Primary patella tuberculosis mimicking pre-patellar bursitis: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: The Patella is very rare site for tuberculosis (TB). The knee is the third most common site for skeletal TB. The incidence of patella TB being 0.09 to 0.15%. CASE PRESENTATION: We report a case of primary tuberculous osteitis isolated from the patella. The complaint was a mixed knee pain without notion of trauma. The CT showed a large osteolysis of the upper half of the patella. The diagnosis was established on the histological study after biopsy. The patient was operated by a medial approach without arthrotomy and the pathological tissue was resected and curetted. Complementary anti-bacillary antibiotic treatment was administered for 12 months. At the last clinical control, the knee was free and painless, and we had no recurrence. CLINICAL DISCUSSION: Aitken reported the first case in literature in 1933. The initial signs and symptoms are non-specific and sometimes confounded by a coincidental history of trauma. It is difficult to diagnose TB of patella in early stages because there are no constitutional symptoms. Sometimes serological parameters are inconclusive. CT scan can help if the osteolysis contained a central bone sequestration, bordered by peripheral sclerosis. Confirmation of patellar tuberculosis is made on biopsy. CONCLUSION: The tuberculous localization in the patella is rare and it can pose a problem of differential diagnosis with other affections, in particular infectious and tumors. It should always be kept in mind, especially in the face of a picture of pre-patellar bursitis which progresses slowly and whose biological inflammatory syndrome is not straightforward.

Intra-articular leiomyoma of the knee mimicking a ganglion cyst in a child: A case report and review of literature.

INTRODUCTION AND IMPORTANCE: Angioleiomyoma is a rare benign soft tissue tumor of smooth muscle getting its origin from the muscular layer of vessel walls. The localized type of leiomyoma occurs on the skin, deep soft tissues, in the genitourinary, gastrointestinal, and respiratory tracts. CASE PRESENTATION: We report a case of a 16-year-old patient who presented with an intra-articular leiomyoma developed in the anterior cruciate ligament and treated with arthroscopy. CLINICAL DISCUSSION: Angioleiomyoma can occur anywhere in the body and is most often seen in the extremities, particularly the lower limbs, but is very rare in the knee joint. Angioleiomyoma should be included in the differential diagnosis of nodular lesions mimicking loose body, such as lipomas, inclusion cysts, ganglion, pigmented villonodular synovitis (PVNS), fibroma, nodular synovitis, hemangioma, synovial sarcoma, myopericytoma, leiomyosarcomas, glomus tumor. CONCLUSION: Angioleiomyoma related to the cruciate ligaments of the knee should be considered in the differential diagnosis of a painful knee especially when associated with a decreased of range of motion of knee. The arthroscopic debridement should be considered the treatment of choice in order to reliably restore active ROM.

Endoscopic lateral decompression of calcaneo-fibular impingement: Case Report and literature Review.

INTRODUCTION AND IMPORTANCE: The calcaneo-fibular impingement syndrome is frequent after calcaneal fracture. The impinging lesion could be in bone and/or in soft tissue. The operative treatment aims to remove the impinging lesions either by open or endoscopic surgery. CASE PRESENTATION: We report a case of a 33-year female patient with calcaneo-fibular impingement syndrome. The condition was managed using endoscopic bone resection, soft tissue debridement and peroneal tendons release. CLINICAL DISCUSSION: Endoscopic treatment of calcalneo-fibular impingement syndrome has gradually been broadened as a safe, minimally invasive, and effective procedure. This endoscopic approach could reduce the wound complications associated with the open procedure and ensure early return to activity, better cosmetic and better patient satisfaction. The lateral approach could reduce nervous and tendinous complications associated with posterior approach. CONCLUSION: The endoscopic surgery using lateral approach is a reliable and a minimally invasive technique to address calcaneo-fibular impinging. However, this procedure is less useful for advanced cases of calcaneal malunion (Stephens and Sanders II and III).

Primary sclerosing epithelioid fibrosarcoma presenting as lombosciatic syndrome: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Sclerosing epithelioid fibrosarcoma (SEF) is a rare variant of low grade fibrosarcoma, with specific histological and immunohistochemical features. SEF is a difficult to diagnose. The prognosis is poor with a 40% mortality rate. CASE PRESENTATION: We report a case of 45-year-old female patient who presented to our department with a history of right sciatalgia evolving for three months. On physical examination, a firmly not well-defined mass was found in the right gluteal region. The histological diagnosis revealed a SEF. CLINICAL DISCUSSION: SEF appears to be a slowly growing tumor often present for several months or years before diagnosis. The 3-month delay of our diagnosis shows the difficulty arising from the inconclusive clinical of this tumor. CONCLUSION: SEF of the gluteal region can induce sciatalgia. The diagnosis should be made as early as possible in order to improve the prognosis.