scholarly journals Arthroscopic Treatment of 2 Consecutive Cases of Dysplasia Epiphysealis Hemimelica of the Ankle: A 5-Year Follow-Up Report

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Cosma Calderaro ◽  
Carlo Iorio ◽  
Francesco Turturro ◽  
Federico Morelli ◽  
Luca Labianca ◽  
...  
Keyword(s):  
Rare Disease ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Unknown Etiology ◽  
Histological Findings ◽  
Dysplasia Epiphysealis Hemimelica

The dysplasia epiphysealis hemimelica (DEH) is a rare disease of unknown etiology consisting in an abnormal osteocartilaginous growth at the epiphysis, usually hemimelic with histological findings similar to benign osteochondroma. In this case series, we described the results of the arthroscopic treatment of 2 consecutive cases of intra-articular ankle localization of DEH in 2 patients aged 9 and 10 years. The good result obtained, persistent at the 5-year follow-up, leads us to consider the arthroscopic approach as a reliable treatment in patient affected by intra-articular ankle DEH.

scholarly journals Treatment of cam-type femoroacetabular impingement

Joints ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 67-71 ◽  
Author(s):  
Gennaro Fiorentino ◽  
Alberto Fontanarosa ◽  
Riccardo Cepparulo ◽  
Alberto Guardoli ◽  
Luca Berni ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Alpha Angle ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Correct Selection ◽  
Harris Hip Score ◽  
Radiographic Examination ◽  
Level Of Evidence

Purpose: the aim of this study was to evaluate preliminary clinical and radiographic results of arthroscopic treatment of cam-type femoroacetabular impingement (FAI). Methods: thirty-eight patients underwent hip arthroscopy for cam-type FAI between 2009 and 2012. Preoperative assessment was based on clinical examination, modified Harris Hip Score (mHHS) and radiographic examination with anteroposterior pelvis, frogleg and Lequesne views. The patients’ clinical conditions at follow-up were assessed using the mHHS administered as a telephone survey. Radiographic outcome measurements evaluated pre and postoperatively were the alpha angle and femoral head-neck offset. Results: the patients were clinically evaluated at a mean follow-up of 36 months. Radiographic follow-up was performed at an average of 12.7 months. Thirty of the 38 patients (79%) were satisfied with the results of the arthroscopic procedure. A total of nine patients subsequently underwent a total hip replacement. All 30 patients who declared themselves satisfied recorded an mHHS increase; in particular, the mHHS increased from a mean of 52.9 preoperatively (range: 27.5-82.5) to a mean of 85.6 postoperatively (range: 45.1-100.1). Three significant differences between the two groups of patients (satisfied and not satisfied) were recorded: mean age, alpha angle and BMI were all significantly greater in the patients who were not satisfied with the treatment. Conclusions: a crucial aspect in order to obtain good clinical outcomes of arthroscopic treatment of camtype impingement is correct selection of patients who are likely to benefit from this kind of surgery. Hip arthroscopy should be avoided in patients aged over 50 years with risk factors for early osteoarthritis (high BMI and a significantly increased alpha angle). Level of evidence: Level IV, therapeutic case series.

Anterior and Posterior Arthroscopic Treatment of Primary Synovial Chondromatosis of the Ankle

2020 ◽  
pp. 107110072097096
Author(s):  
Ivan Bojanić ◽  
Mihovil Plečko ◽  
Ana Mataić ◽  
Damjan Dimnjaković
Keyword(s):  
Malignant Transformation ◽  
Case Series ◽  
Synovial Chondromatosis ◽  
Unknown Etiology ◽  
Loose Bodies ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient’S Satisfaction ◽  
Operative Session

