Tratamiento artroscópico de pacientes con cuerpos libres articulares en la rodilla

Introducción: Existe escasa información en la literatura nacional sobre los cuerpos libres articulares en la articulación de la rodilla. Estos ocurren como consecuencia de lesiones traumáticas, degenerativas, inflamatorias e isquémicas. Objetivo: Actualizar los conocimientos en los aspectos más generales de los cuerpos libres articulares en la rodilla y de su tratamiento mediante la vía artroscópica. Método: La búsqueda y análisis de la información se realizó en un periodo de 59 días (1 de enero al 28 de febrero de 2023) y se emplearon las siguientes palabras: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 211 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline. Se empleó el gestor de búsqueda y administrador de referencias EndNote. Del total se utilizaron 33 contribuciones seleccionadas para realizar la revisión, 32 fueron de los últimos cinco años. Desarrollo: Se hace referencia al diagnóstico positivo basado en los antecedentes, cuadro clínico e imagenología. En relación al diagnóstico diferencial de esta entidad se hace especial énfasis con todas las afecciones que producen bloqueo articular. En específico, se revisan las lesiones de menisco, así como las clasificaciones más empleadas según tamaño, origen, cantidad y movilidad. En relación al tratamiento artroscópico se describen las cuatro etapas que consisten en: identificación, atrapamiento, extracción y revisión. Consideraciones finales: La vía artroscópica por sus múltiples ventajas representa la modalidad quirúrgica más efectiva para el diagnóstico y tratamiento de pacientes con cuerpos libres articulares de la rodilla.

Introduction: Currently, there is a lack of information in the national literature concerning joint loose bodies in the knee joint. These occur as a consequence of traumatic, degenerative, inflammatory and ischemic injuries. Objective: To update knowledge on the most general aspects concerning joint loose bodies in the knee and the use of the arthroscopy procedure on its treatment. Method: Search and analysis of the information was performed on 59 days (January 1 to February 28, 2023) and the following keywords were used: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Based on the information obtained, a bibliographic review was made of a total of 211 articles published in the PubMed, Hinari, SciELO and Medline databases. The EndNote search manager and reference manager was used. Of the total of articles, 33 contributions selected for the review were used, 32 were published the last five years. Development: It was refered in the study on the positive diagnosis based on the history, clinical picture and imaging. In relation to the differential diagnosis of this entity, special emphasis is made up with all the conditions that produce joint blockage. Specifically, meniscal lesions are reviewed, as well as the most commonly used classifications according to size, origin, quantity and mobility. In relation to the arthroscopic treatment, the following four stages were described: identification, trapping, extraction and revision. Final considerations: The arthroscopic approach, due to its multiple advantages, represents the most effective surgical modality for the diagnosis and treatment of patients with joint loose bodies in the knee.

Introdução: Há poucas informações na literatura nacional sobre corpos articulares livres na articulação do joelho. Ocorrem como consequência de lesões traumáticas, degenerativas, inflamatórias e isquêmicas. Objetivo: Atualizar o conhecimento nos aspectos mais gerais dos corpos livres articulares no joelho e seu tratamento por via artroscópica. Método: A busca e análise das informações foi realizada em um período de 59 dias (1º de janeiro a 28 de fevereiro de 2023) e foram utilizadas as seguintes palavras: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Com base nas informações obtidas, foi realizada revisão bibliográfica de um total de 211 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline. O mecanismo de busca EndNote e o gerenciador de referências foram usados. Do total, 33 contribuições selecionadas foram utilizadas para realizar a revisão, sendo 32 dos últimos cinco anos. Desenvolvimento: Refere-se ao diagnóstico positivo baseado na história, quadro clínico e imagiologia. Em relação ao diagnóstico diferencial desta entidade, é dada especial ênfase a todas as condições que causam bloqueio articular. Especificamente, são revisadas as lesões meniscais, assim como as classificações mais utilizadas quanto ao tamanho, origem, quantidade e mobilidade. Em relação ao tratamento artroscópico, são descritas as quatro etapas, que consistem em: identificação, encarceramento, extração e revisão. Considerações finais: A abordagem artroscópica, por suas múltiplas vantagens, representa a modalidade cirúrgica mais eficaz para o diagnóstico e tratamento de pacientes com corpos livres articulares do joelho.

