Medial gastrocnemius proximal fasciotomy in patients with chronic plantar fasciitis: A systematic review. / Fasciotomía proximal de gemelo interno en pacientes con fascitis plantar crónica: una revisión sistemática.

INTRODUCTION: Plantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal fasciotomy of the medial gastrocnemius (FPGM) has increased to treat chronic plantar fasciitis. MATERIAL AND METHODS: Systematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. RESULTS: Three articles were included in the review: two randomized clinical trials and one cohort study with a total of 138 patients. In the analyzed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. CONCLUSION: Proximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.

Validez de la artrorresonancia magnética como herramienta diagnóstica en el síndrome de atrapamiento femoroacetabular / Validity of magnetic resonance arthrography as a diagnostic tool in femoroacetabular impingement syndrome

Introducción. El síndrome de atrapamiento femoroacetabular es una de las causas de coxalgia en el adulto joven; así mismo, es una entidad clínica que contribuye en la etiopatogenia de la coxartrosis en estos pacientes. Un diagnóstico clínico certero apoyado por las técnicas de imagen diagnósticas disponibles es fundamental para poder determinar el mejor tratamiento. El objetivo de nuestro trabajo es determinar la correlación diagnóstica entre la artrorresonancia magnética directa y los hallazgos artroscópicos. Material y método. Revisamos una serie de 36 pacientes con diagnóstico de atrapamiento femoroacetabular intervenidos mediante artroscopia de cadera realizada entre 2009 y 2012 con estudio de artrorresonancia previo realizado en nuestro centro. Valoramos en ambos el hallazgo de lesiones labrales, deformidad tipo CAM femoral y lesiones condrales, tanto femorales como acetabulares. Resultado. Tomando los hallazgos de la artroscopia de cadera como el diagnóstico de certeza, calculamos una sensibilidad del 87% y una especificidad del 77% con un VPP del 87% para el diagnóstico de las lesiones labrales mediante artrorresonancia magnética directa, respectivamente. La especificidad para el diagnóstico de la deformidad tipo CAM femoral es del 100%, con una sensibilidad del 79% y un VPP del 100%. Para las lesiones condrales en acetábulo y cabeza femoral obtenemos valores más bajos, sensibilidad del 78,5%, especificidad del 82%, VPP del 73% y VPN del 80% para las acetabulares, sensibilidad del 71,5%, especificidad del 73%, VPP del 62,5% y VPN del 80% en las femorales. Conclusiones. Dadas la alta sensibilidad para la detección de lesiones labrales y la alta especificidad para determinar la presencia de deformidad en giba, la artrorresonancia magnética directa de cadera supone una buena herramienta diagnóstica en el atrapamiento femoroacetabular (AU)

Introduction. Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adult and a contributory factor for development of early primary osteoarthritis. An accurate clinical diagnosis, supported by imaging studies, is important to determine the best treatment for the patient. The aim of this study is to determine the diagnostic correlation between direct magnetic resonance imaging (MRI) arthrography and the arthroscopic findings. Materials and method. A review was performed on a series of 36 patients diagnosed with FAI, and who underwent hip arthroscopy surgery between 2009 and 2012. All of them had a direct MRI arthrography performed in our hospital. The presence of labral lesions, CAM deformity, and acetabular and femoral cartilage damage, were evaluated in both imaging techniques. Result. After analysing the results and taking the hip arthroscopy as ‘gold standard’, a sensitivity of 87% and a specificity of 77% were obtained, with a PPV of 87% for the diagnosis of labral lesions by direct MR arthrography. The specificity for CAM deformity was 100%, with a sensitivity of 79% and PPV of 100%. For chondral disorders lower values were found for both acetabulum and femoral head. For acetabular lesions the sensitivity was 78.5%, and specificity was 82% with a PPV of 73% and NPV of 80%. For femoral lesions, there was a sensitivity of 71.5%, a specificity of 73%, with a PPV of 62.5% and NPV of 80%. Conclusions. Due to the high sensitivity for the detection of labral lesions and the high specificity to detect CAM deformity, hip MR arthrography is a useful diagnostic tool for femoroacetabular impingement (AU)

Validity of magnetic resonance arthrography as a diagnostic tool in femoroacetabular impingement syndrome.

INTRODUCTION: Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adult and a contributory factor for development of early primary osteoarthritis. An accurate clinical diagnosis, supported by imaging studies, is important to determine the best treatment for the patient. The aim of this study is to determine the diagnostic correlation between direct magnetic resonance imaging (MRI) arthrography and the arthroscopic findings. MATERIALS AND METHOD: A review was performed on a series of 36 patients diagnosed with FAI, and who underwent hip arthroscopy surgery between 2009 and 2012. All of them had a direct MRI arthrography performed in our hospital. The presence of labral lesions, CAM deformity, and acetabular and femoral cartilage damage, were evaluated in both imaging techniques. RESULT: After analysing the results and taking the hip arthroscopy as 'gold standard', a sensitivity of 87% and a specificity of 77% were obtained, with a PPV of 87% for the diagnosis of labral lesions by direct MR arthrography. The specificity for CAM deformity was 100%, with a sensitivity of 79% and PPV of 100%. For chondral disorders lower values were found for both acetabulum and femoral head. For acetabular lesions the sensitivity was 78.5%, and specificity was 82% with a PPV of 73% and NPV of 80%. For femoral lesions, there was a sensitivity of 71.5%, a specificity of 73%, with a PPV of 62.5% and NPV of 80%. CONCLUSIONS: Due to the high sensitivity for the detection of labral lesions and the high specificity to detect CAM deformity, hip MR arthrography is a useful diagnostic tool for femoroacetabular impingement.