Background: Primary synovial chondromatosis (PSC) is a progressive disorder of unknown etiology resulting in formation of multiple loose bodies. If left untreated, it may lead to degenerative changes or malignant transformation to chondrosarcoma. Methods: Seventeen patients who underwent combined posterior and anterior ankle arthroscopy within the same operative session and had histologically confirmed PSC were included in this retrospective study. American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score was used to evaluate ankle function preoperatively and at a final follow-up. A 3-question survey was used to evaluate patient’s satisfaction at the final follow-up. Results: In 14 patients, loose bodies were found in both compartments of the ankle, in 2 only in the anterior compartment, and in 1 only in the posterior compartment. All patients had evident signs of synovial inflammation in both compartments. The AOFAS Ankle-Hindfoot score increased from the preoperative median score of 65 (range, 29-90) to 95 (range, 65-100) at the final follow-up. Fourteen patients reported they were extremely satisfied with the outcome, 1 was moderately satisfied, and 2 were dissatisfied. No cases of recurrence of synovitis or loose body formation were noted, nor any signs of malignant transformation during the follow-up period. Conclusion: We believe the risk of recurrence of PSC, which is in close relation to malignant transformation, can be minimized by performing a complete synovectomy of the ankle. Our experience and review of literature makes us believe that ankle PSC should be regarded as a whole joint disorder. Performing a combined posterior and anterior arthroscopic procedure within the same operative session should always be considered in patients with ankle PSC. Level of Evidence: Level IV, retrospective case series.

scholarly journals Dysplasia epiphysealis hemimelica: A case report

2014 ◽  
Vol 71 (11) ◽  
pp. 1081-1084
Author(s):  
Dalibor Jovanovic ◽  
Milena Ilic ◽  
Milos Milosavljevic ◽  
Zorica Mihajlovic ◽  
Radisa Vojinovic ◽  
...  
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Ankle Joint ◽  
Developmental Disorder ◽  
Histopathological Examination ◽  
Sporadic Case ◽  
Unknown Etiology ◽  
Histological Findings ◽  
Tarsal Bone ◽  
Dysplasia Epiphysealis Hemimelica

Introduction. Dysplasia epiphysealis hemimelica, also known as Trevor?s disease, is an extremely rare skeletal developmental disorder of unknown etiology, characterized by an osteocartilaginous outgrowth of one or more epiphyses or of a tarsal bone during childhood. Case report. We presented a sporadic case of dysplasia epiphysealis hemimelica developed in the talus. A 6- year-old boy complained of swelling of his right ankle joint, with painful and reduced movements. Radiographies suggested excessive overgrowth of the dorsomedial aspect of the talus. The tumor was surgically excised and the gross and histological findings were consistent with those of osteochondroma. Conclusion. Dysplasia epiphysealis hemimelica is diagnosed by clinical, radiographic and histopathological examination. Early diagnosis is important for the condition to be treated before the deformity becomes disabling.

scholarly journals Arthroscopic treatment of subtalar joint injuries

2019 ◽  
Vol 13 (1) ◽  
pp. 22-27
Author(s):  
Felipe Ayusso Correa Sossa ◽  
Inacio Diogo Asaumi ◽  
Alfonso Apostólico Netto ◽  
Rafael Da Rocha Macedo ◽  
Donato Lo Turco ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Level Of Evidence ◽  
Before And After ◽  
Reduction Of Pain ◽  
Vas Scores ◽  
The Mean ◽  
Status Level

Objective: To evaluate the results of arthroscopic treatment of various subtalar joint pathologies. Methods: Retrospective study of patients undergoing arthroscopy of the subtalar joint from 2005 to 2013, totaling 10 cases over a mean follow-up of 27.1 months, in which the American Orthopedic Foot and Ankle Society (AOFAS) scale and pain visual analogue scale (VAS) scores before and after surgery were compared. Results: The preoperative AOFAS scores ranged from 35 to 74, with a mean score of 50.1 points, and the postoperative scores ranged from 82 to 100 points, with a mean score of 90.8 points. When comparing the scores, we observed an average gain of 40.1 points. The mean VAS score for the initial pain assessment was 6.5 points, and the mean postoperative score was 1.4 points. Conclusion: Arthroscopic treatment of the reported subtalar pathologies led to encouraging results, with a significant reduction of pain and improvement of functional status. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Immediate Unrestricted Postoperative Weightbearing and Mobilization after Bone Marrow Stimulation of Large Osteochondral Lesions of the Talus

