Osteocondromatosis sinovial de rodilla: una causa infrecuente de gonalgia en edad pediátrica / Synovial chondromatosis of the knee. A rare cause of knee pain in pediatric age

La osteocondromatosis sinovial es una metaplasia benigna de la membrana sinovial que afecta a 1 de cada 100 000 personas, en su mayoría adultos, y es extremadamente infrecuente en edad pediátrica. Predomina en grandes articulaciones, sobre todo la rodilla, y la sintomatología es, por lo general, inespecífica. Dado que la radiografía simple no suele ser concluyente, se recurre a la resonancia magnética nuclear y a la tomografía axial computarizada para orientar el diagnóstico. Se expone el caso de una paciente de 10 años de edad con gonalgia y dismorfia en la patela izquierda de seis meses de evolución, con diagnóstico de osteocondromatosis sinovial. Se presenta el caso dado que se trata de una entidad muy rara en niños, pero que requiere un tratamiento quirúrgico precoz para evitar sus posibles complicaciones, como la destrucción articular progresiva o la malignización a condrosarcoma.

Synovial osteochondromatosis consists of a synovial metaplasia which affects 1 per 100 000 people. It is a very rare disease among children. It typically affects large joints of the body, especially the knee. Due to the lack of specificity of the signs and symptoms and X-Ray images, imaging tests such as nuclear magnetic resonance or computerized tomography are frequently needed for diagnosis.We report a case of a ten-year-old female patient with a six months history of pain and deformity of left patella which was diagnosed with synovial osteochondromatosis. This case highlights the importance of clinical suspicion, not only because it is an extremely rare disease in children, but also because it needs a surgical treatment as soon as possible in order to avoid consequences it might have in pediatric age, as joint destruction or malignization to chondrosarcoma.

Osteotomía de apertura anterior de tibia bilateral en recurvatum de rodilla: a propósito de un caso / Anterior tibial osteotomy in bilateral knee recurvatum. Case report

En los recurvatum de rodilla, existen varios métodos de corrección, la osteotomía descripta por Brett y Lexer E. modificada es una opción para su tratamiento. El objetivo de este trabajo es describir la técnica como una solución para los recurvatum de rodilla tibiales y mostrar la evolución de un caso clínico. El paciente presentaba un recurvatum bilateral de rodilla de origen tibial idiopático, con valores angulares de 26 grados a derecha y 20 grados a izquierda de ángulo diafiso-epifisario. Con el objetivo de corregir la deformación para calmar el dolor de características mecánicas por sobrecarga articular y evitar la pérdida del equilibrio articular, se decidió realizar esta técnica. Las cirugías fueron realizadas comenzando con la derecha y un año y medio después la rodilla izquierda. Para la rodilla derecha se logró corregir la deformidad llevando el platillo tibial de 26° de inclinación anterior a 6°. En cuanto a la rodilla izquierda de 20° se corrigió a 0°. Resulta una técnica reproducible, que soluciona los recurvatum de origen tibial epifiso-metafisarios, que no altera la biomecánica del aparato extensor como otras osteotomías. Esta técnica no permite corregir las deformidades diafisarias. Creemos que es una de las mejores opciones para la corrección del recurvatum, que a pesar de no lograr corrección total de la alteración ósea, mejora la función de la rodilla y la sintomatología, sin alterar la mecánica del aparato extensor.

In the knee recurvatum, there are several methods of correction osteotomy, the modified Brett and Lexer E. osteotomy is an option for this type of pathology. The aim of this paper is to describe the technique as a solution to the tibial recurvatum and show the outcome of a case. The patient had a bilateral tibial idiopathic knee recurvatum, with angular values of 26 degrees right and 20 degrees left of diafiso-epiphyseal angle. In order to correct the deformation and release pain secondary to mechanical overload and prevent loss of articular balance, we decided to perform this technique. The surgeries were performed first the right and a year and a half after his left knee. His right knee, we managed to correct the tibial plateau deformity from 26° of anterior tilt, to 6°. As for the left knee was corrected from 20° to 0°. It is a reproducible technique that solves tibial epiphyseal-metaphyseal origin recurvatum, which does not alter the biomechanics of the extensor mechanism as other osteotomies. This technique does not allow correction of diaphyseal deformities. We believe it is one of the best options for the correction of recurvatum, which despite not achieveing full correction of bone alteration improves knee function and symptoms without altering the extensor mechanism.

