All-Inside Arthroscopic Cancellous Allograft for the Large Cystic Osteochondral Defect of the Talus

Category: Arthroscopy; Sports; Trauma Introduction/Purpose: The purpose of this study was to evaluate the surgical technique and long-term clinical outcomes of all- inside arthroscopic treatment for large cystic osteochondral defect of the talus with the use of cancellous allograft. Methods: Eight patients admitted from January 2016 to October 2018 by our hospital for large cystic osteochondral defect of the talus was retrospectively analyzed with their complete follow-up data. The subjects consisted of 5 males and 3 females, aged between 27 to 50 years, and with an average age of 34.2 years. All of these cystic osteochondral defects were larger than 15 mm in diameter, sized 1.3cm3 to 5.2cm3. The visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Karlsson Ankle Functional Score (KAFS) and subjective satisfaction survey rating were obtained. CT scan and magnetic resonance imaging of the ankle were obtained before and after surgery. Results: All incisions were healed in the first stage, and no complications such as nerve, blood vessel and tendon injuries occurred. All patients were available for follow-up at a mean of 26.2 months (range, 18 to 48 months). By the last follow-up, the postoperatively AOFAS 、 KAFS scores were 86.5 and 84.2 compared with 60.8 and 59.3 preoperatively, respectively. And the mean VAS score decreased from 6.4 preoperatively to 1.1. The range of motion of the ankle joint was normal and returned to the pre-pain state for these patients. Six patients rated their result as excellent, 2 as good and none as fair. Conclusion: All-inside arthroscopic cancellous allograft was an effective option for the treatment of large cystic talus osteochondral defects.

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Endoscopic Resection of Different Types of Talocalcaneal Coalition

Foot & Ankle International ◽

10.1177/1071100718770625 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1082-1088 ◽

Cited By ~ 4

Author(s):

Wael Aldahshan ◽

Adel Hamed ◽

Faisal Elsherief ◽

Ashraf Mohamed Abdelaziz

Keyword(s):

Endoscopic Resection ◽

Nonoperative Treatment ◽

Level Of Evidence ◽

Vas Score ◽

Talocalcaneal Coalition ◽

Short Term Study ◽

Different Types ◽

The Mean ◽

American Orthopaedic

Background: The purpose of this study was to describe the technique of endoscopic resection of talocalcaneal coalition (TCC) by using 2 posterior portals and to report the outcomes of endoscopic resection of different types and sites of TCC. Methods: An interventional prospective study was conducted on 20 feet in 18 consecutive patients who were diagnosed by computed tomography to have TCC for which nonoperative treatment had failed and endoscopic resection was performed. The patients were divided into groups according to the site of the coalition (middle facet or posterior facet) and according to type (fibrous, cartilage, or bony). The mean follow-up period was 26 months (range, 6-36). Results: The average preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 57.7 (range, 40-65), and the average preoperative visual analog scale (VAS) score was 7.8 (range, 6-8). The average postoperative AOFAS hindfoot score was 92.4 (range, 85-98; P < .01). The average postoperative VAS score was 2.4 (range, 1-4). All patients showed no recurrence on postoperative lateral and Harris-Beath X-ray until the end of the study. Conclusions: Endoscopic resection of TCC was an effective and useful method for the treatment of talocalcaneal coalition. It provided excellent outcomes with no recurrence in this short-term study. Resection of the fibrous type had a better outcome than resection of cartilage and bony types. Endoscopic resection of the posterior coalition had a better outcome than resection of the middle coalition. Level of Evidence: Level III, comparative study.

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Supramalleolar Osteotomy combined with Intra-articular Osteotomy for the Reconstruction of Malunited Supination-Adduction Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000130 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Guo Changjun ◽

Xiangyang Xu

Keyword(s):

