Synovial Lipomatosis (Lipoma Arborescens) of the Knee

Objectives: The goals of this retrospective study are to emphasize that the patients who have non surgical treatments for several times due to the massive swelling in their knees should be considered the SL and this pathology is treatable by arthroscopic synovectomy Methods: Seventeen patients (four female and thirteen male), were evaluated retrospectively from May 2009 and April 2013. Mean age for female group was 34,75 (range between 32 to 41) and for male group was 34,23 (range between 26 to 46). Mean follow-up period was 14,76 months (range between 6 months and 38 months). Mean duration of compliance was 26,23 months (range between 9 to 96) months. All patients rated by Knee Society Score preoperatively and postoperatively arthroscopic synovectomy, performed by using radiofrequency ablation and arthroscopic shaver for treatment procedure. Patients were discharged at the end of the one day hospitalization. Postoperatively all patients were allowed to full range of motion and full weight-bearing within one day after surgery. Results: Patients were evaluated preoperatively and postoperatively using the Knee Society Score. The mean Knee Society Score was 67,82 preoperatively and 88,23 was postoperatively. There is significant difference between preoperative and postoperative Knee Society scores.(p <0.05) At the end of the three months, MRI studied and there was no clue of recurrence except two patients. All patients returned to their daily activities with full of range of motion and without swelling of the affected knee joints. At the microscopic histological studies were reported as synovial lipomatosis for all patients Conclusion: Arthroscopic synovectomy is the safe and dramatically effective method of treatment in synovial lipomatosis with less complication, curability and retrieving patients full range of motion with no limitation in their daily activities

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Impact of Early Weight-Bearing Following Ankle Arthroscopy and Microfracture of Talar Osteochondral Defects

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00272 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0027

Author(s):

Thomas Lefebvre ◽

Daniel J. Scott ◽

Jonathan Peterson ◽

Samuel Adams ◽

Annunziato Amendola

Keyword(s):

Range Of Motion ◽

Weight Bearing ◽

Ankle Arthroscopy ◽

Full Weight Bearing ◽

Osteochondral Defects ◽

Foot And Ankle ◽

Ankle Impingement ◽

Significant Difference ◽

Vas Scores

Category: Arthroscopy Introduction/Purpose: Ankle impingement and ankle osteochondral defects are common problems seen by foot and ankle specialist that often go on to require surgical managment. After conservative treatment fails, ankle impingement is often managed by arthroscopic debridement, whereas ankle OCDs are often treated with ankle arthroscopy and microfracture as a first line treatment. However, surgeons have various treatment protocols post-operatively after these procedures, with some surgeons allowing immediate weight bearing, were as other surgeons restrict patients weight bearing. There is similar heterogeneity in the manner of immobilization post-operatively. The purpose of this study is to retrospectively review the outcomes of patients undergoing ankle arthroscopy and micro fracture, to determine if immediate weight bearing or removable immobilization had any impact on outcomes. Methods: We retrospectively reviewed 79 patients at our institution who underwent ankle arthroscopy with microfracture for talar osteochondral defects over 3 years. This included surgeries performed by one of 7 fellowship trained foot and ankle surgeons at our institution. Each surgeon had different protocols for post-operative weight bearing and immobilization, allowing for a comparison of various post-operative protocols. Patient outcomes were reviewed pre-operatively and post-operatively including age, sex, comorbidities, etiology of talar pathology, post-operative weight bearing status, time to first weight bearing, as well as method and length of immobilization, VAS scores, range of motion, and complications. Clinical outcomes such as time to return to work and return to sport were also evaluated. Results: The average patient age was 38. 42 patients (53%) had an additional procedure performed at the time of ankle arthroscopy and microfracture. There was no significant difference in the average pre-op and post-op VAS or range of motion between the immediate weight bearing group and the delayed weight bearing group. There was interestingly a trend towards lower VAS scores in the immediate weight bearing group (1.4 vs 2.6). Conclusion: Following ankle arthroscopy and microfracture, we found no difference in VAS, range of motion, or complications when allowing immediate, full weight bearing as well as using removable immobilization as compared to a variety of other protocols at early follow up. In fact, there was a trend towards lower VAS scores in the immediate full weight bearing group. Though this study has early follow up, it does suggest at least the equivalency of allowing immediate weight bearing and removable immobilization following ankle arthroscopy and talar microfracture.