Efficacy of adhesive taping in controlling genu recurvatum in diplegic children: a pilot study

Adhesive taping has been commonly used to improve the performance through supporting joint structure and reducing pain. Restoring knee alignment in diplegic children is critical in an effective treatment program. The purpose of this article is to investigate whether adhesive taping is effective in controlling genu recurvatum in diplegic cerebral palsy children. Fourteen children with diplegic cerebral palsy [8 boys and 6 girls with a mean age of 6.22 years], participated in a 12-week program. Children were assigned randomly to one of two groups: therapeutic taping + physical therapy or knee cage + physical therapy. Therapeutic taping was applied for periods of up to 60 h over knee. The effects were assessed with the Gross Motor Function Measure [GMFM-88], Auto CAD, Screen protractor at baseline and 12 weeks after treatment. The primary outcome measure was knee angulations, using Auto CAD and screen protractor software. The Gross Motor Function Measure-88 [GMFM-88] standing and walking subsections were the secondary outcome measures. No significant differences were found between groups over time. Adhesive taping does not evoke a positive change in controlling genu recurvatum in children with diplegic cerebral palsy

Calcification of the lateral collateral ligament of the knee: a rare cause of acute knee pain

Calcification of the lateral collateral ligament is a rare phenomenon, which can cause acute knee pain. The management is usually conservative and there is subsequent resolution of the calcification seen on initial radiographs. It is important to exclude more sinister pathology such as septic arthritis as a cause of pain. We report the case of an elderly lady who presented with acute knee pain. Initial radiographs showed calcification at the lateral aspect of the knee joint. The pain settled with conservative management. Resorption of calcification was demonstrated on subsequent radiographs

Treatment of Popliteal Pterygium Using an Ilizarov External Fixator

Popliteal pterygium syndrome is a rare congenital disorder that consists of popliteal webs and craniofacial, genitourinary and extremity anomalies. Only moderate successful surgical excision of the fibrotic band within the popliteal web has been reported because the nerves and vessels in the affected site are short and displaced into the web and they are attached to adjacent tissues. We performed hamstring tenotomy on the ischial tuberosity, tenotomy of the flexor hallucis longus and Z-lengthening of the Achilles tendon on the ankle in our patient, and this was followed by gradual correction using an Ilizarov external fixator. Full extension of the knee joint was achieved at the ninth postoperative week. However, some recurrence of flexion contracture was noted at two years follow-up. Gradual soft tissue lengthening with an Ilizarov external fixator can be one of the optimal procedures when excision of a fibrous band and Z-plasty are not possible due to severe adhesion of the nerves and vessels into a fibrotic band. However, a cautious approach is recommended when considering the high risk of recurrence.

Genu valgo idiopatico: tratamiento quirurgico en niños y adolescentes / Idiopathic genu valgum: surgical treatment in late childhood and adolescence

Introduccion: Las deformidades en valgo de los miembrosinferiores en niños y adolescentes son un motivo frecuente de consulta en la practica ortopedica. Tienden a considerarse propias de la evolucion regional con el crecimiento y por ello a ser subestimadas. Algunas constituyen una entidad patologica que requiere una minuciosa valoracion de magnitud y evolutividad y pueden ocasionar no solo alteraciones esteticas sino funcionales, por lo cual necesitan un tratamiento específico. Materiales y metodos: Se estudiaron 29 pacientes (58 rodillas) con genu valgo idiopatico tratados quirurgicamente antes de la finalizacion del crecimiento. Se realizo arresto epifisario femoral medial distal (AEFMD) basado en la tecnica de Blount. La indicacion se adopta según la presencia de dolor o dificultad para la marcha, razones esteticas-deformidad o como profilaxis de alteraciones secundarias en la edad adulta. Resultados: Basados en la ausencia de dolor de rodilla, mejoria de la deambulacion, ausencia de mialgias y correccion del deseje en valgo los resultados fueron excelentes y buenos en todos los casos.Conclusiones: El arresto epifisario femoral medial distales un metodo quirurgico adecuado para corregir deformidades en valgo en niños y adolescentes con cartilago de crecimiento permeable. Actua sobre el eje central del problema, es de facil realizacion, poco cruento, no requiere inmovilizacion y permite un pronto retorno a las tareas habituales.

