scholarly journals Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

2019 ◽  
Vol 65 (3) ◽  
pp. 370-374 ◽  
Author(s):  
Nacime Salomão Barbachan Mansur ◽  
Tiago Soares Baumfeld ◽  
André Vitor Kerber Cavalcante Lemos ◽  
Rafael Mohriak de Azevedo ◽  
Lucas Furtado da Fonseca ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Subtalar Joint ◽  
Case Series ◽  
Visual Analogue Pain Scale ◽  
Functional Evaluation ◽  
Arthroscopic Debridement ◽  
Visual Analogue Pain ◽  
Sinus Tarsi ◽  
Sinus Tarsi Syndrome

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

scholarly journals TL 18075 - Subtalar arthroscopic debridement for treatment of sinus tarsi syndrome

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 70S
Author(s):  
Tiago Soares Baumfeld ◽  
Nacime Salomão Barbachan Mansur ◽  
André Lemos ◽  
Juliana Doering Xavier da Silveira ◽  
Lucas Furtado Fonseca ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Signs And Symptoms ◽  
Final Evaluation ◽  
Functional Evaluation ◽  
Arthroscopic Debridement ◽  
Safe Alternative ◽  
Sinus Tarsi ◽  
Sinus Tarsi Syndrome ◽  
Pain Visual Analog Scale

Introduction: Sinus tarsi syndrome (SST) can be understood as a set of conditions that affect this anatomical region and manifest as common signs and symptoms. When the nonsurgical approach fails, subtalar arthroscopic debridement is a viable alternative with high rates of good outcomes. The objective of this study is to report the outcomes of subtalar arthroscopic debridement in 8 patients with SST refractory to conservative treatment. Methods: This is a retrospective study with 8 patients diagnosed with SST who underwent subtalar arthroscopic debridement of the sinus tarsi from January 2015 to January 2017, after 6 months of conservative treatment. All patients filled out an epidemiological questionnaire and underwent functional evaluation using the pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale preoperatively and at the final evaluation, after an average of 12 months (6-24 months). Results: All patients presented with intense synovitis in the region. Seven patients had remnants of talocalcaneal ligaments, and 6 had remnants of cervical ligaments. The AOFAS score increased by a mean of 30 points (from 51.75 preoperatively to 82.62 at the final evaluation), and the VAS decreased by a mean of 5 points (from 7.37 preoperatively to 2.12 at the final evaluation); these differences were significant, at p=0.043 and p=0.032, respectively. Six patients described the outcome as excellent, and 2 described it as good. No complications were reported. All patients resumed sports activities after 6 months of follow-up.  Conclusion: Subtalar arthroscopic debridement is an effective and safe alternative in the treatment of SST refractory to conservative treatment. Further prospective studies are necessary to prove the outcome of this technique.

Percutaneous Bunionette Correction: Retrospective Case Series

2020 ◽  
pp. 193864002093750
Author(s):  
Gustavo Nunes ◽  
Tiago Baumfeld ◽  
Caio Nery ◽  
Daniel Baumfeld ◽  
Paulo Carvalho ◽  
...  
Keyword(s):  
Case Series ◽  
Distal Region ◽  
Pain Scale ◽  
Invasive Technique ◽  
Visual Analogue Pain Scale ◽  
Retrospective Case ◽  
Visual Analogue Pain ◽  
Significant Difference ◽  
American Orthopaedic

Introduction. Bunionette is a deformity of the fifth metatarsal in which there is a painful lateral bony prominence of the distal region of this bone caused by various anatomical and biomechanical changes. The aim of this study is to report on a minimally invasive technique without the use of hardware to treat these deformities. Methods. This is a case series of 18 patients, 25 feet, who underwent bunionette percutaneous surgical treatment. All patients answered the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the visual analogue pain scale (VAS) preoperatively and at the last follow-up. Standard radiological evaluation included measurement of intermetatarsal (4-5 IMA) and fifth toe metatarsophalangeal (5-MTTP) angles. Time to radiographic consolidation, complications, and satisfaction rate were also documented. Results. The average follow-up was 15.9 months, the AOFAS increased from 49.6 to 92.4 and the VAS decreased from 7.7 to 1.2. It was observed that average 5-MTTP decreased from 15° to 2.7° and that 4-5-IMA decreased from 9.1° to 3.3°. These outcomes showed a statistically significant difference ( P < .001). The most common observed complication was the formation of a hypertrophic bone callus in the third postoperative month in three operated feet (12%). One patient had algodystrophy, which improved after conservative treatment. There were no cases of infection, neuropraxis, or recurrences. Fifteen patients rated the result as excellent, 2 as good, and 2 as regular. Conclusion. Percutaneous osteotomy of the fifth metatarsal without the use of hardware is a safe, reproducible technique and presents good clinical and radiographic results for the treatment of bunionette. Levels of Evidence: Therapeutic studies, Level IV: Case series

Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

2019 ◽  
Vol 41 (2) ◽  
pp. 187-192
Author(s):  
Ricardo E. Colberg ◽  
Monte Ketchum ◽  
Avani Javer ◽  
Monika Drogosz ◽  
Melissa Gomez ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Plantar Fasciitis ◽  
Case Series ◽  
Successful Outcome ◽  
Oral Steroid ◽  
Tarsal Tunnel ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Plantar Fasciotomy

Background: Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. Methods: A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% ( N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. Results: The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders ( P < .05). Being an athlete was a positive confounder ( P = .02). Conclusion: Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. Level of Evidence: Level IV, retrospective case series.

A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity

2021 ◽  
pp. 107110072110513
Author(s):  
Yin-Chuan Shih ◽  
Chui Jia Farn ◽  
Chen-Chie Wang ◽  
Chung-Li Wang ◽  
Pei-Yu Chen
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Lateral Column ◽  
Metatarsal Angle ◽  
Lateral Column Lengthening ◽  
Adult Acquired Flatfoot Deformity ◽  
The Mean

Background: Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). However, the relative position between the facets is violated, and other problems may include nonunion, malunion, and calcaneocuboid (CC) joint subluxation. Herein, we report a modified extra-articular technique of LCL with hockey-stick osteotomy, which preserves the subtalar joint as a whole, increases bony apposition to enhance healing ability, and preserves the insertion of the calcaneofibular ligament to stabilize the posterior fragment to promote adduction of the forefoot. Methods: We retrospectively recruited 24 patients (26 feet) with stage II AAFD who underwent extra-articular LCL. The mean age was 55.7 ± 15.7 years, and the mean follow-up period was 33.4 ± 12.1 months. Associated procedures of spring ligament repair/reconstruction and posterior tibial tendon plication or flexor digitorum longus transfer were routinely performed and may also include a Cotton osteotomy, heel cord lengthening, or hallux valgus correction. Clinical and radiographic outcomes at the final follow-up were compared with the preoperative assessments. Results: All patients achieved calcaneus union within 3 months of operation. The VAS pain score improved from 5.3 ± 0.75 preoperatively to 1.2 ± 0.79 at the final follow-up ( P < .001), and the AOFAS Ankle-Hindfoot Scale from 63.5 ± 8.5 to 85.8 ± 4.8 points ( P < .001). The radiographic measurements significantly improved in terms of the preoperative vs final angles of 8.9 ± 5.3 vs 15.2 ± 3.6 degrees for calcaneal pitch ( P < .001), 20.5 ± 9.2 vs 4.9 ± 4.8 degrees for Meary angle ( P < .001), 46.5 ± 5.2 vs 41.9 ± 3.2 degrees for lateral talocalcaneal angle ( P < .001), 23.9 ± 8.5 vs 3.9 ± 3.1 degrees for talonavicular coverage angle ( P < .001), and 18.2 ± 9.2 vs 7.3 ± 5.0 degrees for talus-first metatarsal angle ( P = .002). The CC joint subluxation percentage was 7.0% ± 5.4% preoperatively compared with 8.5% ± 2.4% at the final follow-up ( P = .101). No case showed progression of CC joint arthritis or CC joint subluxation (>15% CC joint subluxation percentage). One case showed transient sural nerve territory paresthesia, and 1 had pin tract infection. Three cases had lateral foot pain, which could be relieved by custom insoles. Conclusion: Modified extra-articular LCL as part of AAFD correction is a feasible alternative technique without subtalar joint invasion and may be associated with less CC joint subluxation compared with the Evans osteotomy. Level of Evidence: Level IV, retrospective case series.

