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1.
The purpose of this study was to examine the longevity of postoperative careers and quality of performance of 461 Thoroughbred racehorses after arthroscopic removal of dorsoproximal first phalanx (P1) osteochondral fractures. Six hundred and 59 dorsoproximal P1 chip fractures were removed arthroscopically from 574 joints in 461 horses presented for lameness or decreased performance attributed to the chip fractures. Radiological and arthroscopic examination revealed an average of 1.43 fragment sites/horse, 1.15 fragment sites/joint and 1.25 affected joints/horse. Eighty-nine percent of the horses (411/461) raced after surgery and 82% (377/461) did so at the same or higher class. Fifty horses did not race after surgery. Sixty-eight percent of the horses raced in a Stake or Allowance race postoperatively. Data, previously undocumented, establishes that the quantity and quality of performance is not diminished after arthroscopic treatment of dorsoproximal P1 fragmentation. Surgical removal of chip fractures is a means of preserving the economic value of an injured Thoroughbred, allowing a rapid and successful return to racing at the previous level of racing performance.  相似文献   

2.
REASONS FOR PERFORMING STUDY: Studies have shown that surgical removal of apical fracture fragments in Standardbred racehorses carries the best prognosis for return to racing performance, but there are no reports involving mature Thoroughbred (TB) racehorses. OBJECTIVES: To describe the incidence of apical proximal sesamoid fractures in TB racehorses and determine probability and quality of racing performance after arthroscopic removal of such fractures in TB racehorses age > or = 2 years. METHODS: Medical records and pre- and post operative race records of TB racehorses age > or = 2 years that underwent arthroscopic surgery for removal of apical proximal sesamoid fracture fragments were reviewed. RESULTS: Sixty-four percent of fractures occurred in the hindlimbs and 36% in the forelimbs. Horses with forelimb fractures had a reduced probability of return to racing (67%) compared to those with hindlimb fractures (83%), but the majority (77%) of treated horses recovered to return to race post operatively. Horses with medial forelimb fractures raced at only a 47% rate; those with suspensory desmitis at 63%. Unlike Standardbreds, there was no difference in probability of racing post operatively between horses that had, and had not, raced preoperatively. CONCLUSIONS: Data show that arthroscopic removal of apical proximal sesamoid fracture fragments is successful at restoring ability to race in skeletally mature TB horses without evidence of severe suspensory ligament damage. Prognosis for return to racing is excellent (83%) in horses with hindlimb fractures and good (67%) in those with forelimb fractures. Medial fractures of the forelimb have the worst prognosis. POTENTIAL RELEVANCE: The determination of prognosis for differing sites in TB racehorses should increase knowledge of apical proximal sesamoid bone fractures and improve communication from veterinarian to owner, and trainer, on the potential for arthroscopic restoration of the ability to race.  相似文献   

3.
OBJECTIVES: To describe the outcome after arthroscopic electrosurgical excision of axial osteochondral (OC) fragments of the proximal plantar aspect of the 1st phalanx (P1) in horses. STUDY DESIGN: Retrospective study. POPULATION: Twenty-three Standardbred racehorses. METHODS: Medical records of Standardbred racehorses that had arthroscopic dissection of axial OC fragments of the proximal plantar aspect of P1 with electrocautery probes were reviewed. Horses were positioned in dorsal recumbency; a 1.5% glycine solution was used to maintain joint distension. The arthroscope portal was in the proximal plantar joint pouch and OC fragments were approached using either an ipsilateral or a contralateral triangulation technique. Dissection of the fibrous attachments was performed using loop and hook electrocautery probes. Follow-up was obtained by telephone questionnaire of owners or trainers and examination of race summary records. RESULTS: Thirty-three axial OC fragments were removed from 28 metatarsophalangeal joints (left, 14; right, 14). No major operative or postoperative complications occurred. Seven of 8 (79%) of horses that raced before surgery raced after surgery. Thirty-six percent (n=4) of horses that had not raced before surgery raced after surgery. CONCLUSION: Intra-articular electrosurgery is a safe, easy alternative to conventional excision of axial OC fragments of the proximal plantar aspect of P1. CLINICAL RELEVANCE: Arthroscopic excision using electrocautery probes is a valid alternate method for removal of axial OC fragments of the proximal plantar aspect of P1. In addition, the dorsal recumbency position facilitates removal of several fragments and multiple joint surgery.  相似文献   