Ankle Fractures ◽

Ankle Arthritis ◽

Vas Score ◽

Supramalleolar Osteotomy ◽

Significant Difference ◽

Scale Scores ◽

Effective Option ◽

Vertical Impaction ◽

Control Study

Category: Ankle Arthritis, Trauma Introduction/Purpose: The supination-adduction ankle fractures often showed vertical impaction of the tibial medial plafond. The malunion of these fractures cause the varus ankle deformity and secondary ankle arthritis. This retrospective control study looked at the use of supramalleolar osteotomy combined with intra-articular osteotomy in patients with malunited supination- adduction ankle fractures. Methods: Twelve patients were treated with malunited supination-adduction ankle fractures between January 2013 and December 2014. All of these patients had the varus ankle deformity and secondary ankle arthritis. Supramalleolar osteotomy combined with intra-articular osteotomy were underwent for the reconstruction surgery. The visual analog scale (VAS) score for pain during daily activities, Olerud and Molander Scale scores, subjective satisfaction survey rating and the modified Takakura classification stage were obtained. Ten patients were available for follow-up at a mean of 35.4 months (range, 28 to 40 months). Results: Average postoperative Olerud and Molander Scale score 24 months after surgery was 83±10 compared with 60±14 preoperatively. The mean VAS score decreased from 7±2 preoperatively to 2±2 at the latest follow-up. Six patients rated their result as excellent, 3 as good and 1 as fair. No significant difference in the modified Takakura classification stage was observed between the preoperative and the last follow-up. Conclusion: The use of supramalleolar osteotomy combined with intra-articular osteotomy was an effective option for the treatment of malunited supination-adduction ankle fractures.

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Selective Arthrodesis for Treatment of Symptomatic Müller-Weiss Disease

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00033 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0003 ◽

Cited By ~ 1

Author(s):

Le Cao ◽

Xu-dong Miao

Keyword(s):

Ct Scan ◽

Stage Iv ◽

Subjective Ratings ◽

Aofas Score ◽

Triple Arthrodesis ◽

Vas Score ◽

American Orthopaedic ◽

Hindfoot Arthrodesis ◽

Old Females

Category: Midfoot/Forefoot Introduction/Purpose: Müller-Weiss Disease (MWD) is also known as Müller-Weiss Syndrome, which is reported an uncommon adult navicular osteonecrosis, frequently occurring in middle-aged and old females and characterized by compression and fragmentation of the lateral aspect of the navicular bone and progressive malformation. In this study, we report the results of selective midfoot and hindfoot arthrodesis for treating symptomatic MWD. Methods: From January 2006 to December 2011, 28 patients (31 feet) with MWD were treated with selective arthrodesis with tricortical autologous iliac crest block fixated by screws and plate and retrospectively reviewed. These included 24 females and 4 males, with an average age of 53.1 years (31-65 years), and an average symptoms duration of 8.6 years (1.5-13 years). The disease was staged according to Maceira, which included 3 feet in stage II, 15 feet in stage III, 7 feet in stage IV, and 6 feet in stage V. Pre- and postoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS), radiologic examination, and patients’ satisfaction rate of the surgery were evaluated at an average of 6.6 years (4-12 years) following surgery. Results: Selective arthrodesis according to various symptoms and CT-scan findings related to MWD, 12 feet had talonavicular arthrodesis, 16 feet had talonavicular-cuneiform arthrodesis, and 3 feet had triple arthrodesis. The follow-up visit showed satisfactory outcomes, solid union was achieved in all cases, with average fusion time was 15.2 weeks (12-26 weeks). VAS score reducing from the preoperative 7.8 (7-9) to postoperative 2.3(0-4), whereas the AOFAS score improved from the preoperative 25.4 (19-42) to the postoperative 80.3 (73-88). The patient’s subjective ratings showed excellent results in 8 feet, good results in 18 feet, and fair outcomes in 5 feet. Conclusion: Selective arthrodesis according to various symptoms and CT-scan findings related to MWD, 12 feet had talonavicular arthrodesis, 16 feet had talonavicular-cuneiform arthrodesis, and 3 feet had triple arthrodesis. The follow-up visit showed satisfactory outcomes, solid union was achieved in all cases, with average fusion time was 15.2 weeks (12-26 weeks). VAS score reducing from the preoperative 7.8 (7-9) to postoperative 2.3(0-4), whereas the AOFAS score improved from the preoperative 25.4 (19-42) to the postoperative 80.3 (73-88). The patient’s subjective ratings showed excellent results in 8 feet, good results in 18 feet, and fair outcomes in 5 feet.

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Quality of Life with Vulvar Carcinoma Treated with Palliative Electrochemotherapy: The ELECHTRA (ELEctroCHemoTherapy vulvaR cAncer) Study

Cancers ◽

10.3390/cancers13071622 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1622

Author(s):

Anna Myriam Perrone ◽

Martina Ferioli ◽

Lisa Argnani ◽

Francesca De Terlizzi ◽

Cecilia Pirovano ◽

...

