Intra and extraarticular localized pigmented villonodular synovitis

<p class="abstract">A 28 year old woman had a history of knee trauma and presented with unilateral knee acute swelling and pain symptoms with sudden onset, which was there from last 2 years. She had been treated for seronegative rheumatoid patient for 1 year. Recent expansion of the LPVNS (localized pigmented villonodular synovitis) caused the development of a tender palpable soft tissue mass in the anterolateral aspect of the knee and acute reduced mobility. Preoperative magnetic resonance imaging of the knee revealed the presence of only the soft tissue mass and mild degenerative changes. Open synovectomy was performed successfully to excise the mass. Intraoperatively, macroscopic features of the bright brown inflamed synovium suggested LPVNS, which was confirmed histopathologically. Postoperatively, the symptoms of limited mobility and pain were appreciably relieved. Recurrence was not observed during the clinical follow up at 1, 6 or 18 months after surgery. Here, we reported the unique case of localized pigmented villonodular synovitis of the knee in a misdiagnosed patient with intra and extraarticular lesion, which might be attributed to the history of knee trauma and the focal defect of the lateral patellar retinaculum. Open synovectomy effectively relieved the symptoms of limited mobility and pain and no recurrence was observed prior to 18 months postoperatively. To reduce misdiagnosis, MRI examinations are recommended for all patients suspected of having PVNS, including those who have a history of hyperuricemia.</p>

Surface-Related High School Football Game Injuries on Pad and No-Pad Fields

Background: Artificial turf fields are increasingly being installed with lighter weight infill systems that incorporate a pad underlayer, which is reported to reduce surface shock and decrease injuries. At this time, the effects of a pad underlayer on football trauma are unknown. Hypothesis: Athletes would not experience differences in surface-related injuries between pad and no-pad fields. Study Design: Cohort study; Level of evidence, 2. Methods: Artificial turf fields were divided into 2 groups based on a pad underlayer or no-pad system, with 58 high schools participating across 3 states over the course of 7 seasons. Outcomes of interest included injury severity, head and knee trauma, injury category, primary type of injury, injury mechanism, anatomic location of trauma, tissue type injured, and elective imaging and surgical procedures. Data underwent multivariate analyses of variance (MANOVA) using general linear model procedures and were expressed as injury incidence rates per 10-game season. Results: Of 658 varsity games, 260 games were played on fields containing pads, and 398 games were played on no-pad fields, with 795 surface-related injuries reported. MANOVA indicated significant main effects by injury severity ( F3,791 = 11.436; P < .0001), knee trauma ( F9,785 = 2.435; P = .045), injury category ( F3,791 = 3.073; P < .0001), primary type of injury ( F10,785 = 2.660; P < .0001), injury mechanism ( F13,781 = 2.053; P < .001), anatomic location ( F16,778 = 1.592; P < .001), type of tissue injured ( F4,790 = 4.485; P < .0001), and elective imaging and surgical procedures ( F4,790 = 4.248; P < .002). Post hoc analyses indicated significantly greater incidences ( P < .05) of substantial and severe injury, player-to-turf trauma, patellofemoral syndrome, neck strain, lower leg strain, and elective imaging and surgical procedures when games were played on padded turf fields. No differences in concussion rate from turf impact between pad and no-pad fields were observed. Conclusion: In contrast to conventional wisdom, the addition of a pad under an artificial turf surface increases injury rates when compared with nonpadded fields across most injury categories. At this time, findings do not support the current trend of installing lightweight padded infill systems at the high school level of play.

What Does the Future Hold? Health-Related Quality of Life 3–12 Years Following a Youth Sport-Related Knee Injury

