Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results.

Introduction: Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Methods: Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco's zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. Results: All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. Conclusion: The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure.

Ankle arthroscopy does not elevate complication rates in ankle fractures.

INTRODUCTION: Ankle fractures rank as the second most common lower limb fractures, and surgical intervention is essential for unstable ankle fractures. The use of ankle arthroscopy in such cases offers several advantages. This study aim is to assess whether arthroscopy influenced on complication rates in 171 ankle fractures treated with arthroscopic assistance. METHODS: This retrospective epidemiological analysis encompassed adult ankle fractures between December 2018 and December 2021. Initially, 173 patients were considered, but two were excluded, leaving a final sample of 171 patients. Postoperative complications were categorized as major or minor. RESULTS: The study included 171 patients with surgically treated ankle fractures assisted by arthroscopy, comprising 76 females and 95 males, with an average age of 41.9 years. Syndesmosis injuries were treated in all diagnosed cases (55.0%), and deltoid ligament injuries received attention when identified (33.7%). Arthroscopic techniques were preferred over open techniques (47.4%). Ten patients experienced complications, consisting of 2 major and 8 minor complications (5.8%). DISCUSSION: Our study's epidemiological findings align with prior literature, demonstrating that intra-articular injuries accompany 63% to 79% of ankle fractures. Arthroscopy allows for both diagnosis and treatment within the same procedure, including joint lavage to reduce inflammation. We diagnosed 57 deltoid injuries and identified a statistical relationship between chondral, syndesmotic, and deltoid ligament injuries. Infection is a common complication in ankle fracture surgery, with rates ranging from 1.44% to 16%. Our study yielded a 5.8% complication rate, comprising 1.2% major and 4.6% minor complications. Patients undergoing ORIF with arthroscopic assistance had a lower prevalence of infection. CONCLUSION: The use of arthroscopic assistance in the surgical treatment of ankle fractures does not increase the overall complication rate. LEVEL OF EVIDENCE: IV.

The Pathogenetic Role of RANK/RANKL/OPG Signaling in Osteoarthritis and Related Targeted Therapies.

Background: Osteoarthritis (OA) is the most common degenerative joint disease and affects millions of people worldwide, particularly the elderly population. The pathophysiology of OA is complex and involves multiple factors. Methods: Several studies have emphasized the crucial role of inflammation in this process. The receptor activator of NF-κB ligand (RANKL), the receptor activator of NF-κB (RANK), and osteoprotegerin (OPG) trigger a signaling cascade that leads to the excessive production of RANKL in the serum. Conclusions: The aim of this narrative review is (i) to assess the role of the RANK/RANKL/OPG signaling pathway in the context of OA progression, focusing especially on the physiopathology and on all the mechanisms leading to the activation of the inflammatory cascade, and (ii) to evaluate all the potential therapeutic strategies currently available that restore balance to bone formation and resorption, reducing structural abnormalities and relieving pain in patients with OA.

Development of the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS BrP): a cross-cultural adaptation with reliability and construct validity evaluation.

BACKGROUND: There is a need for a patient-relevant instrument to evaluate outcome after treatment in patients with a total Achilles tendon rupture. The purpose of this study was to undertake a cross-cultural adaptation of the Achilles Tendon Total Rupture Score (ATRS) into Brazilian Portuguese, determining the test-retest reliability and construct validity of the instrument. METHODS: A five-step approach was used in the cross-cultural adaptation process: initial translation (two bilingual Brazilian translators), synthesis of translation, back-translation (two native English language translators), consensus version and evaluation (expert committee), and testing phase. A total of 46 patients were recruited to evaluate the test-retest reproducibility and construct validity of the Brazilian Portuguese version of the ATRS. Test-retest reproducibility was performed by assessing each participant on two separate occasions. The construct validity was determined by the correlation index between the ATRS and the Orthopedic American Foot and Ankle Society (AOFAS) questionnaires. RESULTS: The final version of the Brazilian Portuguese ATRS had the same number of questions as the original ATRS. For the reliability analysis, an ICC(2,1) of 0.93 (95 % CI: 0.88 to 0.96) with SEM of 1.56 points and MDC of 4.32 was observed, indicating excellent reliability. The construct validity showed excellent correlation with R = 0.76 (95 % CI: 0.52 to 0.89, P < 0.001). CONCLUSION: The ATRS was successfully cross-culturally validated into Brazilian Portuguese. This version was a reliable and valid measure of function in patients who suffered complete rupture of the Achilles Tendon.