Excision of 93 loose bodies of synovial osteochondromatosis in the left ankle: a case report

Primary synovial osteochondromatosis is an uncommon benign joint disorder characterized by the formation of cartilaginous bodies within the synovial of the different joints, tendon sheaths, and bursae. Loose bodies occur in the late stage of the disease. Excision of loose bodies is needed to treat synovial osteochondromatosis. A 20-year-old female patient presented to us with a chief complaint of pain, swelling, and discomfort sensation in the left ankle while walking. Plain X-ray on her left ankle showed loose bodies surrounding the ankle. We performed excision to remove the loose bodies. Histological examination confirmed the diagnosis. The range of motion (ROM) of the ankle increased after surgery. The patient was able to walk more comfortably. Synovial osteochondromatosis is considered benign. In this case, open excision was chosen because the ankle joint is not amenable to arthroscopy. Follow up is needed to detect early recurrence and transformation of malignancy.

Tratamento artroscópico da condromatose sinovial do ombro: relato de caso / Arthroscopic treatment of synovial chondromatosis of the shoulder: a case report

Os autores descrevem caso raro de condromatose sinovial do ombro e seu tratamento cirúrgico. A artroscopia possibilitou a visualização de todos os compartimentos da articulação glenoumeral, permitindo a remoção dos corpos livres e realização da sinovectomia.

The authors describe a rare case of synovial chondromatosis of the shoulder and its surgical treatment. Arthroscopy enabled the visualization of all compartment of the glenohumeral joint, and allowed the removal of free bodies and the performance of a synovectomy.

Arthroscopic Removal of the Intraarticular Fracture Fragment after Internal Fixation of Acetabular Fracture: A Case Report

Osteochondral fragements incarcerated in the hip joint during fracture-dislocation have been reported to be the cause of posttraumatic arthritis, and open reduction of the fracture or removal of the fragments during surgery is recommended. Locking symptoms developed during hip joint movement in a patient with a history of hip joint fracture-dislocation (Thompson and Epstein (T-E) type III) after undergoing internal fixation of the acetabular fracture. Computer tomographic (CT) scan revealed a bony fragment impinging on the acetabular weight-bearing portion. This bony fragment was removed using hip arthroscopy. We recommend that CT evaluation be performed after surgery for acetabular fractures. We also recommend arthroscopic removal as a treatment option for posttraumatic loose bodies in the hip joint.

Arthroscopy diagnosis and removal of loose bodies in the posterior compartments of the knee with osteoarthritis / 中华骨科杂志

Objective To report the method and outcomes ot arthroscopic examination and removal of the.loose bodies from the posterior compartments of the knee. Methods Four mm 30? arthroscope was used to examine the patients with osteoarthritic loose body in the politeal fossa on the preoperative roentgenograms via posterolateral and posteromedial portals. An assistant portal at 1 - 1.5 cm in front of the standard portals was made, and loose bodies were removed arthroscopically. Postoperative algesia on the leg and foot, active flexion and extension of the malleolus, toe and phalanxes, and the lateral stress test of the knee were observed. Results Of the three hundred and sixty-four cases undergone knee arthroscopy during January 1999 to December 2000, 17 case had osteoarthritis and loose bodies in the posterior compartment on the roentgenograms. Loose bodies were found in the posterolateral portal in 9 cases, which were removed arthroscopically. Howerver, no loose body was found via the posteromedial portal. The mean duration of follow-up was 14. 88 months. Except one case with subcutaneous loose body was overlooked and one patient developed hematoma, there was no neurovascular or ligamentous complications. Conclusion It is safe and possible to use 4 mm 30? arthroscope to examine the posterior compartments of the knee and to remove loose bodies.