Correction of genu recurvatum in poliomylitis by the ilizarov method

Mild Genu Recurvatum can cause some disability, but when quadriceps is severely weakened as in poliomyelitis, such a deformity is desirable. However severe genu recurvatum is significantly disabling. The Ilizarov apparatus was used to correct genu recurvatum in eight patients suffering from poliomyelitis using our new technique of pate liar block of the proximal tibia. In six cases, the genu recurvatum was entirely due to capsuloligamentous stretching resulting in posterior translation of the tibia whereas in two cases it was associated with osseous deformity. Preoperatively, the angle of recurvatum averaged 33.8° [23 to 42]. The average duration of external fixation was 4.8 month [3 to 7]. At the last follow-up, all patients, except one, had achieved an excellent or good radiological and functional outcome. Three patients suffered complications including, pin-track infection and Knee stiffness. Our results indicate that the Ilizarov apparatus is an effective tool for managing the deformity of Capsuloligamentous Genu recurvatum, with or without shortening

[ effect of trans-cutaneous electrical nerve stimulation [TENS] on range of motion and morning stiffness of knee joint on patient with knee osteoarthritis]

Osteoarthritis is the most prevalent human joint disease and knee joint is the most common joint, which is affected in the disease. The most common signs of this disease are reducing of motion range and morning stiffness of knee joint. Therefore, this study was conducted to assess the effect of TENS technique, as a non-pharmacological therapy, on range of motion and morning stiffness of knee joint on patients with knee osteoarthritis. In this quasi-experimental and single blind study, a total of 57 patients with knee osteoarthritis who referred to Imam Khomeini hospital in Tehran in 2005 were randomly divided into two groups of case [29] and control [28]. TENS technique [110 Htz] was administered to the case group for 4 weeks [3 times a week for 20 minutes]. Then, range of motion and morning stiffness of knee joint measured in different times during the intervention in this group. The same situation was used for the control but with turn-off system [Placebo]. Range of motion and morning stiffness of knee joint was measured in the two groups in the first season [beginning], sixth session and at the end of study. Data were analyzed using analysis of variance, KV, and t tests. The mean of motion range in the case group was 82.2 +/- 2.26 before intervention, and increased to 89.7 +/- 3.07 and 117 +/- 4.5 at the sixth session and at the end of intervention, respectively [p<0.001]. In the control group, the mean of this parameter in different times of intervention was not significant. Moreover, in the two groups, there was not significant difference in joint morning stiffness in different times of intervention. Based on the results, TENS technique affects remarkably on range of motion with no effect on morning stiffness of knee joint in patients with osteoarthritis. Thus, this method would increase range of knee motion in patients with osteoarthritis

Management of chondral and osteochondral defects of the knee using osteochondral autograft transplantation

Evaluate the treatment of Chondral and Osteochondral defects of the femoral condyles of the knee using ipsilateral osteochondral autograft transplantation. This work was done at Ain Shams university hospitals, between 2003 and 2005. Eleven patients were submitted in this work aging between 20 and 53 years with lesions varying between an articular cartilage lesion and lesions involving cartilage and subchondral bone. They were treated using Osteochondral autograft transplantation [open technique]. Cases with malalignment, ligamentous instability; arthritic or mentally unreliable were excluded. Cases were evaluated 6 months following surgery using the HSS [Hospital of Special Surgery] scoring system. Ten out of eleven patients had a score ranging from excellent to good as they noted considerable improvement in symptoms especially concerning pain. Only one patient had a poor score. On the basis of these encouraging results, I believe that Mosaicplasty may be a good alternative for the treatment of localized chondral and Osteochondral defects

Efectividad del tratamiento termal en pacientes con gonoartrosis. Atención de enfermería / Effectiveness of the thermal treatment in patients with gonoarthosis. Nursing care

La balneología es una de las ramas más antiguas de la medicina, la cual fue desarrollada por los romanos durante milenios, para lo cual crearon las bases científicas de estos tratamientos. Se realizó una investigación retrospectiva y longitudinal en 30 pacientes con gonoartrosis en el Balneario de San Diego de los Baños, con el objetivo de demostrar la efectividad del tratamiento y relacionar la atención de enfermería; a dichos pacientes se les entrevistó y revisaron sus historias clínicas, recogiendo las siguientes variables: edad sexo, signos y síntomas, uso de rodillera y bastón, tratamiento y efectivad de éstos, datos tabulados por el método de palotes para su mejor comprensión, y se concluyó que en la mayoría de los pacientes predominó el dolor y la limitación articular, así como la efectividad del tratamiento termal complementado con tratamiento fisioterapéutico, y que es significativa la atención de enfermería en estos pacientes(AU)

