Papers by Pinkawas Kongmalai
Popliteal cysts are characterized by enlargement of the gastrocnemius-semimembranosus bursa. The ... more Popliteal cysts are characterized by enlargement of the gastrocnemius-semimembranosus bursa. The patho-genesis includes a valvular opening between the knee joint and the bursa, and associated intra-articular pathology may give rise to knee effusion. The mainstay of treatment is conservative. If popliteal cysts are symptomatic, analgesia, aspiration , and steroid injection therapy may be considered, but most recur rapidly. In the past, open excision was an option if they remained symptomatic, but the associated recurrence rate was high. One important reason was that the intra-articular pathology causing the knee effusion was not treated. We present an alternative minimally invasive arthro-scopic treatment using dye (methylene blue) directly injected into the cyst, which will leak from the cyst into the joint, to identify the valvular opening. The thickened valve is opened using a basket forceps and then enlarged using a motorized shaver to disrupt the 1-way mechanism between the joint and bursa, as well as to establish an unobstructed freeway connection between them. We also present a safe technique to create a direct posterior portal. Intracystic debridement of the fibrous membrane, nodules, and septa through this portal will decrease the recurrence rate of the popliteal cyst.
A posterior horn of medial meniscal peripheral capsular is usually associated with the anterior c... more A posterior horn of medial meniscal peripheral capsular is usually associated with the anterior cruciate ligament injury. The conventional repair technique with the camera in the anterolateral portal cannot precisely restore the slope capsular synovium to the original attachment point. We present the arthroscopic technique for improving the accuracy and quality of the repair by working in the posterior compartment. When the posterolateral portal is used as the viewing portal, the accuracy of repair is improved because we can assess the full extent of the lesion and lift the sagging peripheral tissue to the more central part.
Objective: We conducted this study in order to find out the demographic causes of pathology for c... more Objective: We conducted this study in order to find out the demographic causes of pathology for chronic lateral elbow pain along arthroscopic criteria. Material and Method: We conducted descriptive study of the medical records of the patients with chronic lateral elbow pain who refractory to conservative treatment. Diagnostic arthroscopy of the elbow was performed by a specialist in elbow surgery at HRH Princess Maha Chakri Sirindhorn Medical Center from March 2011 to October 2014. Results: There were 29 patients who met inclusion criteria in our study. With regard to intra-articular pathologies, we found a radiocapitellaplica in 41% of the patients. In 21% of the patients, we found isolated tennis elbow. The concomitant radiocapitellaplica and tennis elbow were also found in 21% of patients. Cartilage lesion was found in 10% of the patients and plica with posterolateral impingement was found in 7% of patients. Conclusion: Causes of the chronic lateral elbow pain are complex. The diagnosis should be made by precise clinical sign and proper investigations. In our series, the lateral epicondylitis was not the majority cause of chronic lateral elbow pain. The benefits of arthroscopy are not just the minimal invasive approach directly to the lesion, but also the intra-articular and dynamic investigation allow the surgeon to make sure that all pathology were treated.
Objective: The authors developed the autologous fibrin-base scaffold for chondrocytes and bone ma... more Objective: The authors developed the autologous fibrin-base scaffold for chondrocytes and bone marrow mesenchymal stem cells (BM-MSCs) implantation and evaluated cells viability in autologous fibrin-base scaffold comparing to commercial fibrin glue. Material and Method: The chondrocytes and BM-MSCs were seeded into autologous fibrin-base scaffold and commercial fibrin glue. The cell viability and proliferation were evaluated at 1 and 7 days. The histology were evaluated with hematoxylin-eosin (H&E) staining and cartilaginous matrices formation with Alcian blue, Saffanin-0, Toluidine blue, and Collagen type II staining at 6 weeks. The fixation of the scaffolds was observed. Results: The chondrocytes and BM-MSCs could not survive in commercial fibrin glue. The chondrocytes and BM-MSCs in autologous fibrin-base scaffold could proliferate and synthesize the cartilaginous matrices on Alcian blue, Saffanin-0, Toluidine blue, and Collagen type II staining at 6 weeks. The fixation strength is excellent. Conclusion: The developed autologous fibrin-base scaffold can be used as the scaffold for chondrocytes and BM-MSCs implantation with potential to implant chondrocytes and BM-MSCs arthroscopically.