scholarly journals Six out of ten patients with sinus tarsi syndrome returned to pre-injury type of sport after subtalar arthroscopy

2020 ◽  
Author(s):  
Kenny Lauf ◽  
Jari Dahmen ◽  
J. Nienke Altink ◽  
Sjoerd A. S. Stufkens ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
Clinical Outcomes ◽  
Median Time ◽  
Outcome Measures ◽  
Return To Sport ◽  
Injury Type ◽  
Sinus Tarsi ◽  
Sinus Tarsi Syndrome ◽  
Improved Performance

Abstract Purpose The purpose of this study was to determine multiple return to sport rates, long-term clinical outcomes and safety for subtalar arthroscopy for sinus tarsi syndrome. Methods Subtalar arthroscopies performed for sinus tarsi syndrome between 2013 and 2018 were analyzed. Twenty-two patients were assessed (median age: 28 (IQR 20–40), median follow-up 60 months (IQR 42–76). All patients were active in sports prior to the injury. The primary outcome was the return to pre-injury type of sport rate. Secondary outcomes were time and rate of return to any type of sports, return to performance and to improved performance. Clinical outcomes consisted of Numerous Rating Scale of pain, Foot and Ankle Outcome Score, 36-item Short Form Survey and complications and re-operations. Results Fifty-five percent of the patients returned to their preoperative type of sport at a median time of 23 weeks post-operatively (IQR 9.0–49), 95% of the patients returned to any type and level sport at a median time of 12 weeks post-operatively (IQR 4.0–39), 18% returned to their preoperative performance level at a median time of 25 weeks post-operatively (IQR 8.0–46) and 5% returned to improved performance postoperatively at 28 weeks postoperatively (one patient). Median NRS in rest was 1.0 (IQR 0.0–4.0), 2.0 during walking (IQR 0.0–5.3) during walking, 3.0 during running (IQR 1.0–8.0) and 2.0 during stair-climbing (IQR 0.0–4.5). The summarized FAOS score was 62 (IQR 50–90). The median SF-36 PCSS and the MCSS were 46 (IQR 41–54) and 55 (IQR 49–58), respectively. No complications and one re-do subtalar arthroscopy were reported. Conclusion Six out of ten patients with sinus tarsi syndrome returned to their pre-injury type of sport after being treated with a subtalar arthroscopy. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures. Level of evidence IV.

scholarly journals EndoTech® minimally invasive trigger thumb release

2021 ◽  
Vol 3 (2) ◽  
pp. 157-160
Author(s):  
Michael J Fitzmaurice
Keyword(s):  
Minimally Invasive ◽  
Pain Scale ◽  
Minimally Invasive Technique ◽  
Endoscopic Technique ◽  
Invasive Technique ◽  
Visual Analogue Pain Scale ◽  
Trigger Thumb ◽  
Visual Analogue Pain ◽  
Minimal Incision

We describe a novel minimally invasive technique for the treatment of trigger thumb. 37 patients with a total of 41 thumbs were included in the study. A visual analogue pain scale was used before surgery and also at 2 week and 6 month follow up visits. The pain was significantly improved from a pre op of 7.92 (+/- 1.6) to .65 (+/- .8) at the 2 week follow up and finally .29 (+/- 1.8) at the 6 month follow up. All of the patients had relief of triggering and only 1 patient required any therapy. This endoscopic technique for trigger thumb allows the surgeon to perform a trigger release with a minimal incision and provides excellent relief without any complications.