4.
Reasons for performing study: Standing fracture repair in the horse is a recently described surgical procedure and currently there are few follow‐up data. This case series contains 2 novel aspects in the standing horse: repair of incomplete sagittal fractures of the proximal phalanx and medial condylar repair from a lateral aspect. Objectives: To describe outcome in a case series of horses that had lower limb fractures repaired under standing sedation at Rossdales Equine Hospital. Method: Case records for all horses that had a fracture surgically repaired, by one surgeon at Rossdales Equine Hospital, under standing sedation and local anaesthesia up until June 2011, were retrieved. Hospital records, owner/trainer telephone questionnaire and the Racing Post website were used to evaluate follow‐up. Results: Thirty‐four horses satisfied the inclusion criteria. Fracture sites included the proximal phalanx (incomplete sagittal fracture, n = 14); the third metacarpal bone (lateral condyle, n = 12, and medial condyle, n = 7); and the third metatarsal bone (lateral condyle, n = 1). One horse required euthanasia due to caecal rupture 10 days post operatively. Twenty horses (66.7% of those with available follow‐up) have returned to racing. Where available, mean time from operation to return to racing was 226 days (range 143–433 days). Conclusions: Standing fracture repair produced similar results to fracture repair under general anaesthesia in terms of both the number of horses that returned to racing and the time between surgery and race. Potential relevance: Repair of lower limb fracture in the horse under standing sedation is a procedure that has the potential for tangible benefits, including avoidance of the inherent risks of general anaesthesia. The preliminary findings in this series of horses are encouraging and informative when discussing options available prior to fracture repair.  相似文献   

5.
Arthroscopic surgery for osteochondral fractures of the proximal phalanx was performed on 74 fetlock joints of 63 horses for a total of 87 fractures during a 2-year period. The medial dorsal proximal aspect of the proximal phalanx of the forelimbs was most commonly involved (59 fractures), followed by the lateral aspect (26 fractures), and 2 fractures occurred in the fetlock joint of the right hindlimb. At surgery, 82 fragments were removed and 5 fragments that had healed or were embedded in the joint capsule were not removed. Of the fragments removed, 15 were fixed firmly to the proximal phalanx, 63 were easily movable by arthroscopic instruments (but had soft tissue attachments to the proximal phalanx), and 4 were floating free within the joint. Arthroscopic surgery allowed excellent visualization and appreciation of the attachments of fragments and their stage of healing. Horses returned to full race training at an average of 11 1/2 weeks (range, 6 to 24 weeks). Thirty eight of 46 horses (82.6%) with adequate postoperative follow-up returned to athletic performance at least equal to that before fetlock injury.  相似文献   

6.
Medical and racing records of 155 Thoroughbred racehorses that underwent arthroscopic surgery for carpal chip fractures were investigated. Articular damage for 98.4% of the fractures was classified as G1 or G2 using McIlwraith's criteria. The rate of return to racing after surgery was 82.6%. Evaluation of racing performance after surgery was attempted using a placing index (PI) based on race finish position. There was no significant difference in the PI distribution between horses that underwent surgery and other healthy horses.  相似文献   

7.
REASONS FOR PERFORMING STUDY: Studies on arthroscopic removal of apical proximal sesamoid fracture fragments in Thoroughbred (TB) horses age > or = 2 years have reported a high success rate. However, there are no reports documenting the racing prognosis of TB horses that undergo such surgery as weanlings or yearlings. OBJECTIVES: To describe the incidence of apical proximal sesamoid fractures in immature TB horses, age < 2 years and determine probability and quality of racing performance after arthroscopic removal of such fractures in 151 TB weanlings and yearlings. METHODS: The medical records of TB horses age < 2 years that underwent arthroscopic surgery for removal of apical proximal sesamoid fracture fragments were reviewed. Follow-up information was obtained from race records. Student's t tests were used to compare performance variables of operated racehorses to that of their maternal siblings. RESULTS: Ninety-two percent (139/151) of fractures occurred in the hindlimbs and 8% (11/151) in the forelimbs (fracture of both fore- and hindlimb, n = 1). Horses with forelimb fractures had a greatly reduced probability of racing (55%) compared to those with hindlimb fractures (86%). Overall, 84% of the horses raced post operatively and had performance records similar to that of their maternal siblings, 78% (787/1006) of which raced. CONCLUSIONS: Arthroscopic removal of apical proximal sesamoid fracture fragments in TB weanlings and yearlings carries an excellent prognosis for racing in horses with hindlimb fractures and a reduced prognosis in those with forelimb fractures. Medial fractures of the forelimb carry the worst prognosis. POTENTIAL RELEVANCE: The determination of prognosis increases knowledge on apical sesamoid bone fractures and potential for arthroscopic restoration of the ability to race; and enables the value of yearlings for subsequent sale to be established.  相似文献   