Keyword(s):

Quality Of Life ◽

Vulvar Cancer ◽

Pain Scale ◽

Outcome Data ◽

Before And After ◽

Effective Option ◽

Cancer Project ◽

Multicenter Prospective Observational Study

The ELECHTRA (ELEctroChemoTherapy vulvaR cAncer) project was conceived to collect data on palliative electrochemotherapy (ECT) in vulvar cancer (VC) assessing patients’ outcomes (response and survival) and impact on quality of life (QoL). After reporting outcome data in 2019, here, we present the results on QoL. A multicenter prospective observational study was conducted on patients with VC refractory or not amenable to standard therapies undergoing palliative ECT as per clinical practice. The following questionnaires were administered before and after ECT (two and four months later, early and late follow-up): visual analog pain scale (VAS), EuroQol 5-Dimension 5-Level (EQ-5D-L5) and Functional Assessment of Cancer Therapy—Vulva cancer (FACT—V). Analyses were conducted on both the whole study population and by subgroups (clinical response after ECT and site, number and size of lesions). Questionnaires from 55 patients were evaluated. Compared to the baseline (6.1 ± 2.1), the VAS was significantly reduced at early (4.3 ± 2.5) and late follow-up (4.6 ± 2.8) (p < 0.0001). The FACT—V score improved significantly at early (9.6 ± 4.0) (p < 0.0001) and late follow-up (8.9 ± 4.1) (p < 0.0054) as compared to the baseline (7.1 ± 3.6). No EQ-5D-5L statistically significant changes were observed. Subgroup analyses showed worse QoL in patients with stable or progressive disease, posterior site and multiple or larger than 3 cm nodules. This is the first study reporting improved QoL in VC patients after palliative ECT. Based on these results, ECT in VC should be considered an effective option based on the favorable outcomes both in terms of response and QoL.

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Efficacy and experience of arthroscopic lateral patella retinaculum releasing through/outside synovial membrane for the treatment of lateral patellar compression syndrome

10.21203/rs.2.17728/v2 ◽

2020 ◽

Author(s):

Ji-Bin Chen ◽

Dong Chen ◽

Ya-Ping Xiao ◽

Jian-Zhong Chang ◽

Te Li

Keyword(s):

Synovial Membrane ◽

Lysholm Score ◽

Compression Syndrome ◽

Vas Score ◽

Kujala Score ◽

Before And After ◽

Lateral Patella ◽

Improved Function ◽

Lateral Patellar Compression Syndrome

Abstract Objective: To investigate the method and effect of arthroscopic lateral patella retinaculum releasing (LPRR) either through or outside synovial membrane for the treatment of lateral patellar compression syndrome (LPCS).Methods: From September 2014 to December 2017, 125 patients with LPCS underwent arthroscopic LPRR either through or outside synovial membrane combined with joint debridement. In the outside synovial membrane (OSM) group, synovial membrane was retained. In the through synovial membrane (TSM) group,The synovial membrane was cut open. Active rehabilitation training was conducted after surgery. Before and after surgery, Lysholm score, patella medial shift, Kujala score, VAS score and surgical complications were evaluated and compared.Results: All patients in this study were followed up for 1.5-5 years. All patients had significant reduction in knee pain and improved function after 1 month and 1 year. The Lysholm score, the distance of patella medial shift, the Kujala score, and the VAS score in the OSM group and the TSM group were significantly improved in the final follow-up compared with before surgery ( P <0.001), but these observed targets before surgery and at the last follow-up between the two groups were compared with no statistical differences. However, the number of occurrences of joint hematoma and adhesion was significantly higher in the TSM group than the OSM group ( P =0.024).Conclusion: Arthroscopic closing LPRR for the treatment of LPCS can effectively improve the function and symptoms of the patellofemoral joint with the advantages of small trauma, rapid recovery and less complications. But, the number of occurrences of hemarthrosis and joint adhesion in the TSM group were significantly higher than those in the OSM group.