PROSPECTIVE AND COMPARATIVE STUDY ON FUNCTIONAL OUTCOMES AFTER OPEN AND ARTHROSCOPIC REPAIR OF ROTATOR CUFF TEARS.

OBJECTIVE: To prospectively assess the surgical results from patients undergoing repairs to rotator cuff injuries via open and arthroscopic procedures, with regard to functional and clinical features, and by means of ultrasound examinations, and to compare occurrences of renewed tearing. METHODS: Sixty patients underwent operations performed by the same surgeon (29 via open surgery and 31 via arthroscopy), to repair complete rotator cuff tears. The procedures were performed at Hospital Governor Israel Pinheiro (HGIP) and Mater Dei Hospital in Belo Horizonte, Minas Gerais, between August 2007 and February 2009. The patients were assessed functionally by means of the UCLA score before and after the operation, and magnetic resonance imaging was done before the operation. All the patients were reassessed at least 12 months after the operation, and an ultrasound examination was also performed at this time. RESULTS: Out of the 29 patients who underwent open surgery, 27 (93.1%) presented good or excellent results, with a mean UCLA score of 32 after the operation. Their mean follow-up was 14 months. Three patients presented renewed tearing on ultrasound, of whom one remained asymptomatic. Out of the 31 patients who underwent arthroscopic procedures, 29 (93.5%) presented good or excellent results, with a mean UCLA score of 33 after the operation. Their mean follow-up was 19 months. Two patients presented renewed tearing, of whom one remained asymptomatic and one evolved with loosening of an anchor, with an unsatisfactory result. CONCLUSION: The repairs on rotator cuff injuries presented good results by means of both open surgery and arthroscopy, with similar functional results in the two groups and similar rates of renewed tearing.

GUYON'S CANAL SYNDROME DUE TO A SYNOVIAL CYST.

We present a case of Guyon's canal syndrome caused by a synovial cyst within the left wrist of a 48-year-old female patient. The patient presented pain and paresthesia in the region of the ulnar nerve, with loss of muscle strength and left-hand deformity. Electroneuromyography showed a compression of the ulnar nerve at the wrist level. Surgical decompression of the nerve at Guyon's canal with resection of the cyst was performed. After the surgery, the patient presented an improvement in the pain and paresthesia, as well as an increase in muscle trophism and correction of the deformity.

Estudo prospectivo e comparativo dos resultados funcionais após reparo aberto e artroscópico das lesões do manguito rotador / Prospective and comparative study on functional outcomes after open and arthroscopic repair of rotator cuff tears

