Allograft and Autologous Reconstruction Techniques for Neglected Achilles Tendon Rupture: A Mid-Long-Term Follow-Up Analysis.

Achilles tendon ruptures that are not immediately recognized and treated are sometimes diagnosed as delayed injuries and may require different surgical repair options based on gap size. The potential complications associated with using an allograft for reconstruction may lead some surgeons to prefer the use of autologous techniques. However, allografts are often considered a salvagement option when large defects are present. In this study, we examined the long-term clinical outcomes and complications of 17 patients who underwent surgical repair for chronic ruptures with large gaps using both autologous and allograft techniques. During an 11-year period, nine patients were treated with autologous techniques (mean gap of 4.33 ± 1.32 cm) and Achilles allograft reconstruction was performed in eight patients (47.1%) (mean gap of 7.75 ± 0.89 cm). At a mean of 82 ± 36.61 months of follow-up, all 17 patients (100%) were able to perform a single heel rise and improved AOFAS (American Orthopaedic Foot and Ankle Society) and ATRS (Achilles Tendon Total Rupture Score) scores. No infections, complications, or re-ruptures were recorded at the end of the follow-up. No significant differences were found in the AOFAS and ATRS scales between both techniques. When an extensive defect is present, the reconstruction with an Achilles tendon allograft can be considered a proper treatment option, as it does not show a higher rate of complications than autologous techniques achieving similar functional outcomes.

Conservative Treatment of Ankle Osteoarthritis.

Despite the disabling nature of ankle osteoarthritis (OA), there is poor scientific evidence for a conservative treatment compared to the hip and knee OA. In this regard, most of the treatment options in use are not based on clinical studies of the ankle, and they are extracted from evidence obtained from clinical studies of other lower limb joints. However, this does not seem to be a good idea, since the aetiology of ankle OA is quite different from that of the hip or knee. Nonpharmacological and pharmacological treatments such as nonsteroidal anti-inflammatory drugs, hyaluronic acid, corticosteroid, platelet-rich plasma injection and mesenchymal stem cells injections have been reported. However, further research is required in this field to obtain a specific clinical practice guideline for the conservative treatment of ankle OA.

Minimally invasive technique for stage III adult-acquired flatfoot deformity: a mid- to long-term retrospective study.

PURPOSE: The purpose of this study was to present the functional, radiological, and quality of life outcomes of a series of stage III adult-acquired flatfoot deformity corrections using an original operative approach based on minimal incision surgery (MIS). METHODS: Sixty-two patients (67 feet) with a symptomatic stage III flatfoot deformity were treated using a modified double arthrodesis by MIS. The mean age was 63 years (range, 50 to 81) and the mean follow-up was 6.6 years (range, 3.2 to 11.5). Clinical, radiological, American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score), quality of life (SF-36), and satisfaction scores were collected retrospectively. RESULTS: The mean AOFAS score improved by 54.27 (95% [CI], 57.27-51.3; P < 0.0001), and the SF-36 improved by a mean of 17.5 points (95% CI, 1.4-20.9) in the physical component summary (PCS). Deformity correction was confirmed by a significant improvement in the x-ray measurements (six angles). Bony union was observed in 89.5% of cases (60/67). In all, nine patients (13.4%) needed a secondary surgery: three for talonavicular nonunion, four for progression of the flatfoot deformity, and two for screw protrusion. No cases of superficial infection, wound dehiscence, or avascular necrosis of the talus were observed. CONCLUSION: The present series represents the largest study of stage III flatfoot correction using MIS with a mid- to long-term follow-up. Because the data showed clinical and functional improvement after surgery with fewer complications, this technique may be ideal for patients at risk of complications. Graphical abstract.

Protective Approach for Anatomical Structures at Risk in Total Ankle Replacement.