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Screw osteosynthesis of transverse fracture of the patella in children

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000014 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000014

Author(s):

Simon Oksbjerre Mortensen ◽

Anne Mette Stausholm ◽

Rikke Thorninger

Keyword(s):

Screw Fixation ◽

Weight Bearing ◽

Full Range ◽

Surgical Techniques ◽

Full Weight Bearing ◽

Transverse Fracture ◽

Excellent Outcome ◽

Fractures In Children ◽

Patella Fractures ◽

Special Surgery

ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified superior technique for children. The aim of this study is to assess the functional outcome after screw fixation of transverse patella fractures in children.MethodsTwo boys at 11 years of age were presented with a transverse fracture of the patella within the same week. Open reduction and fixation of the fractured patella with periost sutures and a 4.0 mm titanium screw inserted from the distal fragment. Afterward, the quadriceps expansion was meticulously repaired with sutures.ResultsThe patients could fully weight bear immediately on a fully extended knee in an orthosis. After 4 weeks, radiological healing was obtained. At the 8-week and 6-month follow-up, the modified Hospital of Special Surgery knee score was 100 points in both patients.ConclusionSingle screw fixation provides an excellent outcome after 8 weeks with a full range of motion and full weight bearing, providing a faster recovery.

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Medial femoral condyle fracture during an Oxford unicompartmental knee replacement surgery: case report

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000311 ◽

2020 ◽

pp. jisakos-2019-000311

Author(s):

Rafael Calvo ◽

David Figueroa ◽

Zoy Anastasiadis ◽

Gonzalo Espinoza ◽

Daniel Sarango

Keyword(s):

Range Of Motion ◽

Rare Complication ◽

Femoral Condyle ◽

Intraoperative Complications ◽

Weight Bearing ◽

Full Range ◽

Unicompartmental Knee Replacement ◽

Medial Condyle ◽

Unicompartmental Knee ◽

Condyle Fracture

Oxford unicompartmental knee arthroplasty has been used as a good alternative for medial unicompartmental osteoarthritis due to its association with early rehabilitation and a low rate of intraoperative complications. This case describes a rare complication during the procedure of an intraoperative fracture of the medial condyle that was treated with osteosynthesis with 6.5 mm cannulated screws and a compression technique. The patient followed a non-weight-bearing protocol for 6 weeks and reached full range of motion at 3 months. Complete radiological fusion and good functional outcome were observed. Intraoperative fractures can benefit from stable osteosynthesis that allows free range of motion and does not jeopardise the final surgical result.

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The Role of a Primary Arthroplasty in the Treatment of Proximal Tibia Fractures in Orthogeriatric Patients

BioMed Research International ◽

10.1155/2016/6047876 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Thomas Haufe ◽

Stefan Förch ◽

Peter Müller ◽

Johannes Plath ◽

Edgar Mayr

Keyword(s):

Knee Society Score ◽

Proximal Tibia ◽

Weight Bearing ◽

Womac Score ◽

Tibia Fracture ◽

Full Weight Bearing ◽

Knee Score ◽

Promising Alternative ◽

Proximal Tibia Fracture ◽

Primary Arthroplasty

The total knee arthroplasty (TKA) is the gold standard for patients with an advanced symptomatic gonarthrosis. However, there are very few publications dealing with the primary TKA for patients with a proximal tibia fracture. In our retrospective study we evaluated 30 patients treated with a TKA for a proximal tibia fracture in our institution between 01/2008 and 12/2014. We collected the following statistical data from each patient: age, classification of the fracture (AO-classification), type of prosthesis used, length of the operation and hospitalization, and complications during the follow-up. We used the Knee Society Score (KSS) and the WOMAC score to evaluate the function. The Knee Society Score showed an average “general knee score” (KSS1) of 81.1 points and an average “functional knee score” (KSS2) of 74.5 points. The average WOMAC score was 78.6 points. Immediate postoperative mobilization with the possibility of a full-weight bearing is of crucial importance for the geriatric patients to maintain the mobility they had prior to the operation and reduce medical complications. Because of these advantages, the primary TKA seems to be a promising alternative to the ORIF of a proximal tibia fracture in the orthogeriatric patient.

