study, we aimed to investigate the histological changes in the IPFP tissue resulting from PT. Material: The use of rats for experiments in this study was approved by the animal research ethics committee of the authors’ institution. Eighteen male Wistar rats (9 weeks old) were used in this study. Method: After administering anesthesia, the hairs over the lower limb were shaved and the patellar tendon was located by positioning the knee at 90 degrees. Twenty microliters (0.015 mg/ml in 0.9% saline) of bacterial collagenase I (9 rats, PT group) or saline (9 rats, control group) was injected into the patellar tendon intratendinously using a 30-gauge needle in one limb, while the contralateral limb was left untreated. Free cage activity was allowed after injection. All the animals survived until they were sacrificed. The rats were killed at week 12, and the patellar tendon and the IPFP were harvested for hematoxylin-eosin staining. Images of the hind limbs of each rat were taken at a magnification of 10. We adapted the IPFP histological grading protocol using the histological grading protocols for synovial tissue described by BJ Heard et al. IPFP samples were graded according to 3 general criteria: cellularity, fibrosis, and vascularity. Scores for cellularity were graded from 0 to 3: 0 ¼ scattered cells, 1 ¼ focal clustering, 2 ¼ diffuse increase, and 3 ¼ severe diffuse increase. Scores for fibrosis were graded from 0 to 3: 0 ¼ absent (<10 % of image area), 1 ¼ mild (10e30 % of image area), 2 ¼ moderate (30e60 % of image area), and 3 ¼ severe (>60 % of image area). Scores for vascularity (cross-sections of the vessels of all diameters) were graded from 0 to 3: 0 ¼ no vessels present, 1 ¼ 1e2 vessels, 2 ¼ 3e4 vessels, and 3 ¼ 5 vessels. Finally, total scores were calculated by summation of each of the criterion scores. For statistical analysis, a Shapiro-Wilk test for normality was performed. Due to the lack of normally distributed data, variables were tested with the Mann-Whitney U-tests. The significance was set at P<0.05. Results: Significant differences in cellularity, fibrosis, and vascularity scores were found between the two groups. The mean scores for cellularity were 1.67 in the PT group and 0.44 in the control group (P<0.01). The mean scores for fibrosis were 1.78 in the PT group and 0.67 in the control group (P¼0.013). The mean scores for vascularity were 2.67 in the PT group and 0.89 in the control group (P<0.01). There was also a significant difference in the total score between the PT group and the control group (6.11 and 2.00, respectively; P<0.01). Discussion: The histological findings of the rat IPFP in response to PT have thus been characterized. At 12 weeks following collagenase injection to the patellar tendon, the IPFPs showed significantly greater cellularity, fibrosis, and vascularity. According to a previous study, up-regulated messenger ribonucleic acid (mRNA) expression levels for degenerative proteinases were found in key joint tissues such as the synovium and cartilage after knee surgery. For example, sustained collagen types I and III expression and fibrosis result from the accrual of extracellular matrix components due to excessive synthesis of collagen types I and III, and impaired degradation
104
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
of these proteins. In a previous study, transforming growth factor (TGF)-b1 expression was shown to increase in rats with PT. TGF-b1 contributes to the control of cellular proliferation and a vast number of other cellular activities including fibrosis and wound healing; hence, the IPFP cellularity and fibrosis was demonstrated in the PT group. TGF-b1 is also known to play a role in angiogenesis, thereby contributing to the observed vascularization of the IPFP. Either an investigation of the mRNA expression levels for molecules in inflammation or an immunohistochemistry analysis of the IPFP blood vessel epithelial cells should be performed, in order to clarify the etiology of IPFP degeneration in patients with PT. Conclusion: Histological changes from inflammation are observed in IPFP tissue due to PT. Keywords: patellar tendinopathy, infrapatellar fat pad, histological changes, inflammation, rats, cellularity, fibrosis, vascularity
Arthroscopy others EP-264 CLINICAL APPLICATION OF ARTHROSCOPIC TECHNIQUES IN THE DIAGNOSES AND TREATMENTS TO COMPLICATED DISEASES OF HIP JOINT Chen Gang, Mao Yunhe, Zhang Zhong, Li Jian, Li Jian. Department of Orthopaedics And Sports Medicine, West China Hospital, Sichuan University, China Objective: To explore the application and surgical techniques of arthroscopy in the diagnoses and treatments to complicated diseases of hip joint. Method: A total of 11 patients with hip joint pain of undefined causes between January 2013 and December 2015 in single center were retrospectively studied. The patient-specific factors were analyzed, including gender, side, onset age, history of trauma, physical examination results and radiology imaging. We analyzed operation findings and pathological sections, preoperative and postoperative sings, symptoms and function of the hip joint were also compared. Result: 5 of the patients were male and 6 were female. According to the operation findings and pathological sections, 4 of them were diagnosed with villonodular synovitis, 3 were synovial chondroma, 3 were labrum acetabulare injury and 1 synovium giant cell tumor. All of the diagnoses were confirmed, 9 of the patients gained short-termed postoperative symptom improvements, and the other 2 patients’ symptoms were relieved after comprehensive treatments. Conclusion: For patients with complicated hip joint pain, arthroscopic techniques can determine the cause of the disease more rapidly and provide more effective treatments comparing with open surgeries, it is worthy of promotion and application for its minimal surgical injury and satisfying postoperative rehabilitation. Keywords: Hip joint, arthroscopy, synovitis