Currently, total ankle replacement (TAR) is an alternative to arthrodesis in selected patients, with the anterior approach being the most widely used to carry it out. Regardless of the type of implant used, the pins for bone resection guides, chisels, and the saw for distal tibial resection can endanger the neurovascular and tendon structures that lie in intimate proximity to the posterior aspect of the ankle. Additionally, there is a documented complication rate of up to 15.3% in such surgery. We have implemented a protective posteromedial approach that complements the anterior approach to reduce this risk of intraoperative iatrogenic injury. Using this method we introduce a protective instrument that separates the posterior anatomical structures from the posterior cortex of the tibia. This article describes the surgical technique used to carry out TAR through an anterior approach in a safer way, without increasing complications or the duration of real-time surgery.

Mejoría de la función cardio-respiratoria en paciente con circulación de fontán tras la intervención quirúrgica de su escoliosis / Improvement of the cardio-respiratory function in fontan patients after surgery of scoliosis

La escoliosis puede tener un impacto negativo sobre la función cardio-respiratoria en pacientes con cirugía de Fontán. Cuando las consecuencias de la progresión de la deformidad sobre la calidad de vida y la supervivencia potencial a largo plazo del paciente superan los riesgos de la intervención se aconseja el tratamiento quirúrgico de la curva. Desafortunadamente, este grupo de pacientes presenta un elevado riesgo anestésico y un difícil manejo durante el procedimiento quirúrgico, debido a la necesidad de mantener una presión venosa central elevada que garantice un adecuado flujo pulmonar, circunstancia que dificulta la consecución de una hipotensión controlada, habitual en estos procedimientos para el control del sangrado. Presentamos el caso de una paciente de 13 años con enfermedad congénita cardiaca (ECC) y fisiología de Fontán sometida a corrección quirúrgica de su escoliosis tóraco-lumbar, su manejo y mejora de la función cardiaca tras la cirugía raquídea mediante fusión raquídea posterior

Scoliosis can negatively impact the cardio respiratory function in patients with Fontan anatomy. Surgical treatment of the spinal curvature is advised when the consequences of the progression of the deformity on the survival and quality of life at the long term overcome the risks of the intervention. Unfortunately, this group of patients presents a high anesthetic risk and a difficult management during the surgical procedure, because they need to support a high central venous pressure to ensure an adequate pulmonary flow, circumstance which makes difficult to achieve a controlled hypotension, usual in these procedures for control of bleeding. We report here about a 13 years old patient with congenital heart disease (CHD) and Fontan physiology presented for posterior spinal fusion for the treatment of thoracolumbar scoliosis, her management and later progress of her cardiac function after the spinal fusion surgery

Luxación inveterada anterior de hombro tratada mediante artroplastia invertida en paciente anciana. A propósito de un caso / Anterior inveterate dislocation of the shoulder in an elderly patient treated by reverse arthroplasty. Case report

Objetivos: se presenta un caso de luxación anterior inveterada de hombro derecho y su tratamiento mediante implantación de prótesis invertida. Material y métodos: Paciente de 69 años que se diagnostica de luxación anterior inveterada de hombro con antecedentes de luxación anteroinferior postraumática 6 meses antes, tratada conservadoramente. Mediante pruebas de imagen se objetivó la existencia de un voluminoso Bankart óseo, así como rotura masiva del manguito rotador. Se optó por realizar cirugía abierta, reconstruyendo el defecto glenoideo con autoinjerto y osteosíntesis mediante tornillos canulados. Se decidió tratamiento definitivo en un mismo acto quirúrgico con la implantación de prótesis invertida con técnica de aumentación del offset. Resultados: Se consiguió una adecuada congruencia y estabilidad articular con excelente función global a los 6 meses de la intervención, libre de dolor. Conclusiones: La luxación anterior inveterada de hombro es una patología infrecuente en la práctica clínica habitual de la que no se dispone mucha información en la literatura. El tratamiento quirúrgico mediante artroplastia invertida de hombro puede ser adecuado para el tratamiento de la misma, debido a los buenos resultados clínicos, radiológicos y funcionales que proporciona