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Isolated PCL and ACL Avulsion Fractures of the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00185 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0018

Author(s):

Özgur Baysal ◽

Engin Ecevız ◽

Fevzi Saglam ◽

Nurzat Elmalı

Keyword(s):

Range Of Motion ◽

Avulsion Fracture ◽

Weight Bearing ◽

Full Range ◽

Imaging Modalities ◽

Advanced Imaging ◽

Avulsion Fractures ◽

Pull Out ◽

Partial Weight ◽

Acl Avulsion

Objectives: Isolated combined PCL and ACL avulsion fractures is a rare condition. A 40 year old woman had both PCL and ACL avulsion fracture due to a car accident. These fractures often have a subtle appearance at conventional radiography. Advanced imaging modalities, particularly CT and MRI are helpful to diagnose correctly and define the extent of damage. The aim of the study was point out this rare injury. We diagnosed this patient who had both PCL and ACL avulsion fractures. In the literature only a few case have been reported. We think that these fractures may be missed in the Emergency Department. If a patient is brought to the ED with high-velocity trauma, careful evaluation of bone and soft tissues followed by advanced imaging modalities should be performed. Methods: The PCL avulsion fracture was fixed with a cancellous screw via posterior approach and ACL avulsion fracture was fixed with arthroscopically assisted pull-out sutures 10 days after the traumatic event. The knee was immobilized in 20° flexion. Isometric knee, hip and ankle exercises were started immediately. Six weeks later after the operation active range of motion exercises and partial weight-bearing were allowed. In the third month full weight bearing was allowed and full range of motion was achieved. Results: Both PCL and ACL avulsion fractures healed uneventfully. Conclusion: Although knee injuries are frequent, simultaneous PCL and ACL avulsion fractures are rare . The clinician should have a high index of suspicion for these injuries. Careful physical examination and radiological imaging, especially magnetic resonance imagination is helpful in the diagnosis. Early surgical repair and appropriate rehabilitation are the keys to a good outcome in these injuries.

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Results of Arthroscopic Synovectomy for Treatment of Synovial Lipomatosis (Lipoma Arborescens) of the Knee

The Journal of Knee Surgery ◽

10.1055/s-0037-1604440 ◽

2017 ◽

Vol 31 (06) ◽

pp. 536-540 ◽

Cited By ~ 4

Author(s):

Melih Malkoc ◽

Özgur Korkmaz

Keyword(s):

Knee Joint ◽

Inflammatory Cells ◽

Knee Joints ◽

Lipoma Arborescens ◽

Arthroscopic Synovectomy ◽

Tumor Pathology ◽

Significant Difference ◽

The Mean ◽

Synovial Lipomatosis

AbstractSynovial lipomatosis (SL; lipoma arborescens) is a tumor-like condition with villous proliferation of the synovium. The exact etiology of SL is still unknown. The knee is the most commonly involved part. The goal of this retrospective study was to report the results of arthroscopic synovectomy in patients with SL in their knee joints as well as to emphasize the importance of considering this pathology when treating patients with recurrent knee joint effusions. In total, 21 patients (8 females and 13 males) were evaluated retrospectively from May 2009 to July 2014. The mean follow-up period was 29.13 (range, 12–61) months. The mean duration of compliance was 22.76 (range, 7–61) months. All patients were evaluated by Knee Society score pre- and postoperatively. The mean preoperative and last follow-up Knee Society scores were 67.82 and 88.23 points, respectively. There was a significant difference between the preoperative and postoperative Knee Society scores (p = 0.0001). Histopathological examinations showed that the subsynovial layer exhibited diffuse replacement by mature fat cells that had formed villous projections. In addition, infiltration of mononuclear inflammatory cells was observed at different stages. SL is a nondestructive and benign tumor pathology of the knee joint without a clearly identified etiology. The main difficulty in diagnosis is lack of clinical practice.

