BACKGROUND:The literature on the osteochondral lesion of the talus (OLT) in skeletally immature children is scarce and little is known about the clinical outcomes and the radiologic appearance of ...these lesions after surgical treatment. The aim of this study was to assess mid-term clinical and magnetic resonance imaging (MRI) outcomes after arthroscopic microfracture (AM) of OLT in skeletally immature children.
METHODS:Thirteen patients with OLT treated by AM before skeletal maturity were included in the study. The Berndt and Harty outcome question, the Single Assessment Numeric Evaluation question, and the Martin questionnaire were used to obtain patients’ subjective satisfaction with their operated ankle. Functional outcomes preoperatively and postoperatively were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. MRI scans were performed postoperatively using a magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for 11 ankles.
RESULTS:The median age was 15 years (range, 13 to 16 y) and the median follow-up period was 5.6 years (range, 3.8 to 13.6 y). According to the Berndt and Harty outcome question, good clinical results were reported in 10 (76.9%) and fair in 3 (23.1%) patients. The postoperative AOFAS score was significantly improved when compared with the preoperative AOFAS score, with a mean increase of 35 points (P<0.001). The overall MOCART score was 65 (range, 10 to 75). MRI variables of the MOCART scoring system showed no association with clinical outcomes.
CONCLUSIONS:AM seems to be an effective surgical method for the treatment of OLT in skeletally immature children.
LEVEL OF EVIDENCE:Level IV—therapeutic studies, case series.
BACKGROUNDIntra-articular osteoid osteoma (iaOO) can be found in 5.2% up to 10% of cases. They may cause non-specific symptoms, mimicking degenerative or traumatic pathologies. If iaOO is left ...untreated, it may lead to severe muscle atrophy, tenderness, swelling, and limited range of motion. Therefore, surgical treatment is recommended. The main goal of surgical treatment is complete removal or destruction of iaOO. AIMTo evaluate the efficiency of arthroscopic removal of iaOO of the knee in our cases and cases available in the literature. METHODSAnalysis of available hospital records of four patients with iaOO of the knee treated by arthroscopic removal from August 2005 to December 2015 at our Department was performed. All patients had a diagnosis of iaOO confirmed by histopathologic analysis. Additional literature review of cases of iaOO of the knee available on PubMed and Google Scholar was made. All cases of iaOO of the knee treated by arthroscopic or arthroscopically assisted removal were reviewed in order to further evaluate the efficiency of the method. RESULTSThe average age of patients included in our study was 23.2 (range 16-37) years. The average duration of the symptoms prior to surgery was 14.2 (range 6-24) months. All of the patients had persistent knee pain. Three patients reported worsening of pain during the night, while two reported worsening of pain during activity. Three patients reported alleviation of pain on non-steroidal anti-inflammatory drugs (NSAIDs), while one patient reported partial alleviation of pain on NSAIDs. No intraoperative complications were noted, and the postoperative period was uneventful in all patients. The patients reported immediate pain relief in the postoperative period. No recurrence of the disease was noted in any of the patients during the follow-up period of at least 24 mo. The literature review revealed 14 cases with an average age of 27.6 (range 16-48) years and onset of symptoms 27.7 (range 6-108) months prior to surgery, with recurrence of the disease noted in a single case. CONCLUSIONArthroscopic removal is an efficient treatment method that allows excision of iaOO that is neither insufficient nor excessive, thus avoiding disease recurrence while obtaining adequate material for histopathologic analysis.
The aim of this study was to describe relevant medical history, clinical symptoms and outcomes in 12 patients having undergone surgical treatment of intra-articular ganglion cysts of the knee at our ...Department from January 2010 to June 2016. Patient demographics, medical history, knee manifestations, management and outcome were evaluated. The mean patient age was 26.4 (range, 16-46) years. Th ere were seven female and five male patients. Duration of symptoms prior to the operation varied from 2 months to 3 years (mean, 17.1 months). All patients had preoperative magnetic resonance imaging work-up of the knee. Pain was the most common clinical presentation. All patients were surgically treated arthroscopically, and an additional open approach was used in only one of the patients. There were no complications during surgery and the postoperative period was uneventful in all patients. The mean follow up period was 43.5 (range, 9-83) months and no recurrence was observed. All patients remained symptom-free with full range of motion at final follow up. Despite a wide range of intra-articular ganglion cyst presentations and symptoms, our cohort demonstrated an excellent remission rate and functional prognosis following surgical treatment of the ganglion cysts of the knee.
