Variación del espacio articular externo de la rodilla posterior a la ostectomía del peroné / Change of the external intra joint space of posterior knee after fibular ostectomy

RESUMEN Introducción: en el diagnóstico y tratamiento del genu varo doloroso es importante el estudio radiográfico de la rodilla, se pueden visualizar los cambios estructurales que aparecen en las superficies articulares de la rodilla. Objetivo: demostrar desde el punto de vista radiológico la variación que ocurre posterior a la ostectomía del peroné en los pacientes operados de genus varos. Materiales y métodos: se realiza un estudio descriptivo, prospectivo y lineal en el Hospital Militar Dr. Mario Muñoz Monroy de Matanzas desde abril del 2016 -2017 donde se aplica la técnica de ostectomía del peroné, del Dr. Zhang Ying-Ze, se presentan los primeros 51 pacientes operados, un total de 57 rodillas, a los cuales se les realizó radiografía previa a la operación y posterior a ella al cabo de los 6 meses, donde se midió la altura del espacio articular externo. Resultados: el promedio de edad es de 67,2 años (50 años el menor y 84 años el mayor), de los cuales 23 eran hombres y 28 mujeres, previo al tratamiento quirúrgico el promedio de este espacio fue de 8,84 mm±1,01 mm (18 mm el mayor y el menor 2 mm) y al cabo de los 6 meses fue de 6,08 mm±0,9 mm(el mayor 10 mm y el menor 2 mm), en 6 pacientes no hubo variación de esta medida. Conclusiones: con la ostectomía proximal del peroné se logra disminuir el espacio articular externo modificando el eje mecánico y anatómico del miembro inferior, lo que se traduce por una disminución de la compresión interna articular (AU).

ABSTRACT Background: the radiographic study of the knee is very important in the painful genu varum diagnosis and treatment: structural changes appearing in the knee joint surfaces may be observed. Objective: to show the changes taking place after fibular ostectomy in the patients surgically treated of genu varum from the radiological point of view. Material and methods: a lineal, prospective, descriptive study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy" of Matanzas from April 2016 to April 2017, in 51 patients operated on applying Dr Zhang Ying-Ze's fibular ostectomy technique: a total of 57 knees. X-rays were taken before the surgery and six months after it, measuring the height of the external intra joint space. Results: the average age was 67.2 years (50 years the youngest and 84 the eldest patients); 23 were men and 28 women. Before the surgical treatment the average space was 8.84 mm±1.01 mm (18 mm the biggest and 2 mm the smallest); six months after surgery, it was 6.08 mm±0.9 mm (10 mm the biggest and 2 mm the smallest); six patients did not showed changes of the space. Conclusions: with the proximal fibular ostectomy we achieved the reduction of the external fibular space, modifying the anatomical and mechanical axis of the lower limb, what leads to a reduction of the internal joint compression (AU).

Hematoma de Morel Lavallée gigante en la rodilla derecha: reporte de un caso / Giant Morel Lavallée hematoma in the right knee: case report

RESUMEN Se presenta el caso del paciente de 36 años de edad, con antecedentes de acondroplasia que desde hace 7 meses sufrió una lesión traumática no de gravedad en la rodilla derecha. La cual comienza a aumentar de volumen con contenido líquido fluctuante. Fue puncionado en dos ocasiones obteniéndose líquido serohemático; al no resolver y continuar aumentando de tamaño, se le plantea que es portador de un hematoma seroso de Morel Lavallée, que se produce por la fricción entre el tejido celular subcutáneo y la fascia. Su localización es infrecuente en la rodilla por lo que se decide presentar el caso ya que en la literatura revisada; no aparece ningún caso descrito. Por lo que constituye el objetivo principal de este trabajo, describir su proceder y la eficacia del tratamiento quirúrgico, con el que se obtuvo resultado satisfactorio (AU).

ABSTRACT We present the case of a patient aged 36 years, with antecedents of achondroplasia who 7 months ago suffered a non serious traumatic lesion in the right knee. The volume of the lesion began to increase with a fluctuant fluid contain. It was punctured twice draining serohematic fluid; it did not solve and the size increased more and more, so the patient was said that he had a serous Morel Lavallée hematoma, produced by the friction between the subcutaneous cell tissue and fascia. Its location in the knee is infrequent and it was not found any case like this in the reviewed literature; therefore we decided to present the case. The main objective of our work was describing it, showing the procedure and efficacy of the surgical that gave a satisfactory result (AU).