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90° Spinning of Polyethylene Inserts in Mobile Bearing Unicompartmental Knee Arthroplasty

Case Reports in Orthopedic Research ◽

10.1159/000521363 ◽

2022 ◽

pp. 1-6

Author(s):

Connor Fitz-Gerald ◽

David Kieser

Keyword(s):

Range Of Motion ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Weight Bearing ◽

Full Range ◽

Mobile Bearing ◽

Good Resolution ◽

Polyethylene Insert ◽

Medial Knee ◽

Unicompartmental Knee

Background The objective of this article is to describe for the first time a case of 90° spin out of a mobile bearing unicompartmental knee arthroplasty (UKA) polyethylene insert. In this report, we present a 57-year-old gentleman with a medial compartment UKA for osteoarthritis in 2017 who developed dislodgement and 90° rotation subsequent to traumatic injury when he was involved in a bus crash and impacted the anterolateral knee sustaining a valgus type injury 1 week postoperatively. Following the injury, he reported medial knee pain and a sensation of something moving within the joint. He was initially managed conservatively and progressed to full weight bearing; however, he experienced intermittent symptoms of catching and blocking of the joint, as well as medial knee swelling, that inhibited his ability to perform activities involving walking, kneeling, or pivoting. Imaging taken in 2018 show a 90° rotation of the polyethylene insert. These images showed the longitudinal metallic marker on the insert facing in an anteroposterior direction as opposed to the normal medial-lateral orientation. Failing conservative management, he presented to our clinic in 2019 and proceeded for revision of his UKA. Intraoperatively, his insert was reviewed and seen to easily spin on axis. The liner was therefore removed and upsized from a size 5 medium to a size 7 medium insert which provided excellent stability and stopped any further spinning. He has done tremendously well since the operation and reports full range of motion and no concerns. In patients with a history of pain, swelling, or locking following a UKA, it would be prudent to consider insert spinning, as well as the more common dislocation, through confirming the orientation of the metallic insert marker. Revision surgery to correct the spinning defect has proven effective with good resolution of symptoms and return to full range of motion.

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Immediate Weight Bearing and Range of Motion After Internal Fixation of Unstable Ankle Fractures: A Retrospective Controlled Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00216 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0021

Author(s):

Brianna R. Fram ◽

Ryan G. Rogero ◽

Daniel Corr ◽

Gerard Chang ◽

James Krieg ◽

...

Keyword(s):

Risk Factors ◽

Internal Fixation ◽

Range Of Motion ◽

Ankle Fracture ◽

Weight Bearing ◽

Ankle Fractures ◽

Controlled Study ◽

Posterior Malleolus ◽

Significant Difference ◽

Operative Complications

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are the third most common adult fractures. Further, they are the second most common fracture type to require inpatient admission, behind only hip fractures, despite occurring in a population on average nearly 30 years younger. There is evidence that early or immediate weight bearing and range of motion may be safe following ankle fracture fixation, but existing studies are small and largely exclude patients with syndesmotic or posterior malleolar fixation. We therefore studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of unstable ankle fractures in a diverse cohort and attempted to identify risk factors for complications. Methods: We performed a retrospective case-control study. Out of 268 patients who underwent primary ORIF of an unstable ankle fracture from 2013-18, we identified 133 (49.6%) who were IWBAT and IROM. The treating surgeon excluded patients from IWBAT if they had an ipsilateral leg injury requiring non-weight bearing, a large displaced posterior malleolus fragment, or Maisonneuve injury with fracture of the proximal fibula. We used propensity-score matching to identify 172 controls who were non-weight bearing (NWB) and no range of motion for 6 weeks post-op. We reviewed medical records and radiographs for demographic, injury and treatment characteristics. Our primary outcome was complications. We compared demographics, injury characteristics, treatment episode, and complications between the IWBAT and NWB groups and performed within group analysis to identify risk factors for complications. A p-value <0.05 was considered significant. Results: The groups did not differ significantly in age, BMI, Charleston Comorbidity Index (CCI), smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB, p=0.11), posterior malleolus (24.1% IWBAT, 26.7% NWB, p=0.59), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, p=0.85). There was no significant difference in total complications (9.8% IWBAT vs. 12.8% NWB, p=0.41), nonoperative complications (6.8% IWBAT vs. 8.7% NWB, p=0.53), or operative complications (3.8% IWBAT vs. 4.1% NWB, p=0.89). We did not identify any factors associated with increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, CCI or pre-injury assisted ambulation. Conclusion: IWBAT and IROM may be safe following ankle fracture ORIF in a broader patient population than previously believed. We did not identify specific risk factors for post-operative complications. Further study on patient selection may allow for more extensive use of this protocol to reduce the morbidity associated with unstable ankle fractures. [Table: see text]