8.
Reasons for performing study: The metacarpo/metatarsophalangeal (MCP/MTP) joint is a common site of lameness in the Thoroughbred racehorse. Radiographs may fail to show pathology consistent with the degree of lameness. With a high incidence of stress fractures occurring in the distal third metacarpal/metatarsal (MC3/MT3) condyles and proximal phalanx, a definitive diagnosis as to the nature of the pathology is essential. Objective: To describe the low‐field magnetic resonance imaging (MRI) findings in Thoroughbred racehorses with MCP/MTP joint pain scanned under standing sedation. Methods: The MR images and clinical records of all Thoroughbred racehorses undergoing MRI of the MCP/MTP joint between October 2006 and August 2010 were reviewed. A total of 168 joints from 131 horses were selected for inclusion. The MRI finding considered most significant in the lame (or lamest) limb was noted. Results: Diagnostic quality images were obtainable in 97.8% of horses. The most common finding was palmar/plantar osteochondral disease in MC3/MT3 (54.9% of horses). Incomplete condylar fracture was diagnosed in 19.8% of horses, with the lateral condyle predominating. An incomplete sagittal fracure of P1 was diagnosed in 14.5% of horses and 11.4% were diagnosed with ‘dorsal joint disease’. Other findings included transverse MC3 stress fractures (1.5%), soft tissue injuries (12.2%) and proximal phalangeal ‘contusions’ (3.8%). No significant bone/soft tissue injury was detected in 5.4% of cases. Conclusions: Standing MRI can detect a spectrum of disease within the MCP/MTP joints of racehorses. The procedure is well tolerated and may lead to a definitive diagnosis where radiographic imaging is inconclusive. Potential relevance: A total of 35.8% of cases had MRI findings consistent with fracture pathology, which could not be confirmed radiographically at the time of the MRI examination. This has important therapeutic and prognostic implications and may help to prevent catastrophic injury.  相似文献   

9.
OBJECTIVE: To compare results (ie, return to racing and earnings per race start) of surgical versus nonsurgical management of sagittal slab fractures of the third carpal bone in racehorses. DESIGN: Retrospective study. ANIMALS: 32 racehorses (19 Thoroughbreds, 11 Standardbreds, and 2 Arabians). PROCEDURE: Medical records and radiographs were reviewed to obtain information regarding signalment and treatment. Follow-up information was obtained from race records. Robust regression analysis was performed to evaluate earnings per start in horses that raced at least once before and after injury. RESULTS: 22 (69%) horses raced at least once after treatment of the fracture. All 7 horses treated by means of interfragmentary compression raced after treatment, and horses that underwent interfragmentary compression had significantly higher earnings per start after the injury than did horses treated without surgery. Eight of 9 horses treated by means of arthroscopic debridement of the damaged cartilage and bone raced after treatment, but only 7 of 16 horses treated without surgery (ie, stall rest) were able to return to racing after treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that racehorses with sagittal slab fractures of the third carpal bone have a favorable prognosis for return to racing after treatment. Horses treated surgically were more likely to race after treatment than were horses treated without surgery.  相似文献   

10.
Chronic proliferative synovitis of 27 metacarpophalangeal joints in 16 horses is described. The diagnosis was based on a history of lameness and, or, poor performance, pain on flexion of the metacarpophalangeal joint, the response to intra-articular anaesthesia, and plain and contrast radiography. Radiographic findings included concavity of the distal dorsal metacarpus proximal to the sagittal ridge, and an increase in size of the synovial tissue adjacent to the proximal, dorsal attachment of the joint capsule. Mineralisation of the synovial tissue was present in some joints, and chip fractures from the dorsal aspect of the proximal phalanx were also occasionally seen. Treatment by arthroscopic resection of the tissue gave excellent results.  相似文献   