Cartilage ◽  
2016 ◽  
Vol 8 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Gregory A. Lundeen ◽  
Linda J. Dunaway
Keyword(s):  
Bone Marrow ◽  
Case Series ◽  
Lesion Size ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Postoperative Rehabilitation ◽  
Level Of Evidence ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation

Objective There remains no consensus on a postoperative protocol following arthroscopic treatment of osteochondral lesions of the talus (OLTs) and most studies report a period of immobilization and nonweightbearing. Outcomes are believed to decrease with larger size. The purpose of our study was to evaluate patients who underwent arthroscopic treatment of large (≥150 mm2) OLTs with immediate unrestricted weightbearing and mobilization postoperatively. Design Patients who underwent arthroscopic bone marrow stimulation for osteochondral defects were identified. Exclusion criteria included lesions less than 150 mm2, additional procedures other than ligament reconstruction, incongruent ankle joint, arthritis, and tibial plafond lesions. Postoperatively, all patients were placed into a soft dressing and were allowed immediate weightbearing as tolerated. Patients were considered failures if their AOFAS (American Orthopaedic Foot and Ankle Society) score was less than 80 or if they underwent osteochondral transplant. Results Thirteen patients were available for follow-up. Two patients underwent osteochondral transplant and were considered failures. Of the remaining 11, the average follow-up time after surgery was 33 months (range, 7-59 months). Average age was 37 years (range, 15-56 years), and lesion size averaged 239 mm2 (range, 150-400 mm2). Average postoperative scores included foot function index 50 (range, 23-136), visual analog scale 3 (range, 0-8), and AOFAS hindfoot 82 (range, 40-100). The group’s overall success rate was 54% (7/13). Conclusion The results of our study are higher than those previously published studies on large lesions with a more restricted postoperative rehabilitation, suggesting that unrestricted weightbearing and range of motion does not diminish patient outcomes. Level of Evidence: IV, Case series.

Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Suspended Position With the Patient in a Prone Position

2019 ◽  
Vol 40 (7) ◽  
pp. 811-817
Author(s):  
Chenyu Wang ◽  
Min Wook Kang ◽  
Hyong Nyun Kim
Keyword(s):  
Compartment Syndrome ◽  
Prone Position ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Arthroscopic Microfracture ◽  
The Mean

Background:The purpose of this study was to evaluate the clinical results and the safety of arthroscopic microfracture with the ankle suspended on a shoulder-holding traction frame for simultaneous anterior and posterior ankle arthroscopy in the prone position.Methods:Between May 2010 and January 2016, 31 patients with posterior osteochondral lesions of the talus (OLTs) were treated with arthroscopic microfracture in a suspended position with the patient prone. Ankle distraction was achieved by suspending the affected ankle on a shoulder-holding traction frame. The 100 mm visual analog scale (VAS) and the Foot Function Index (FFI) were checked preoperatively and at final follow-up. Postoperative complications related to the suspended position were analyzed. Lower leg intramuscular compartment pressure was checked after the surgery to determine if there was any risk of compartment syndrome.Results:The mean 100-mm VAS score, and FFI improved from 62.8 ±11.3 and 48.5 ± 12.1, respectively, preoperatively to 15.8 ± 10.4 and 16.4 ± 9.2, respectively, at final follow-up ( P = .025, and P = .005, respectively). The mean anterior, lateral, superficial posterior, and deep posterior compartment pressures were 7.3 ± 1.5, 8.1 ± 1.1, 5.6 ± 1.9, and 9.2 ± 2.4 mmHg, respectively. No compartment syndrome occurred.Conclusion:Arthroscopic treatment of OLT in a prone position with the ankle suspended on a shoulder-holding traction frame allowed the use of simultaneous anterior and posterior portals for viewing and instrumentation without major operative complications, such as compartment syndrome.Level of Evidence:Level IV, retrospective case series.