MRI observation of migration paths of disk fragment in the anterior epidural space / 中华放射学杂志

Objective To observe the migration paths of disk fragment in the anterior epidural space (AES). Methods Eighteen operation-proved cases with herniated nucleus pulposus of lumbar disk were collected and the MR findings were retrospectively reviewed. Results The disk fragments moved in a superior (12 cases,67%) or inferior (6 cases,33%) direction from the donor disk. 10 cases occurred in right septum and 8 cases in left septum. The displaced disk components were most frequently dislodged into the right or left AES, and rarely straddled the midline. On sagittal T 2WI, fragments exhibited low or intermediate signal intensity and compressed the dura mater of spinal cord. On T 1WI, fragments exhibited intermediate signal intensity and compressed the PLL and the spinal cord. On axial T 2WI, fragments exhibited compression of the PLL, the midline septum, and the dura mater of spinal cord. On fat-suppression scan, fragments exhibited increased signal intensity. Conclusion The migrating path of a disk fragment is determined by the anatomy of the AES. Fat-suppression scan has a clinical diagnostic significance.

Arthroscopic Removal of Loose Bodies from the posterior Knee Compartment using Direct Posterior - Posterior Triangulation

PURPOSE: To report the advantages and the results of arthroscopic removal of loose bodies by posteri-or-posterior triangulation, using the posteromedial and posteroleteral portal. MATERIALS AND METHODS: Sixteen cases in this study had loose bodies in the posterior compartment of the knee joint; nine cases in the posteromediaI, three cases in the posterolateral and four cases in the both compartments. Under the supine position, the knee is flexed to a 90 angle, and an obturator was inserted in the posterolateral compartment through the fat areolar tissue eliminating the loose bodies in the posterior compartment. RESULT: In sixteen cases we eliminated all loose bodies under arthroscopy which were in the posterior compartment of the knee joint and there was no complication such as saphenous nerve palsy, common peroneal nerve palsy, or the rupture of popliteal artery. CONCLUSION: Arthroscopic removal of loose body in the posterior compartment of the knee joint using posterior-posterior triangulation was considered as one of the useful methods in terms of safety and good visualization.

The Removal of Loose Bodies from the Knee Under Arthroscopic Control / 대한정형외과학회잡지

We studied retrospectively twenty-nine operations for removal of loose bodies from the knee under arthroscopic control from August, 1982 to Mach, 1985. We succed to remove loose bodies arthroscopically in 24 knees, but failed in 5 knees. The loose bodies were not visible radiologically in 12knees, and more than one loose body was present in 10 knees. The loose bodies, above Smm in diameter among the removed, were forty three; their mean diameter was 7.5mm and the most large one was 35 mm in diameter. The loose bodies were found most commonly from intercondylar notch area and the most common associated internal derangements was meniscal injury. The mean time for return to work was 2.5weeks(range 1 to 4.5weeks). The operation required considerable arthroscopic expertise and could be technically more exacting than other artroscopic procedures. After average two years and four months follow-up(range one year and five months to three years and eleven months), pain on knee joint was remained in five patients who had taken other associated derangement in same knee, but the patients who had loose bodies in knee joint as only problems were cured completely to normal knee joint function.

Clinical analysis of 12 cases of primary synovial chondromatosis of hip joint / 解放军医学杂志

Objective To study the clinical, imageological and pathologic characters of primary synovial chondromatosis of hip joint, and effect of open surgery. Method 12 cases of primary synovial chondromatosis of the hip joints admitted from May 1973 to May 2004 were retrospectively studied in respect to clinical manifestations, X-ray picture, and pathological findings. The effects of operation were followed up. Results Intermittent pain, swelling, limitation of hip joints were the main complaints. Mass and myatrophy near involved hip joint were discernible in a few patients. Although there was no obvious image of calcification, swelling of articular capsule was seen in X-ray film in 4 patients. CT scan showed arthroedema, loose bodies and bone erosion of the femoral head in the hip joint. The X-ray films of the other 8 patients showed obvious calcified loose bodies. All cases were diagnosed by pathology after operations. 8 cases were categorized Milgram Ⅱstage, and 4 cases Milgram Ⅲ stage. Eight patients were followed-up for a period of 1 to 7 years (mean 5 years). Recurrence occurred in 2 cases. Conclusion The diagnosis should be based on clinical characters, X-ray films and pathologic findings, and the pathology is most reliable. In order to decrease recurrence, CT or MRI examinations should be taken before the operation. X-ray monitoring should be carried out during the operation of the patient in whom loose bodies were found in X-ray film before the operation.