Endoscopic release of the median nerve in the proximal third of the forearm. A new approach. / Liberación endoscópica del nervio mediano en el tercio proximal del antebrazo. Nuevo abordaje.

INTRODUCTION: Pronator syndrome has classically required open surgery that leaves a large scar; initial endoscopic techniques required approaches of an average 4cm without achieving release of all structures. The purpose of this study was to describe a new endoscopic approach that allows the median nerve to be safely and completely decompressed, leaving a smaller and less visible scar. METHODS: Description of a new approach for decompression of the median nerve in the proximal third of the forearm with minimal incision and endoscopic technique in cryopreserved cadaveric specimens, describing incision, endoscopic anatomy, safe corridors and decompression sites. RESULTS: In 20 elbows of cadavers, an endoscopic approach of the median nerve in the proximal forearm with a 4mm endoscope and 0° of angulation was performed. The advantages and limitations of the technique and surgical details are presented for release in the most common compression points of the nerve in the forearm. We performed this technique in 3 patients with good results without complications. DISCUSSION: Release of the median nerve and section of potential aponeurotic compression structures by endoscopy is possible. The ulnar head of the pronator and the aponeurotic arch of the flexor digitorum superficialis are frequently implicated in the syndrome. The scar is aesthetically good. It is a relatively new technique, with lower morbidity that allows faster recovery of patients. CONCLUSIONS: It is possible to perform a complete decompression of the median nerve in the forearm using an endoscopic approach, safely with lower comorbidity for the patient.

Complications associated with the techniques for anterior cruciate ligament reconstruction in patients under 18 years old: a systematic review. / Complicaciones asociadas a las diferentes técnicas de reconstrucción del ligamento cruzado anterior en menores de 18 años: Revisión sistemática.

OBJECTIVE: Determine the complications related to the different techniques for anterior cruciate ligament reconstruction in patients under 18 years old. METHODOLOGY: Systematic review using the databases Medline, Cochrane Database of Systematic Reviews and Embase (until July 2016), additional studies were included conducting a search of the references of previous studies. The terms included in the search were: «cruciate¼, «ligament¼, «anterior¼, «immature¼, «complications¼, «outcome¼, «acl reconstruction¼,« cruciate ligament anterior reconstruction¼, «children¼, «child¼, «infants¼, «adolescent¼, «open physis¼, «growth plate¼ and «skeletally immature¼. RESULTS: A number of 73 studies were included; 1300 patients in total, average age 13 years, 70% were male, medial and lateral meniscal lesions in 26% and 30% respectively. Eleven cases of length discrepancy (0,8%): 4 cases were presented with physeal-sparing techniques (1,4%), 3 cases with partial physeal-sparing techniques (2.2%) and 4 cases were presented with transphyseal techniques (0.4%). There were 22 cases of axis deviation: 6 cases with physeal-sparing techniques (2%), 3 cases with partial physeal-sparing techniques and 13 cases with transphyseal techniques (1.4%). The use of allograft achilles tendon allograft and fascia lata was associated with increased length discrepancy and axis deviation (25%). There was no difference according to Tanner. CONCLUSIONS: The different anterior cruciate ligament reconstruction techniques in patients under 18 years old had low complications related to lower limb growth, arthrofibrosis and review. There was a higher percentage of cases of length discrepancy and axis deviation with physeal-sparing techniques than with the other surgical techniques. The evidence level studies cannot determine causality.