scholarly journals NK-cell enteropathy: a benign NK-cell lymphoproliferative disease mimicking intestinal lymphoma: clinicopathologic features and follow-up in a unique case series

Blood ◽  
2011 ◽  
Vol 117 (5) ◽  
pp. 1447-1452 ◽  
Author(s):  
Adnan Mansoor ◽  
Stefania Pittaluga ◽  
Paul L. Beck ◽  
Wyndham H. Wilson ◽  
Judith A. Ferry ◽  
...  
Keyword(s):  
T Cell ◽  
Nk Cell ◽  
Autologous Bone Marrow Transplantation ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Unknown Etiology ◽  
Cell Phenotype ◽  
Endoscopic Biopsies ◽  
Gastrointestinal Lesions

Abstract Intestinal T-cell and natural killer (NK)–cell lymphomas are clinically aggressive and can be challenging to diagnose in small endoscopic biopsies. We describe 8 patients in whom atypical NK-cell lymphoproliferative lesions mimicked NK- or T-cell lymphoma. The patients (2 men; 6 women; ages 27-68 years) presented with vague gastrointestinal symptoms with lesions involving stomach, duodenum, small intestine, and colon. At endoscopy, the lesions exhibited superficial ulceration, edema, and hemorrhage. Biopsies revealed a mucosal infiltrate of atypical cells with an NK-cell phenotype (CD56+/TIA-1+/Granzyme B+/cCD3+), which displaced but did not invade the glandular epithelium. Epstein-Barr virus–encoded RNA in situ hybridization was negative, and T-cell receptor-γ gene rearrangement showed no evidence of a clonal process. Based on an original diagnosis of lymphoma, 3 patients received aggressive chemotherapy followed by autologous bone marrow transplantation in 2. Five patients were followed without treatment. However, no patient developed progressive disease or died of lymphoma (median follow-up, 30 months). Repeat endoscopies in 6 of 8 patients showed persistence or recurrence of superficial gastrointestinal lesions. This unique entity mimics intestinal and NK-/T-cell lymphomas on endoscopic biopsies and can result in erroneous diagnosis, leading to aggressive chemotherapy. We propose the term “NK-cell enteropathy” for this syndrome of as yet unknown etiology.

scholarly journals Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110116
Author(s):  
Attila Pavlik ◽  
Miklós Tátrai ◽  
Annamária Tátrai ◽  
András Tállay
Keyword(s):  
Shoulder Instability ◽  
Case Series ◽  
High Risk Group ◽  
Arthroscopic Treatment ◽  
Anterior Shoulder Instability ◽  
Fisher Exact Test ◽  
Level Of Evidence ◽  
Study Results ◽  
The Mean

Background: Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players. Purpose: To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players. Study Design: Case series; Level of evidence, 4. Methods: Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test. Results: The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) ( P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005). Conclusion: The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.

Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 5-Year Follow-up

2020 ◽  
Vol 48 (4) ◽  
pp. 901-907 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
Edward C. Beck ◽  
Kyle N. Kunze ◽  
Jorge Chahla ◽  
Jonathan Rasio ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Impingement Syndrome ◽  
Arthroscopic Treatment ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

