[Medial discoid meniscus in a pediatric patient. Case report and review of the literature]. / Menisco discoide medial en paciente pediátrico. Presentación de un caso y revisión de la literatura.

Discoid meniscus is a congenital morphological variant of the meniscus, which tends to occur more frequently in its lateral form than in the medial form. This anomaly is characterized by central hypertrophy of the meniscus and a larger diameter than the normal meniscus, resulting in an abnormal shape and greater coverage of the tibial plateau. The clinical presentation of this condition varies depending on the stability of the meniscus. In pediatric patients, in particular, it is common to experience progressive and atraumatic symptoms, such as pain and limited mobility. Diagnosis is based on imaging studies, with magnetic resonance imaging being the preferred tool, where the "bowtie sign" is a classic finding. Surgery is recommended for symptomatic patients, with a focus on preserving the peripheral portion of the meniscus. Saucerization is the most commonly used technique, followed by stability assessment to determine if additional procedures are required. In this case, a 9-year-old patient with a medial discoid meniscus presented symptoms following trauma. Despite this atypical presentation, a successful outcome was achieved through arthroscopic surgery, underscoring the importance of accurate diagnosis and proper management of this condition in pediatric patients. Understanding the anatomical and pathophysiological characteristics of the discoid meniscus is essential for an effective therapeutic approach.

El menisco discoide es una variante morfológica congénita del menisco, que suele presentarse con mayor frecuencia en su forma lateral que en la medial. Esta anomalía se caracteriza por la hipertrofia central del menisco y un diámetro mayor que el menisco normal, lo que resulta en una forma anormal y una mayor cobertura del platillo tibial. La presentación clínica de esta condición varía según la estabilidad del menisco. En pacientes pediátricos, en particular, es común experimentar síntomas progresivos y atraumáticos, como dolor y limitación de la movilidad. El diagnóstico se basa en estudios de imagen, siendo la resonancia magnética la herramienta preferida, donde el "signo del corbatín" es un hallazgo clásico. Se recomienda la cirugía para pacientes sintomáticos, con un enfoque en preservar la porción periférica del menisco. La saucerización es la técnica más utilizada, seguida de la evaluación de la estabilidad para determinar si se requiere un procedimiento adicional. En el presente caso, se describe a un paciente de nueve años con un menisco discoide medial que manifestó síntomas después de un traumatismo. A pesar de esta presentación atípica, se logró un resultado exitoso mediante una cirugía artroscópica, lo que resalta la importancia de un diagnóstico preciso y un manejo adecuado de esta condición en pacientes pediátricos. La comprensión de las características anatómicas y patofisiológicas del menisco discoide es esencial para un enfoque terapéutico efectivo.

[Restoring horizontal stability in III-V acromioclavicular dislocations by anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments; surgical technique]. / Restablecimiento de la estabilidad horizontal en luxaciones acromioclaviculares III-V mediante la reconstrucción anatómica de los ligamentos coracoclaviculares y acromioclaviculares; técnica quirúrgica.

INTRODUCTION: dislocation of the acromioclavicular (AC) joint is a common injury seen in young adults. The objective is to describe a surgical technique that can restore the horizontal and vertical stability of the AC joint. MATERIAL AND METHODS: we describe a surgical technique that can restore horizontal and vertical stability using an allograft for the anatomical reconstruction of the CC and AC ligaments, for AC grade III-V dislocations according to the Rockwood classification. RESULTS: this is a surgical technique with anatomical and biological reconstruction of the CC and AC ligaments, using an allograft. Two bone tunnels are made in the clavicle, passing the lateral end of the graft below the acromion; then the two ends are fixed with two bioabsorbable screws, restoring vertical and horizontal stability. CONCLUSION: this procedure allows to restore the vertical and horizontal stability of the AC joint. Follow up studies are required to report functional and radiological results, in order to ensure advantages compared to existing techniques.

INTRODUCCIÓN: la luxación de la articulación acromioclavicular (AC) es una lesión frecuente que se observa en adultos jóvenes. El objetivo es describir una técnica quirúrgica que pueda restablecer la estabilidad horizontal y vertical de la articulación AC. MATERIAL Y MÉTODOS: se describe una técnica quirúrgica utilizando un aloinjerto para la reconstrucción anatómica de los ligamentos coracoclaviculares (CC) y AC para luxaciones AC grado III-V de acuerdo con la clasificación de Rockwood. RESULTADOS: es una técnica quirúrgica con reconstrucción anatómica y biológica de los ligamentos CC y AC con injerto. Se realizan dos túneles óseos en la clavícula pasando el cabo lateral del injerto por debajo del acromion; posteriormente se fijan los dos cabos con dos tornillos bioabsorbibles, restaurando de esta manera la estabilidad vertical y horizontal. CONCLUSIÓN: este procedimiento permite restablecer la estabilidad vertical y horizontal de la articulación AC. Se requieren estudios de seguimiento para reportar resultados funcionales y radiológicos con el fin de poder asegurar ventajas en comparación con las técnicas existentes.

