PLAR: a combined percutaneous and arthroscopic treatment for iliotibial band syndrome description of surgical technique and short-term results: description of surgical technique and short-term results.

INTRODUCTION: Description of a new surgical procedure (percutaneous lengthening and arthroscopic release, PLAR) that combines all the possible interventions on the iliotibial band (ITB), and evaluates its outcomes in a group of distance runners diagnosed with ITBS. METHODS: A prospective observational study was made of distance runners diagnosed with ITBS and operated upon using the PLAR technique between 1 and 2018 and 31 June 2020. The surgical technique is described in detail, and the demographic data and functional outcomes measured by the sports performance scales Activity Rating Scale (ARS) and International Knee Documentation Committee (IKDC) are presented. RESULTS: A total of 14 patients were included, with a mean follow-up of 16 months (range 12-42 months). All the patients resumed their previous sporting activity after an average of 4 (range 2.5-6) months, and no complications were recorded. In all cases, statistically significant improvement was evidenced by the ARS and IKDC scales following PLAR (p < 0.001), with excellent outcomes in 71% of the cases according to the ARS scale and in 86% according to the IKDC scale (mean difference between preoperative and final follow-up scores of 12.1/16 and 34.2/100 points, respectively). CONCLUSION: The PLAR technique is effective in allowing a return to previous sports performance levels in a short period of time among patients with ITBS refractory to conservative management, with a high satisfaction rate and the absence of complications.

Ultrasound-guided distal minimally invasive metatarsal osteotomies (US-DMMO): A cadaveric study about its safety and accuracy.

BACKGROUND: Distal minimally invasive metatarsal osteotomies have become increasingly popular. This technique requires fluoroscopic control, but recently, an ultrasound-guided procedure has been described. The aim of this anatomical study was to assess the quality safety of ultrasound-guided minimally invasive metatarsal osteotomies. METHODS: Ultrasound-guided distal minimally invasive metatarsal osteotomies were performed in 9 cadaveric pieces. The location of the osteotomy, its angulation, and the adjacent anatomical structures injuries was evaluated RESULTS: Thirty-six osteotomies were performed. The osteotomy was metaphyseal in 97.2% of the cases, the average angulation was 47.67° (±4.49, 40-59°) and the average distance to the articular cartilage was 3.22 mm (±1.27, 1-7 mm). One osteotomy (2.8%) was intraarticular and there was one joint capsule lesion (2.8%). The failure, the extreme point distance and angulation values, and the joint capsule injury correspond to a fifth metatarsal. CONCLUSIONS: The ultrasound-guided technique is safe and allows a correct location and angulation of the osteotomies.

Tips, quips and pearls: Ultrasound-guided distal metatarsal minimal invasive osteotomy (US-DMMO).

Metatarsalgia is a frequent cause of forefoot pain. Surgical treatment is based on the performance of osteotomies at the level of the minor radii to restore a normal distribution of pressure within the forefoot and improve the biomechanics during gait. In recent years, percutaneous surgery of the foot, and specifically distal metatarsal minimal invasive osteotomy, have proven to be a valid technique, providing satisfactory clinical results, similar to open osteotomy with less soft tissue aggression, but it requires intraoperative fluoroscopy to be performed. This article will present a modification to guide the procedure by ultrasound providing a new option that eliminates radiation and provides greater portability and accessibility.

Retrograde Tibial Nail and Trabecular Titanium Spacer Block for the Treatment of Missing Talus: A Rare Case Report.

Astragalus enucleation with complete bone loss is a rare pathology, and there is no current classification or treatment protocol. A 34-year-old woman sustained an open total enucleation of the talus without bone recovery in a motorcycle accident. Initially, she was treated at the emergency department with wound cleaning, surgical debridement, and external fixation with intravenous antibiotic therapy. Definitive treatment was delayed 8 weeks because of acute infection, which was treated with lavage, surgical debridement, and specific antibiotic therapy. To avoid leg-length discrepancy, we performed a tibiocalcaneal arthrodesis using a trabecular titanium spacer block with retrograde intramedullary nailing. We report satisfactory clinical, functional, and radiological results at 24 months after surgery. No complications or dysmetria was reported. The treatment of choice after an open talar enucleation with bone loss is the tibiocalcaneal arthrodesis, and it can be done isolated or with an associated autologous bone graft or allograft. The most frequent complications are infection, pseudoarthrosis, and, if the talar space is not adequately filled, dysmetria. We present a new way of filling this defect, which is not described in the current literature, using a trabecular titanium spacer block (indicated for revision of ankle arthrodesis of the hindfoot) together with retrograde intramedullary nailing, with promising results.

Total Hip Arthroplasty in Patients of Post Polio Residual Paralysis: A Retrospective Case Series.

BACKGROUND: Poliomyelitis is a viral, nervous system disease that affects both the upper and the lower extremities. The treatment of severe coxarthrosis in these patients with total hip arthroplasty (THA) has been widely questioned because of the high risk of subsequent complications. The aim of the present study was to describe both radiological and medium term clinical results in a series of patients with post polio residual paralysis that underwent THA. MATERIALS AND METHODS: We report a retrospective review of a series of 5 five patients diagnosed with severe coxarthrosis secondary to post polio residual paralysis who were operated between 2008 and 2012. Uncemented THA was performed in all cases by the same surgeon. Clinical evaluation was carried out using the Harris Hip Score (HHS) at the preoperative visit, at 6 months, and annually after surgery. RESULTS: The median age was 47 years, and the median followup was 55 months (interquartile range P25-P75: range 31-72 months). According to the HHS, a significant clinical improvement was observed in all patients with a median score of 81 points (interquartile range P25-P75: range 74-89) at 1 year of followup. A case of relapsing dislocation that required revision surgery of the implant was recorded. No cases of component loosening were found. CONCLUSION: THA surgery in patients with post polio residual paralysis is a complex procedure with a significant complication rate, but a predictable clinical improvement may encourage surgeons to perform in patients with severe coxarthrosis and moderate functional expectations.