Ubicación inusual de lesiones osteocondrales en la rodilla del adolescente / Unusual location of osteochondral lesions in adolescent’s knees

Las lesiones osteocondrales en la rodilla del adolescente se localizan principalmente en las áreas de carga a nivel de los cóndilos femorales, las lesiones ubicadas en la tróclea son excepcionales abarcando menos de 1%. La etiología de la ODJ sigue siendo desconocida; puede ser causa de lesiones osteocondrales los traumatismos directos frontales en los cóndilos femorales y por trauma directo de la patela sobre la tróclea en las luxaciones de ésta. En este nivel, ambos mecanismos pueden causar lesiones tanto condrales como osteocondrales. En este trabajo presentamos dos casos, en que se incluye a un paciente con afectación bilateral de la tróclea; ambos de las mismas características, se realizó artroscopía con extracción de cuerpos libres, regularización del lecho y perforaciones con resultados satisfactorios a largo plazo. La presencia de lesiones osteocondrales en la tróclea es muy rara; en la literatura hay descritos muy pocos casos de bilateralidad. La etiología exacta de la ODJ en la rodilla sigue siendo discutida. En nuestros casos, el mecanismo podría explicarse por un impacto de baja presión pero a alta velocidad de la patela sobre la tróclea. Este tipo de lesiones podría encontrarse sobre defectos u anomalías de la osificación de la infancia, la bilateralidad de uno de estos casos apoyaría esta hipótesis. El tratamiento depende de la estabilidad de la lesión y de la edad del paciente. El tratamiento quirúrgico debe ser considerado en los pacientes con fisis abierta que tengan lesión inestable o desprendida y en aquellos en que la fisis está por cerrar, pero que no han respondido al tratamiento conservador, como también en aquellos pacientes con cuerpo libre intraarticular. Otro punto a considerar es que la fijación sin pastilla ósea o insuficiente ofrece resultados mediocres.

Osteochondral knee lesions in adolescents are primarily located in loading areas at the level of the femoral condyles. Lesions located in the trochlea are exceptional and account for less than 1%. The etiology of juvenile osteochondritis dissecans (JOCD) is still unknown. Osteochondral lesions may be caused by direct frontal trauma of the femoral condyles and by direct trauma of the patella on the trochlea in dislocations of the latter. At this level both mechanisms may cause both chondral and osteochondral lesions. We present herein two cases with the same characteristics that include one patient with bilateral involvement of the trochlea. Arthroscopy was performed with removal of loose bodies, regularization of the bed and perforations, with appropriate long term results. Osteochondral lesions are rarely found in the trochlea; the literature contains very few bilateral cases described. The exact etiology of JOCD of the knee continues to be debated. In our cases the mechanism could be explained by a low-pressure high-speed impact of the patella on the trochlea. This type of lesions may be added to defects or abnormalities of ossification during childhood. The bilaterality of one of these cases would support this hypothesis. Treatment depends on lesion stability and patient age. Surgical treatment should be considered in patients with open physes with an unstable or detached lesion and in those in whom the physis is about to close but have not responded to conservative treatment, as well as in patients with an intraarticular loose body. Another point to consider is that insufficient fixation or fixation without a bone chip leads to mediocre results.

[Unusual location of osteochondral lesions in adolescent's knees]. / Ubicación inusual de lesiones osteocondrales en la rodilla del adolescente.

Osteochondral knee lesions in adolescents are primarily located in loading areas at the level of the femoral condyles. Lesions located in the trochlea are exceptional and account for less than 1%. The etiology of juvenile osteochondritis dissecans (JOCD) is still unknown. Osteochondral lesions may be caused by direct frontal trauma of the femoral condyles and by direct trauma of the patella on the trochlea in dislocations of the latter. At this level both mechanisms may cause both chondral and osteochondral lesions. We present herein two cases with the same characteristics that include one patient with bilateral involvement of the trochlea. Arthroscopy was performed with removal of loose bodies, regularization of the bed and perforations, with appropriate long term results. Osteochondral lesions are rarely found in the trochlea; the literature contains very few bilateral cases described. The exact etiology of JOCD of the knee continues to be debated. In our cases the mechanism could be explained by a low-pressure high-speed impact of the patella on the trochlea. This type of lesions may be added to defects or abnormalities of ossification during childhood. The bilaterality of one of these cases would support this hypothesis. Treatment depends on lesion stability and patient age. Surgical treatment should be considered in patients with open physes with an un stable or detached lesion and in those in whom the physis is about to close but have not responded to conservative treatment, as well as in patients with an intraarticular loose body. Another point to consider is that insufficient fixation or fixation without a bone chip leads to mediocre results.

