Dolor crónico del tobillo: banda fibrosa (Web Impingement) / Chronic ankle pain. Web impingement

Objetivo: Presentamos una serie de pacientes con dolor crónico de tobillo y estudios por imágenes negativos, en los que hallamos solamente una banda fibrosa intraarticular como causa probable del dolor en la artroscopia diagnóstica. Métodos: Entre el año 2010 y 2016 se realizaron 212 artroscopias anteriores de tobillo. En 19 pacientes (8,96%) se encontró una banda fibrosa intrarticular. En 13 pacientes se encontraban asociadas con otras patologías y solo en 6 pacientes (2,83%) fueron aisladas, sin lesión asociada. El promedio de edad fue de 40,42 años. El seguimiento promedio de 20,42 meses. La mayoría de los pacientes fueron atendidos en centros de aseguradoras de riesgo de trabajo. Resultados: Se utilizó el score AOFAS con un promedio para el preoperatorio de 55,63 y para el postoperatorio de 92.26. No hubo complicaciones en esta serie. Conclusiones: La banda fibrosa es una patología infrecuente, con sintomatología clínica similar a la de otras patologías que producen un síndrome friccional anterior de partes blandas del tobillo. La mayoría tenía antecedentes traumáticos. Los estudios por imágenes utilizados fueron la radiografía y la Resonancia. Ninguno de ellos fue de utilidad en el diagnóstico. La banda fibrosa es una de las diferentes formas de impingement en la cara anterior del tobillo y puede ser una causa de fricción y dolor. Dado que los estudios por imágenes no fueron concluyentes, la artroscopía fue nuestro método de elección para el diagnóstico y tratamiento en los pacientes con dolor crónico de tobillo con imágenes negativas. Tipo de trabajo: Serie de casos. Nivel de evidencia: IV.

Purpose: We present a series of patients with chronic anterior ankle pain and negative imaging studies, in which we found an isolated fibrous intrarticular band as a probable cause of pain in diagnostic arthroscopy. Methods: Between 2010 and 2016 we performed 212 anterior ankle arthroscopies. In 19 patients (8,96%) a fibrous web like band was found. In 13 cases they were associated with other diseases and only 6 of them (2.83 %) were isolated. Average age was 42 years. Follow up was between 4 months and 3 years (average 20.42 months). Most of them were workers compensation patients. Results: We used the AOFAS scores with an average value of 55,63 preoperative and 92.26 points postoperative. No complications were found in this series. Conclusions: Intra articular fibrous band is an infrequent pathology, with clinical presentation similar to other soft tissues anterior impingement. Most of them had previous trauma. Imaging studies performed were radiographs and MRI, but they have not proven to be useful due to their low or none sensitivity to this condition. Intra articular fibrous bands is one of the causes of anterior impingement of the ankle, and may be a cause of friction and pain. Most of them had history of previous trauma. Imaging studies were not conclusive, and arthroscopy was our election method for diagnosis and treatment in patients with chronic ankle pain and negative imaging studies. Type of study: Case series. Level Of Evidence: IV.

Advantage of Minimal Anterior Knee Pain and Long-term Survivorship of Cemented Single Radius Posterior-Stabilized Total Knee Arthroplasty without Patella Resurfacing

BACKGROUND: The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. METHODS: Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS: Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. CONCLUSIONS: The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.

Effectiveness and satisfaction evaluation of patients submitted to TMJ arthrocenthesis: a case series

The aim of this study was to evaluate the effectiveness and level of satisfaction of patients who underwent TMJ arthrocentesis under local anesthesia by considering the following parameters: joint pain, mouth opening, mastication, and satisfaction. Fourteen patients (13 women and one man; mean age, 37.6 years with TMJ arthralgia were selected. The patients underwent arthrocentesis under local anesthesia, and pain intensity was measured before, during, and 1 year after treatment using a visual analog pain scale (VAS 0–100 mm). A Likert scale was used to assess patients’ opinion regarding the improvement of mouth opening and mastication. After treatment, patients were questioned on levels of satisfaction provided by arthrocentesis in regard to their quality of life. At the end of 1 year, patients showed a marked improvement in their pain clinical picture (p < 0.0001). Mouth opening and mastication, evaluated separately and then correlated (R2 = 0.925, p < 0.0001), also showed a marked improvement. When questioned, all patients reported being satisfied with the treatment outcome.

Facetectomia lateral de patela / Lateral facectomy of rhe patella

Os autores analisaram 15 pacientes (17 joelhos), submetidos a facetectomia lateral da patela. A idade variou de 30 a 68 anos (média 50,8), nao tendo influência nos resultados, e o tempo de seguimento médio foi de 34,2 meses. O achado freqüente foi de artrose femoropatelar, na faceta lateral, em todos os casos. Os resultados obtidos foram 64,7 por cento de bons, 23,5 por cento de regulares e 11,7 por cento de ruins. Os piores resultados estiveram no grupo de joelhos de pacientes portadores de artrose femorotibial associada. Concluem posicionando a facetectomia de patela como procedimento cirúrgico intermediário a diversas técnicas cirúrgicas de tratamento da artralgia femoropatelar e, quando obedecidos parâmetros de indicaçäo e técnica cirúrgicas, conduz a resultados satisfatórios.