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Book ; Online ; E-Book: Arthroscopy and endoscopy of the elbow, wrist and hand

Bhatia, Deepak N.

surgical anatomy and techniques

2022

Author's details	Deepak N. Bhatia [and three others], editors
Keywords	Elbow/Endoscopic surgery ; Colze ; Canell ; Mà ; Cirurgia endoscòpica ; Diagnòstic per la imatge ; Artroscòpia
Subject code	617.574
Language	English
Size	1 online resource (1122 pages)
Publisher	Springer
Publishing place	Cham, Switzerland
Document type	Book ; Online ; E-Book
Remark	Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
ISBN	3-030-79423-7 ; 3-030-79422-9 ; 978-3-030-79423-1 ; 978-3-030-79422-4
Database	ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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Article ; Online: Endoscopic anterior capsulectomy for severe elbow contractures.

Bhatia, Deepak N

Journal of ISAKOS : joint disorders & orthopaedic sports medicine

2024

Abstract: Elbow stiffness secondary to trauma or surgical reconstruction can sometimes result in a severe contracture with restricted joint space, and arthroscopic access to the joint is difficult. Previous surgery and severe stiffness can also alter the position ... ...

Abstract	Elbow stiffness secondary to trauma or surgical reconstruction can sometimes result in a severe contracture with restricted joint space, and arthroscopic access to the joint is difficult. Previous surgery and severe stiffness can also alter the position of neurovascular structures and iatrogenic injury is possible with an inside-out arthroscopic approach. To overcome these technical difficulties, an endoscopic approach to the anterior capsule can be performed as an alternative to open approach. The endoscopic approach utilises the sub-brachialis space for an outside-in capsular resection under vision. Identification of standard anatomic landmarks is useful as a guide for safe resection in a central to peripheral direction.
Language	English
Publishing date	2024-02-17
Publishing country	England
Document type	Journal Article
ISSN	2059-7762
ISSN (online)	2059-7762
DOI	10.1016/j.jisako.2024.02.003
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Book: Arthroscopy and Endoscopy of the Elbow, Wrist and Hand

Bhatia, Deepak N. / Bain, Gregory I. / Poehling, Gary G. / Graves, Benjamin R.

Surgical Anatomy and Techniques

2021

Keywords	upper extremity ; basic portals ; tendinopathy ; osteoarthritis ; advanced portals ; small joints of the upper limb ; stiff elbow ; wrist fracture ; wrist dislocation
Language	English
Size	1191 p.
Edition	1
Publisher	Springer International Publishing
Document type	Book
Note	PDA Manuell_11
Format	178 x 254
ISBN	9783030794224 ; 3030794229
Database	PDA

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Article: "All-Endoscopic" Management of Refractory Elbow Bicipitoradial Bursitis and Partial Distal Biceps Tendon Tears.

Bhatia, Deepak N

Arthroscopy techniques

2022 Volume 11, Issue 6, Page(s) e1087–e1095

Abstract: Elbow bicipitoradial bursitis and partial distal biceps tendon (DBT) tears are a result of chronic overuse or other infective/inflammatory pathology and may be refractory to conservative treatment. The all-endoscopic approach provides minimally invasive ... ...

Abstract	Elbow bicipitoradial bursitis and partial distal biceps tendon (DBT) tears are a result of chronic overuse or other infective/inflammatory pathology and may be refractory to conservative treatment. The all-endoscopic approach provides minimally invasive access to the bursal space and DBT, and diagnostic and therapeutic procedures can be performed under direct endoscopic vision. The technique uses 2 portals, the proximal parabiceps portal and distal anterior portal, and the bursa is insufflated to create a working space. Tissue biopsies are obtained under direct endoscopic visualization, and debridement along 6 bursal zones can be effectively performed. An endoscopic probe test is demonstrated for assessment of partial DBT tears, and low-grade tears are debrided to stable tissue. The all-endoscopic technique is safe and reproducible, and it is a stepping-stone in the learning curve of all-endoscopic repair and reconstruction of distal biceps ruptures.
Language	English
Publishing date	2022-05-21
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2653101-X
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2022.02.017
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: All-endoscopic approach for distal biceps tendon pathology: Analysis of long-term outcomes in partial and complete ruptures.