Balneology is one of the most ancient medicine branches which was developed by the Romans for millennia and for which they created the scientific basis of these treatments. A retrospective longitudinal study was made on 30 patients with gonoarthrosis in San Diego de los Baños spa, with the aim of showing the effectiveness of the treatment and the nursing care. These patients were interviewed and their medical histories were reviewed taking into account the following variables: age, sex, signs and symptoms, use of knee guard and walking stick, kinds of treatments and effectiveness, etc. Data were tabulated by the downstroke method (método de palotes) for a better understanding. It was concluded that pain and joint restriction predominated in most patients, thermal treatment supplemented with physiotherapy was effective and that care given by nurses to these patients was significant(AU)

Aplicaçäo do método Ilizarov na correçäo das deformidades em flexäo do joelho / The use of Ilizarov technique to correct knee flexion

Foram estudados 32 pacientes portadores de 34 deformidades em flexao do velho de etiologia variada, todas acima de 40 graus, tratadas pelo método de ILIZAROV. A montagem utilizada consta de um bloco femoral composto por um semi-arco proximal e um anel distal e um bloco tibial composto por dois anéis, sendo um proximal e um distal. A conexao entre eles é realizada por meio de duas dobradiças, as quais sao posicionadas na regiao anterior do joelho e duas barras distratoras posteriores. O tempo médio de uso do aparelho foi de 6 meses e 3 dias. 1 tempo de seguimento foi em média de 67 meses e 3 dias. Dentre as etiologias a mais freqüente foi a traumática (32 por cento). A limitaçao da extensao da articulaçao do joelho foi. em média de 70,2 graus com um mínimo de 40 a um máximo de 110 graus. O arco de movimento no pré-operatório estava em média de 43,4 graus sendo que após o tratamento efetuado houve melhora do arco de movimento para 60,7 graus. A complicaçao mais grave foi a anquilose articular, encontrada em 83,3 por cento dos pacientes que apresentavam etiologia infecciosa da deformidade. A avaliaçao dos resultados foi baseada nos critérios de BONGIOVANNI et. ai (19971. Foram avaliadas: a limitaçao da extensao do joelho, o arco de movimento da articulaçao e a presença de dor. Obtivemos excelentes resultados em 23,5 por cento, bons resultados em 26,5 por cento, regulares em 11,8 por cento e resultados ruins em 38,2 por cento. Concluímos que o método de Ilizarov consiste num valioso método de tratamento para as deformidades em flexao do joelho maiores que 40 graus, com baixo índice de complicaçoes desde que seja aplicado seguindo-se rigorosamente a técnica recomendada

Análisis Biomécanico del ligamento cruzado anterior y del efecto de la rotación del injerto hueso-tendón patelar-hueso

Realizamos un estudio en 46 rodillas de cadáveres descibiendo las características morfológicas y biomecánicas del ligamento cruzado anterior y del injerto hueso-tendón patelar-hueso y realizando un análisis comparativo del efecto que sobre las propiedades mecánicas presenta la rotación de 90 grados sobre su eje. Como resultado se encontró una tensión del ligamento cruzado anterior y del injerto menor a lo reportado en estudios biomecánicas similares, probablemente atribuibles a las características de nuestra población y finalmente se encontró un aumento estadísticamente significativo en términos de resistencia y tensión mediante la rotación del injerto

Fijación proximal con botón interior ®Endo-boton¼ en la reconstrucción del ligamento cruzado anterior

El presente estudio pretende evaluar biomecánica y clínicamente el botón interior, fabricado en nuestro medio, como alternativa de fijación a nivel femoral en la reconstrucción y revisión del ligamento cruzado anterior. Experimentalmente se toman 20 injertos de tendón rotuliano de cadáver fresco y se prepara un sistema ®injerto-sutura-botón interior¼ que se somete a tensión progresiva hasta su ruptura, encontrando una resistencia máxima de 343 Newtons en los sistemas rotados 90§. Entre abril 1995 y abril 1997 se intervienen 45 pacientes por insuficiencia del LCA con edad promedio 30.4 años evaluados pre y post-op con los test de Lisholm, Cincinnaty e IKDC, se encontraron luego de 25,9 meses de seguimineto resultados excelentes y buenos en el 90 por ciento y regulares y malos en el 10 por ciento. Se concluye que el botón interior en una alternativa segura y confiable que permite obviar potenciales desventajas de otros dispositivos de fijación proximal del injerto que reemplaza el LCA