11.
There is limited information on the treatment of lateral malleolus (LM) fractures in the horse, with no previously published case series for the outcome following arthroscopic removal of such fractures. This report reviews and evaluates findings of a retrospective study of 13 horses admitted to a private equine referral hospital over a 10 year period (1999–2009) that underwent arthroscopic removal of fractures of the LM. Hospital records were reviewed and details including patient history, aetiology of the fracture and limb affected, results of all diagnostic tests and surgical reports were documented. Performance information concerning Thoroughbred horses that went onto race post operatively was collected using an online database. Owners and trainers were contacted regarding the return to performance for non‐Thoroughbred cases or those that did not go onto race post operatively. Of the 13 horses presented, 12 were Thoroughbreds, 9 of which were National Hunt racehorses and 3 were Flat racehorses. The other horse in the study was used for general purpose riding. All cases presented with an acute unilateral fracture. Eleven of the 13 had >6 months post operative follow‐up and all were nonlame. Of the 12 Thoroughbreds, 10 have raced again, a total of 104 times (median 5 times). The median time from surgery to return to racing was 241 days (180–366 days). It is concluded that horses with fractures of the LM have an excellent prognosis for return to full athletic performance following arthroscopic debridement; and that arthroscopic fragment removal is an appropriate treatment method for fractures of the LM.  相似文献   

12.
Medical records, radiographs, and sonograms of 63 horses with metacarpophalangeal joint synovial pad proliferation were examined retrospectively. All horses had lameness, joint effusion, or both signs associated with one or both metacarpophalangeal joints. Bony remodeling and concavity of the distodorsal aspect of the third metacarpal bone (Mc3) just proximal to the metacarpal condyles was identified by radiography in 71 joints (93%); 24 joints (32%) had radiographic evidence of a chip fracture located at the proximal dorsal aspect of the proximal phalanx. Fifty-four joints (71%) were examined by ultrasound. The mean ± SD sagittal thickness of the synovial pad was 11.3 ± 2.8 mm. Seventy-nine percent of the horses had single joint involvement with equal distribution between the right and left forelimbs. Sixty-eight joints in 55 horses were treated by arthroscopic surgery. Sixty joints (88%) had debridement of chondral or osteochondral fragmentation from the dorsal surface of Mc3 beneath the synovial pad and 30 joints (44%) had a bone chip fracture removed from the medial or lateral proximal dorsal eminence of the proximal phalanx. Complete or partial excision of both medial and lateral synovial pads was completed in 42 joints. Only the medial synovial pad was excised or trimmed in 21 joints, and 5 joints had only the lateral pad removed. Eight joints in eight horses were treated by stall rest, administration of intra-articular medication and systemic nonsteroidal anti-inflammatory drugs. Follow-up information was obtained for 50 horses treated surgically and for eight horses treated medically. Forty-three (86%) that had surgery returned to racing; 34 (68%) raced at an equivalent or better level than before surgery. Three (38%) of the medically treated horses returned to racing; only one horse raced better than the preinjury level. Horses that returned to racing at a similar or equal level of performance were significantly younger in age than horses returning at a lower level or not racing (P≤.05). Overall, horses with synovial pad proliferation treated by arthroscopic surgery had a good prognosis for return to racing at a level equal or better than before injury.  相似文献   

13.
OBJECTIVE: To assess individual and combined associations of high-speed exercise and horseshoe characteristics with risk of forelimb proximal sesamoid bone fractures and proximal sesamoid bone midbody fractures in Thoroughbred racehorses. ANIMALS: 269 deceased Thoroughbred racehorses. PROCEDURES: A case-control study design was used to compare 121 horses with a fracture of at least 1 of 4 forelimb proximal sesamoid bones (75 horses had a midbody fracture) and 148 horses without a forelimb proximal sesamoid bone fracture. Univariable and multivariable logistic regression analyses were used to evaluate potential risk factors for association with proximal sesamoid bone fracture. RESULTS: Compared with horses that died without proximal sesamoid bone fractures, horses that died with proximal sesamoid bone fractures were more likely to be sexually intact males, spend more time in active trainingand racing, complete more events, train and race longer since their last layup, have higher exercise intensities during the 12 months prior to death, and have greater cumulative distances for their career. Horses with proximal sesamoid bone midbody fractures were more likely to be sexually intact males, train and race longer since their last layup, and have higher exercise intensities during the 12 months prior to death. CONCLUSIONS AND CLINICAL RELEVANCE: Limitingexercise intensity and the continuous time spent in activity duringa horse's career may decrease the frequency of forelimb proximal sesamoid bone fractures in Thoroughbred horses.  相似文献   