Bhatia, Deepak N / Malviya, Parimal

Journal of shoulder and elbow surgery

2024

Abstract: ... predominantly bursitis (type I, n=2) and predominantly partial tears (type IIA and B, n=7). The complete tear ... group (65%) included isolated short or long head tears (type IIIA and IIIB, n=2) and complete tendon ... ruptures (types IV, V, and VIA-C, n=15). Endoscopic débridement of the bursitis/ low grade tears and repair ...

Abstract	Background: Distal biceps tendon (DBT) pathology is a spectrum that ranges from tendinopathy to complete retracted ruptures, and surgical treatment is usually performed via open approaches. The purpose of this study was to analyze safety and long-term outcomes of all-endoscopic surgery for entire spectrum of primary DBT pathology. The hypothesis was that at an all-endoscopic technique would result in satisfactory clinical outcomes and a low complication rate. Methods: Consecutive patients who underwent all-endoscopic surgery for primary isolated DBT pathology (bursitis, partial and acute/chronic complete tears) between January 2013 and December 2021 were assessed and analyzed retrospectively. Refractory bursitis and low-grade partial tears underwent endoscopic débridement, and high-grade partial tears and complete ruptures underwent all-endoscopic repair or graft reconstruction. Preoperative and follow-up assessment included functional assessment using Mayo Elbow Performance Score (MEPS) and a Patient-Reported Distal Biceps Score (PRDBS), and radiological assessment was performed using plain biplanar radiographs and sonography. Pre- and postoperative scores for the overall group, and for partial and complete tears, were compared using a paired T-test. Results: Overall, 26 male patients underwent an all-endoscopic surgery for distal biceps tendon tears; the pathology was classified by endoscopic findings into 6 types, and follow-up period ranged from 21 to 125 months (mean 79.4 months). Nine chronic partial tears (35%) included predominantly bursitis (type I, n=2) and predominantly partial tears (type IIA and B, n=7). The complete tear group (65%) included isolated short or long head tears (type IIIA and IIIB, n=2) and complete tendon ruptures (types IV, V, and VIA-C, n=15). Endoscopic débridement of the bursitis/ low grade tears and repair of the high-grade and complete ruptures resulted in complete resolution of symptoms and significant improvement in both MEPS and PRDBS (p<0.001). Autografts were necessary in 35% (6/17) of complete tears, and no significant difference was found in functional scores in this group as compared to those where primary repairs were possible. There were 2 minor complications (7.6%) that involved transient lateral antebrachial cutaneous nerve (LACN) neuropraxia. Follow-up sonography and radiographs showed an intact tendon and absence of heterotopic ossification or synostosis. Conclusions: An all-endoscopic approach for treating distal biceps tendon pathology was safe and reliable and was associated with significant improvement in subjective and functional outcomes in the long term. The dual-anchor onlay repair technique showed long-term radiologically demonstrable structural integrity of the tendon and was associated with a low minor complication rate and absence of heterotopic ossification.
Language	English
Publishing date	2024-02-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2024.01.020
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Article: Arthroscopic Bursa-Augmented Rotator Cuff Repair: A Vasculature-preserving Technique for Subacromial Bursal Harvest and Tendon Augmentation.

Bhatia, Deepak N

Arthroscopy techniques

2021 Volume 10, Issue 5, Page(s) e1203–e1209

Abstract: Rotator cuff repairs are associated with suboptimal outcomes and possibly greater incidence of retears if the biological healing environment is compromised. Strategies to optimize tendon-bone healing include the use of bioinductive scaffolds and ... ...