Reconstrucción del ligamento cruzado anterior en esqueleto inmaduro

Se realizó u estudio experimental en caninos con el fin de comparar las alteraciones histológicas y clínicas con dos técnicas de reconstucción del ligamento cruzado anterior (LCA) en esqueleto inmaduro. Fueron intervenidos 16 perros criollos entre 2 y 3 meses de edad. Luego de la resección completa del LCA, éste fue reconstruido con autoinjerto de fascia lata. Los perros se dividieron en 2 grupos de estudio de 8 cada uno. En el grupo (A) el LCA fue reconstruido con el paso del autoinjerto de fascia lata a través del túneles transfisiarios, mientras en el grupo (B) se realizó la técnica ®sobre el cóndilo¼ sin túneles transfisiarios. 4 perros de cada grupo se sacrificaron a las 6 y 12 semanas de cirugía. Se realizó un análisis histomorfométrico midiendo el espesor fisiario, la presencia o no de puentes óseos y la pérdida del patrón celular en la fisis. Estos parámetros fueron comparados con sus controles contralaterales. La longitud de fémur, tibia y extremidad total fue medida y comparada con los controles contralaterales a las 6 y 12 semanas de cirugía. Los resultados fueron comparados por un análisis pareado T-test y un análisis de varianza de 2 vías, como tambien los resultados normalizados comparando las diferencias entre las exptremidades intervenidas y sus controles. El promedio de reducción en el espesor fisiario entre la 6a y 12a semanas fue significativamente mayor en los especímenes operados con túneles transfisiarios, sugiriendo un efecto inductor del cierre fisiario. El promedio de reducción del cierre fisiario fue menor en las extremidades intervenidas con la técnica ®sobre el cóndilo¼ al compararlas con sus controles, sugiriendo un efecto inhibitorio en el cierre fisiario, debido probablemente a un efecto externo sobre la fisis. Tanto en las tibias con técnica ®sobre el cóndilo¼ como en las tunelizadas se encontró una mayor reducción del espesor fisiario en el punto externo de medición, sugiriendo un cierre más rápido de la fisis en este sitio. Este efecto podría generar una deformidad angular con el tiempo, utilizando ambas técnicas. No encontramos discrepancia de longitud entre los grupos a las 12 semanas de cirugía, ni una correlación con los hallazgos histológicos. Los cambios significativos en el espesor fisiario, patrón celular y cierre fisiario nos llevan a colcluir que una alteración de la fisis con ambas técnicas de reconstrucción de LCA

Evaluation of arthroscopic partial meniscectomy

We reveiwed 155 patients with isolated meniscal lesions after arthroscopic partial meniscectomy [3]. 129 patients were male and 26 patients were female with a mean age of 29 year. Satisfactory results were obtained in 92% of cases, while 5% had fair results and only 3% had poor results. On the basis of these findings, we strongly recommended performing arthroscopic patial meniscectomy as early as possible in symptomatic lesions with careful evaluation of older patients

Luxaçäo congênita do joelho: revisäo crítica do tratamento cirúrgico: relato de um caso bilateral / Congenital luxation of the knee: critical review and surgical treatment: report of a bilateral case

Os autores apresentam o estudo crítico de um caso de luxaçao congênita bilateral do joelho. Realizam revisao pormenorizada da bibliografia procurando realçar os aspectos clínicos, radiográficos e o caráter envolutivo da deformidade. O tratamento cirúrgico é discutido nos seus detalhes de técnica, indicaçao e evoluçao. A classificaçao de Finder é adotada no trabalho por ser abrangente na graduaçao das deformidades de hiperextensao do joelho e na indicaçao correta do tratamento. O método cirúrgico empregado no trabalho deverá ser utilizado sempre que os meios conservadores convencionais falharem e nos casos irredutíveis de longa evoluçao sem tratamento prévio.

Femoral corrective osteotomy for management of knee deformities in poliomyelitis.

V-shaped femoral osteotomy used by Aglietti in 1987 to treat lateral unicompartmental knee osteoarthritis associated with valgus deformity did not achieve good results because of immobilizing an arthritic knee in plaster of Paris cast for a long period. Modified Agliettis method was used in twelve patients arranged in age from 16 to 25 years; their knee deformities were due to poliomyelitis, traumatic or developmental. The advantages of this technique are limb length is preserved, correction of deformities in more than one plane is possible, faster healing due to wide surface area and impaction, no internal fixation, no second surgery to remove implants, alignments can be adjusted postoperative, and the osteotomy is stable without fixation