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Efficacy of Calcaneus Osteotomy for Treatment of Symptomatic Müller-Weiss Disease

Foot & Ankle International ◽

10.1177/1071100716677741 ◽

2016 ◽

Vol 38 (3) ◽

pp. 261-269 ◽

Cited By ~ 9

Author(s):

Shu-Yuan Li ◽

Mark S. Myerson ◽

Manuel Monteagudo ◽

Ernesto Maceira

Keyword(s):

Case Series ◽

Stage Iv ◽

Retrospective Case ◽

Level Of Evidence ◽

Vas Score ◽

Calcaneal Osteotomy ◽

Alternative Treatment Option ◽

American Orthopaedic ◽

Hindfoot Arthrodesis

Background: Various methods of midfoot and hindfoot arthrodesis for treating symptomatic Müller-Weiss disease (MWD) have been reported in the literature. In this study, we present the results of a previously unreported method of treatment using a calcaneal osteotomy incorporating a wedge and lateral translation. Methods: Thirteen patients (14 feet) with MWD were treated with a calcaneal osteotomy and retrospectively reviewed. These included 7 females and 6 males, with an average age of 56 years (33-79 years), and an average symptoms duration of 10.6 years (1-16 years). The disease was staged according to Maceira, which included 5 feet in stage II, 4 feet in stage III, 4 feet in stage IV, and 1 foot in stage V. Pre- and postoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS), radiologic examination, and patients’ satisfaction rate of the surgery were evaluated at an average of 3.7 years (range, 1-8.5 years) following surgery. Results: The final follow-up visit showed satisfactory outcomes, with VAS score reducing from the preoperative 8 (7-9) to postoperative 2 (0-4), whereas the AOFAS score improved from the preoperative 29 (20-44) to the postoperative 79 (70-88). The patient’s subjective ratings showed excellent results in 4 feet, good results in 8 feet, and fair outcomes in 2 feet. The hindfoot range of motion remained unchanged, as did the extent of the navicular complex arthritis, and no patient required an arthrodesis since surgery. Conclusion: A calcaneal osteotomy can be used as an alternative treatment option for selected MWD patients regardless of the radiologic stage of the disease. Level of Evidence: Level IV, retrospective case series.

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Proximal Oblique Crescentic Osteotomy in Hallux Valgus

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-94-1-43 ◽

2004 ◽

Vol 94 (1) ◽

pp. 43-46 ◽

Cited By ~ 11

Author(s):

Ozcan Pehlivan ◽

Ibrahim Akmaz ◽

Can Solakoglu ◽

Ahmet Kiral ◽

Haluk Kaplan

Keyword(s):

Hallux Valgus ◽

Osteotomy Site ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Valgus Angle ◽

Before And After ◽

The Mean ◽

American Orthopaedic ◽

Severe Hallux Valgus

Twenty-six patients with moderate-to-severe hallux valgus deformities were evaluated before and after treatment. All of the patients had incongruent great toe joints. The patients underwent modified proximal crescentic osteotomy, which was termed proximal oblique crescentic osteotomy. The results were evaluated at an average follow-up time of 55 weeks. Objective criteria were hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal, and angulation at the osteotomy site. Clinical evaluation was made according to the rating system of the American Orthopaedic Foot and Ankle Society. The mean correction of the hallux valgus and intermetatarsal angles was 22.1° and 9.9°, respectively. Short-term results indicate that proximal oblique crescentic osteotomy is effective in the treatment of hallux valgus; its advantages over other procedures include its technical ease and low rate of complications. (J Am Podiatr Med Assoc 94(1): 43-46, 2004)

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Combined Microwave Ablation and Osteosynthesis for Long Bone Metastases

Medicina ◽

10.3390/medicina57080825 ◽

2021 ◽

Vol 57 (8) ◽

pp. 825

Author(s):

Claudio Pusceddu ◽

Giuseppe Dessì ◽

Luca Melis ◽

Alessandro Fancellu ◽

Giuseppe Ruggiu ◽

...

Keyword(s):

Bone Metastases ◽

Microwave Ablation ◽

Complete Recovery ◽

Long Bone ◽

Vas Score ◽

Walking Capacity ◽

Before And After ◽

Painful Bone Metastases ◽

Treated Site

Background and Objectives: The purpose of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) in combination with open surgery nail positioning for the treatment of fractures or impending fractures of long bone metastases. Material and Methods: Eleven patients (four men, seven women) with painful bone metastases of the humerus, femur or tibia with non-displaced fractures (one case) or impending fractures (10 cases) underwent open MWA in combination with osteosynthesis by locked nail positioning. Pain intensity was measured using a VAS score before and after treatment. CT or MRI were acquired at one month before and 1, 3, 6, 12 and 18 months after treatment. Results: All procedures were successfully completed without major complications. The level of pain was significantly reduced one month after treatment. For the patients with humerus metastases, the complete recovery of arm use took 8 weeks, while for the patients with femoral metastases the complete recovery of walking capacity took 11 weeks. The VAS score ranged from 7 (4–9) before treatment to 1.5 (0–2.5) after treatment. During a mid-term follow-up of 18 months (range 4–29 months), none of the patients showed tumor relapse or new fractures in the treated site. Two patients died due to tumor disease progression. Conclusion: Results of this preliminary study suggest that combined MWA and surgical osteosynthesis with locked nails is a safe and effective treatment for pathological fractures or malignant impending fractures of long bone metastases of the humerus, femur and tibia. Further analyses with larger cohorts are warranted to confirm these findings.