14.
To assess the clinical usability of propofol-ketamine anesthesia for internal fixation of fractures in racehorses, hemodynamics, blood pH and gases, and vital responses to the continuous intravenous anesthesia in 7 surgical cases were analyzed. The quality of induction with propofol was variable for individual horses. The vital signs reflecting circulation, breath, and anesthetic depth were kept good without any troubles throughout the surgery. Mean time from the end of anesthesia to standing up was prolonged, however recovery from anesthesia was calm and smooth in all cases. Propofol-ketamine anesthesia may be a clinically usable technique for internal fixation of fractures in racehorses, however induction with propofol alone is not recommended.  相似文献   

15.
The case record, and subsequent racing performance, of 110 horses that had undergone arthroscopic surgery of the carpus, were reviewed. Of these, 87% resumed racing, with 43% able to win at least one race, after surgery. Horses with chip fractures from the distal radius had the best prognosis, while horses with sagittal fractures of the third carpal bone had the poorest. The performance of horses with bilateral lesions was similar to those with unilateral lesions. It was concluded that arthroscopic surgery was a suitable technique for the diagnosis and treatment of carpal lesions in the horse.  相似文献   

16.
Reasons for performing study: The effectiveness and best method to manage dorsal cortical stress fractures is not clear. This study was performed to evaluate the success of lag screw fixation of such fractures in a population of Thoroughbred racehorses. Hypothesis: Lag screw fixation of dorsal cortical stress fractures is an effective surgical procedure allowing racehorses to return to their preoperative level of performance. Methods: The records of 116 racehorses (103 Thoroughbreds) admitted to Equine Medical Centre, California between 1986 and 2008 were assessed. Information obtained from medical records included subject details, limb(s) affected, fracture configuration, length of screw used in repair and presence of concurrent surgical procedures performed. Racing performance was evaluated relative to these factors using Fisher's exact test and nonparametric methods with a level of significance of P<0.05. Results: Of 92 Thoroughbred horses, 83% raced preoperatively and 83% raced post operatively, with 63% having ≥5 starts. There was no statistically significant association between age, gender, limb affected, fracture configuration or presence of concurrent surgery and likelihood of racing post operatively or of having 5 or more starts. The mean earnings per start and the performance index for the 3 races following surgery were lower compared to the 3 races prior to surgery; however, 29 and 45% of horses either improved or did not change their earnings per start and performance index, respectively. Conclusions and potential relevance: Data show that lag screw fixation is successful at restoring ability to race in horses suffering from dorsal cortical stress fractures.  相似文献   

17.
Equine carpal and fetlock joints have been the most frequent sites for arthroscopic surgical procedures and were the initial locations where techniques were developed. The primary indication for surgical treatment of chip fragments in the equine athlete is normalization of the interior of the joint and prevention of osteoarthritis. Osteochondral chip fragments in the equine carpus are common in racehorses. The overall success rate with arthroscopic removal is 68.1% racing at a level equal to or better to preinjury in 88.6% starting at least one race. Depending on the degree of articular cartilage and bone damage, the prognosis for return to racing at a level equal to or better than preinjury ranges from 71% to 54%. Success rate with proximodorsal first phalanx chip fragments is 83.5% return to their previous use; 73.6% return to racing at the same level of performance. Other fracture fragments operated in the fetlock joint include, plantar or palmar first phalanx fragments, osteochondritis dissecans fragments from the sagittal ridge and distal dorsal metacarpus as well as apical, abaxial and basal sesamoid fragments. The success rates with these various arthroscopic surgeries are also presented.  相似文献   