Estudo comparativo entre métodos manual e digital no cálculo do ângulo do platô tibial em cães / Comparative study of manual and digital method in the calculation of the tibial plateau angle in dogs

São poucos os dados publicados sobre a aplicabilidade ou a confiabilidade dos métodos digitais para mensuração do ângulo do platô tibial (APT) em comparação à mensuração manual. O objetivo deste estudo foi comparar o APT obtido pelo cálculo manual padrão, em filmes radiográficos, com os valores obtidos por cálculos em imagens digitais, por meio do software do computador. Foram analisadas radiografias digitais do membro pélvico, direito e esquerdo, em perfil verdadeiro, de 20 cães saudáveis, com idade superior a um ano. Três observadores com graus de experiência semelhantes em cálculo do APT realizaram as mensurações em cada radiografia. Primeiramente, foram calculados os ângulos dos platôs tibiais manualmente nas películas radiográficas e, posteriormente, os cálculos foram realizados na imagem digital, por meio do software para medicina veterinária do sistema de raios X digital. Os resultados do presente estudo demonstraram diferenças significativas entre os métodos, com valor das médias do cálculo digital 20,48±3.71 e do cálculo manual 23.90±4.02. Valor de P foi < 0,01 na comparação entre médias dos dois grupos. Na avaliação interobservadores, houve diferença significativa no cálculo manual no perfil direito, o que sugere maior variação no cálculo manual quando comparado ao digital. O cálculo realizado pelo software apresentou menor variação nos valores interobservadores. Acredita-se que a menor variação obtida nos resultados aqui apresentados se dê em razão das facilidades proporcionadas pelo software. Conclui-se que houve diferença entre os valores obtidos por meio dos métodos convencional e digital no cálculo do ângulo do platô tibial, sendo os valores digitais menores entre os observadores, e que o método digital no cálculo do ângulo do platô tibial levou à menor variação quando comparado ao método manual.(AU)

There are few published data on the applicability and reliability of digital methods for measuring the TPA compared with manual measurement. The objective of this study was to compare the TPA obtained by calculating standard manual on conventional radiographs, with the values obtained by calculations in digital images through a computer program. Bilateral digital radiographs of hind limb were analyzed in true profile for 20 healthy dogs older than two years. Three observers with similar levels of experience in calculating the TPA conducted measurements on each radiograph. First we calculated the angle of the tibial plateaus manually in x-ray film and then the calculations were made through the program offered by the computer program in the digital image. The results of this study showed significant differences between the methods, with average value of 20.48±3.71 digital calculating average and 23.90±2.4 in the manual calculation. P value was < 0.01 when comparing averages. No significant difference in manual calculation in right profile were found between interobserver assessments, suggesting greater variation in manual calculation compared to digital. The calculation performed by the software showed less variation in values. The slight variation obtained in our results is believed to be due to the facilities provided by the software. There was a difference between the values obtained by means of conventional and digital methods for calculating the angle of the tibial plateau, and the smaller digital values between the observers and the digital method in the calculation of the tibial plateau angle led to less variation when compared to the manual method.(AU)

Agenesis of the medial gastrocnemius and plantar muscle: case presentation / Agenesia del gastrocnemio medial y del músculo plantar: presentación de caso

We present the case of a left medial gastrocnemius and plantar muscle agenesis in a 58-years old male cadaveric specimen from the Anatomy Laboratory at the Universidad Industrial de Santander (Bucaramanga-Colombia). These unusual muscle absences and associated functional alterations, enrich anatomical knowledge and become important by the time the affected individual may need a reconstructive procedure.

Se presenta un caso de agenesia de los músculos gastrocnemio medial y plantar izquierdos en un espécimen cadavérico masculino de 58 años, del laboratorio de anatomía de la Universidad Industrial de Santander (Bucaramanga- Colombia). Estas raras ausencias musculares enriquecen el conocimiento anatómico con sus alteraciones funcionales concomitantes y permiten postular los posibles procedimientos reconstructivos requeridos en los individuos que las presentan.

Do you know this syndrome? Nail patela syndrome: a pathognomonic dermatologic finding

Abstract: The nail-patella syndrome involves a clinical tetrad of changes in the nails, knees, elbows and the presence of iliac horns. Nail changes are the most constant feature: absent, hypoplastic, or dystrophic. A pathognomonic finding is the presence of the triangular lunula. The diagnosis of nail-patella syndrome is based on clinical findings. In this paper we will discuss a case report of this syndrome and its relation with a dermatological finding.