OBJETIVO: Avaliar prospectivamente o resultado cirúrgico dos pacientes submetidos ao reparo das lesões do manguito rotador por via aberta e artroscópica, quanto ao aspecto funcional, clínico e por exame de ultrassonografia (US), além de comparar a ocorrência de reruptura. MÉTODOS: Foram operados 60 pacientes pelo mesmo cirurgião, sendo 29 pacientes por via aberta e 31 por via artroscópica para reparo das lesões completas do manguito rotador (MR), entre agosto de 2007 e fevereiro de 2009 no Hospital Governador Israel Pinheiro (HGIP) e Hospital Mater Dei (HMD) em Belo Horizonte, MG. Os pacientes foram avaliados funcionalmente através do escore da UCLA feito no pré e no pós-operatório e exames de ressonância magnética realizados no pré-operatório. Todos os pacientes foram reavaliados com um período mínimo de 12 meses de pós-operatório, quando foi realizado também exame de US. RESULTADOS: Dos 29 pacientes operados por via aberta, 27 (93,1 por cento) apresentaram resultados bons/excelentes, com UCLA médio de 32 no pós-operatório. O seguimento médio foi de 14 meses. Três pacientes apresentaram reruptura ao US, sendo que um deles permaneceu assintomático. Dos 31 pacientes operados por via artroscópica, 29 (93,5 por cento) apresentaram resultados bons/excelentes, com UCLA médio de 33 no pós-operatório. O seguimento médio foi de 19 meses. Dois pacientes apresentaram reruptura, sendo que um deles permaneceu assintomático, e um paciente evoluiu com soltura de âncora com resultado insatisfatório. CONCLUSÃO: O reparo das lesões do manguito rotador apresenta bons resultados tanto por via aberta como artroscópica, com resultados funcionais semelhantes entre os grupos, bem como a taxa de reruptura.

OBJECTIVE: To prospectively assess the surgical results from patients undergoing repairs to rotator cuff injuries via open and arthroscopic procedures, with regard to functional and clinical features, and by means of ultrasound examinations, and to compare occurrences of renewed tearing. METHODS: Sixty patients underwent operations performed by the same surgeon (29 via open surgery and 31 via arthroscopy), to repair complete rotator cuff tears. The procedures were performed at Hospital Governor Israel Pinheiro (HGIP) and Mater Dei Hospital in Belo Horizonte, Minas Gerais, between August 2007 and February 2009. The patients were assessed functionally by means of the UCLA score before and after the operation, and magnetic resonance imaging was done before the operation. All the patients were reassessed at least 12 months after the operation, and an ultrasound examination was also performed at this time. RESULTS: Out of the 29 patients who underwent open surgery, 27 (93.1 percent) presented good or excellent results, with a mean UCLA score of 32 after the operation. Their mean follow-up was 14 months. Three patients presented renewed tearing on ultrasound, of whom one remained asymptomatic. Out of the 31 patients who underwent arthroscopic procedures, 29 (93.5 percent) presented good or excellent results, with a mean UCLA score of 33 after the operation. Their mean follow-up was 19 months. Two patients presented renewed tearing, of whom one remained asymptomatic and one evolved with loosening of an anchor, with an unsatisfactory result. CONCLUSION: The repairs on rotator cuff injuries presented good results by means of both open surgery and arthroscopy, with similar functional results in the two groups and similar rates of renewed tearing.

Síndrome do canal de Guyon causada por cisto sinovial / Guyon's canal syndrome due to a synovial cyst

Apresentamos um caso de síndrome do canal de Guyon por um cisto sinovial no punho esquerdo de uma paciente do sexo feminino, de 48 anos. A paciente apresentava dor e parestesia na topografia do nervo ulnar, diminuição da força muscular e deformidade na mão esquerda. A eletroneuromiografia evidenciava compressão do nervo ulnar no nível do punho. Realizada a ressecção do cisto e descompressão do nervo no canal de Guyon. Após a cirurgia a paciente apresentou melhora da dor e da parestesia, além de aumento do trofismo muscular e correção da deformidade.

The authors present a case of Guyon's canal syndrome due to a synovial cyst within the left wrist of a 48-year-old female patient. The patient reported pain and paresthesia in the topography of the ulnar nerve, loss of muscular strength and left hand deformity. Electromyography showed a compression of the ulnar nerve at the wrist level. Surgical decompression at the Guyon canal with resection of the cyst was performed. After surgery, the patient presented with improvement of pain and paresthesia, as well as an increase in muscular trophism and correction of the deformity.

