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INTRODUCTION AND IMPORTANCE: Heterotopic ossification (HO) often arises in response to trauma, prior surgical procedures, neurological injuries, or burns. However, its presentation as a complication of shoulder arthroscopy is uncommon and can sometimes lead to functional impairment. In our study, we report a case of HO complicating rotator cuff repair, along with details of the surgical treatment and subsequent progression. CASE PRESENTATION: We report the case of a 45-year-old man with no medical history, who had undergone a rotator cuff arthroscopic repair of his left shoulder. Despite initial improvements, he developed intense pain and stiffness of the operated shoulder. X-rays revealed an extensive HO. Surgical revision and excision of the ossification, followed by high-dose indomethacin in combination with proton pump inhibitors and specialized physiotherapy, resulted in remarkable improvement in shoulder function. CLINICAL DISCUSSION: Studies investigating HO in shoulder arthroplasty have unveiled a diverse range of formation rates, spanning from 15 % to 62 %. Nonetheless, it's noteworthy that the prevalence of HO around the shoulder remains less common in comparison to other anatomical sites, especially in the context of arthroscopic surgical procedures. The exact mechanism and pathophysiology that leads to HO formation remains unknown. It is believed to stem from a combination of multiple factors and is associated with various contributors. Arthroscopic intervention, coupled with high-dose Indomethacin, offers an effective approach for managing HO. CONCLUSION: While HO remains an uncommon complication after shoulder arthroscopy, it is crucial for clinicians to consider it in patients experiencing post-surgery stiffness and pain.
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INTRODUCTION AND IMPORTANCE: Solitary spinal plasmacytoma (SSP) is an uncommon neoplasm originating from bone marrow plasma cells. Although infrequent in the thoracic region, it has the potential to induce substantial damage. In this study, we present the case of a patient with thoracic spine SSP treated through surgical intervention. CASE PRESENTATION: We report the case of a 38-year-old female who presented with progressive mid-back pain, numbness, weakness in both lower limbs and gait disturbance. Imaging showed an osteolytic lesion with vertebral collapse of T11. MRI was strongly suggestive of solitary plasmocytoma. Hematologic tests were normal. Surgery was carried out. At the first stage, a posterior approach with laminectomy and fixation were performed. Biopsy of tumor cells confirmed the diagnosis of SSP. At the second stage, a trans-thoracic approach was performed, the tumor was resected in a single block and anterior interbody fusion was done. After the surgery the patient fully recovered from the paraparesis and at two years follow up no recurrence of tumor cells was detected. CLINICAL DISCUSSION: Spinal malignant bone tumors are rare, with solitary plasmacytoma being the most common. Diagnosis of SSP is based on bone biopsy findings. MRI and CT scans assess tumor extent and spinal stability. Prognosis relates to the likelihood of progressing into multiple myeloma. Though radiotherapy is common, surgery offers local control, especially for instability and neurological issues. CONCLUSION: SSP in the thoracic spine is a rare condition that requires a multidisciplinary approach and a prompt treatment.
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INTRODUCTION: Tunnel enlargement following anterior cruciate ligament (ACL) reconstruction has been frequently reported since the nineties, yet its etiologies remain unclear. AIM: To elucidate the factors favoring this phenomenon and to investigate its clinical and anatomical consequences. METHODS: This was a descriptive retrospective study conducted on 37 patients who underwent ACL reconstruction surgery using single-bundle hamstring tendons with fixation using absorbable interference screws at the Traumatology Department of the Kassab National Institute of Orthopedics. The patients were collected between January 2014 and September 2016. Tunnel enlargement, footprint, and tunnel orientation were assessed using standard knee radiographs. At follow-up, patients were evaluated using functional scores (Lysholm, Tegner, and IKDC), clinical examination, and Telos radiographs. RESULTS: The average global Tunnel enlargement was 51.7% in the femur and 48.88% in the tibia. Femoral tunnel enlargement values were higher than tibial tunnel enlargement at all measurement levels, and it appeared to be a time-evolving phenomenon. Factors favoring tunnel enlargement seemed to include advanced age, male gender, delayed surgery, accelerated rehabilitation protocols, non-compliant placement of transplant footprints, and tunnel horizontalization. Tunnel enlargement did not influence functional scores (Lysholm, Tegner, and IKDC). However, based on the differential study of Telos radiographs, femoral and tibial tunnel enlargement in the lax knees group (38% of cases) was higher than in the stable knees group (62%). Nonetheless, our results were statistically non-significant with respective p-values of 0.584 and 0.53. CONCLUSION: Several modifiable factors such as delayed surgery, accelerated rehabilitation protocols, incorrect footprint placement, and tunnel orientation appeared to influence the tunnel enlargement phenomenon. However, prospective studies with a larger sample would be necessary to confirm these findings.