Background: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have gained prominence as important variables in the orthopaedic outcomes literature. In hip preservation surgery, much attention has been given to defining early clinically meaningful outcome; however, it is unknown what represents meaningful patient-reported outcome improvement in the medium to long term. Purpose: (1) To define MCID, PASS, and SCB at a minimum 5 years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to evaluate the time-dependent nature of MCID, PASS, and SCB. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing primary hip arthroscopy for FAIS between January 2012 and March 2014 were included. Clinical and demographic data were collected in an institutional hip preservation registry. MCID, PASS, and SCB were calculated for each outcome score including the Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL), Hip Outcome Score–Sport-Specific subscale (HOS-SS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool (iHOT-12) at 1, 2, and 5 years. MCID was calculated by use of a distribution-based method, whereas PASS and SCB were calculated by use of an anchor method. Results: The study included 283 patients with a mean ± SD age of 34.2 ± 11.9 years. The mean changes in 1-year, 2-year, and 5-year scores, respectively, required to achieve MCID were as follows: HOS-ADL (8.8, 9.7, 10.2); HOS-SS (13.9, 14.3, 15.2); mHHS (6.9, 9.2, 11.4); and iHOT-12 (15.1, 13.9, 15.1). The threshold scores for achieving PASS were as follows: HOS-ADL (89.7, 88.2, 99.2); HOS-SS (72.2, 76.4, 80.9); mHHS (84.8, 83.3, 83.6); and iHOT-12 (69.1, 72.2, 74.3). Last, the threshold scores for achieving SCB scores were as follows: HOS-ADL (89.7, 91.9, 94.6); HOS-SS (78.1, 77.9, 85.8); mHHS (86.9, 85.8, 94.4); and iHOT-12 (72.6, 76.8, 87.5). More patients achieved MCID, SCB, and PASS at 2-year compared with 1-year follow-up; however, by 5 years, fewer patients had achieved clinically meaningful outcome (minimum 1-, 2-, and 5-year follow-up, respectively: MCID, 82.6%, 87.3%, 79.3%; PASS, 67.6%, 74.9%, 67.5%; SCB, 62.3%, 67.2%, 56.6%). Conclusion: The greatest proportion of patients achieved MCID, PASS, and SCB at 2-year follow-up after arthroscopic treatment of FAIS compared with 1- and 5-year time points. Improvements were maintained out to 5-year follow-up, although the proportion of patients achieving clinical significance was slightly decreased.

Aorto-left ventricular tunnel: case series of a rare disease

2020 ◽  
pp. 1-5
Author(s):  
Obayda M. Diraneyya ◽  
Fahad Alhabshan ◽  
Abdullah Alghamdi ◽  
Hussein Moafa ◽  
Mohammed Alnasef ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Rare Disease ◽  
Aortic Root ◽  
Surgical Repair ◽  
Case Series ◽  
Left Ventricular ◽  
Patch Closure

Abstract Introduction: Aorto-left ventricular tunnel is a rare disease that can cause significant morbidity early in life due to volume overload and left ventricular failure. Surgical intervention is usually curative with minimal early complications. However, long-term effects and outcome are not fully determined. Objective: We are reporting a case series of this rare CHD with its long-term outcome. Methods: We conducted a retrospective analysis of all children from birth to 14 years of age who were admitted between 2001 and 2020 with the diagnosis of aorto-left ventricular tunnel. Demographic, echocardiographic, and perioperative data were collected and reviewed. The pre-operative data were compared with data reviewed on the last outpatient follow-up. Results: Total of five patients fulfilled our inclusion criteria. Three patients were diagnosed after auscultating an incidental murmur, one had symptoms of congestive heart failure, and one had an abnormal fetal echocardiogram. Echocardiography demonstrated stenotic and regurgitant aortic valve with severely depressed left ventricle function in two patients, one of them with also single left coronary artery. The other three patients had normal aortic valve structure and normal ventricular function. All five patients had surgical repair, two by patch closure at aortic end of aorto-left ventricular tunnel, two by patch closure at both aortic and left ventricular ends, and one by aortic root replacement using a homograft. During follow-up, there was no residual aorto-left ventricular tunnel in any of our five cases, two had moderate aortic regurgitation and one had moderate residual aortic stenosis. Conclusions: Spectrum of presentation for aorto-left ventricular tunnel varies from an occult lesion to frank left heart failure due to volume or less commonly, pressure overload. Early surgical repair is recommended and is usually associated with complete resolution. Long-term follow-up is recommended for aortic root dilatation and aortic valve competency, as valve function need to be addressed in a timely manner to avoid further complications.

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