Medial patellofemoral muscle: report of a rare variant / Músculo patelofemoral medial: reporte de una rara variante

Muscle anatomic variants range from absence of a muscle to supernumerary muscles, with a spectrum of possibilities that include anomalous course, anomalous origin or insertion, accessory slips, and others. The most common muscle variants around the knee include aberrant origin and accessory slips of the gastrocnemius muscles, presence of tensor fascia suralis muscle, and accessory popliteus. The medial patellofemoral ligament is a distinct extra-articular condensation of fibers located superficially to the medial joint capsule. We describe the presence of an accessory medial patellofemoral muscle in the expected location of the medial patellofemoral ligament, which to our knowledge has not been described in the literature before.

Las variantes anatómicas musculares van desde la ausencia de un músculo hasta la presencia de músculos supernumerarios, en un espectro de posibilidades que incluyen trayecto anómalo, origen anómalo o inserción, fascículos accesorios, y otros. Las variantes más comunes de músculos presentes alrededor de la rodilla incluyen el origen aberrante y fascículos accesorios del músculo gastrocnemio, la presencia del músculo tensor de la fascia sural y el músculo poplíteo accesorio. El ligamento medial patelofemoral es una clara condensación extra-articular de fibras localizado superficialmente a la cápsula articular medial. Se describe la presencia de un músculo patelofemoral medial accesorio en la ubicación esperada del ligamento patelofemoral medial, que a nuestro conocimiento no se ha descrito antes en la literatura.

Prevalence of bipartite patella in Turkish population: analysis of bilateral knee radiographs in 897 subjects / Prevalencia de patela bipartita en una población turca: análisis de radiografías bilaterales de rodilla en 897 sujetos

Bipartite patella is a normal anatomic variant of patella. There are various data about the prevalence of bipartite patella in the literature. The aim of this study was to investigate its prevalence, type distribution and sex predilection in Turkish population. Bilateral knee radiographs were retrospectively reviewed of 897 consecutive adult patients. Cases with bipartite patella were categorized according to the Oohashi classification. Medical records were examined in order to differentiate symptomatic and asymptomatic bipartite patellae. We contacted symptomatic patients by telephone to learn continuity of knee pain. We identified 11 cases (7 male, 4 female) of bipartite patella among the 283 male and 614 female patients. No bilateral cases were identified. The prevalence of bipartite patella was 1.22% overall, 2.47% in males, and 0.65% in females. The most common type was superolateral bipartite patella as seen in 9 patients (81.8%). One subject had lateral bipartite and one subject had superolateral tripartite patella. Painful bipartite patella was found in only 2 patients (18%). One of them had continuing symptoms even after 12 months. In conclusion, we found that the prevalence of bipartite patella in Turkish population was approximately 1%. Both inclusion of only adult (skeletally mature) subjects and assessment with bilateral imaging increased the reliability of this value. In accordance with the literature, bipartite patella was found significantly more frequent in males and mostly in superolateral type. More studies are needed in order to obtain the prevalence, type and sex distribution of bipartite patella in different populations.

La patela bipartita es una variante anatómica normal. En la literaturahay varios datos sobre la prevalencia de patela bipartitae. El objetivo de este estudio fue investigar la prevalencia, distribución y aparición según sexo en la población turca. Se revisaron retrospectivamente radiografías bilaterales de rodilla de 897 pacientes adultos. Los casos con patela bipartita se clasificaron de acuerdo a la clasificación de Oohashi. Fueron examinados los registros médicos de los pacientes con el fin de diferenciar los casos de patela bipartita sintomática y asintomática. Se estableció contacto con los casos sintomáticos por teléfono para conocer la continuidad del dolor de rodilla. Se identificaron 11 casos (7 varones, 4 mujeres) de patela bipartita entre 283 hombres y 614 pacientes de sexo femenino. No se identificaron casos bilaterales. La prevalencia de patela bipartita fue de 1,22% en total, 2,47% en varones y 0,65% en las mujeres. El tipo más común fue la patela bipartita superolateral en 9 pacientes (81,8%). Un sujeto presentó patela bipartita lateral y en otro caso, patela tripartita superolateral. La patela bipartita dolorosa fue encontrada en sólo 2 pacientes (18%). Uno de ellos presentó síntomas que continuaron incluso después de 12 meses. En conclusión, se encontró que la prevalencia de la patela bipartita en la población turca fue de aproximadamente un 1%. La inclusión en esta investigación de solo sujetos adultos (con el esqueleto maduro) y el estudio de imágenes bilaterales aumentó la fiabilidad de estos parámetros. De acuerdo con la literatura, la patela bipartita se encontró significativamente de manera más frecuente en hombres y en su mayoría se trató del tipo superolateral. Se necesitan más estudios para obtener la prevalencia, tipo y distribución por sexo de la patela bipartita en diferentes poblaciones.