Abstract	Rotator cuff repairs are associated with suboptimal outcomes and possibly greater incidence of retears if the biological healing environment is compromised. Strategies to optimize tendon-bone healing include the use of bioinductive scaffolds and regenerative stem cell therapy. The subacromial bursa has been shown to have significant pluripotent stem cell potency for tendon healing and has the advantage of easy accessibility and no added cost. However, a reproducible surgical technique for bursal mobilization, harvest, and vascularity preservation has not been described. We describe our technique for vasculature-preserving bursal mobilization and harvest of the entire posterosuperior and lateral subacromial bursa, and its use in rotator cuff repair augmentation is presented. The technique involves mobilization of the bursa as a continuous layer by maintain its medial and lateral vascularity. The bursa is advanced laterally, and the "vascular bursal duvet" and cuff tendons are repaired together as a tendon-bursa unit.
Language	English
Publishing date	2021-04-03
Publishing country	Netherlands
Document type	Journal Article
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2021.01.013
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Endoscopic anatomy of distal biceps tendon insertion and bicipitoradial bursa: a cadaveric study.

Bhatia, Deepak N

Journal of shoulder and elbow surgery

2021 Volume 30, Issue 8, Page(s) 1759–1767

Abstract: ... A bare oval tuberosity area (n = 20) bounded by the supinator and DBT was observed. The DBT inserted ... ulnar to the bare area (n = 16) and the presence of an intervening wide (n = 1) or narrow (n = 3 ... differentiated into 2-5 fiber bundles (n = 15). The volar-ulnar DBT surface was always extrabursal and was ...

Abstract	Background: Distal biceps endoscopy has emerged as a minimally invasive alternative to open procedures for distal biceps tendon (DBT) pathology. The purpose of this study was to systematically describe the static and dynamic appearance and variations of the DBT insertional region using a standardized endoscopic technique and dissection in healthy cadaveric elbows. Methods: Endoscopic assessment of the DBT insertional region was performed using a standard proximal parabiceps portal in 20 fresh frozen cadaveric upper extremities. A 6-point endoscopic evaluation of the DBT and bicipitoradial bursa was performed in a static supination position and with dynamic rotation. Anatomic variations in the DBT insertional characteristics, as well as the extent and appearance of the intrabursal space, were documented. Each cadaver was then dissected to correlate endoscopic findings with gross anatomic structures. Results: A bare oval tuberosity area (n = 20) bounded by the supinator and DBT was observed. The DBT inserted ulnar to the bare area (n = 16) and the presence of an intervening wide (n = 1) or narrow (n = 3) tuberosity sulcus were documented. The dorsoradial DBT surface was consistently intrabursal and was differentiated into 2-5 fiber bundles (n = 15). The volar-ulnar DBT surface was always extrabursal and was associated with endoscopically identifiable proximal and distal fat pads. The bicipitoradial bursa formed a bursal sac that was attached to the dorsoradial (n = 13) or volar (n = 7) aspect of the tuberosity and extended proximally along the DBT for 3-5 cm (parabiceps space). A distinct ligament-like band (transverse radioulnar ligament) extended transversely across the proximal radioulnar space and appeared to form a sling that provided ulnar support to the DBT during dynamic rotation. The intact DBT surface was robust and could not be breached, even with firm pressure using a probe. Conclusions: The bare tuberosity area, the bursal sac, and the parabiceps space are consistent anatomic landmarks that can be used during DBT endoscopy. An insertional tuberosity sulcus and DBT surface differentiation are normal anatomic variations. The transverse radioulnar ligament provides ulnar support for the DBT during pronation and forms a pulley mechanism for smooth tendon gliding motion.
MeSH term(s)	Arm ; Cadaver ; Elbow ; Endoscopy ; Humans ; Tendons
Language	English
Publishing date	2021-01-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2020.11.033
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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Article: Arthroscopic Biological Augmentation for Massive Rotator Cuff Tears: The Biceps-Cuff-Bursa Composite Repair.

Bhatia, Deepak N

Arthroscopy techniques

2021 Volume 10, Issue 10, Page(s) e2279–e2285

Abstract: Surgical repair of massive and chronic rotator cuff tears is difficult due to tendon retraction and severe atrophy, and the resultant retear rate in the structurally weak tendons is high. Commercially available patches and bioinductive scaffolds have ... ...