Arthroscopy others EP-265 VENOUS THROMBOEMBOLIC EVENTS AFTER ARTHROSCOPIC KNEE SURGERY: A CURRENT REVIEW OF RISK FACTORS AND THROMBOPROPHYLAXIS Xiaoxu Wang, Xue Xia. Department of Joint Surgery, The Second Affiliated Hospital of University of South China, China Background: Arthroscopic knee surgery (AKS) is currently the most common orthopedic procedure, which has increased by 50% in the past decade, with more than 3 million operations each year worldwide. The venous thromboembolic events (VTEs), including the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE), are viewed as a relatively rare complication following AKS with the frequency of this procedures, however, the potential outcome can be life-threatening. Literature-based date on the risks and prophylaxis are limited and controversial, the purpose of this comprehensive review is to put existing knowledge about VTEs after AKS in order, to raise more concern about establishing individual assessment criteria of high risk patients and to help
guide future individualization of prophylactic treatment. Materials: Screened articles regarding VTEs and AKS between March7, 2006 to December3, 2016. Methods: The PubMed and MEDLINE datebases were searched between March7, 2006 to December3, 2016, with the key terms “venous thromboembolism,” “VTE,” “deep vein thrombosis,” “DVT,” “pulmonary embolism,” “PE,” “venous thromboembolism events,” “arthroscopic knee surgery,” and “knee arthroscopy”, produced 113 hits. First stage screening of titles and abstracts to exclude 56 irrelevant articles. And then, commentaries, opinions and cases reports about patients with heritable thrombophilias. Finally, articles about VTE and AKS in review included case report of VTEs after AKS, studies reporting the incidence of VTEs, articles attempting to identified the high risk factors and researches conducted to confirm the efficiency of pharmacologic thromboprophylaxis. Results: Concluded literatures regarding the risk factors of VTEs after ASK are retrospective studies, using symptomatic VTEs and imaging-confirmed cases as primary outcome measures. R.A.Van adrichem et al. found a strongly increased risk for patients with ligament reconstruction and for patients with additional acquired or genetic risk factors, such as oral contraceptives, factor V Leiden, factor II G 20210A mutation, or non-O blood type. Aaron et al. selected a case-control methodology to identify potential risk factors with 12595 AKS cases, finding an incidence of 0.30% for DVT, 0.06% for PE, and 0.34% for VTEs overall. Factors associated with risk of symptomatic postoperation VTEs included a history of malignancy, a history of VTEs, or the presence of more than 2 classic risk factors for VTEs. And researchers also confirmed the concept of “classic risk factors” described by Delis et al. in 2001, including age older than 65 years, body mass index(BMI) greater than 30 kg/m2, smoking, oral contraception or hormone replacement therapy, and chronic venous insufficiency. Jourdan et al. confirmed high altitude was an independent risk factor for VTEs after AKS, which was similar to another retrospective review conducted by Jared et al, finding the incidence of VTE at low-elevation was 0.13%, and at a high-elevation was 0.49%, the relative risk of developing a VTE was 3.8 times higher at high elevation. And Jourdan et al. also conducted a cohort study including 13358 patients to investigate the relationship between tobacco use and rates of complication after anterior cruciate ligament reconstruction, identifying that the rate of VTE was also significantly higher in patients who use tobacco (1.0%) compared with matched controls (0.5%) and suggesting that tobacco use should be included as a patient-related risk factor for postoperative VTE after primary ACL reconstruction when considering the use of thromboprophylaxis. Camporese et al. demonstrated a statistically significant reduction of the relative risks of VTEs after AKS with use of LMWH and better than graduated compression stockings. L.Munoa et al. conducted a randomized control study to confirm rivaroxaban is as efficient and safe as bemiparin. I.David et al. demonstrated efficiency of prevention of VTEs after AKS in a low risk population with aspirin, excluding patient who has classic risk factors. There are no difference in the development of complications between the aspirin group and control group from the above study, the use of aspirin in a low-risk population is not warranted. Contrary to Camporese et al, a latest study conducted by Raymond et al. Researchers carried out a randomized trail with 1543 patients, and rate of VTEs occurred in LMWH treatment group was 0.7%, while 0.4% in the control group, showing that LMWH was not effective in preventing symptomatic VTE in the 8 days after AKS. Discussion: The relatively high incidence of VTEs after specific surgery procedures has been extensively studied and has led to the development of comprehensive guidelines for postoperative prophylaxis, and the group model works well for procedures such as lip or knee arthroplasty. Similar guidelines have not been established for patients undergoing AKS due to the reported low incidence of VTEs. However, the individual model including patient-specific risk factors and medical or surgical interventionspecific risk factors such as type of surgical procedure, anesthesia, elevation, is more appropriate to guide stratification of thromboprophylaxis for higher risk patients. Whether thromboprophylaxis should be given routinely in patients with high risk factors undergoing AKS is controversial now, and risk prediction and tailored thromboprophylactic strategies for high risk patients should be a topic for further research. Conclusion: VTEs is regarded as a rare complication of AKS, while the outcome can be catastrophic for patients with thromboembolic complications, because the millions of knee arthroscopies performed each year.