Tratamiento quirúrgico de la tendinopatía aquílea crónica no insercional en corredores mediante el uso de radiofrecuencia bipolar / Surgical treatment of chronic non-insertional Achilles tendinopathy in runners using bipolar radiofrequency

Objetivo. Presentar la técnica quirúrgica con liberación del peritendón y radiofrecuencia como un tratamiento eficaz para los pacientes con tendinopatía crónica del cuerpo del tendón de Aquiles en deportistas. Material y método. Se trata de un estudio descriptivo tipo serie de casos retrospectivo. La serie se compone de 17 tendones de Aquiles operados en 13 pacientes, todos ellos practicantes habituales de carrera a pie. Fueron incluidos aquellos pacientes con tendinopatía no insercional del tendón de Aquiles refractaria al tratamiento conservador. Se realizó un seguimiento mínimo de 12 meses, evaluándose la mejoría clínica con ayuda de la escala de Nirschl-Pain, así como el rendimiento deportivo de los atletas. Resultados. Se obtuvo un 94% de desaparición de los síntomas y una vuelta al rendimiento previo del 70% de los casos en los 12 meses de seguimiento. Discusión. La liberación del peritendón combinada con radiofrecuencia bipolar se presenta como una solución eficaz en esta enfermedad sobre la cual no existe en la actualidad un consenso acerca del mejor tratamiento. En los pacientes que tras un tratamiento conservador adecuado durante un periodo suficiente (al menos 6 meses) persiste la tendinopatía no insercional del tendón de Aquiles, la adhesiólisis abierta asociada a radiofrecuencia bipolar constituye una intervención segura y con una alta tasa de éxito, tanto clínica como funcional. En el deportista de alto rendimiento esta técnica permite la vuelta a la actividad previa en un alto porcentaje (AU)

Objective. To present the surgical technique with release of peritendon and radiofrequency as an effective treatment for athletes with chronic tendinopathy of the Achilles tendon body. Materials and methods. This is a retrospective case series descriptive type study. The series consists of 17 Achilles tendon surgeries in 13 patients, who habitually run. The study included patients with non-insertional Achilles tendinopathy refractory to conservative treatments. After a minimum follow-up of 12 months, clinical improvement of the athletes was assessed using the Nirschl pain scale, as well as athletic performance. Results. An improvement was obtained in 94% of symptoms and a return to the previous performance in of 70% of cases in the 12 months follow-up. Discussion. Peritendon release combined with bipolar radiofrequency is presented as an effective solution in this condition, for which there is currently no consensus on the best treatment. In patients in whom, after an appropriate conservative treatment for a sufficient period (at least 6 months) the non-insertional Achilles tendinopathy persists, open adhesiolysis combined with bipolar radiofrequency is a safe and with a high success rate clinical and functional intervention. In high performance athletes this technique allows a return to previous activity in a high percentage of cases (AU)

Hemipelvectomías tras sarcomas de localización pélvica de alto grado: pronóstico en condrosarcomas frente a otros tipos histológicos / Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types

Introducción. La baja incidencia y la heterogeneidad histológica de los sarcomas pélvicos primarios dificulta el análisis y publicación de cohortes homogéneas. Objetivo. Describir el pronóstico vital y funcional dependiendo del tipo histológico en una serie de sarcomas primarios de localización pélvica de alto grado localmente avanzados tratados mediante hemipelvectomía. Material y métodos. Estudio descriptivo, epidemiológico y funcional de 15 casos tratados entre 2006-2012. Se realizó análisis de supervivencia, valoración funcional y estudio comparativo en función del tipo histológico, comparando los condrosarcomas frente al resto de diagnósticos histológicos. Resultados. El tipo histológico más frecuente en la serie fue el condrosarcoma (46%), y la localización más frecuente la zona P2 (periacetabular) (73%). Se realizó una hemipelvectomía interna en el 66% de los casos, siendo mayor (83%) en el caso de los condrosarcomas. La supervivencia global a los 2 años fue del 54%, siendo más elevada en el grupo condrosarcoma (67%) que en el resto (43%). La situación funcional dependió del tipo de intervención, sin encontrar diferencias en función del tipo histológico ni de la realización de reconstrucción. Discusión y conclusiones. La hemipelvectomía como procedimiento quirúrgico está indicada para el tratamiento de los sarcomas primarios de localización pélvica de alto grado localmente avanzados independientemente del tipo histológico. La incidencia de conservación del miembro y la supervivencia global es mayor en los condrosarcomas frente al resto de tipos histológicos (AU)

Introduction. The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. Objective. To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. Methods. A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. Results. The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. Discussion and conclusions. Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas (AU)

[Surgical treatment of chronic non-insertional Achilles tendinopathy in runners using bipolar radiofrequency]. / Tratamiento quirúrgico de la tendinopatía aquílea crónica no insercional en corredores mediante el uso de radiofrecuencia bipolar.