Objective: We present the case of an inveterate anterior dislocation of the glenohumeral joint and following treatment by reverse artrhoplasty. Materials and methods: 69 years-old female patient, diagnosed of anterior inveterate dislocation of the shoulder with a history of traumatic dislocation, treated conservatively 6 months earlier. The existence of a large bony Bankart and a massive rotator cuff tear was observed by imaging studies. Open surgery was performed,filling the glenoid defect with autograft and internal fixation using cannulated screws. Final treatment was decided in the same surgery performing bony increased-offset reverse shoulder arthroplasty (BIO-RSA) technique. Results: proper articular congruency and painfree stability with excellent overall function at 6months after surgery was achieved. Conclusions: The anterior inveterate glenohumeral dislocation is a rare condition in clinical practice from which much information is not available in the literature. Surgical treatment by reverse shoulder arthroplasty may be an appropriate therapeutic option to treat it, due to the good clinical, radiological and functional results it provides

Prótesis unicompartimental lateral de rodilla. Indicaciones, técnica y resultados a mediocorto plazo / Lateral unicompartimental knee replacement: indications, sugery procedures and shortmidterm outcomes

Objetivos: En los casos de gonartrosis del compartimento lateral, la prótesis unicompartimental es una de las alternativas quirúrgicas utilizadas, por el menor traumatismo que supone, corta estancia hospitalaria y rápida recuperación del paciente. Este estudio revisa nuestros casos. Material y método: Se describe la técnica utilizada y la prótesis implantada (polietileno móvil bicóncavo, OXFORD DOMED). Estudio observacional longitudinal retrospectivo de 15 casos intervenidos entre 2010 y 2013, 13 mujeres y 2 hombres, con una media de edad de 60’7 años, con diagnóstico de gonartrosis monocompartimental externa, sin afectación del compartimento medial ni fémororrotuliano y con ligamentos cruzados indemnes, con un seguimiento medio de 25 meses. Se les ha pasado escalas de funcionalidad y satisfacción. Resultados: Los resultados son favorables, con una mejoría de 6,60 puntos en la escala de EVA, de 3,73 sobre 1 en la función postoperatoria, muy satisfactorios en la OKS con una media de 38 puntos sobre 50, sin necesidad de ninguna revisión quirúrgica. Observamos tendinitis anserina en un 20% de los casos. Conclusiones: Se valoran los beneficios de esta cirugía frente a sus alternativas, así como de sus posibles inconvenientes. La artroplastia de rodilla unicompartimental externa es una alternativa efi caz en casos de gonartrosis confi nada al compartimento lateral sin otras lesiones asociadas

Objectives: In patients with lateral osteoarthritis of the knee, use of external unicompartmental knee arthroplasty it is a well known surgical alternative, used by the minor trauma involved, short hospital stay and rapid recovery. The purpose of this study is to show the clinical outcomes to short-medium term of patients undergoing this procedure. Methods: we describe the technique used and the peculiarities of the prosthesis (A Mobile-bearing lateral unicompartmental knee replacement, Oxford Domed(R)). This is an observational retrospective longitudinal study, of 15 arthroplasties performed in 13 women and 2 men, between 2010 and 2013, with a mean age of 60’7 years, with a diagnosis of lateral osteoarthritis of the knee, without involvement of the medial or patellofemoral compartment and cruciate ligaments functionally intact, with a mean follow up of 25 months. All patients complete the Oxford Knee Score and Visual Analog Scale (VAS) during the study. Results: The results are favorable, with an improvement of 6.60 points on the EVA, 3.73 for 1 in the postoperatory funcionality, the OKS very satisfactory with an average of 38 points over 50 and without any postoperative function surgical revision. Anserine tendinitis was observed in 20% of cases. Conclusions: The benefi ts of this surgery against their alternatives are assessed, and their potential drawbacks. External unicompartmental knee arthroplasty is an effective alternative in cases of knee osteoarthritis of the lateral compartment with no other associated injuries (AU)