Ultrasound-Guided Treatment of Extrusive Medial Meniscopathy: A 3-Step Protocol.

Medial knee pain is commonplace in clinical practice and can be related to several pathologic conditions: ie, medial plica syndrome, saphenous nerve entrapment, pes anserine syndrome, medial collateral ligament injury, and medial meniscus disorders. Ultrasound (US) imaging represents a valuable first-line diagnostic approach to adequately visualize the superficial structures in the medial compartment of the knee to easily plan for prompt treatment. Currently, the management of chronic degenerative diseases involving the menisci, and causing their extrusion, consists of surgery (arthroscopic partial meniscectomy). This procedure often allows only a partial resolution of pain and functional impairment. In the pertinent literature, US-guided interventions for the medial meniscus are proposed, mainly to decrease pain and inflammation or to induce regeneration. Likewise, this Technical Innovation describes in detail the US findings of medial extrusive meniscopathy and also illustrates a novel US-guided technique to treat the bursa of the medial collateral ligament, the extruded fragment of the medial meniscus, and the synovial parameniscal recesses simultaneously.

Treatment of a calcific bursitis of the medial collateral ligament: a rare cause of painful knee.

Medial knee pain is common in clinical practice and can be caused by various conditions. In rare cases, it can even be by calcific bursitis of the medial collateral ligament (MCL). Treatment of calcific bursitis and/or calcification of the MCL classically includes observation, local injections, shockwave therapy and surgical resection. We report a case of nontraumatic medial knee pain poorly responsive to conservative treatments. Ultrasound (US) imaging revealed a massive lobed hyperechoic formation with partial acoustic shadow in the MCL context compatible with calcific bursitis, and magnetic resonance imaging (MRI) confirmed the presence of the bursa's calcific deposit surrounded by hyperintense signal compatible with pericalcific edema. We performed a double-needle ultrasound-guided percutaneous lavage (UGPL), which is today a fairly common treatment for many musculoskeletal disorders, such as rotator cuff calcific tendinopathy and elbow extensor tendons pathology, but regarding the knee, it is not part of ordinary care. This report shows the clinical and imaging presentation of calcific bursitis of the MCL and describes in detail the technique to perform the UGPL with a system of two needles, two syringes and a double connection to ensure a correct lavage of the calcium deposit without significant intrabursal pressure increase and consequently without pain during the procedure.

Rehabilitation Complexity Scale: Italian translation and transcultural validation.

PURPOSE: The aim of the present study was translation, cultural adaption and validation of the extended version 12 of the Rehabilitation Complexity Scale (RCS-E) in a sample of patients with stroke and total hip replacement. METHOD: The cross-cultural validation required RCS-E forward-backward translation, revision by an expert committee and its application in an Intensive Rehabilitation setting through a retrospective collection of data from clinical records. The evaluation of the psychometric properties was carried out by analyzing the correlations between RCS-E score and other measures (Functional Independence Measure, Braden, Morse, Cumulative Illness Rating Scale) and the assessment of reliability in terms of reproducibility (inter-observer agreement) and repeatability (intra-observer agreement). RESULTS: The backward and forward processes of translation of the scale did not create problems of interpretation of terms. Some adaptation was required for the items nursing (N), medical care (M) and therapeutic intensity (TI) due to differences on the national health system structure. The Italian version of the scale proved to be valid, reliable with high reproducibility and repeatability. CONCLUSIONS: The Italian version RCS-E has been successfully validated, showing good psychometric properties, which partly reproduce the results obtained for the original version. However, some assumption was made for some items thus preventing possible comparison with other countries. IMPLICATIONS FOR REHABILITATION: Admittance at an Intensive Rehabilitation care setting in Italy requires to evaluate the complexity of rehabilitation needs. The Rehabilitation Complexity Scale (RCS-E) has proved to be reliable for assessing clinical complexity and consequently for planning rehabilitation needs. The Italian version of RCS-E has been successfully validated, showing good psychometric properties, which reproduce the results obtained for the original version. The items included in the therapy intensity subscale do not fit the Italian health system rules for intensity of rehabilitation care and needs adaptation.