Length, thickness, and elasticity of the patellar tendon after closed wedge high tibial osteotomy: a shear wave elastographic study.

PURPOSE: To compare the length, thickness, and elasticity of the patellar tendon between operated and non-operated knees following closed wedge high tibial osteotomy (CWHTO). METHODS: Three men and 17 women aged 52 to 75 (mean, 64.8) years who underwent unilateral CWHTO by a single surgeon and were followed up for a mean of 11 (range, 5-22) years were included, as were 3 male and 17 female healthy controls aged 35 to 61 (mean, 47.9) years. The length, thickness, and elasticity of the bilateral patellar tendons in the patients and healthy controls were measured using shear wave elastography. RESULTS: In the CWHTO patients, the patellar tendon on the operated side was thicker (4.4 vs. 3.3 mm, p=0.001) and stiffer (74.1 vs. 47.7 kPa, p<0.001) than on the non-operated side. CONCLUSION: Patellar tendon contracture (thickening and stiffening) is associated with CWHTO.

Laparoscopic management of inferior lumbar hernia (Petit triangle hernia).

Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8 x 10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.

Anterior spinal artery syndrome after peripheral angiography of the lower limbs.

STUDY DESIGN: A case report of temporary anterior spinal artery syndrome secondary to peripheral angiography of the lower limbs. OBJECTIVES: To report a rare case of spinal cord ischemia following a straightforward peripheral angiography with femoral access. SETTING: Istanbul, Turkey. CASE REPORT: A 70-year-old patient with peripheral vascular disease developed temporary paraplegia after angiography caused by anterior spinal ischemia. His motor weakness improved gradually over a 2 month period. CONCLUSION: Spinal complications are extremely rare after peripheral angiography. The possible mechanisms of spinal cord damage are discussed, and the relevant data regarding the etiology are reviewed.

Late onset Pott's paraplegia.

BACKGROUND: Pott's disease may cause late neurological involvement due to development of sharp kyphosis. Anterior decompression and fusion is the treatment of choice for this disorder. OBJECTIVE: To determine the mid-term clinical results of patients with late onset Pott's paraplegia, who underwent anterior decompression and grafting after neurological deterioration. SETTING: A university hospital in Istanbul, Turkey. METHODS: Eight patients who developed late onset paraplegia with a mean period of 24.6 years (range, 9-46 years) after the active disease were treated with anterior decompression and grafting. The mean age at surgery was 36.1 years (range, 18-63 years) and the mean duration of neurological deterioration before surgery was 7.4 weeks (range, 2-13 weeks). The mean kyphosis angle of the patients was 105.63 degrees (range, 80 degrees- 135 degrees). No attempt to correct the curve was made in any operation. All but two patients' neurological status were evaluated according to the International Standards for Neurological and Functional Classification of Spinal Cord Injury determined by ASIA-IMSOP on admission. RESULTS: Neurological status of all patients showed progression either in Frankel scale or in motor scores in the early postoperative period. One patient needed to be reoperated on because of a deterioration of neurological status 26 months after surgery. The mean length of time since the operations is 75.9 months (range, 48 173 months) and all the patients are carrying out their lives independently with a mean motor score of 97.5 and full pin-prick and light touch scores. CONCLUSIONS: Anterior decompression and grafting is an effective procedure for the treatment of late onset paraplegia in Pott's disease.

Myositis ossificans in early childhood.

A 5-year-old boy underwent arthroscopic surgery because of a lateral discoid meniscus, which was followed by an overly strenuous rehabilitation program. At 6-week follow-up, a painful mass at the distal part of the thigh and a flexion restriction of the operated knee were detected, caused by myositis ossificans inside the vastus medialis muscle. The symptoms disappeared with an appropriate rehabilitation program and the patient recovered.

Coverage of knee-tumor-resection prostheses with free flaps.

Free latissimus dorsi free flaps were used for the treatment of three patients with malignant tumors localized at the distal end of the femur. In all cases, a knee prosthesis was used after tumor resection. In two patients, the prosthesis was covered with a free latissimus dorsi flap immediately after insertion. In one patient, the exposed prosthesis that was inserted 9 months previously was also covered with a free latissimus dorsi flap. Histopathologic diagnosis of the tumors was osteosarcoma in two cases and fusiform cell sarcoma in one case. Free-tissue transfers were successful in spite of preoperative chemotherapy and/or radiotherapy. Chemotherapy was started 3 weeks postoperatively in all cases. Patients ambulated 6 weeks after surgery and knee functions were satisfactory during a 1 year follow-up.