Abstract Periarticular osteoid osteoma often presents with unspecific clinical symptoms, mimicking other clinical conditions. This can lead a clinician to a ''diagnostic side path'' and a delayed or ...missed diagnosis compared with extra-articular osteoid osteoma. We report the cases of 9 patients with a mean age of 22 (range 14 to 32) years who were diagnosed with periarticular osteoid osteoma of the ankle and were surgically treated in our department during a 12-year period. The diagnostic difficulties associated with periarticular osteoid osteoma must be resolved by obtaining a detailed patient history and performing a thorough physical examination. Computed tomography is the ultimate imaging method to confirm the suspicion of osteoid osteoma. Arthroscopic removal of the osteoid osteoma was performed in all 9 patients in the present case series, with synovectomy performed when indicated. Under arthroscopic visualization, a specimen was obtained for histopathologic analysis to confirm the diagnosis, followed by tumor excision. All the patients were pain free at the final follow-up visit after a mean duration of 6 years (range 6 months to 12.7 years) postoperatively. We suggest arthroscopic removal of periarticular osteoid osteomas of the ankle as an effective treatment method, because it allows complete tumor excision, synovectomy when needed, a short postoperative rehabilitation period, and satisfactory functional results.
Excessive metal femoral head wear has been described only as revision surgery complication after primary ceramic-on-ceramic total hip arthroplasty (THA). Here, we present the first case of metal ...femoral head wear after primary metal-on-polyethylene THA. A 56-year-old woman was referred to our outpatient clinic 17 years after primary right-sided THA, experiencing pain and decreased right hip range of motion. Radiographic examination revealed acetabular cup dislocation, eccentric femoral head wear, damaged titanium porous coating of femoral stem, metallosis, and pseudotumor formation. Endoprosthetic components were extracted, but further reconstruction was impossible due to presence of large acetabular bone defect. Macro- and micro-structure of extracted components were analyzed. Acetabular liner surface was damaged, with scratches, indentations, and embedded metal debris particles present on the entire inner surface. Analysis of metal debris by energy-dispersive spectroscopy showed that it consisted of titanium and stainless-steel particles. Femoral head was gravely worn and elliptically shaped, with abrasive wear visible under scanning electron microscope. No signs of trunnionosis at head/neck junction were observed. Microstructure of femoral head material was homogeneous austenitic, with microhardness of 145 HV 0.2, which is lower than previously described titanium hardness. In conclusion, detached titanium porous coating of femoral stem can cause stainless-steel femoral head wear in primary metal-on-polyethylene THA. As soon as such detachment becomes evident, revision surgery should be considered to prevent devastating complications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Lateral inverted osteochondral fracture of the talus (LIFT) is a rare variant of stage IV osteochondral lesion of the talus (OLT), where the fragment is inverted in situ by 180°. The management of ...LIFT lesion is very challenging and early recognition crucial, given that treatment options depend on the articular cartilage condition and sufficiency of the adjacent bone of the displaced fragment. We describe two LIFT cases referred from other institutions after unsuccessful conservative treatment of OLT. They presented with pain, swelling and tenderness over the anterolateral aspect of the right ankle. We recognized the LIFT lesion on the magnetic resonance imaging scans in patient 2, while in patient 1 the orientation of the fragment was recognized upon direct visualization during operative treatment. Both patients underwent arthroscopic procedure. Due to articular cartilage damage and insufficiency of the adjacent bone of the fragment, both patients were treated with excision fol-lowed by microfracture. Treatment of the LIFT lesion should start arthroscopically to allow clear evaluation of the osteochondral fragment, assessment of the talar defect and identification, as well as treatment of associated disorders. If the articular cartilage appears intact with sufficient subchondral bone, fixation of the fragment is optimal management, otherwise excision and microfracture can be the treatment of choice.