OBJECTIVE: To present the surgical technique with release of peritendon and radiofrequency as an effective treatment for athletes with chronic tendinopathy of the Achilles tendon body. MATERIALS AND METHODS: This is a retrospective case series descriptive type study. The series consists of 17 Achilles tendon surgeries in 13 patients, who habitually run. The study included patients with non-insertional Achilles tendinopathy refractory to conservative treatments. After a minimum follow-up of 12 months, clinical improvement of the athletes was assessed using the Nirschl pain scale, as well as athletic performance. RESULTS: An improvement was obtained in 94% of symptoms and a return to the previous performance in of 70% of cases in the 12 months follow-up. DISCUSSION: Peritendon release combined with bipolar radiofrequency is presented as an effective solution in this condition, for which there is currently no consensus on the best treatment. In patients in whom, after an appropriate conservative treatment for a sufficient period (at least 6 months) the non-insertional Achilles tendinopathy persists, open adhesiolysis combined with bipolar radiofrequency is a safe and with a high success rate clinical and functional intervention. In high performance athletes this technique allows a return to previous activity in a high percentage of cases.

[Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types]. / Hemipelvectomías tras sarcomas de localización pélvica de alto grado: pronóstico en condrosarcomas frente a otros tipos histológicos.

INTRODUCTION: The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. OBJECTIVE: To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. METHODS: A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. RESULTS: The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. DISCUSSION AND CONCLUSIONS: Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas.

Fractura completa de estrés de escafoides tarsiano en corredora de mediofondo. A propósito de un caso / Complete stress fracture of the tarsal navicular in middle-distance runner. Case report

Presentamos el caso de una joven atleta de medio fondo que presentó una fractura de estrés completa del escafoides tarsiano de su pie izquierdo. Tras la sospecha clínica el diagnóstico se hizo con radiografías simples, existiendo un desplazamiento de 2 mm entre los fragmentos. Por ello, el tratamiento indicado fue quirúrgico mediante fijación interna percutánea con un tornillo. La evolución fue completamente satisfactoria, reiniciando sus entrenamientos de carrera a los cuatro meses. Las fracturas de estrés de escafoides deben sospecharse en atletas y practicantes de otros deportes en los que existe carrera y salto, que presenten dolor en el mediopie. El diagnóstico precoz y el tratamiento adecuado dan un buen pronóstico a esta lesión, mientras que el retraso en el diagnóstico o un tratamiento inadecuado pueden traer graves consecuencias , incluida la imposibilidad para continuar con la práctica deportiva. En fracturas completas y desplazadas creemos que el tratamiento de elección es quirúrgico (AU)

The case of a young middle-distance runner with a complete stress fracture of the tarsal navicular bone of her left foot. Clinical suspicion and plain x-rays confirm the diagnosis, with a gap between the fragments of 2 mm. Surgical treatment was performed by percutaneus reduction and internal fixation with a screw. Patient came back to her running trainings in 4 months. Navicular stress fractures should be suspected in athletes and practitioners of other sports that include running and jumping with midfoot pain. Early diagnosis and appropriate treatment could result in good functional recovery, but delay in diagnosis or insufficient treatment could have important consequences and difficult to come back to sports. In our opinion complete and displaced fractures have to be operated (AU)

[Minimally invasive surgical treatment of acromioclavicular dislocations]. / Tratamiento quirúrgico de las luxaciones acromioclaviculares mediante cirugía mínimamente invasiva.

INTRODUCTION: Treatment of grade III Rockwood acromioclavicular lesions continues to be controversial. A new surgical technique for reduction using minimally invasive surgery provides good results. The purpose of this paper is to present the short and medium-term results of a series of patients with grade III acromioclavicular dislocations who underwent surgery. METHODS: Prospective assessment of a series of 14 patients with acromioclavicular dislocation who underwent surgery from May 2009 to June 2010 consisting of open reduction and synthesis with coracoclavicular fixation with a double anchor. Radiologic, functional and personal satisfaction parameters were assessed. RESULTS: Statistically significant radiologic results were obtained, which reflect a correct reduction. An "excellent" mean score was obtained in the functional assessment using the Imatani test. Patients reported subjective satisfaction during the interviews at the outpatient visits. CONCLUSIONS: There are only a few papers reporting postoperative results with this surgical technique. Without a control group it is not possible to make a comparison with orthopedic treatment, so comparisons were made with published series using classical techniques. The surgical technique provides similar results; it is simple, inexpensive and has not shown to have any postoperative complications during a mean follow-up of 13.7 months. Surgical treatment of grade III acromioclavicular lesions using this surgical technique has provided appropriate results in this group of patients.