Knee trauma can lead to poor health-related quality of life (HRQoL) and osteoarthritis. We aimed to assess HRQoL 3–12 years following youth sport-related knee injury considering HRQoL and osteoarthritis determinants. Generic (EQ-5D-5L index, EQ-VAS) and condition-specific (Knee injury and Osteoarthritis Outcome Score quality of life subscale, KOOS QOL) HRQoL were assessed in 124 individuals 3–12 years following youth sport-related knee injury and 129 uninjured controls of similar age, sex, and sport. Linear regression examined differences in HRQoL outcomes by injury group. Multivariable linear regression explored the influence of sex, time-since-injury, injury type, body mass index, knee muscle strength, Intermittent and Constant Osteoarthritis Pain (ICOAP) score, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) moderate-to-strenuous physical activity. Participant median (range) age was 23 years (14–29) and 55% were female. Injury history was associated with poorer KOOS QOL (−8.41; 95%CI −10.76, −6.06) but not EQ-5D-5L (−0.0074; −0.0238, 0.0089) or EQ-VAS (−3.82; −8.77, 1.14). Injury history (−5.14; −6.90, −3.38), worse ICOAP score (−0.40; −0.45, −0.36), and anterior cruciate ligament tear (−1.41; −2.77, −0.06) contributed to poorer KOOS QOL. Worse ICOAP score contributed to poorer EQ-5D-5L (−0.0024; −0.0034, −0.0015) and higher GLTEQ moderate-to-strenuous physical activity to better EQ-VAS (0.10; 0.03, 0.17). Knee trauma is associated with poorer condition-specific but not generic HRQoL 3–12 years post-injury.

Primary Medial Gastrocnemius Vein Aneurysm With Thrombosis

A venous aneurysm (VA) in a calf muscle is extremely rare. In this case study, a primary medial gastrocnemius vein aneurysm (MGVA) with thrombosis is reported. A female patient presented with left medial knee pain for 2 weeks. Radiograph demonstrated severe osteoarthritis of the medial compartment of the left knee. Sonography of the knee incidentally detected a focal saccular dilation in one of the gastrocnemius veins, within the medial head of the gastrocnemius (MHG). The diameter of the dilation was almost three times its connected normal vein. Two-thirds of the saccular dilation was occupied by hyperechoic content. Duplex sonography confirmed that the dilation was a saccular MGVA with thrombosis. The patient had no history of knee trauma, surgery, or inflammation. A small Baker’s cyst, medial to the MHG, was also excluded from the cause of the MGVA. These suggest that this MGVA was of a primary cause. The complications of a MGVA are briefly discussed as part of this case study.

Differences in Knee Shape between ACL Injured and Non-Injured: A Matched Case-Control Study of 168 Patients

Objective: Anterior cruciate ligament (ACL) injury prevention programs could be more effective if we could select patients at risk for sustaining an ACL rupture. The purpose of this study is to identify radiographic shape variants of the knee between patients with and patients without an ACL rupture. Methods: We compared the lateral and Rosenberg view X-rays of 168 prospectively followed patients with a ruptured ACL to a control group with intact ACLs, matched for gender, after knee trauma. We used statistical shape modeling software to examine knee shape and find differences in shape variants between both groups. Results: In the Rosenberg view X-rays, we found five shape variants to be significantly different between patients with an ACL rupture and patients with an intact ACL but with knee trauma. Overall, patients who had ruptured their ACL had smaller, flatter intercondylar notches, a lower lateral tibia plateau, a lower medial spike of the eminence, and a smaller tibial eminence compared to control patients. Conclusion: Patients with an ACL rupture have smaller intercondylar notches and smaller tibial eminences in comparison to patients with an intact ACL after knee trauma.

The absence of the great saphenous vein: aplasia or involution? A clinical case

There are different types of great saphenous vein (GSV) anatomy that have been reported in the literature. GSV hypoplasia is frequently observed anatomical type with twice higher incidence than GSV aplasia. Proximal GSV aplasia including sapheno-femoral junction (SFJ) is the rarest anatomical type that is always accompanied by anterior accessory saphenous vein (AASV) acting as the alternative drainage route in such cases. In the case of SFJ absence the AASV connects common femoral vein at the level of typical SFJ location. In this case report we present the situation of complete GSF and AASV absence with the subsartorious perforating vein as the proximal junction between superficial and deep veins. At the same time this perforating vein is the source of pathological venous reflux towards the varicose veins of the thigh and leg. There is no information about phlebectomy of GSV in this case but it is known that the accident of the knee trauma with a subsequent operation and also the operation on the GSV tributaries on the leg (puncture without avulsion according to the patient memories) took place in the past. As such events are associated with the risk of thrombotic complications the postthrombotic involution of GSV could be contemplated in this case as the reason of GSV disappearance. Foam sclerotherapy of the incompetent thigh perforator vein with miniphlebectomy on the thigh was performed. Leg varicose veins were left untreated as their reduction after reflux elimination was expected. 14 days after treatment perforating vein obliteration and leg varicose veins reduction were diagnosed.