Accessory soleus muscle (ASM) is a rare supernumerary anatomical variant that commonly presents as a posteromedial ankle swelling, which may become painful during physical activity. As it may mimic a ...soft tissue tumor, it is essential to differentiate this condition from ganglion, lipoma, hemangioma, synovioma, and sarcoma. However, ASM may also present with a painful syndrome, characterized by pain and paresthesia of the ankle and foot, mimicking the tarsal tunnel syndrome (TTS). Two cases of ASM are presented in this article. The first case had a typical presentation with painful posteromedial ankle swelling. After the initial assessment, the diagnosis was confirmed by magnetic resonance imaging (MRI), and ASM was treated by complete resection. The second case presented with pain and paresthesia in the right ankle and foot, but no swelling was noticeable. It was initially misdiagnosed by a rheumatologist and afterward overlooked on an MRI by a musculoskeletal radiology specialist and therefore mistreated by numerous physicians before being referred to our outpatient clinic. After further assessment, the diagnosis has been confirmed, and ASM was treated by complete resection combined with tarsal tunnel decompression. To the best of our knowledge, this is the first case reported in which ASM caused symptoms but presented without posteromedial swelling. This might be due to a proximally positioned belly of the ASM, followed by a tendinous insertion on the medial side of the calcaneus.
This study presents a series of 13 patients who underwent peroneal tendoscopy as a solitary or accessory procedure at our department in 2013. Patients were clinically diagnosed with peroneal tendons ...disorders and underwent an additional radiological assessment. Peroneal tendoscopy was carried out in a standard manner before any other arthroscopic or open procedure. Postoperative management depended on the type of pathology. We found 3 peroneus brevis tendon partial tears, 4 cases of a low-lying peroneus brevis muscle belly, 5 cases of tenosynovitis, and 1 case of an intrasheath peroneal tendon subluxation. In 5 patients peroneal tendoscopy was performed as a solitary procedure and in 8 patients as an accessory procedure--together with anterior or posterior ankle arthroscopy, combined posterior and anterior ankle arthroscopy, or open surgery. Both as a solitary and accessory procedure, peroneal tendoscopy was safe and successful, ie, all patients were without any symptoms at one-year follow-up. Our series of patients showed that peroneal tendoscopy can be used both as an independent procedure as well as a valuable accessory procedure.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Fondaparinux has been shown to be as effective as low molecular weight heparin
in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. The
main goal of this ...prospective randomized controlled trial was to define whether thromboprophylaxis
in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) influences
clinical parameters in the same manner in patients receiving fondaparinux as in those receiving
nadroparin during the first 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent
unilateral TKA performed by the same surgeon and were randomized into two groups of 30
patients receiving either fondaparinux or nadroparin thromboprophylaxis. Patients were compared
according to the duration of operation, perioperative blood loss, laboratory results and clinical evaluation
of the edema during the early postoperative period. No differences were found between the
groups in the mean duration of surgery, perioperative blood loss, and most of laboratory results. The
level of urea was significantly lower in the nadroparin group on the first and second postoperative day.
No cases of heparin induced thrombocytopenia, deep vein thrombosis or pulmonary embolism were
noted during the study. Study results showed both fondaparinux and nadroparin to have the same
influence on clinical parameters during the first 7 postoperative days in patients undergoing TKA.
Synovial chondromatosis of the elbow Dimnjaković, Damjan; Bojanić, Ivan; Mahnik, Alan ...
Collegium antropologicum
37, Številka:
2
Journal Article
Recenzirano
Synovial chondromatosis (SC) is a rare, mostly benign proliferation of the synovium of the joint, tendon or bursa which results in the formation of loose bodies. It can appear in one of 33 described ...localisations, but it is most common in the knee. In our study we gathered a group of 7 patients (6 male and 1 female) with SC of the elbow, which underwent arthroscopic surgery of the elbow, performing both removal of the loose bodies and complete synovectomy. Mayo Elbow Performance Score (MEPS) was used to evaluate and compare the patients' condition before the operation and at the final follow-up, 31 months, on average, after the operation (range 18-56 months). All patients had poor MEPS before the operation, with an average of 40.7 (range 15-50 points). At the final follow-up, 6 patients had a good or excellent MEPS, while a poor MEPS was present in a single patient. The average MEPS was 85 (range 45-100 points). The one patient who's MEPS remained poor developed heterotopic ossification in the same elbow shortly after arthroscopic surgery. This patient was reoperated 8 months later using an open technique. No other complications occurred in the rest of the operated patients and no recurrence of SC occurred in any of the operated patients. Our results confirm that arthroscopic removal of loose bodies and complete synovectomy should be the treatment of choice for SC of the elbow.
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