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Background: Here, we introduce a comprehensive treatment algorithm for posterolateral rotatory instability (PLRI) of the elbow, a condition affecting elbow mobility. We outline a diagnostic approach and a novel surgical management plan through the arthroscopic surgeon's point of view. Methods: The central focus of this management approach is the integrity of common extensor origin (CEO). High clinical suspicion must be evident to diagnose PLRI. Special clinical and imaging tests can confirm PLRI but sometimes the final confirmation is established during the arthroscopic treatment. The most appropriate treatment is determined by the degree of CEO integrity. Results: The treatment strategy varies with the CEO's condition: intact or minor tears require arthroscopic lateral collateral ligament imbrication, while extensive tears may need plication reinforced with imbrication or, in cases of retraction, a triceps tendon autograft reconstruction of the lateral ulnar collateral ligament alongside CEO repair. These approaches aim to manage residual instability and are complemented using a tailored rehabilitation protocol to optimize functional outcomes. Conclusion: PLRI is a unique clinical condition and should be treated likewise. This algorithm offers valuable insights for diagnosing and treating PLRI, enhancing therapeutic decision-making.
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The Achilles tendon represents the most commonly ruptured tendon of the human body. Numerous studies have evaluated, throughout the years, management options regarding acute Achilles tendon rupture. Minimally invasive techniques have recently gained more popularity. Endoscopic flexor hallucis longus tendon transfer has been mainly described as a treatment method for neglected Achilles tendon ruptures. However, it has recently been described as an applicable treatment option for acute Achilles tendon ruptures as well. Nevertheless, this procedure is technically quite demanding and should be performed by experienced surgeons. This technical note thoroughly describes the endoscopic flexor hallucis longus transfer technique for acute Achilles tendon ruptures, focusing on the most important technical aspects, thus attempting to simplify and render this procedure more widely accepted.
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Introduction:Osteoarthritis (OA) is a leading cause of disability in older adults. The majority of cruciate ligament injuries progress to OA through numerous mechanisms. The aim of this study was to identify the histological changes of cruciate ligaments in OA knees from patients undergoing total knee arthroplasty (TKA) as well as possible correlations with coronal plate deformities and patients' characteristics. Methods:A total of 50 consecutive patients with knee OA undergoing TKA with posterior stabilized prosthesis were included in the study. Demographics, preoperative range of flexion, the flexion contracture, Visual Analogue Scale (VAS) score, coronal plane deformity, Kellgren and Lawrence radiological degree of OA and Beguin-Locker classification of intraoperative degree of OA were recorded. The histopathological changes evaluated in specimens from both cruciate ligaments included myxoid and mucoid degeneration, chondroid metaplasia and orientation of collagen fibers. Results:A total of 24 males (48%) and 26 females (52%) with a mean age of 71 years (SD 5.93) participated in our study. The mean preoperative duration of pain was 3.62 years (SD 2.2). The K-L scale mean score was 2.60 (SD 0.64) and the mean VAS score 6.38 (SD 1.1). The mean varus deformity was 10.14 degrees (SD 3.7). Knee flexion/flexion contracture were recorded at 95.76±6.183 and 16.14±4.914 degrees, respectively. Intraoperatively, the B-L scale mean score was 2.02 (SD 0.77). Mucoid degeneration in ACL was the most common histopathological feature (15.7%) (SD 12.9), followed by chondroid metaplasia in both ACL and PCL [14.3% (SD12.5) and 14.3% (SD 13.2), respectively]. A negative correlation between BMI and myxoid ACL (p=0.01) as well as between varus deformity and mucoid ACL (p=0.05) was found, while a negative correlation between height and myxoid ACL (p=0.05) has been also revealed. Conclusion:Degeneration of cruciate ligaments is associated with degenerative joint disease and OA should be considered a disease involving the whole joint including ligaments, menisci, synovium and joint capsule. However, the correlation between degeneration of cruciate ligaments and OA is not yet fully understood and more research is needed.
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The finite element method (FEM) represents a computer simulation method, originally used in civil engineering, which dates back to the early 1940s. Applications of FEM have also been used in numerous medical areas and in orthopedic surgery. Computing technology has improved over the years and as a result, more complex problems, such as those involving the spine, can be analyzed. The spine is a complex anatomical structure that maintains the erect posture and supports considerable loads. Applications of FEM in the spine have contributed to the understanding of bone biomechanics, both in healthy and abnormal conditions, such as scoliosis, fractures (trauma), degenerative disc disease and osteoporosis. However, since FEM is only a digital simulation of the real condition, it will never exactly simulate in vivo results. In particular, when it concerns biomechanics, there are many features that are difficult to represent in a FEM. More FEM studies and spine research are required in order to examine interpersonal spine stiffness, young spine biomechanics and model accuracy. In the future, patient-specific models will be used for better patient evaluations as well as for better pre- and inter-operative planning.
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INTRODUCTION: Open interphalangeal (IP) dislocations are completely uncommon. Up to now, different patterns of dislocation have been described. The combination of axial loading and hyperdorsiflexion forces, leading to plantar dislocation of the distal phalanx, is a rare type of injury, which has yet not been reported. CASE REPORT: A rare case of traumatic open dislocation of the left great toe IP joint in a highly active, overweighted, male, amateur football player is presented. The possible underlying mechanism was impact of the left great toe against the ground and subsequent hyperdorsiflexion. The distal phalanx was dislocated plantarly, whereas the proximal phalanx was protruding out the dorsal skin of the toe. Open exploration and reduction led to excellent clinical results 6 months after surgery. CONCLUSION: Open traumatic IP dislocation of the great toe due to low force activity is a very rare mode of injury, which requires adequate treatment including immediate purification of the exposed joint, control of the sesamoids' position, exclusion of intra-articular fractures, joint's reduction, soft-tissue repair, and proper stabilization.
