ABSTRACT
We report a chronic Morel-Lavallée lesion around the knee in a competitive high schooler softball player, successfully treated with video-assisted endoscopic debridement. Endoscopic surgery is a viable option to treat Morel-Lavallée lesions in active patients who seek a rapid return to sport. The potential advantages of an endoscopic treatment would be a faster healing process and an earlier return to motion and function due to a less morbid and more cosmetic surgical approach.
ABSTRACT
BACKGROUND: The pathophysiology of posterior tibial tendon dysfunction (PTTD) is poorly understood. It has been theorized that changes in hormone physiology may be a factor influencing tendon health. Estrogen's influence on the fibroblast has been studied in other musculoskeletal tissues. Gender differences in anterior cruciate ligament (ACL) injuries have been studied and it has been discovered that the Estrogen receptor (ER) as well as Progesterone receptor (PR) are expressed in the ACL. MATERIAL AND METHODS: Eight patients with PTTD requiring surgery were enrolled in our pilot study. The mean patient age was 52.4 (range, 18 to 73) years. There were five female and three male patients. Tendon samples were harvested from diseased PTT. Tendon samples harvested from healthy PTT and healthy flexor digitorum longus (FDL) tendon were used as controls. Tendon samples were processed using specific protocols for total RNA isolation from hypocellular, dense connective tissues. ERα and ERß transcripts were quantified using real time RT-PCR. Quantitative values were obtained from the threshold cycle (Ct) number at which the increase in fluorescent signal associated with an exponential increase of PCR products can be detected. RESULTS: Transcripts of both ERα and ERß were reproducibly detected in RNA samples isolated from our tendon samples. There was no difference in receptor expression between diseased and control tendon samples. There was no difference in receptor expression between male and female patients. CONCLUSION: We found that the tenocyte of the PTT and FDL tendons express ERα and ERß. Normal and diseased tendons of both male and female patients expressed both estrogen receptors. CLINICAL RELEVANCE: Identifying ERα and ERß gene expression in the fibroblast was an initial step in discovering whether tenocytes are targets for estrogen function. Estrogen receptors were identified indirectly by measuring receptor gene expression but we were unable to show a significant difference between diseased and control tendons.
Subject(s)
Estrogen Receptor alpha/metabolism , Estrogen Receptor beta/metabolism , Posterior Tibial Tendon Dysfunction/metabolism , Tendons/metabolism , Adolescent , Adult , Aged , Case-Control Studies , Estrogen Receptor alpha/genetics , Estrogen Receptor beta/genetics , Female , Humans , Male , Middle Aged , Pilot Projects , RNA, Messenger/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Young AdultABSTRACT
A popular rotating-platform total knee implanted with a cementless technique was studied to determine long-term durability of fixation. A total of 70 knees in 59 patients (34 men, 25 women) was included. The primary indication for surgery was osteoarthritis (80%). A total of 23 of the 70 knees was available at final follow-up (average, 16 years). Clinical and radiographic data suggested durable fixation. In addition, the entire cohort of patients was studied with Kaplan-Meier statistics. Survivorship with respect to aseptic loosening was 97% at 17 years. Only 1 of the 70 knees was revised for aseptic loosening. However, overall survivorship was 76%, which was primarily because of failures of the metal-backed rotating patella.