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Immediate effect of foam roller on pain and ankle range of motion in patients with plantar fasciitis: A randomized controlled trial

Hong Kong Physiotherapy Journal ◽

10.1142/s1013702521500025 ◽

2020 ◽

pp. 1-9

Author(s):

Aishwarya R. Ranbhor ◽

Ashish J. Prabhakar ◽

Charu Eapen

Keyword(s):

Range Of Motion ◽

Plantar Fasciitis ◽

Statistical Significance ◽

Weight Bearing ◽

Group Analysis ◽

Plantar Fascia ◽

Foam Rolling ◽

Pressure Pain Thresholds ◽

Difference Formula ◽

Significant Difference

Background:Stretching has been proven to be effective on pain and range of motion (ROM) in patients with plantar fasciitis. Despite recent gain in popularity and the proposed theories of effectiveness of foam roller, there is a lack of literature on the effect of foam rolling on plantar fasciitis. Objective:The objective of this study was to compare the effects of foam rolling and stretching on pain and ankle ROM in patients with plantar fasciitis. Methods:A total of 50 participants were included and randomly allocated to the stretching and foam roller groups. Visual analog scale (VAS), pressure pain thresholds (PPTs) for gastrocnemius, soleus and plantar fascia and weight-bearing lunge test (WBLT) measurements were recorded at baseline and immediately after treatment. Results:Within-group analysis has shown there is a statistically significant difference ([Formula: see text]) in all the outcome measures in both foam roller and self-stretching groups. The between-groups analysis showed no statistical significance difference in VAS, plantar fascia PPT and WBLT parameters (with [Formula: see text]-values of 0.171, 0.372 and 0.861, respectively); however, significant differences were found in gastrocnemius PPT ([Formula: see text]) and soleus PPT ([Formula: see text]). Conclusion: It was seen that both stretching and foam rolling techniques helped in reducing pain and increasing the ROM. However, the effectiveness of foam roller was superior to stretching in terms of increase in PPTs at gastrocnemius and soleus. Clinical Trial Registration No: CTRI/2018/01/011398. Name of registry: The Clinical Trials Registry — India (CTRI); https://ctri.nic.in .

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An Uncemented Spreading Stem for the Fixation in the Metaphyseal Femur: A Preliminary Report

Sarcoma ◽

10.1155/2016/7132838 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Daniel Burger ◽

Matthias Pumberger ◽

Bruno Fuchs

Keyword(s):

Weight Bearing ◽

Full Range ◽

Implant Design ◽

Full Weight Bearing ◽

Tumour Resection ◽

Rigid Fixation ◽

Femoral Bone ◽

Bone Resection ◽

Uncemented Fixation

Surgical treatment to restore full range of motion and full weight bearing after extensive femoral bone resection in patients with primary or metastatic femoral tumours is individually challenging. Especially when the remaining distal or proximal bone is very short, a rigid fixation of an implant is difficult to achieve due to the reverse funnel shape of the metaphysis. Herein, we present a novel implant design using a spreading mechanism in the distal part of the prosthesis for rigid, uncemented fixation in the remaining femoral bone after extensive tumour resection of the femur. We present the outcome of 5 female patients who underwent implantation of this spreading stem after extensive proximal or distal femoral bone resection. There was no radiological or clinical loosening or implant-related revision surgery in our follow-up (mean 21.46 months, range 3.5–46 months). This uncemented spreading stem may therefore represent an alternative option for fixation of a prosthetic device in the remaining metaphyseal femur.

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