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.
Tenosinovijalni gigantocelularni tumor (TGCT) je rijetka benigna monoartikularna bolest koja zahvaća sinovijalnu ovojnicu zgloba, tetive ili burze. Razlikujemo lokalizirani i difuzni oblik bolesti ...pri čemu je histološka slika kod oba oblika jednaka. Stopa pojavnosti lokaliziranog oblika TGCT-a (LTGCT) iznosi deset slučajeva na milijun ljudi od čega se u oko 5% svih slučajeva pojavljuje u gležnju.
Prikazan je rijedak slučaj pojave LTGCT-a u prednjem dijelu gležnja u adolescentice koji se očitovao oteklinom i povremenim bolovima, napose pri sportskim aktivnostima. Na snimci magnetske rezonancije (MR) u prednjem je dijelu gležnja bila vidljiva heterogeno strukturirana, oštro ograničena tumorska tvorba, dok su sve ostale prikazane strukture bile urednih intenziteta signala i primjerene morfologije. Osim bezbolne otekline prednjeg dijela gležnja kliničkim je pregledom utvrđen i deficit dorzalne fleksije stopala. Zahvat je načinjen artroskopski, a tumorska se tvorba zbog svoje veličine nije mogla odstraniti u jednom komadu već se odstranila u dijelovima.
Patohistološka analiza je utvrdila da je riječ o TGCT-u. Tijekom razdoblja praćenja od dvije godine bolesnica se nije žalila na
tegobe s operiranim gležnjem, a na kontrolnim MR-ima nije zamijećen recidiv.
Na TGCT valja pomisliti kao moguću diferencijalnu dijagnozu kod bolesti gležnja, napose kad se bol i oteklina pojave bez ozljede.
Artroskopski zahvat je sigurna i učinkovita metoda liječenja LTGCT-a u gležnju ako ju izvodi iskusan operater kojeg prati uhodan tim, no valja istaknuti da se odabir načina kirurškog liječenja treba prilagoditi kako anatomskom položaju tvorbe u zglobu tako i procjeni i preferenciji kirurga.
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.
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.
Highlights • PVNS of the ankle is seen more often than reported. • Ankle complaints warrant a structured diagnostic algorithm. • Arthroscopy is an excellent option for treating LPVNS of the ankle ...joint. • Complete resection of the altered synovial tissue is paramount to avoid recurrence. • Pathohistological examination has the final say in determining the diagnosis.
SAŽETAK
Cilj istraživanjaArtroskopija gležnja je kirurški zahvat koji se čini ili kao samostalan zahvat u prednjem, odnosno stražnjem dijelu gležnja ili kao zahvat u kojem se operacija u prednjem i ...stražnjem dijelu gležnja čini u istom aktu. Cilj je ovog istraživanja bio analizirati indikacije, komplikacije i učinkovitost artroskopskih zahvata tijekom kojih je načinjena artroskopija prednjeg i stražnjeg dijela gležnja u istom aktu i usporediti ih s rezultatima drugih istraživanja.
Ispitanici i metodePretraživanjem operacijskih protokola Klinike za ortopediju Kliničkoga bolničkog centra Zagreb i Medicinskog fakulteta Sveučilišta u Zagrebu pronađeno je da je u devetogodišnjem razdoblju načinjeno 169 uzastopnih artroskopija prednjeg i stražnjeg dijela gležnja u istom aktu.
RezultatiNajčešća indikacija za artroskopiju prednjeg i stražnjeg dijela gležnja u istom aktu bio je prednji i stražnji sindrom sraza. Preostale indikacije bile su poslijetraumatska kontraktura, poslijetraumatski osteoartritis te sinovitisi u gležnju različite etiologije. Tijekom promatranog razdoblja uočeno je i zabilježeno u dostupnoj dokumentaciji sveukupno šest poslijeoperacijskih komplikacija. Nadalje, kod trinaest bolesnika operacijski zahvat na gležnju je tijekom praćenja načinjen ponovno.
ZaključakOvo istraživanje govori u prilog činjenici da je najčešće postavljana indikacija za činjenje artroskopije prednjeg i stražnjeg dijela u istom aktu prednji i stražnji sindrom sraza gležnja. Isto tako, ovo istraživanje potvrđuje sigurnost i učinkovitost artroskopskog zahvata u prednjem i stražnjem dijelu gležnja u istom aktu kako kod liječenja sindroma prednjeg i stražnjeg sindroma sraza tako i kod drugih ozljeda i oštećenja u području gležnja, poput poslijetraumatske kontrakture gležnja, poslijetraumatskog osteoartritisa gležnja te sinovitisa u gležnju različitih etiologija.
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.
To evaluate the outcome of patients who underwent microfracture procedure on osteochondritis dissecans (OCD) lesions in the elbow, which had already been proven successful on OCD lesions in the knee ...and ankle.
Nine young patients who were previously treated by arthroscopic debridement and microfracture by a single surgeon were included in the study. The median age at operation was 15 years (range 12-19). The median time between the procedure and evaluation was 5 years (range 2-9). The evaluation included physical examination and patient interview with elbow function scoring. Success of treatment was determined according evaluation Mayo Elbow Performance Index scores and the patients' return to sports.
Eight patients scored excellent results and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether.
We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum.
Cilj ovog rada jest ukazati na moguću pojavu stražnjeg sindroma sraza gležnja (SSSG) u populaciji adolescenata te provjeriti tvrdnju da se u toj populaciji njegova dijagnoza postavlja s vremenskom ...odgodom. Osim toga, željeli smo prikazati i rezultate provedenog kirur- škog liječenja SSSG-a artroskopskim zahvatom u adolescenata te usporediti dobivene rezultate s rezultatima objavljenim u literaturi. U istraživanju je sudjelovalo 16-ero ispitanika koji su u trenutku zahvata imali ≤19 godina i kod kojih je zbog SSSG-a načinjen artro- skopski zahvat samo u stražnjem dijelu gležnja. Sva dostupna medicinska dokumentacija sustavno je pretražena s ciljem utvrđiva- nja razdoblja od pojave prvih simptoma do točne dijagnoze te uzroka nastanka SSSG-a, kao i traženja zabilješki o komplikacijama liječenja. Na pregledu provedenom u sklopu istraživanja procjena funkcijskog stanja gležnja provedena je upitnikom Američkog ortopedskog društva za stopalo i gležanj (AOFAS upitnik), dok je zadovoljstvo ispitanika načinjenim zahvatom ocijenjeno pomoću Abdelatifova upitnika. Prosječna životna dob ispitanika u trenutku zahvata iznosila je 16,8 godina, a medijan trajanja simptoma do postavljanja točne dijagnoze iznosio je 8,5 mjeseci. Zahvat je u svih protekao bez komplikacija, a one nisu uočene ni u poslijeoperacijskom razdoblju. Utvrđeno je značajno poboljšanje rezultata AOFAS upitnika s prosječno 70,9 prije zahvata na 97,0. Svi su ispitanici izrazili izrazito zadovoljstvo načinjenim zahvatom i istaknuli da im se funkcija gležnja popravila nakon načinjenog zahvata. Ovo je istraživanje potvrdilo konstataciju iz literature da se dijagnoza SSSG-a u populaciji adolescenata postavlja s vremenskom odgodom. Osim toga, ovo je istraživanje potvrdilo iznimnu uspješnost liječenja SSSG-a artroskopskom kirurgijom.
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