Abstract	Surgical repair of massive and chronic rotator cuff tears is difficult due to tendon retraction and severe atrophy, and the resultant retear rate in the structurally weak tendons is high. Commercially available patches and bioinductive scaffolds have been used to provide strength and superior healing environment in partial and complete rotator cuff tears. Biological biceps autograft has been used for superior capsular reconstruction, and the subacromial bursa has been shown to have significant pluripotent stem cell potency for tendon healing. We describe our technique for combined use of the long biceps tendon (LBT) and vasculature-preserved subacromial bursa as autografts in rotator cuff repair augmentation. The technique involves obtaining a LBT graft of sufficient length using a "traction and tenodesis" technique. The subacromial bursa is mobilized as a continuous layer (vascular bursal duvet) by maintaining its medial and lateral vascularity. All-suture anchors are used to minimize the insertion apertures (3 mm) in tuberosity. The bursa is advanced laterally, and the mobilized cuff is repaired together as a biceps-cuff-bursa composite unit. Combined use of the biceps and bursa as biological autografts has the advantage of structural and regenerative augmentation, and the autografts are easily accessible without added cost.
Language	English
Publishing date	2021-09-14
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2653101-X
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2021.07.003
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: How does dynamic arthroscopic tracking compare with radiologic glenoid track for identification of on- and off-track lesions in anterior shoulder instability?

Bhatia, Deepak N / Malviya, Parimal

Journal of shoulder and elbow surgery

2023 Volume 33, Issue 1, Page(s) 23–31

Abstract: Background: Current treatment paradigms for anterior shoulder instability are based on radiologic measurements of glenohumeral bone defects, and mathematical calculation of the glenoid track (GT) is used to classify lesions into on-track and off-track ... ...

Abstract	Background: Current treatment paradigms for anterior shoulder instability are based on radiologic measurements of glenohumeral bone defects, and mathematical calculation of the glenoid track (GT) is used to classify lesions into on-track and off-track morphology. However, radiologic measurements have shown high variability, and GT widths under dynamic conditions have been reported to be significantly smaller than those under static radiologic conditions. The purpose of this study was to assess the reliability, reproducibility, and diagnostic validity of dynamic arthroscopic standardized tracking (DAST) in comparison to the gold-standard radiologic track measurement method for the identification of on- and off-track bony lesions in patients with anteroinferior shoulder instability. Methods: Between January 2018 and August 2022, 114 patients with traumatic anterior shoulder instability were evaluated using 3-T magnetic resonance imaging or computed tomography scans; glenoid bone loss, Hill-Sachs interval, GT, and Hill-Sachs occupancy ratio (HSO) were measured, and defects were classified as on-track or off-track defects and peripheral-track defects (based on HSO percentage) by 2 independent researchers. During arthroscopy, a standardized method (DAST method) was used by 2 independent observers to classify defects into on-track defects (central and peripheral) and off-track defects. Interobserver reliability of the DAST and radiologic methods was calculated using the κ statistic and reported as percentage agreement. Diagnostic validity (sensitivity, specificity, positive predictive value, and negative predictive value) of the DAST method was calculated using the radiologic track (HSO percentage) as the gold standard. Results: The radiologically measured mean glenoid bone loss percentage, Hill-Sachs interval, and HSO in off-track lesions were lower with the arthroscopic method (DAST) as compared with the radiologic method. The DAST method showed nearly perfect agreement between the 2 observers for the on-track/off-track classification (κ = 0.96, P < .001) and the on-track central or peripheral /off-track classification (κ = 0.88, P < .001). The radiologic method showed greater interobserver variability (κ = 0.31 and κ = 0.24, respectively) with only fair agreement for both classifications. Inter-method agreement varied between 71% and 79% (95% confidence interval, 62%-86%) between the 2 observers, and reliability was assessed as slight (κ = 0.16) to fair (κ = 0.38). Overall, for identification of an off-track lesion, the DAST method showed maximum specificity (81% and 78%) when radiologic peripheral-track lesions (HSO percentage of 75%-100%) were considered off-track and showed maximum sensitivity when arthroscopic peripheral-track lesions were classified as off-track. Conclusion: Although inter-method agreement was low, a standardized arthroscopic tracking method (DAST method) showed superior interobserver agreement and reliability for lesion classification in comparison to the radiologic track method. Incorporating DAST into current algorithms may help reduce variability in surgical decision making.
MeSH term(s)	Humans ; Shoulder Joint/diagnostic imaging ; Shoulder Joint/surgery ; Shoulder Joint/pathology ; Joint Instability/diagnostic imaging ; Joint Instability/surgery ; Joint Instability/pathology ; Shoulder Dislocation/diagnostic imaging ; Shoulder Dislocation/surgery ; Shoulder Dislocation/pathology ; Reproducibility of Results ; Shoulder/pathology ; Arthroscopy/methods ; Bone Diseases, Metabolic ; Recurrence
Chemical Substances	diethylaminosulfur trifluoride (78622BV6IJ)
Language	English
Publishing date	2023-06-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2023.05.018
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: How does anterior glenoid bone loss affect shoulder stability? A cadaveric analysis of glenoid concavity and bony shoulder stability ratio.