Polectomía Percutánea Guiada por Eco. Parte I: Descripción anatómica de las «zonas seguras» / Percutaneous ultrasound guided A1 pulley release. Part I: Description of the «safe area»

Material y métodos: En 100 dedos de 10 voluntarios empleamos ecografía Doppler para posicionar las estructuras en riesgo (arterias, nervios y tendones) y los límites de los sectores que las engloban. Desde el punto más volar de la vaina sinovial, línea teórica estándar para la liberación de la polea A1, medimos la posición relativa de las paredes arteriales próximas, el grosor de la polea y la anchura del espacio sinovial. El punto más radial fue establecido como 0º, el más cubital como 180º y los valores volares considerados positivos para realizar un diagrama de dispersión con la posición de las arterias que fue analizado digitalmente para determinar los límites de la «zona segura». Resultados: Desde el punto más volar de la vaina sinovial, la posición media a la pared arterial más cercana fue de 8,96 mm (3,5 / 20,6) para la arteria digital radial y 7,59 mm (3,7/ 16,8) para la arteria digital cubital. La «zona segura» se extendió volarmente de modo casi semicircular desde 6,1º hasta 180º. Conclusiones: La «zona segura» está situada volarmente, respecto a la línea quirúrgica estándar, en la superficie palmar de la vaina sinovial en la polea A1 y permite situar los instrumentos quirúrgicos en la liberación percutánea guiada por ecografía para el dedo en resorte (AU)

Purpose: This study defines a «safe area» in volunteers for performing a percutaneous A1 pulley release under ultrasonography guidance for the treatment of trigger fingers. Materials and Methods: In 100 fingers of 10 volunteers we used Doppler ultrasound to determine the position of structures at risk (arteries, nerves, and tendons) and the limits of the sectors that enclosed these structures. From the synovial sheath’s most volar point, which corresponds to the standard theoretical line for releasing A1, we measured the relative position of the nearest arterial walls, pulley thickness and synovial space width. Then, the most radial point was set as 0º, the most ulnar as 180º and volar values were considered as positive for performing a scatterplot overlay of the arterial positions, which was digitally analyzed for determining the limits of the risk and safe areas. Results: From the theoretical line at the volar synovial sheet for releasing A1, the average position of the closest arterial wall for the radial digital artery was 8,96 mm (3,5 / 20,6) and, for the ulnar digital artery, this distance was 7,59 mm (3,7/ 16,8). The «safe area» was a volar semicircular-like sector extending from +6,1º to +180º. Conclusions: The present study describes a «safe area» volar to the standard surgical line on the volar surface of the synovial sheet at A1, thus, providing a safe direction for aiming surgical instruments for a percutaneous ultrasound guided release of the A1 pulley in trigger fingers (AU)

Polectomía Percutánea Guiada por Eco. Parte II: técnica intravaginal / Percutaneous ultrasound guided A1 pulley release. Part II: Intravaginal technique

Objetivo: Desarrollar la liberación percutánea intravaginal de la polea A1 guiada con ecografía para el tratamiento del dedo en resorte. Material y métodos: Liberamos la polea A1 en 46 dedos de 5 cadáveres, dirigiendo el instrumento de corte hacia la «zona segura» volar desde un posicionamiento intravaginal. Mediante disección, evaluamos la precisión, seguridad y eficacia del método. Sigue un estudio clínico prospectivo en 62 pacientes (62 dedos) comparando la polectomía abierta (n=17) con nuestra técnica (n=45) y evaluando los tiempos quirúrgicos de uso de analgésicos postoperatorios, recuperación motora y reincorporación a tareas habituales. Resultados: La precisión quirúrgica fue adecuada en los cadáveres, sin daños a las estructuras adyacentes. Se efectúa una liberación completa en 44 dedos (95,7%) e incompleta, menor de 1,6 mm en dos. El tiempo quirúrgico mostró correlación con la fecha de intervención (r2 = 0,44). La duración media en la toma de analgésicos, recuperación motora y reincorporación a tareas habituales fueron significativamente menores con nuestra técnica. Conclusiones: Se describe un método de posicionamiento intravaginal de instrumentos quirúrgicos para dirigir su filo hacia la «zona segura» volar en la liberación percutánea de A1 guiada por ultrasonidos. Sugerimos prudencia en el pulgar y conversión a una cirugía abierta si la visualización ecográfica no fuera óptima. La curva de aprendizaje influye en el tiempo de intervención. Los resultados clínicos de esta técnica son mejores a los de las técnicas convencionales (AU)

Purpose: To develop a percutaneous intravaginal A1 pulley release under ultrasonography guidance for the treatment of Trigger Fingers. Materials and Methods: We released the A1 pulley on 46 fingers in 5 cadavers aiming our cutting device towards the volar «safe area» (described in our previous study) from an intravaginal positioning. The precision, safety and efficacy of the release were evaluated by surgical exposure. We performed a prospective clinical study in 62 patients (62 fingers) comparing the open approach (n=17) with our technique (n=45). Timings assessed for: surgery, use of postsurgical analgesics, motor recovery and return to normal daily tasks. Results: Surgical precision was good in cadavers with no injuries to adjacent structures, a complete release in 44 digits (95,7%) and a less than 1,6 mm incomplete release in two digits. Clinically, surgical times showed a lineal correlation with the date of surgery (R2 = 0,44). The average times for using analgesics, motor recuperation and returning to daily tasks were significantly shorter with our technique. Conclusions: This study shows a method for positioning surgical instruments intravaginally for aiming their edge towards the volar «safe area» in a percutaneous ultrasound guided release of A1. We suggest being cautious in the thumb and converting the surgery to an open procedure if the ultrasound visualization is suboptimal. Clinical results of this technique are better that the classical approach (AU)