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Follow-Up Study Evaluating the Long Term Outcome of ChondroMimetic in the Treatment of Osteochondral Defects in the Knee

Applied Sciences ◽

10.3390/app10165642 ◽

2020 ◽

Vol 10 (16) ◽

pp. 5642

Author(s):

Agnes Berta ◽

Matthew S. Shive ◽

Andrew K. Lynn ◽

Alan Getgood ◽

Saara Totterman ◽

...

Keyword(s):

Clinical Outcomes ◽

Cartilage Repair ◽

Osteochondral Defect ◽

Rating System ◽

Osteochondral Defects ◽

T2 Relaxation ◽

Long Term Outcome ◽

Defect Filling

Scaffolds are thought to be a key element needed for successful cartilage repair treatments, and this prospective extension study aimed to evaluate long-term structural and clinical outcomes following osteochondral defect treatment with a cell-free biphasic scaffold. Structural outcomes were assessed using quantitative 3-D magnetic resonance imaging (MRI) and morphological segmentation to determine the percentage of defect filling and repair cartilage T2 relaxation times, and clinical outcomes were determined with the modified Cincinnati Rating System, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Seventeen subjects with osteochondral defects in the knee were treated with ChondroMimetic scaffolds, from which 15 returned for long-term evaluation at a mean follow-up of 7.9 ± 0.3 years. The defects treated were trochlear donor sites for mosaicplasty in 13 subjects, and medial femoral condyle defects in 2 subjects. MRI analysis of scaffold-treated defects found a mean total defect filling of 95.2 ± 3.6%, and a tissue mean T2 relaxation time of 52.5 ± 4.8 ms, which was identical to the T2 of ipsilateral control cartilage (52.3 ± 9.2 ms). The overall modified Cincinnati Rating System score was statistically significant from baseline (p = 0.0065), and KOOS subscales were equivalent to other cartilage repair techniques. ChondroMimetic treatment resulted in a consistently high degree of osteochondral defect filling with durable, cartilage-like repair tissue at 7.9 years, potentially associated with clinical improvement.

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Clinical Efficacy of Unicompartmental Knee Arthroplasty in the Treatment of Spontaneous Osteonecrosis of the Knee

10.21203/rs.3.rs-61773/v1 ◽

2020 ◽

Author(s):

Hao Li ◽

Ting ting Liu ◽

Min Zhang

Keyword(s):

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Stage Iv ◽

Knee Joints ◽

Short Term ◽

Vas Score ◽

Unicompartmental Knee ◽

Spontaneous Osteonecrosis ◽

Before And After

Abstract BackgroundThis retrospective study aimed to evaluate the short-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of spontaneous osteonecrosis of the knee (SONK).MethodsThe patients who were diagnosed as SONK and received UKA in our hospital from January 2012 to January 2018 were retrospectively analyzed. The patients were diagnosed and staged by X-ray and MRI techniques before surgery. The range of motion (ROM), femorotibial angle (FTA), and visual analog scale (VAS) score of patients' knee joints were assessed before and after surgery. Clinical outcomes were evaluated by the hospital for special surgery (HSS) knee score.ResultsA total of 18 patients with spontaneous osteonecrosis (4 males and 14 females; mean age: 62.5 years) met the inclusion criteria participated in this study. According to the Mont grades, 12 cases (66.7%) were in stage III, and 6 cases (33.3%) were in stage IV. The average follow-up was 19.6 months. At the last follow-up, it was found that the hospital for HSS score was increased from 61.22 ± 2.90 to 91.0 ± 2.89 (P < 0.05); VAS score was decreased from 6.44 ± 1.04 to 1.94 ± 0.99 (P < 0.05); FTA was improved from 178.42 ± 0.84 to 176.17 ± 0.87 (P < 0.05); ROM (120.17 ± 5.88) was not significantly different from that before surgery (119.61 ± 5.56, P = 0.601).ConclusionThe encouraging results of this study indicate that UKA has an excellent short-term clinical effect in the treatment of SONK.

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