[Functional evaluation of the management of massive rotator cuff ruptures with the use of the subacromial balloo]. / Evaluación funcional del manejo de rupturas masivas del manguito de los rotadores con el uso del balón subacromial.

INTRODUCTION: Rotator cuff (MR) ruptures occur in more than 50% of patients over the age of 60, and can cause changes in normal shoulder biomechanics that can trigger rotator cuff tear arthropathy. There is currently no consensus on treatment for massive rotator cuff tears. OBJECTIVE: To evaluate the clinical and radiographic outcomes of subacromial balloon placement in these lesions. MATERIAL AND METHODS: Analytical, longitudinal and retrospective study of 10 consecutive patients treated with the use of the subacromial balloon. Constant (CS) and ASES scales were used preoperatively and at 6, 12 months of post-surgical follow-up. Radiographic results were assessed using the Acromio-humeral Interval (AHI) on a true AP shoulder X-ray. RESULTS: The average improvement in CS was 41.7 ± 8.93 at 12 months of follow-up, the ASES scale showed an average improvement of 64.6 ± 4.9 at 12 months of follow-up. The presurgical AHI was 6.1 ± 1.10 and the mean at 12 months of follow-up was 7.1 ± 0.9. Clinical and radiographic improvement was observed at all scales, however no statistically significant results were found. CONCLUSION: The subacromial balloon prevents the ascent of the humeral head in the first 12 months of placement; we assume that it could restore normal glenohumeral kinematics by improving mobility and decreasing pain.

INTRODUCCIÓN: Las rupturas del manguito de los rotadores (MR) se presentan en más de 50% de los pacientes mayores de 60 años y pueden causar cambios en la biomecánica normal del hombro que pueden desencadenar una artropatía por desgarro del MR. Actualmente, no existe un consenso sobre el tratamiento para el desgarro masivo del MR. OBJETIVO: Evaluar los resultados clínicos y radiográficos de la colocación del balón subacromial en estas lesiones. MATERIAL Y MÉTODOS: Estudio analítico, longitudinal y retrospectivo de 10 pacientes consecutivos tratados con el uso del balón subacromial. Se utilizaron escalas de Constant (CS) y ASES prequirúrgicas, a los seis y 12 meses de seguimiento postquirúrgico. Los resultados radiográficos fueron valorados por medio del intervalo acromio-humeral (IAH) en una radiografía anteroposterior (AP) verdadera de hombro. RESULTADOS: La mejoría promedio en la CS fue de 41.7 ± 8.93 a los 12 meses de seguimiento, la escala de ASES mostró una mejoría promedio de 64.6 ± 4.9 a los 12 meses de seguimiento. El IAH prequirúrgico fue de 6.1 ± 1.10 y la media a los 12 meses de seguimiento fue de 7.1 ± 0.9. Se observó una mejoría clínica y radiográfica en todas las escalas; sin embargo, no se encontraron resultados estadísticamente significativos. CONCLUSIÓN: El balón subacromial previene el ascenso de la cabeza humeral en los primeros 12 meses de colocado; suponemos que podría restaurar la cinemática glenohumeral normal mejorando movilidad y disminuyendo dolor.

[Clinical and functional evaluation of patellofemoral resurfacing arthroplasties]. / Evaluación clínica y funcional de las artroplastías de resuperficialización patelofemoral.

BACKGROUND: The patellofemoral articulation is a biomechanical system susceptible to accelerated wear, affecting 25% of women. Currently, the treatment of osteoarthrosis Patelofermoral has resurfaced thanks to the creation of anatomical and biomechanically appropriate systems, with precise indications, earlier stages and with a better functional result. MATERIAL AND METHODS: A cohort of 24 patients was analyzed during the period from 2010 to 2012, treated with a resurfacing prostheses HemiCap Patello Femoral Resurf (Franklin MA, USA), placed by 2 surgeons. Patients were assessed preoperatively and 2, 4, 6, 12, 18, 24 months postoperative with the Knee Society Score. RESULTS: Twenty-four patients with follow-up of 2 years on average were included. 87.5% were women, an average age of 62 years (45-80 years); an average of 29.5 of body mass index, the right laterality predominated in 54%. An improvement in KSS scale results was observed: in clinical appearance there was an improvement of 35.2% and the functional scale 41.62%. Only two patients were revised by complications of functional limitation, treated one with manipulation under anesthesia and the other with arthroscopic adhesion lysis. CONCLUSION: The patellofemoral prosthesis is an option as a treatment for isolated patellofemoral arthrosis, since the two-year survival rate is good, providing pain relief and improving knee functionality; However, more follow-up time will be required to evaluate the end result of this implant.