Functional improvement and low recurrence rate after combined staged synovectomy and external radiotherapy for diffuse pigmented villonodular synovitis of the knee: a minimum 2 years’ follow-up case series

2020 ◽  
Vol 5 (2) ◽  
pp. 69-73
Author(s):  
Mohamed ElAttar ◽  
Hossam Fathi ◽  
Fahmy Samir Fahmy
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Pigmented Villonodular Synovitis ◽  
Functional Improvement ◽  
Functional Evaluation ◽  
Villonodular Synovitis ◽  
External Radiotherapy ◽  
Sf 36 ◽  
Pigmented Villonodular

ObjectiveTreatment of diffuse pigmented villonodular synovitis (DPVNS) of the knee is problematic and controversial with a high rate of morbidities and local recurrence. The purpose of this study is functional evaluation of patients with diffuse knee PVNS treated with combined surgical and external radiosynovectomy.MethodsBetween June 2011 and May 2015, twelve patients (four males and eight females) with DPVNS of the knee were treated by staged surgical synovectomy (arthroscopic anterior and open posterior) followed by low-dose external radiation. SF-36, Musculoskeletal Tumor Society (MSTS), Lysholm, International Knee Documentation Committee (IKDC) scores and range of motion (ROM) were assessed preoperatively and at the final follow-up.ResultsAfter a mean follow-up period of 46.7±15 (25–72) months, there were statistically significant improvement of ROM from 72.5±17.6 to 94.2±7.01, Lysholm score from 42.8±5.2 to 78.1±5.1, IKDC from 39.6±8.3 to 75.3±6, MSTS from 5.6±2.7 to 19.7±6.06 and SF-36 score from 29.4±7.5 to 72.3±17.5. Apart from limited range of motion, three mild complications were encountered (superficial wound infection, repeated effusion and transient neuropraxia).ConclusionCombined staged synovectomy and external radiotherapy provide functional improvement of the knee and quality of patients’ lives with low rate of recurrence for knee DPVNS cases.Level of evidenceProspective case series; level IV.

Should Focal Nodular Hyperplasia Still be Operated Upon? Analysis of a Case Series

2019 ◽  
Vol 37 (4) ◽  
pp. 309-314
Author(s):  
Enio Campos Amico ◽  
Izadora K. de Souza ◽  
Juliana R. Grigório Trigueiro ◽  
Fernanda Cunha Miranda ◽  
Rogério Lacerda Sousa ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Focal Nodular Hyperplasia ◽  
Case Series ◽  
Immunohistochemical Analysis ◽  
Liver Lesion ◽  
Initial Symptom ◽  
Asymptomatic Patients ◽  
Nodular Hyperplasia ◽  
Lesion Growth

Background: Focal nodular hyperplasia (FNH) is a frequent benign liver lesion. Its course is considered benign, and there is no recommendation for its treatment. Nevertheless, the literature presents a high incidence of surgery. Aim: To evaluate the results of conservative treatment in a series of patients with presumed FNH. Methods: The study included patients diagnosed with FNH from May 2007 to July 2017 based on conventional imaging or magnetic resonance imaging with liver-specific contrast (MRI-LSC) or lesion biopsy (histology/immunohistochemical analysis). Patients were followed clinically and using imaging exams. Results: In a total of 54 patients, the diagnosis was obtained by typical findings on computed tomography scan and gadolinium MRI in 48.1% of the patients, by MRI-LSC in 31.5%, and by histological examination in 20.4% of cases. The mean follow-up time was 35.5 months. The initially asymptomatic patients remained symptom-free, and none of those with HNF-related pain had to worsen of the initial symptom. Conservative treatment was effective in 94.4% of the cases. In only 3 cases, there was a need for some therapeutic approach (5.5%); 2 cases for pain and 1 case for lesion growth during follow-up. Conclusion: The present study suggests that it is safe to conservatively manage patients with FNH presumed by highly accurate imaging tests. Similar to hepatic hemangiomas, surgery for FNH should be an exception.

scholarly journals Late Prosthetic Shoulder Hemiarthroplasty after Failed Management of Complex Proximal Humeral Fractures

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
A. Panagopoulos ◽  
P. Tsoumpos ◽  
K. Evangelou ◽  
Christos Georgiou ◽  
I. Triantafillopoulos
Keyword(s):  
Constant Score ◽  
Humeral Fracture ◽  
Primary Treatment ◽  
Pain Scale ◽  
Visual Analogue Pain Scale ◽  
Shoulder Hemiarthroplasty ◽  
Visual Analogue Pain ◽  
Reconstructive Option ◽  
Complex Proximal Humeral Fractures

Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma.Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN) and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale.Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction.Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails.

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