Abordagem multidisciplinar do paciente diabético com infecção nos pés: prevenção de amputações maiores / Multidisciplinary approach to patients with diabetic foot infection: prevention of major amputation

Objetivos: Avaliar a influência dos parâmetros clínico-laboratoriais na determinação do nível de amputação, além da influência destes no tempo de cicatrização do coto. Materiais e métodos: Entre abril/2008 e dezembro/2009, 25 pacientes diabéticos foram submetidos algum tipo de amputação nos membros inferiores pelo Grupo de Cirurgia do Pé e Tornozelo do Hospital Mater Dei, dos quais foram coletados dados clínico-laboratoriais relevantes para determinação do prognóstico da amputação. Resultados: Apenas 29,2% dos pacientes eram portadores de diabetes do tipo 1 33,3% dos pacientes apresentavam desnutrição proteica, com albumina sérica inferior a 3,0 mg/dl 80% estavam com marcadores inflamatórios alterados, mais notadamente com a proteína C reativa (PCR) elevada 54% eram portadores de vasculopatia com oclusão arterial periférica, sendo que os pacientes que foram submetidos a revascularização apresentaram diminuição significativa do tempo de cicatrização (p=0,024) 32% necessitaram de mais de uma intervenção cirúrgica (média: 1,27 procedimento). Conclusão: A abordagem multidisciplinar realizada por ortopedista, cirurgião vascular e equipe de curativos, aliada ao médico assistente do paciente, diminuiu a ocorrência de amputações maiores, fornecendo, portanto, menor gasto energético para a marcha e melhor qualidade de vida aos nossos pacientes.

Cirurgia conservadora da mama 1981-2002: uma visão histórica* / Conservative mamma surgery 1981-2002: a historical view

Trabalho realizado com o objetivo de estudar a evolução da cirurgia conservadora no período de 1981-2002 no tratamento do câncer de mama da mulher. Para isso, os métodos utilizados foram de levantamento bibliográfico realizado junto à Biblioteca da Faculdade de Medicina da UFMG, sítio da Biblioteca Universitária e Portal da Capes. Após a confirmação de que a cirurgia conservadora não altera a sobrevida das pacientes portadoras de câncer de mama, mas tem efeito consideravelmente benéfico no aspecto psicossocial, e conseqüentemente, na qualidade de vida dessas mulheres, concluímos que a opção por esse tipo de cirurgia deve sempre ser tomada por uma equipe multidisciplinar, mediante avaliação completa da paciente, contando com a participação ativa da mesma, com o objetivo de reintegrá-la, o mais rápido possível, às suas atividades habituais. Houve também a constatação da elaboração de diversas técnicas cirúrgicas que melhoraram significativamente os resultados estéticos, especialmente a técnica do retalho bilobulado descrito no Hospital das Clínicas da UFMG por Tostes et al. (1999).

Cirurgia conservadora da mama 1981-2002: uma visão histórica / Consevative breast surgery 1981-2002: a historical view

Este trabalho foi realizado com o objetivo de estudar a evolução da cirurgia conservadora no período de 1981-2002 no tratamento do câncer de mama da mulher. Para isso, os métodos utilizados foram de levantamento bibliográfico realizado junto à Biblioteca da Faculdade de medicina da UFMG, sítio da Biblioteca Universitária e Portal da Capes. Após a confirmação de que a cirurgia conservadora não altera a sobrevida nas pacientes portadoras de câncer de mama, mas tem efeito consideravelmente benefício benéfico no aspecto psicossocial e, consequentemente, na qualidade de vida dessas mulheres, conclui-se que a opção por esse tipo de cirurgia deve sempre ser tomada por uma equipe multiciplinar, mediante avaliação completa da paciente, contando com a participação ativa da mesma, com o objetivo de reintegrá-la o mais rápido possível às suas atividades habituais. Houve também a constatação da elaboração de diversas técnicas cirúrgicas que melhoraram significativamente os resultados estéticos, especialmente a técnica do retalho bilobulado descrito no Hospital das Clínicas da UFMG por Tostes et al. (1999).

Cirurgia conservadora da mama 1981-2002 uma visão histórica / Conservative breast surgery 1981-2002: a historical view

Estuda a evolução da cirurgia conservadora no período de 1981-2002 no tratamento do câncer de mama da mulher.