ANTECEDENTES: La articulación patelofemoral (PF) es un sistema biomecánico susceptible a desgaste acelerado, afecta a 25% de las mujeres. Actualmente, el tratamiento de la osteoartrosis patelofemoral (OAPF) ha resurgido gracias a la creación de sistemas anatómicos y biomecánicamente adecuados, con indicaciones precisas, estadios más tempranos y con mejor resultado funcional. MATERIAL Y MÉTODOS: Se analizó una cohorte de 24 pacientes durante el período de 2010 a 2012, tratados con prótesis de resuperficialización patelofemoral (PPF) HemiCap Patelofemoral Resurf (Franklin MA, EUA), colocadas por dos cirujanos. Se evaluaron los pacientes prequirúrgicos y a los dos, cuatro, seis, 12, 18, 24 meses postquirúrgicos con la escala Knee Society Score (KSS). RESULTADOS: Se incluyeron 24 pacientes con seguimiento de dos años en promedio. En 87.5% fueron mujeres, edad promedio de 62 años (45-80 años); una media de 29.5 de índice de masa corporal (IMC), la lateralidad derecha predominó en 54%. Se observó una mejoría en los resultados de la escala KSS: en el aspecto clínico hubo una mejoría de 35.2% y en la escala funcional de 41.62%. Sólo dos pacientes fueron reintervenidos por complicaciones de limitación funcional, uno de ellos tratado con manipulación bajo anestesia y el otro con liberación artroscópica de adherencias. CONCLUSIÓN: La PPF es una opción como tratamiento de AOPF aislada, pues la tasa de supervivencia a dos años es buena, proporciona alivio del dolor y mejoría en funcionalidad de la rodilla; sin embargo, se requerirá mayor tiempo de seguimiento para evaluar el resultado final de este implante.

[Nontraumatic causes of bilateral avascular necrosis of the femoral head: link between hepatitis C and pegylated interferon]. / Causas no traumáticas de necrosis avascular bilateral de la cabeza femoral: relación hepatitis C-interferón pegilado.

BACKGROUND: Avascular necrosis of the femoral head is a frequent condition in patients with a history of trauma. The major pathologic causes include vascular diseases, malignancies, hypercoagulability states, long-term steroid treatment, and some patients have a history of hepatitis C infection treated with pegylated interferon and ribavirin. Upon studying the behavior of the hepatitis C virus, Seef, Foster and Poynard found a hypercoagulability state that causes interruption of retinacular blood flow to the femoral head, without an increased incidence of osteonecrosis in this patient group. Lauer states that such viral infections involve an autoimmune process and may result in transient vasculitides. Giampaolo, in 2005, reported the relationship between interferon use for multiple myeloma and other cancers and femoral avascular necrosis. MATERIAL AND METHODS: Cases with a diagnosis of bilateral osteonecrosis of the femoral head were assessed. RESULTS: Five patients were included, 4 females and one male, with a diagnosis of bilateral osteonecrosis of the femoral head. All of them had history of hepatitis C infection treated with pegylated interferon. The final diagnosis was proven by pathology after arthroplasty. A literature review was made of articles on the relationship between this condition and interferon use in patients with hepatitis C infection. CONCLUSIONS: Finding out the relationship between viral diseases such as hepatitis B and C infection and hypercoagulability states, autoimmune processes leading to transient vasculitides and the use of pegylated interferon 2B, will help us discover new nontraumatic causes associated with this condition.

[Proximal humerus fractures: clinical assessment and functional outcome in patients with osteonecrosis of the humeral head]. / Fracturas de húmero proximal: valoración clínica y resultado funcional en pacientes con osteonecrosis de la cabeza humeral.

INTRODUCTION: Fractures of the proximal humerus resulting in three or more fragments represent a high risk of necrosis. The former is the second most frequent site of necrosis, only after the femur, due to either traumatic or nontraumatic causes. The former are the most common, with an incidence rate of necrosis of 13-34% in fractures with more than four fragments. The purpose of this study is to assess the functional outcome of patients with a history of fracture of the proximal humerus and osteonecrosis treated conservatively. MATERIAL AND METHODS: This is a descriptive, retrospective, observational study with a 6-12 month follow-up of patients older than 60 years of age with a diagnosis of fracture of the proximal humerus managed conservatively between January 2004 and November 2009. One hundred and twenty-two patients met the inclusion criteria and 12 were lost to follow-up. Mean age was 71.02 years with a range between 60 and 92 years; 41 males and 69 females. The DASH and CONSTANT scales were applied. RESULTS: After applying the functional assessment scales and validating the results, the correlation coefficient obtained was 0.80, and it was statistically significant. CONCLUSION: Conservative treatment should be used only in patients who meet the necessary criteria. Depending on the type of fracture and the patient's characteristics, treatment should always be aimed at stabilization, early mobilization, and early functional recovery. This study found that fractures treated conservatively eventually develop some degree of osteonecrosis of the head, but they have proper function, similar to that of a healthy limb.