– Purpose and hypothesis: Acromion spur is the extrinsic factor for impingement syndrome and rota... more – Purpose and hypothesis: Acromion spur is the extrinsic factor for impingement syndrome and rotator cuff tear. The Rockwood tilt view can be used to evaluate prominence of the anterior acromion, however no study has shown the correlation of findings between the Rockwood tilt view and the arthroscopic finding. Methods: We developed the arthroscopic classification of acromion spur as type 1 flat spur, type 2 bump spur, type 3 heel spur, type 4 keel spur, and type 5 irregular spur. Patients with rotator cuff syndrome who underwent arthroscopic surgery were recruited. Two observers were asked to classify the type of spur from arthroscopic findings and Rock-wood tilt views separately in random pattern. The prevalence of supraspinatus tendon tear was also recorded as no tear, partial-thickness tear, and full-thickness tear. Results: The keel spur (33.9%) was the most common finding followed by the heel spur (27.8%). The correlation was high especially for the heel, the keel, and the irregular spur (75.47%, 74.03%, and 72.73%, respectively.) These three types of spurs have a high prevalence of full thickness of supraspinatus tendon tear. Conclusion: The Rockwood tilt view can be used to evaluate the morphology of an acromion spur, especially the at-risk spur that correlates highly with the full-thickness supraspinatus tendon tear. The arthroscopic classification will also be a useful tool to improve communication between the surgeon and the guide for appropriate treatment in a rotator cuff tear patient when encountering the heel, keel, and irregular spur.
Objective: Saline load test of the knee could have benefit in the evaluation of the patient with ... more Objective: Saline load test of the knee could have benefit in the evaluation of the patient with traumatic arthrotomy. The aim of this study was to find out the efficacy in aspect of the volume to be used, the position to be done, the sensitivity and clinical efficacy of the test. Material and Method: The articles published after 1995 about the saline load test focusing on the knee joint which were written in English language were reviewed. The universal database including Medline and Google Scholar were used. The searched terms were " saline load test knee " and " saline arthrogram knee ". Results: Ten articles were reviewed for relevancy. They consisted of four articles with level I of evidence and six articles with level III of evidence. There were eight articles with prospective design and two articles with retrospective design. The mean volume of the fluid was 69.8 ml. (ranged from 7.0 ml to 240 ml). The sensitivity ranged from 31% to 99%. Seven articles suggest to use the test but two articles were opposed. One article did not give its recommendation. Conclusion: The saline load test of the knee is a reasonable option to detect a traumatic arthrotomy of the knee. The maximum amount of volume tolerated must be injected to gain the highest sensitivity. However, the negative test could not rule out the potential of joint injury. There should be a discussion about the potential benefits and disadvantages with the patient and the relatives before making a definitive treatment.
There is no definite guideline concerning patient selection for operative intervention on rotator... more There is no definite guideline concerning patient selection for operative intervention on rotator cuff tears in rheumatoid arthritis patients.
This article presents a case of elderly patient with massive rotator cuff tear from rheumatoid arthritis. Physical examination and imaging showed that the supraspinatus and subscapularis tear were reparable. The arthroscopic synovectomy with supraspinatus and subscapularis repair were performed with excellent clinical outcome.
Purpose: Telemedicine is an adaptation of internet-based communication for remote patients. The v... more Purpose: Telemedicine is an adaptation of internet-based communication for remote patients. The video (VDO)
clip-based goniometry method is a type of telemedicine that would be useful for patients who need periodic
assessment. A previous report showed the validation of this technique but it did not verify the generalizability or
reproducibility of the technique. The purpose of this study was to determine the generalizability and
reproducibility of the VDO clip-based goniometry method for measuring the range of motion of the elbow.
Methods: Both elbow flexion and extension, and forearm pronation and supination were measured by the
specialist in elbow surgery using standard goniometer. On the same day, VDO records of 30 subjects were
performed. One week later, the VDO clips were displayed and their range of motion (ROM) was measured
using free download software (PicPick, 3.1.0) by an orthopaedic resident (to determine inter-rater/intra-method
reliability). One month later, measurements were taken again by the same specialist (to determine intrarater/intra-method reliability).
Results: The intraclass correlation coefficient and the Bland-Altman analysis showed the capability of VDO-clip
based goniometry and clinical goniometry by the specialist in elbow surgery and orthopaedic resident especially
in elbow extension and forearm supination. For elbow flexion and forearm pronation, the data showed that there
was some degree of correlation but not as strong as flexion and extension. The results were reproducible by the
specialist in elbow surgery even when the measurements were taken again 1 month later.