Bhatia, Deepak N / Kandhari, Vikram

Journal of shoulder and elbow surgery

2021 Volume 31, Issue 3, Page(s) 553–560

Abstract: ... congruent-arc Latarjet [CAL] procedure). We obtained 108 computed tomography scans of (1) intact scapulae (n ... 12), (2) after each bone defect (n = 48), and (3) after each reconstruction (n = 48). The glenoid ...

Abstract	Background: Concavity compression is an important glenohumeral stabilizing factor, and recent studies have suggested that peripheral glenoid bone loss creates the most relevant change in stability. This study analyzed changes in the bony shoulder stability ratio (BSSR) with sequential anterior glenoid bone loss (0%-40% width) and with reconstructive bone graft procedures. The aim was to quantify the critical bone defect size that would significantly alter the BSSR and determine restoration of the BSSR with the Latarjet procedure. Methods: Anterior glenoid defects were created with sequential osteotomies (10%-40%), and defects were reconstructed using 2 Latarjet modifications (classic Latarjet procedure and congruent-arc Latarjet [CAL] procedure). We obtained 108 computed tomography scans of (1) intact scapulae (n = 12), (2) after each bone defect (n = 48), and (3) after each reconstruction (n = 48). The glenoid concavity depth and concavity radius were measured, and the BSSR was determined using a validated mathematical formula. Statistical analysis was performed to determine significant differences between the intact state and each of the deficient and reconstructed glenoids. Results: The glenoid concavity radius increased by approximately 30% (14 mm) and the glenoid concavity depth decreased by 50% (1.5 mm) from the 0% to 40% defect. The maximal sequential change in depth (1.2 mm, 44%; P < .001) and radius (6 mm, 12%; P < .001) occurred at the 10% glenoid defect. The overall BSSR decreased by approximately 40% (0.15) from the intact glenoid to the 40% defect. This change in the BSSR was most profound (0.11, 30%; P < .001) at the 10% glenoid defect and was only marginal thereafter between the 20% and 40% defects (0.24, 0.22, and 0.21). The Latarjet procedure adequately restored glenoid concavity; however, the CAL procedure significantly overcorrected all 3 parameters at 10% defect. Conclusion: The glenoid concavity depth and BSSR undergo progressive deformation with sequential bone loss, and 90% of this change occurs with a 10% glenoid defect. Articular concavity and the BSSR are adequately restored with the Latarjet procedure, and the CAL procedure significantly overcorrects concavity in mild (0%-10%) defects.
MeSH term(s)	Cadaver ; Glenoid Cavity/diagnostic imaging ; Glenoid Cavity/surgery ; Humans ; Joint Instability/diagnostic imaging ; Joint Instability/surgery ; Scapula/diagnostic imaging ; Scapula/surgery ; Shoulder ; Shoulder Dislocation/surgery ; Shoulder Joint/diagnostic imaging ; Shoulder Joint/surgery
Language	English
Publishing date	2021-10-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2021.09.004
Database	MEDical Literature Analysis and Retrieval System OnLINE

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