Clinical Outcomes of Single Excision Versus Kidner Procedure for Type II Accessory Navicular Associated with Flatfoot in Adults: Does accessory navicular induce flexible flatfoot?

Background Patients with type II accessory navicular (AN) originally complain of the medial pain of foot. With increasing frequency, some of them has been recognized flexible flatfoot (FFF) at the first weightbearing radiographic examination. Posterior tibial tendon (PTT) dysfunction is widely accepted as a significant contributor to FFF. However, the PTT was not affected in these patients. The relationship between AN and FFF remains controversial. The contribution of AN to FFF was designed in this study. Methods Adult patients who complained of medial pain and bone eminence between January 2014 and January 2020 were included. 61 patients were confirmed to have the AN with flatfoot and randomly divided into two operative groups. The AN was excised in Group A, and the PTT was reconstructed to the navicular region with an anchor in Group B. Preoperative and postoperative evaluations were performed, including clinical evaluations, the American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scale, a visual analog scale (VAS) and radiographic assessments of Meary’s angle, Pitch angle, talonavicular coverage, Kite’s angle and naviculocuboid overlap. PTT decline angle (PDA) and AN-Navicular joint inclination angle (ANJCA) in the lateral view were designed to evaluate the effect of AN on FFF. Results Fifty-six patients (56 feet) were included in this study because 5 patients were excluded. The mean follow-up period was 22.29 months with single excision (Group A) and 20.86 months with Kidner procedure (Group B). The AOFAS mid-foot score improved from 70.39±7.78 pre-operationally to 89.46±7.06 at the last follow-up in Group A and from 67.14±8.14 pre-operationally to 89.64±6.88 at the last follow-up in Group B. The VAS score decreased from 2.82±0.39 and 2.86±0.36 to 0.89±0.31 and 0.79±0.42, respectively. The radiographic results representing flatfoot significantly increased in the two groups. In the lateral view, PDA significantly increased after the operation, and the effect of PTT on the arch upward was induced by pull angulations and shorter distances. Conclusion The FFF with AN may be induced by AN and its synchondrosis. The weakened plantar ligament of synchondrosis was impaired under chronic tension and shear forces may be implicated as the etiologic biomechanical mechanism. AN excision or it with PTT reconstruction could release the pain and benefit the PTT pulling sufficiency.

A Narrative Review of Neuroimaging Studies in Acupuncture for Migraine

Acupuncture has been widely used as an alternative and complementary therapy for migraine. With the development of neuroimaging techniques, the central mechanism of acupuncture for migraine has gained increasing attention. This review aimed to analyze the study design and main findings of neuroimaging studies of acupuncture for migraine to provide the reference for future research. The original studies were collected and screened in three English databases (PubMed, Embase, and Cochrane Library) and four Chinese databases (Chinese National Knowledge Infrastructure, Chinese Biomedical Literature database, the Chongqing VIP database, and Wanfang database). As a result, a total of 28 articles were included. Functional magnetic resonance imaging was the most used neuroimaging technique to explore the cerebral activities of acupuncture for migraine. This review manifested that acupuncture could elicit cerebral responses on patients with migraine, different from sham acupuncture. The results indicated that the pain systems, including the medial pain pathway, lateral pain pathway, and descending pain modulatory system, participated in the modulation of the cerebral activities of migraine by acupuncture.

Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

Blood Flow Restriction Therapy Following Microfracture Surgery for Osteochondritis Dissecans in a Collegiate Athlete

A 19-year-old college football wide receiver (height: 193 cm, mass: 94 kg) reported sudden onset medial pain in his right knee during practice. Diagnostic imaging revealed medial femoral condyle osteochondral defects with loose bodies and a grade I medial collateral sprain (MCL). The medical and therapeutic intervention included arthroscopic microfracture, chondroplasty, loose body removal, and a 6-month rehabilitation program that included the use of blood flow restriction therapy. Current evidence estimates a 7–11-month recovery following microfracture surgery for the management of articular cartilage lesions, with a return-to-sport rate of only 50–60%.

Arthroscopy in Treatment of Knee Arthroplasty Complications

Results of the operated joint arthroscopy were presented for 16 patients with complications after knee arthroplasty. The reasons for arthroscopic intervention were: implant instability - 1 case, breaking of implant hinge - 1 case, arthrofibrosis - 2 cases, recurrent hemarthrosis with synovial membrane vessels malformation - 2 cases, reactive aseptic necrosis - 4 cases and resistant medial pain syndrome resulting from neuropathy of the infrapatellar branch of subcutaneous femoral nerve - 6 cases. Arthroscopy after knee arthroplasty enables with high accuracy to diagnose knee joint pathology, to avoid revision arthrotomy, to minimize intraoperative trauma, to improve functional results and patient’s quality of life as well as to reduce the cost of treatment.

Arthroscopy in Treatment of Knee Arthroplasty Complications

Results of the operated joint arthroscopy were presented for 16 patients with complications after knee arthroplasty. The reasons for arthroscopic intervention were: implant instability - 1 case, breaking of implant hinge - 1 case, arthrofibrosis - 2 cases, recurrent hemarthrosis with synovial membrane vessels malformation - 2 cases, reactive aseptic necrosis - 4 cases and resistant medial pain syndrome resulting from neuropathy of the infrapatellar branch of subcutaneous femoral nerve - 6 cases. Arthroscopy after knee arthroplasty enables with high accuracy to diagnose knee joint pathology, to avoid revision arthrotomy, to minimize intraoperative trauma, to improve functional results and patient’s quality of life as well as to reduce the cost of treatment.