Conclusion: The VDO clip-based goniometry method for measuring the range of motion of the elbow was
reproducible by a specialist in elbow surgery. It was also shown to be possible even if the measurement was
obtained by an orthopaedic resident. This offers a great opportunity to follow the outcome assessment of patients
for whom transportation to a tertiary care center is a significant barrier.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2012
To examine the validity of a Telemedicine-Based for measuring elbow range of motion. Cross-sectio... more To examine the validity of a Telemedicine-Based for measuring elbow range of motion. Cross-sectional descriptive studies in elbow flexion-extension and forearm pronation-supination were measured on 30 subjects. The intraclass correlation (ICC) and the percentage of degree of difference within fifteen and ten degrees between measurements obtained by telemedicine-based technique (VDO-clip) and clinical goniometry were found high percentage of correlation inflexion and extension. Pronation and supination, although not as good as flexion and extension, still showed some degree of correlation. Remote range of motion assessment using telemedicine-based is technically feasible.
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Papers by Pinkawas Kongmalai
This article presents a case of elderly patient with massive rotator cuff tear from rheumatoid arthritis. Physical examination and imaging showed that the supraspinatus and subscapularis tear were reparable. The arthroscopic synovectomy with supraspinatus and subscapularis repair were performed with excellent clinical outcome.
clip-based goniometry method is a type of telemedicine that would be useful for patients who need periodic
assessment. A previous report showed the validation of this technique but it did not verify the generalizability or
reproducibility of the technique. The purpose of this study was to determine the generalizability and
reproducibility of the VDO clip-based goniometry method for measuring the range of motion of the elbow.
Methods: Both elbow flexion and extension, and forearm pronation and supination were measured by the
specialist in elbow surgery using standard goniometer. On the same day, VDO records of 30 subjects were
performed. One week later, the VDO clips were displayed and their range of motion (ROM) was measured
using free download software (PicPick, 3.1.0) by an orthopaedic resident (to determine inter-rater/intra-method
reliability). One month later, measurements were taken again by the same specialist (to determine intrarater/intra-method reliability).
Results: The intraclass correlation coefficient and the Bland-Altman analysis showed the capability of VDO-clip
based goniometry and clinical goniometry by the specialist in elbow surgery and orthopaedic resident especially
in elbow extension and forearm supination. For elbow flexion and forearm pronation, the data showed that there
was some degree of correlation but not as strong as flexion and extension. The results were reproducible by the
specialist in elbow surgery even when the measurements were taken again 1 month later.
Conclusion: The VDO clip-based goniometry method for measuring the range of motion of the elbow was
reproducible by a specialist in elbow surgery. It was also shown to be possible even if the measurement was
obtained by an orthopaedic resident. This offers a great opportunity to follow the outcome assessment of patients
for whom transportation to a tertiary care center is a significant barrier.
This article presents a case of elderly patient with massive rotator cuff tear from rheumatoid arthritis. Physical examination and imaging showed that the supraspinatus and subscapularis tear were reparable. The arthroscopic synovectomy with supraspinatus and subscapularis repair were performed with excellent clinical outcome.
clip-based goniometry method is a type of telemedicine that would be useful for patients who need periodic
assessment. A previous report showed the validation of this technique but it did not verify the generalizability or
reproducibility of the technique. The purpose of this study was to determine the generalizability and
reproducibility of the VDO clip-based goniometry method for measuring the range of motion of the elbow.
Methods: Both elbow flexion and extension, and forearm pronation and supination were measured by the
specialist in elbow surgery using standard goniometer. On the same day, VDO records of 30 subjects were
performed. One week later, the VDO clips were displayed and their range of motion (ROM) was measured
using free download software (PicPick, 3.1.0) by an orthopaedic resident (to determine inter-rater/intra-method
reliability). One month later, measurements were taken again by the same specialist (to determine intrarater/intra-method reliability).
Results: The intraclass correlation coefficient and the Bland-Altman analysis showed the capability of VDO-clip
based goniometry and clinical goniometry by the specialist in elbow surgery and orthopaedic resident especially
in elbow extension and forearm supination. For elbow flexion and forearm pronation, the data showed that there
was some degree of correlation but not as strong as flexion and extension. The results were reproducible by the
specialist in elbow surgery even when the measurements were taken again 1 month later.
Conclusion: The VDO clip-based goniometry method for measuring the range of motion of the elbow was
reproducible by a specialist in elbow surgery. It was also shown to be possible even if the measurement was
obtained by an orthopaedic resident. This offers a great opportunity to follow the outcome assessment of patients
for whom transportation to a tertiary care center is a significant barrier.