Artroplastia total de rodilla: experiencia de una unidad monográfica / Total knee replacement: a monographic unit experience

Introducción: Se presenta la experiencia de la Unidad de Prótesis de Rodilla (UPR) del Hospital Clínico de Barcelona. Pacientes y método: Estudio de casos. La población del estudio fueron los pacientes intervenidos durante los meses de mayo y junio, de los años 2004 y 2010. Las variables consideradas fueron: edad, sexo, permanencia promedio, dolor al alta, flexión al alta, deambulación al alta, comorbilidades y complicaciones durante el ingreso. Se compararon los resultados de ambos períodos. Resultado: En la comparación de los años 2004 y 2010 se observó, en el último período citado, un aumento de los recambios de prótesis. La permanencia promedia se mantuvo en alrededor de 7 días. La media de edad de los pacientes se mantuvo por encima de los 70 años. Hubo un mejor control del dolor, de la flexión y de la deambulación al alta. El de número de complicaciones se redujo y hubo un aumento de las personas con obesidad. Conclusiones: En los próximos años habrá una evolución hacia intervenciones más complejas por recambio de prótesis. Los indicadores de calidad para evaluar el éxito del tratamiento continuarán siendo muy parecidos. Habrá una tendencia a la disminución del tiempo de ingreso debido a cambios en la técnica quirúrgica. Se deberá continuar trabajando para disminuir complicaciones relacionadas con la herida quirúrgica y las infecciones. La obesidad será la comorbilidad más presente.

[Evaluation of correlation between Q-angle and anterior knee pain]

Knee pain is one of common cause that patients refer to orthopedic clinics and has several reasons. One group is reversible and other is irreversible. Excessive Q-angle composes of 10% causes of knee pain reasons and is recovered [90%] by physical therapy. This study was conducted for evaluation of correlation of knee pain with excessive Q-angle and comparing both sexes and ages groups. 100 patients [50 men and 50 women] in a simple convenience study were enrolled in this research. Q-angle and pain scale [VSA] were measured and then Q-angle deviation in both sexes and ages groups analyzed using ANOVA, t-test. Spearman test with SPSS17 software. The correlation between severity of knee pain and Q-angle in general population and in both sex was significant using of Spearman's test. There was no significant correlation between different ages and Q-angle. There was significant relationship between Q-angle in men and women [P<0.05]. 10% of men, 18% of women and 14% of general population refered to orthopedic clinic had Q-angle greater than normal range. Higher level of Q-angle in females might be related to anatomical differences and high level of estrogen, multiparity, malnutrition, genetical differences and excessive activity, in females

Ressalto no canto posteromedial do joelho relacionado ao músculo sartório / Posteromedial snapping knee related to the sartorius muscle

As causas da síndrome de ressalto no joelho relatadas com maior frequência são relacionadas a anormalidades meniscais, ao tendão do músculo bíceps femoral e aos tendões grácil e semitendíneo. Neste trabalho é descrito um caso de ressalto no canto posteromedial relacionado à junção miotendínea do músculo sartório em um paciente do sexo masculino, de 58 anos de idade, com hiperextensão do joelho.

The most frequently reported causes of snapping knee syndrome are related to abnormalities of the meniscus, biceps femoris tendon, gracilis and semitendinosus tendons. The present report describes a case of snapping in the posterior-medial corner of the knee related to the myotendinous junction of the sartorius muscle in a 58-year-old male patient with knee hyperextension.

