Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study.

BACKGROUND: Distal tibialis anterior tendinopathy (DTAT) is a chronic condition that may lead to functional impairment and secondary forefoot deformities when left untreated. Current clinical practice is mainly guided by case reports and small retrospective case series; little consensus exists on which treatment protocol is most effective. This study aims to assess a conservative treatment for DTAT consisting of PRP infiltration and walking cast immobilization. METHODS: This prospective study included 18 feet in 18 patients, recruited between September 2020 and September 2022 at a single institution. Ultrasonography was performed; leukocyte-poor PRP was infiltrated around the tibialis anterior tendon insertion. Walking cast immobilization was used for 3 weeks after infiltration, followed by eccentric exercises of the DTAT, and gastrocnemius-soleus muscle complex stretching. Clinical findings, visual analog scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores were recorded at inclusion, and 6 and 12 weeks after PRP infiltration. Minimal clinically important difference (MCID) limits were researched to assess clinical relevance of statistical outcomes. Means were determined for age, sex, and body mass index (BMI). One-way repeated measures ANOVA was performed over time for FFI, AOFAS, and VAS scores. RESULTS: Mean age was 65 years with a mean BMI of 25. Tendon thickening and hypoechogenicity were the most commonly reported ultrasonographic findings. Significant improvement from baseline VAS (VASrest: 4.71 ± 2.7, VASactivity: 5.66 ± 2.5) to 12 weeks follow-up (VASrest: 2.14 ± 2.7, VASactivity: 3.34 ± 2.5) was found. Both AOFAS and FFITotal improved significantly from baseline (AOFAS: 66.9 ± 3.3, FFITotal: 32.9 ± 3.3) to 6-week follow-up (AOFAS6w: 79.4 ± 3.3, P = .019; FFITotal: 19.4 ± 3.3, P = .011). No statistically significant further improvement was found at 12 weeks compared to 6 weeks' follow-up. Two (11%) patients chose operative treatment because of persisting symptoms. CONCLUSION: We found that PRP infiltration with walking cast immobilization as a first-line treatment was associated with general early symptom improvement. LEVEL OF EVIDENCE: Level IV, case series.

Bone marrow oedema syndrome of the foot and ankle in a paediatric population: a retrospective case series with serial MRI evaluation.

PURPOSE: By means of a case series we wanted to describe and correlate the clinical and imaging features of bone marrow oedema syndrome (BMOS) of the foot and ankle in children. METHODS: A retrospective data study was performed on patients born on or after 01 January 2001 who underwent multiple MRI scans of the foot and ankle for pain symptoms. Six patients who presented with increased signal intensity on T2-weighted MR imaging without any underlying causes or concomitant pathology were included. RESULTS: All patients, three boys and three girls with a mean age of 11 years (8 to 14), displayed patchy areas of increased signal intensity on T2-weighted and turbo inversion recovery magnitude (TIRM) images. On average, six tarsal bones were involved (4 to 8). In all patients, treatment consisted of rest and/or protected weight-bearing. The mean time for symptoms to improve during treatment was 6 months (1 to 16). The mean duration of treatment was nine months (3 to 16). In all patients clinical and imaging symptoms were strongly correlated and regressed in time. CONCLUSION: BMOS as a pathological entity should be considered in paediatric patients with foot and ankle pain without a clear underlying cause, and characteristic T2-weighted and TIRM signal intensity increase on MRI images. As BMOS is transient and self-limiting, conservative treatment is advised while the oedema regresses. An early diagnosis of this pathology could prevent unnecessary diagnostic investigations and invasive treatments. LEVEL OF EVIDENCE: IV.

Arthroscopic psoas release for iliopsoas impingement after total hip replacement.

Psoas impingement is a rare cause of persisting pain after hip arthroplasty. Diagnosis is based on clinical examination and exclusion of other complications after arthroplasty by radiographs, ultrasound, CT and blood analysis. The diagnosis is strongly supported by temporary pain relief after infiltration. When conservative measures fail, treatment can consist of a psoas tenotomy or a revision arthroplasty. When there is no obvious cause such as malpositioning for component impingement, psoas release reliably improves pain and function. This procedure is mostly performed through an open approach, which can give significant complications. An arthroscopic technique for psoas tenotomy after hip arthroplasty is described. This report shows that this minimal invasive technique is safe and effective and allows for inspection of the implant in the same session. However, the score used did not improve in a significant way.

The McHale procedure in the treatment of the painful chronically dislocated hip in adolescents and adults with cerebral palsy.

We retrospectively studied the results achieved in adolescent and adult patients with cerebral palsy, following management of chronically painful dislocated hips with the McHale procedure. Thirteen patients with seventeen procedures were included in the study. The indication for surgery was pain in all patients. Limitation in sitting was also reported in eight cases and nursing care was difficult in ten of thirteen patients. All patients underwent clinical and radiological examination of the hips, and a questionnaire was answered by both parents and caretakers. Improvement was noted in all patients with respect to pain. In six patients sitting was tolerated for longer intervals and 10 out of 13 patients were easier to nurse owing to improved mobility of the hip. Although these results appear promising, the procedure had a high complication rate, including heterotopic ossification, residual pain caused by hardware, fracture and pulmonary complications, for which a second procedure was necessary in several cases. There was also in several cases a prolonged period of pain postoperatively, for which an additional procedure was needed in eight patients. The McHale procedure is a technique that can provide pain relief and improvement in motion. There is however a high incidence of failure and complications.