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Introduction Meniscal tears represent one of the most frequent knee injuries and are the most common cause of knee surgery. Historically, age has been considered an independent factor contraindicating meniscal repair due to the assumption that meniscal injuries in this population are frequently chronic tears, mostly with a degenerative tear pattern, and low healing potential. However, recent literature has questioned this paradigm with studies reporting successful outcomes with meniscal repair in older patients. Our study aimed to evaluate and compare the short-term clinical outcomes of meniscal repair versus partial meniscectomy in patients aged ≥40 years old. Methods A retrospective study was conducted that included patients over the age of 40 years, diagnosed with meniscal tears, that underwent arthroscopically assisted meniscal repair or partial meniscectomy between 01 January and 31 December 2020. The patients were divided into two groups: Group 1- partial meniscectomy (PM) and Group 2- meniscal repair (MR). The clinical evaluation was performed 24 months after the surgery, and the studied variables were: function (Tegner Lysholm Knee Scoring Scale), pain (Visual Analogue Scale), patient satisfaction, and failure rate. Results Fifty-one patients met the inclusion criteria, and 7 were excluded due to loss of follow-up during telephone contact. Thus, the final sample consisted of 44 patients (mean age 52.18y), both groups with 22 patients. In both groups, we found an improvement in pain 2 years after the surgery, with a decrease in the VAS value between the pre and post-surgery. On average, the VAS score decreased from 7.9 to 4.5 in the group subjected to partial meniscectomy, and from 7.5 to 3.2 in the meniscal repair. This was statistically significant in both groups, with a p-value <0.01, but not between them (p-value = 0.363). Comparing the degree of satisfaction between both groups, we found no statistically significant difference between them (p=0.167). Regarding the functional outcome (Tegner Lysholm Knee Scoring Scale), the group that underwent the meniscal repair obtained a statistically superior score compared to the partial meniscectomy group (77.55 vs. 64.77; p-value 0.033). The failure rate was exactly equal in both groups (4.5%), therefore no statistically significant difference was found in this variable. Conclusion Age, as an independent factor, should not be considered a contraindication for meniscus repair. In fact, if technically possible, meniscal repair should always be performed as it is associated with better functional outcomes, similar failure rates, and may be protective against the development and progression of arthritis.
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Lisfranc injury is extremely rare in the pediatric population and little evidence exists to guide the treatment at this age. We present a clinical case of a rare Lisfranc fracture-dislocation at pediatric age. An 11-year-old male was admitted to the emergency department, in October 2020, after a motorcycle incident. He was diagnosed with a Lisfranc fracture-dislocation of the right foot: Myerson type B2. Fourteen days after the injury, he underwent surgical treatment with open reduction and internal fixation with 3.5 mm solid fully threaded screws. At 18 months postoperative, the patient was asymptomatic, didn't present any limitations, presented an American Orthopedic Foot and Ankle Score (AOFAS) midfoot score of 93%, and excellent results of the 12-Item Short Form Survey (SF-12) - PCS-12 (Physical Score): 52.52277 and MCS-12 (Mental Score): 62.12820. The foot maintained a good configuration without significant malalignment, however, a screw breakage occurred before the implant removal, and a premature physeal arrest developed on the base of the first metatarsal bone. Clinical and radiographic evaluation of Lisfranc injuries may be challenging in the pediatric population. Regarding the treatment, anatomical alignment is mandatory, and good or excellent outcomes have been achieved with anatomical reduction and internal fixation. We recommend early implant removal to avoid screw breakage and avoid the use of screws in the first metatarsal physis, due to the risk of premature physeal arrest.
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INTRODUCTION: The proximal phalanx fracture is a common fracture of the hand in pediatric ages. Most of these fractures can be treated conservatively with immobilization. There are only few cases reporting tendon entrapment in literature and most of them refer to epiphyseal fractures with only one case reporting tendon entrapment after diaphyseal fracture. CASE REPORT: A 15-year-old boy went to the emergency department after suffering trauma in his right hand caused by a fall. He complained of pain in his second finger of the right hand which was swollen. An imaging study was performed and a fracture of the proximal phalanx diaphysis of the second finger of the right hand was diagnosed. Due to deviation, reduction, syndactyly, and immobilization with Zimmer splint were performed. The control X-ray showed acceptable reduction and the patient was referred for follow-up at an outpatient consultation. During follow-up, the reduction was maintained and the conservative treatment was kept for 25 days, with apparent fracture healing. The patient presented active flexion limitation of the finger that was interpreted as a sequel of the immobilization and he was referred for physical therapy rehabilitation. Six weeks after the initial trauma, the patient was observed at the emergency department for new right-hand trauma. On examination, no active flexion of the third phalanx of the second finger of the right hand was noticed. The patient underwent an ultrasound that revealed deep flexor tendon entrapment at the fracture focus. A surgery was performed consisting in tenolysis and reconstruction of the pulleys using a portion of the long palmar tendon. The patient has good clinical evolution with almost complete recovery of mobility. CONCLUSION: This case illustrates an entrapment of deep flexor tendon after a diaphyseal fracture of the proximal phalanx, with only few cases reported in literature. The authors highlight the importance of having a high index of suspicion to detect this situation once it restrains the success of the conservative treatmentand makes the surgery mandatory to avoid definite sequels and disabilities.
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INTRODUCTION: Arthroscopic-assisted reduction and internal fixation (ARIF) is a recent concept and is increasingly used for articular fractures, due to the minimally invasive nature and high accuracy. However, there are few reports in literature about this procedure in talar fractures. CASE REPORT: The authors describe a clinical case of a 22-year-old woman with a closed right articular talar neck fracture, Hawkins type II, treated with arthroscopically ARIF. CONCLUSION: This is a minimally invasive technique that can allow close accurate reduction and stable fixation of selected articular talar fractures. It avoids some complications of multiple and large incisions of the conventional open surgery, with good functional outcomes and patient satisfaction.
