Intra-articular angioleiomyoma of the knee: a case report.

We report a rare case of angioleiomyoma that occurred in the intra-articular portion of the knee joint. A 43-year-old female was referred to us with a 3-year history of recurrent pain and a loss of full extension of the right knee. Physical examinations revealed swelling and restriction of active full extension. Magnetic resonance imaging (MRI) revealed an intra-articular tumor. Surgical excision was performed, and the histology was characteristic of an angioleiomyoma. The patient became asymptomatic after the operation. At 2-year follow-up after the operation, no recurrence has developed.

Reconstruction of the lateral ankle ligaments with bone-patellar tendon graft in patients with chronic ankle instability: a preliminary report.

BACKGROUND: Unsatisfactory long-term results have been reported after use of a Broström repair for patients with chronic ankle ligament insufficiency. HYPOTHESIS: Repair or reconstruction of both the anterior talofibular and calcaneofibular ligaments is essential for normal kinematics of the ankle-hindfoot. STUDY DESIGN: Case series. METHODS: Thirteen patients with chronic instability of the ankle were found at operation to have injuries of both the anterior talofibular and calcaneofibular ligaments, with a lack of healthy ligament margins suitable for suturing. Reconstruction of the ligaments was performed with bone-patellar tendon graft. The score devised by Good et al. was used to assess the patients' clinical condition before the operation and at final follow-up. RESULTS: Before the operation, six patients had a grade 3 clinical condition and seven had a grade 4 condition. At a mean follow-up of 26.5 months, all patients had a grade 1 condition. The average talar tilt of the patients was improved from 18.4 degrees +/- 5.5 degrees to 4.9 degrees +/- 2.6 degrees, and the average anterior drawer sign was improved from 9.1 +/- 2.6 mm to 5.8 +/- 1.6 mm. CONCLUSION: In cases of combined injuries, short-term results of reconstruction of the anterior talofibular and calcaneofibular ligaments using bone-split patellar tendon graft were good, with a low frequency of complications.

Achilles tendon rupture associated with injury of the calcaneofibular ligament.

A 49-year-old man collided against an infielder when he slid into second base during a recreational baseball game. He was unable to continue in the game due to diffuse pain and swelling of his hindfoot. A rupture of the Achilles tendon was diagnosed incidentally on palpation and observation of a positive Thompson's squeeze test. Subcutaneous hemorrhage at the lateral aspect of the heel and a small bone fragment under the lateral malleolus on an anteroposterior plain radiograph indicated a fracture of the calcaneal wall. At surgery, a complete rupture of the Achilles tendon and an avulsion of the calcaneofibular ligament from the calcaneal wall were seen. Both injuries were surgically repaired, and the patient subsequently did well. The mechanism of injury was thought to be impact hyperdorsiflexion of the ankle with rupture of the Achilles tendon accompanied by an inversion injury. Using a literature search, it was found that this combination of injuries has not been previously reported.

Chondral injuries of the ankle with recurrent lateral instability: an arthroscopic study.

BACKGROUND: Prolonged lateral instability of the ankle after ligament injury has been believed to be a major cause of osteoarthritis of the ankle, yet the rate of development of osteoarthritis of the ankle is relatively low. Clarifying the relationship between patient factors and chondral damage of the ankle with prolonged instability is essential to identify the important risk factors underlying osteoarthritis of the ankle. METHODS: Arthroscopic examination was performed to assess the condition of the articular cartilage in a series of patients with prolonged lateral instability of the ankle. There were ninety-three patients with ninety-nine involved ankles. Their mean age was 28.7 years (range, fifteen to fifty-nine years). The relationships between the severity of the chondral damage and patient factors, the number and combination of torn ligaments, and mechanical instability and alignment of the ankle mortise were studied. RESULTS: Twenty-three ankles were classified as grade 0 (normal cartilage); thirty-five, as grade 1 (superficial softening, fibrillation, or fissuring of the cartilage); twenty-four, as grade 2 (a cartilage defect without exposure of the subchondral bone); and seventeen, as grade 3 (exposure of the subchondral bone). Patient age, the talar tilt angle, and varus inclination of the ankle plafond were significantly associated with more severe chondral changes. CONCLUSIONS: Patient age, the talar tilt angle, and varus inclination of the ankle are risk factors for severe chondral damage of the ankle in patients with a prolonged history of lateral ankle instability.