Alteraciones morfológicas en la escoliosis. Estudio en raquis humanos en crecimiento / Morphological changes in scoliosis during growth. Study in the human spine

Objetivos. Analizar el sustrato anatomopatológico del raquis escoliótico humano durante el crecimiento. Material y métodos. Estudiamos el raquis, obtenidos en la necropsia, de 2 pacientes afectados de escoliosis. Muestra A (niña de 13 años y 2 meses) y muestra B (niño de 14 años y un mes). Se estudiaron las piezas anatómicas obtenidas en la necropsia. Se realizó un estudio radiológico convencional; se valoró la intensidad de las curvas con los grados de Cobb y la rotación vertebral con el método de Pedriolle, cortes de tomografía computarizada (TC) y análisis de la asimetría posterior (giba). Además, en el estudio histológico se valoró la estructura ósea, los cartílagos de crecimiento, el hueso subcondral, la presencia y la distribución del tejido fibroso. Resultados. Se estudiaron los niveles de C7 a L5 de la muestra A y de T2 a L4 de la muestra B. No se evidenció deformidad de los cuerpos vertebrales en el plano frontal, sagital ni axial, salvo en T5 de la muestra A, con acuñamiento en el plano frontal hacia la convexidad. La deformidad se originaba en los discos intervertebrales. La osificación encondral de los cartílagos epifisarios presentaba una mayor actividad en el lado de la convexidad de la curva. El cartílago neurocentral estaba presente a nivel torácico y cervical, habiendo desaparecido a nivel lumbar. No observamos asimetría en los cartílagos neurocentrales. Conclusiones. La deformidad se inicia en los discos intervertebrales produciéndose alteraciones en los cartílagos epifisarios que pueden condicionar, al final del crecimiento, la deformidad de las vértebras escolióticas, básicamente acuñamiento y rotación (AU)

Objectives. To analyse the pathological substrate of human scoliotic spine during growth. Material and methods. We studied two spines obtained at the autopsy of two patients suffering from untreated scoliosis. Sample A (a girl of 13 years and 2 months) and sample B (a boy of 14 years and one month). On the conventional radiological study the curves were measured using the method of Cobb, and the vertebral rotation with the Pedriolle method. A CT scan and analysis of the posterior asymmetry were also performed. The bone structure, growth plate, subchondral bone were evaluated in the histological study, as well as the presence and distribution of fibrous tissue. Results. Levels from C7 to L5 were studied in sample A, and levels from T2 to L4 in sample B. There was no evidence of vertebral deformity in the frontal, sagittal or axial planes, except for T5 in sample A, where wedging into the concavity in the frontal plane was observed. The deformity originated in the intervertebral discs. Endochondral ossification of the epiphyseal cartilage showed increased activity on the side of the convexity of the curve. Neurocentral cartilage was present at thoracic and cervical level, having disappeared at lumbar level. No asymmetry was observed in the neurocentral cartilage. Conclusions. The deformity begins in the intervertebral discs, producing distortions in the epiphyseal cartilage. Those changes may influence the end of growth and therefore the deformity of the scoliotic vertebrae, basically resulting in wedging and rotation of the vertebrae (AU)

Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery.

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries.

[Morphological changes in scoliosis during growth. Study in the human spine]. / Alteraciones morfológicas en la escoliosis. Estudio en raquis humanos en crecimiento.

OBJECTIVES: To analyse the pathological substrate of human scoliotic spine during growth. MATERIAL AND METHODS: We studied two spines obtained at the autopsy of two patients suffering from untreated scoliosis. Sample A (a girl of 13 years and 2 months) and sample B (a boy of 14 years and one month). On the conventional radiological study the curves were measured using the method of Cobb, and the vertebral rotation with the Pedriolle method. A CT scan and analysis of the posterior asymmetry were also performed. The bone structure, growth plate, subchondral bone were evaluated in the histological study, as well as the presence and distribution of fibrous tissue. RESULTS: Levels from C7 to L5 were studied in sample A, and levels from T2 to L4 in sample B. There was no evidence of vertebral deformity in the frontal, sagittal or axial planes, except for T5 in sample A, where wedging into the concavity in the frontal plane was observed. The deformity originated in the intervertebral discs. Endochondral ossification of the epiphyseal cartilage showed increased activity on the side of the convexity of the curve. Neurocentral cartilage was present at thoracic and cervical level, having disappeared at lumbar level. No asymmetry was observed in the neurocentral cartilage. CONCLUSIONS: The deformity begins in the intervertebral discs, producing distortions in the epiphyseal cartilage. Those changes may influence the end of growth and therefore the deformity of the scoliotic vertebrae, basically resulting in wedging and rotation of the vertebrae.