Correccion de deformidades angulares oseas. Analisis experimental de dispositivos dinamicos y estaticos / Correction of bone angle deformities. Experimental analysis with dynamic and static devices

Introducción: La corrección de una deformidad angular en un miembro mediante una hemiepifisiodesis siempre debe ser tenida en cuenta en un niño. La colocación de un dispositivo dinámico (grapa en 8) presentaría la ventaja sobre la grapa convencional de proveer fijación firme a ambos lados de la fisis, actuando principalmente sobre el crecimiento de la hemifisis del lado de la inserción del implante. El objetivo de nuestro estudio es comparar la eficacia de ambos dispositivos (estático y dinámico) para realizar modificaciones angulares. Materiales y métodos: Se utilizaron 17 conejos de 8 semanas de vida. A cada conejo se le colocó una placa en 8 en el fémur distal y una grapa en el fémur contralateral. A las 8 semanas se evaluó la deformidad producida por cada sistema radiológica e histológicamente. Resultados: Deformidad axial: las grapas produjeron una desviación promedio de 48,1° y as placas en 8, de 49,8° (p = 0,44). Crecimiento longitudinal final de los fémures: grapas de 83,17 y para la P8 de 85,7 (p = 0,0042). Análisis histológico: no se hallaron diferencias significativas entre ambos fémures de un mismo espécimen, pero sí ligeras diferencias entre los animales. Conclusiones: La corrección fue más rápida con la grapa convencional. La eficacia de ambos sistemas de epifisiodesis a largo plazo es similar. La inhibición del crecimiento longitudinal es menor con la placa en 8.

Tumor gigantocelular sinovial do joelho / Synovial giant cell tumor of the knee

Tumor gigantocelular sinovial é uma neoplasia benigna, raramente sendo relatada na forma de metástase maligna. A localização mais comum de ocorrer um tumor gigantocelular sinovial é na mão e as mais infrequentes são tornozelo e joelho. No presente estudo os autores têm como objetivo descrever um caso raro de tumor gigantocelular sinovial localizado no joelho e o tratamento escolhido. A artroscopia demonstrou, nesse caso, ser o método ideal para o tratamento da lesão, uma vez que permitiu abordagem pouco agressiva e, ao mesmo tempo, boa visualização de todos os compartimentos da articulação do joelho e a completa ressecção do tumor.

Synovial giant cell tumor is a benign neoplasm, rarely reported in the form of malignant metastasis. Synovial giant cell tumor most frequently occurs on the hand, and, most uncommon, on the ankle and knee. In the present study, the authors describe a rare case of synovial giant cell tumor on the knee as well as the treatment approach. Arthroscopy has been shown, in this case, to be the optimal method for treating this kind of lesion, once it allowed a less aggressive approach, while providing good visualization of all compartments of knee joint and full tumor resection.

Evaluation of serum cartilage oligomeric matrix protein [Comp], soluble tumour necrosis factor receptor-II[sTNF-RII] and interleukin-6 [IL-6] levels in relation to serum estradiol, functional and radiologic findings in postmenopausal females with knee joint osteoarthritis

To evaluate the possible relation between serum levels of cartilage oligomeric matrix protein COMP, sTNF-RII, IL-6 and estradiol in post-menopausal females with clinically and radiologically documented osteoarthritic changes in the knee joint. Twenty post-menopausal females [PMOA] -with clinically and radiologically documented knee joint osteoarthritis were compared to a control group of ten post-menopausal females [control group [I]] and ten pre-menopausal females [control group [2]] "who were clinically and radiologically free of knee joint osteoarthritis. To all the studied subjects, a complete clinical examination was performed, including body mass index calculation, as well as scoring .systems for functional assessment of joint. Plain X-ray of both knee joints was performed. Serum samples were obtained for analysis of urea, creatinine, uric acid, total calcium, inorganic phosphates, C-reactive protein, rheumatoid factor COMP, sTNF-fUI, IL-6, and estradiol levels. The mean serum estradiol values in the PMOA, and control group [I] were significantly lower than their corresponding value in control group [2], and slightly lower in the PMOA than control group [1]. The mean serum COMP value was slightly higher in the PMOA group than its corresponding value in control group [1], and both mean sera values were significantly higher than their corresponding mean value in control group [2]. The mean serum sTNF-RII value was significantly higher in the PMOA group than its corresponding values in control group [1] and control group [2]. As regards mean serum IL-6 value, it was significantly higher in control group [1] than its corresponding values in the both PMOA and control group [2]. Based on ROC curve analysis in PMOA and control group [1], both serum COMP and sTNF-RII yitld a diagnostic specificity of 90% each, while the diagnostic sensitivity was 45% and 50% respectively. By using the combined approach, we were able to increase the diagnostic sensitivity of serum COMP and sTNF-RII to 90% and 83% respectively. On the other hand, the receiver operating characteristics [ROC] curve analysis of the same parameters in PMOA and control group [2], revealed a diagnostic sensitivity of 100% for each of serum COMP and s TNF-PJI as well as a diagnostic specificity of 90% for serum COMP and 70% for sTNF-RII. The fact that radiographic evidence of OA usually appears in advanced stages of the disease led to the need of identifying possible serum biochemical markers that could reflect the joint tissue status. From the above mentioned results, it could be concluded that the combined measurement of serum levels of the biochemical markers COMP and sTNF-RII may be used in identifying osteoarthritis in post-menopausal females. Furthermore, menopausal state per-se could play a role in the limitation of the diagnostic sensitivity of either of the two parameters if one of both analytes was chosen alone for measurement

Pode dançar provocar dor no joelho? / Can dance provoke knee pain?