18.
Lameness associated with osteochondral fragmentation of the carpus is a common injury in racing horses. Frequency distributions of sites of fragmentation have previously been published in racehorses in the USA, Australia, New Zealand and Japan but not in racing Thoroughbreds in the UK. The objectives of the study were to document sites of osteochondral fragmentation in the carpus of a population of Thoroughbred flat racehorses in the UK and compare these with other Thoroughbred populations globally and other flat racing breeds. This study was a single centre retrospective observational study; case records of flat racing Thoroughbreds with sites of carpal bone fragmentation that underwent arthroscopic surgery at Newmarket Equine Hospital between 2008 and 2013 were reviewed. A total of 291 sites of fragmentation were identified arthroscopically within the carpal joints of 174 horses. This involved 135 (75%) middle carpal (MCj) and 44 (25%) antebrachiocarpal joints (ABCj), which differs from other populations reported. The most common sites of fragmentation were dorsodistal radial carpal bone (DDiCr) (49%), dorsoproximal third carpal bone (DPrC3) (22%), dorsodistal radius (DDiR) (15%), dorsoproximal radial carpal bone (DPrCr) (5%) and dorsoproximal intermediate carpal bone (DPrCi) (4%). The dorsodistal radial carpal bone is also the most common site in American (US) Quarter Horses (QHs) and Thoroughbreds (TBs) and Australian (AUS) TBs, while DPrC3 has a greater prevalence in US Standardbreds (SBs). Thereafter the frequency distribution differs between the reported study groups. Although all horses underwent bilateral radiographic examination, 45% of the total population had unilateral arthroscopic evaluation. This may therefore underestimate the total number of sites of fragmentation reported. In summary the frequency distribution of carpal fragmentation in flat racing Thoroughbreds in the UK appears to differ from other populations of racehorses.  相似文献   

19.
Fifty-seven Standardbred and 44 Thoroughbred racehorses and 1 Thoroughbred polo mare with primary clinical signs of exercise intolerance or respiratory tract noise or combined exercise intolerance and respiratory tract noise were referred for laser correction of epiglottic entrapment. Significantly (P less than 0.001) more Standardbred than Thoroughbred racehorses were affected, compared with the observed hospital population during the same period. At referral, 14 horses did not have evident epiglottic entrapment and were returned to exercise without development of entrapment after treatment, which consisted of 1 week of rest and administration of anti-inflammatory medication. In 88 standing horses under sedation and topical anesthesia, epiglottic entrapment was corrected transendoscopically by use of a contact neodymium:yttrium aluminum garnet laser. In these 88 horses, 98% of entrapments were persistent, 92% were thick, 97% were wide, and 45% were ulcerated. Thirty-one percent of the horses had endoscopic evidence of epiglottic hypoplasia, and 8% had deviated epiglottic axis. Complete correction was achieved in 97% of the horses, Persistent dorsal displacement of the soft palate in 1 horse and severe epiglottic hypoplasia with thick, chronic entrapping membranes in 2 horses precluded successful transendoscopic correction with the horses in standing position. Most horses were treated on an outpatient basis, and all were able to be returned to exercise after 7 to 14 days of rest and treatment with anti-inflammatory medication. Entrapment recurred in 4 horses (5%), 3 of which had hypoplastic epiglottis. Dorsal displacement of the soft palate developed after surgery in 9 horses (10%) and continued in 4 horses (5%) that had displaced soft palate before surgery. All these horses had epiglottic hypoplasia. Laser correction of epiglottic entrapment in standing horses was safe, well tolerated, and effective. Laser surgery was an alternative to conventional surgery, and eliminated the need for general anesthesia and laryngotomy. It also reduced convalescence and postoperative complications.  相似文献   

20.
An arthroscopic approach to the palmaroproximal or plantaroproximal pouch of the distal interphalangeal joint was developed in six cadaver limbs and seven limbs of three clinically normal horses. The dorsal aspect of the proximal border and the proximal articular margin of the distal sesamoid (navicular) bone, the palmar aspect of the distal articular margin of the middle phalanx, the collateral sesamoidean ligaments of the distal sesamoid bone, and the joint capsule attachments were readily accessible. Distending the joints with fluid gave access to portions of the articular surface between the distal sesamoid bone and the middle phalanx in all joints, and to a small portion of the distal phalanx in two hind distal interphalangeal joints. Two horses allowed to recover from anesthesia were not lame on days 30 and 37, respectively. Problems encountered initially were difficulty entering the joint, hemarthrosis, and minimal iatrogenic cartilage damage.  相似文献   

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