Regeneration of the hamstring tendons after harvesting for arthroscopic anterior cruciate ligament reconstruction: a histological study in 11 patients.

The purpose of our study is to evaluate whether the hamstring tendons can regrow after harvesting for anterior cruciate ligament (ACL) reconstruction and whether the regenerate tissue can be histologically characterized as tendinous. Eleven of the patients (eight female and three male; mean age, 23 years; range 17-37 years) consented to participate in this study. One year after the ACL reconstruction, surgical biopsy was done. Regeneration of the tendon was detected macroscopically in 9 of the 11 patients. Histologically and immunohistochemically, the regenerated tendons closely resembled normal ones. The results of this study show the hamstring tendons can regenerate after harvesting for the ACL reconstruction.

Premature failure of the polyethylene tibial bearing surface of the Interax knee arthroplasty.

Thirty-four patients (37 knees) were treated with the Interax knee arthroplasty. There were 31 female and 3 male patients with a mean age at surgery of 70 years (range, 53-84 years). Premature failure of the polyethylene tibial bearing surface occurred in 9 patients (9 knees). Eight patients of these required a revision operation because of early wearing out of the tibial surface 20 to 38 months after the operation. The failure was due to inadequate implant design in small component and polyethylene gamma irradiated in the air.

Glomus tumor of the lateral aspect of the knee joint.

BACKGROUND: We report a rare case of glomus tumor that occurred in the lateral joint of the knee. A 54-year-old man was referred to us with a 3-year history of lateral pain in the left knee and the diagnosis of lateral meniscus injury. Physical examination revealed a small trigger point localized just on the lateral joint space. Magnetic resonance imaging (MRI) showed a very small round mass in the subcutaneous tissue at the level of the lateral joint space. TREATMENT: Excisional biopsy was performed, and the histology was characteristic of a glomus tumor. The patient was asymptomatic immediately after the operation. At the 3-year follow-up after the operation, no recurrence was seen.

Tenosynovial osteochondromatosis of the tarsal tunnel.

A case of tenosynovial osteochondromatosis in the tarsal tunnel in a 23-year-old man is presented. The lesion was treated surgically, and multiple osteochondromas were excised, which had no continuity with any tarsal bone or joint cavity but did with the sheaths of the flexor digitorum longus and flexor hallucis longus. Histologic examination of the lesion showed a fibrous capsule, hyaline cartilage and extensive areas of cancellous bone. Necrosis and mitosis were absent in the hyaline cartilage and there were no synovial nodules indicative of synovial metaplasia. The macroscopic findings showed "end-stage" tenosynovial osteochondromatosis. There was no evidence of recurrence 5 years after operation, and the patient remains free of symptoms.

Intra-articular synovial hemangioma; a rare cause of knee pain and swelling.

INTRODUCTION: Synovial hemangioma is a rare intra-articular benign tumor that is difficult to diagnose because of its nonspecific symptoms. Patients are generally children or young adults with a nontraumatic recurrent swollen painful knee. CASE PRESENTATION: A 24-year-old woman presented with a 20-year history of recurrent pain and swelling in the right knee. Physical examination revealed a small painful point adjacent to the medial side of the patella. Magnetic resonance imaging revealed an intra-articular tumor. After arthroscopic examination, surgical excision was performed. The histology was characteristic of synovial hemangioma. RESULTS: Open complete synovectomy of the circumscribed capillary hemangioma was successful, and the patient remains asymptomatic 2 years after surgery.