A dor no joelho e uma das queixas mais freqüentes entre dançarinos. O objetivo deste trabalho foi estabelecer a prevalência e a incidência cumulativa de dor no joelho para melhor entender a relação entre dançar e o corpo do dançarino. Constituíram a amostra 47 alunos da Escola de Dança da UFBA. Para estabelecer a freqüência de dor no joelho foram escolhidos dois desenhos metodológicos: um estudo prospectivo, para estabelecer a prevalência, e um estudo de coorte, para verificar a incidência cumulativa da variável. Como resultado, verificou-se que a prevalência de dor no joelho entre 47 alunos foi de 31.9 por cento (15 alunos). A incidência representada manteve-se entre 13.3 por cento e 2.2 por cento, apresentando uma gradativa tendência à diminuição.

Osteosarcoma central bien diferenciado y de bajo grado de malignidad / Differentiated central osteosarcoma and of low degree of malignancy

Los osteosarcomas constituyen el 20 % de todos los tumores primarios malignos en la población pediátrica, que por lo general se presentan alrededor de la rodilla. Presentamos el caso de un paciente de 13 años de edad, con un osteosarcoma central bien diferenciado de bajo grado de malignidad, de rarapresentación a nivel de la diáfisis de la tibia (el primero en el hospital). Este constituye menos de 2% de todos los sarcomas óseos que se presentan entre la segunda y tercera década de lavida, que pueden tratarse mediante resección del tumor con un margen de seguridad sin perder un segmento anatómico de la extremidad pélvica complementando con una fijación externa y quimioterapia coadyuvante.

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

Prevalence of foot and knee deformities among high school female students in Tehran District No. 5

Foot and knee deformities are among common complaints of patients referred to the orthopedic centers. Most of naturally occurring lower limb deformities in children, which are rather common, would be corrected with further normal growth. However, a small percentage of these problems remain unresolved and may cause complications in the future. The purpose of this descriptive study was to determine the prevalence of foot and knee deformities [such as, genovarus, genovalgus, flat foot.....] among one thousand female high-school students in of Tehran District No. 5. Also relationships of deformities with age, familial and personal history and severity of clinical symptoms were studied. To indicate the severity of symptoms of genovarus and genovalgus, bilateral medial femorocondylar distance and bimalleolar distance were measured respectively. Severity of hallux valgus was determined by measuring the angle formed by medial border of foot and medial border of great toe. Also clinical observance of patient's sole while standing was used to evaluate whether the patient had the pescavus or flat foot. 30. 4% of the studied subjects had knee abnormalities, of which 27.5% were classified as genovarus and 2.9% as genovalgus. 11.2% suffered from foot anomalies, of which 0.2% hadpescavus and 11% had flat foot. Prevalence of hallux valgus was 12.7%. Meaningful relationships were observed between foot and knee deformities and other variables such as age, birth order and severity of clinical symptoms. There was a significant association between foot deformities and familial or personal history. No significant association was detected between knee deformities and familial or personal history. These findings point to the importance of proper physical examination, early diagnosis and on-time treatment of foot and knee deformities in children

Menisco externo discoideo: tratamiento artroscopico con 9 años de seguimiento / External discoid meniscus: arthroscopic treatment with 9 year-follow-up

Se evaluaron 25 pacientes con menisco externo discoideo sintomatico que fueron tratados mediante meniscectomia artroscopica. La exeresis fue total en 8 pacientes y parcial en 17. El seguimiento posoperatorio promedio de la serie fue de 9 años, con un rango entre 4 y 18 años. Segun la evaluacion funcional de Ikeuchi, el 88 por ciento de los pacientes tratados con meniscectomia parcial obtuvo un resultado excelente, mientras que, en los tratados con meniscectomia total, solo el 40 por ciento tuvo un resultado similar. No se evidencio un mayor desgaste articular del compartimiento externo de la rodilla afectada en comparacion con la rodilla contralateral en los pacientes tratados