ABSTRACT
Intra-articular hemorrhage is the clinical hallmark of hemophilia. Synoviorthesis, the intra-articular injection of chemical or radioactive substances in order to produce fibrosis of the hypertrophied synovium, has proved effective in the treatment of chronic hemophilic synovitis. Between December 2006 and July 2007, we treated 21 patients with hemophilic arthropathy by synoviorthesis with rifampicin once a week. The procedures were performed on 14 knees, five elbows, four ankles, and one shoulder (24 joints and 113 injections). The mean age was 16.7 years (range, 7-49 years). According to the Fernandez-Palazzi classification, synoviorthesis was considered satisfactory (excellent or good) in 21 (87.5%) joints and unsatisfactory (fair or poor) in three (12.5%). A mean reduction of 6.3 bleeding episodes per month was obtained (P < 0.0001). The mean pain score was reduced from 2.62 (range, 2-3; SD, 0.49) before treatment to 0.79 (range, 0-2; SD, 0.65) after treatment. The mean World Federation of Hemophilia (WFH) score was 5.45 (range, 2-8) before synoviorthesis and 3.5 (range, 1-7) after treatment. This method effectively reduced hemarthrosis and pain and also improved the range of motion in patients with hemophilic arthropathy. Chemical synoviorthesis with rifampicin appears to be efficient, inexpensive, and simple and also especially practical in developing countries where radioactive agents are not easily available.
Subject(s)
Hemarthrosis/drug therapy , Rifampin/therapeutic use , Synovial Membrane/pathology , Adolescent , Adult , Child , Hemorrhage/prevention & control , Humans , Joint Diseases/drug therapy , Middle Aged , Pain/prevention & control , Range of Motion, Articular/drug effects , Treatment Outcome , Young AdultABSTRACT
Among several graft fixation options in arthroscopic ACL reconstruction for hamstring tendons, transcondylar fixation has been suggested to offer mechanical advantages compared to other femoral fixation systems. Blind nature of the procedure may result in several complications including iliotibial band irritation syndrome, breakage of the bio absorbable cross-pin, stress fracture of the femoral cortex, and more commonly intraoperative wire loop twisting, resulting in fixation failure, wire breakage or graft laceration. We used "wireless" transfixation technique to avoid complications associated with wire loop.
