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1.
BMC Musculoskelet Disord ; 22(1): 748, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461874

RESUMO

BACKGROUND: The fabella is a sesamoid bone in the posterolateral capsule of the human knee joint. In quadrupedal mammals, the fabella is believed to have a role similar to the patella in redirecting extension forces of the knee joint from one point to another. In bipeds, the fabella is not touching the back of the bent knee, and therefore the role in redirecting forces declines. Posterolateral knee pain can be associated with the irritation between the fabella and lateral femoral condyle, a phenomenon also known as fabella syndrome. In cases that are unresponsive to conservative management, surgical fabellectomy can be a successful treatment option. Among the surgical approaches, open resection is most commonly seen. There are also literature reporting arthroscopic-assisted open resection, but seldom mentioned the all-arthroscopic fabellectomy. CASE PRESENTATION: We present 3 patients with a long history (> 12 month) of posterolateral knee pain under suspicion of different pain origins. The diagnosis of fabella impingement was eventually made by ruling out of other causes. All the patients underwent all-arthroscopic fabellectomy for diagnosis and treatment. Investigations of the resected fabella suggested chronic impingement with apparent osteophyte formation and cartilage wearing of the articular side. All patients have been continually followed up at our outpatient department and reported to be pain free after the procedure. CONCLUSIONS: In the patients presenting posterolateral pain, fabella syndrome cannot be ignored due to its relative higher presence in Asian population. In our experience, the all-arthroscopic fabellectomy offers a smaller wound size, less post-operative pain, fewer days of hospitalization and quicker time to rehabilitation for the patients with chronic posterolateral knee pain caused by fabella syndrome.


Assuntos
Ossos Sesamoides , Humanos , Joelho , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Dor , Ossos Sesamoides/diagnóstico por imagem , Ossos Sesamoides/cirurgia , Síndrome
2.
Can Vet J ; 62(8): 867-871, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34341602

RESUMO

The satisfactory outcome of fungal osteitis in an 8-year-old American Quarter Horse is described. The horse was admitted with a grade 4 out of 5 lameness and exhibited metacarpophalangeal synovial effusion, indicative of a mild suppurative inflammation. Results of initial radiographic and ultrasonographic examination were unremarkable. Intra-articular anesthesia of the metacarpophalangeal joint allowed localization of the insult. It was not until day 6 of hospitalization when lytic changes on the axial aspect were observed on radiographic examination. Arthroscopic examination permitted identification and debridement of the affected bone. Fungal culture of the bone yielded Pleosporales spp. The horse was sound at the time of discharge after 12 days of hospitalization. No complications occurred in the post-operative period and the horse resumed his initial level of activity and competition in barrel racing. Key clinical message: To our knowledge, this is the first description of successful outcome of a fungal osteitis of the sesamoid bones following arthroscopic debridement. We hypothesize that the satisfactory outcome is associated with early recognition of the condition and aggressive debridement of the lesion arthroscopically.


Assuntos
Doenças dos Cavalos , Osteíte , Ossos Sesamoides , Animais , Doenças dos Cavalos/cirurgia , Cavalos , Coxeadura Animal , Osteíte/veterinária , Ossos Sesamoides/diagnóstico por imagem , Ossos Sesamoides/cirurgia
3.
Orthop Surg ; 13(2): 669-672, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33624373

RESUMO

BACKGROUND: Common peroneal nerve palsy (CPNP) is a rare but serious complication following primary total knee arthroplasty (TKA). The common peroneal nerve is one of the main molecules of the sciatic nerve. CPNP is a series of symptoms caused by common peroneal nerve injury due to paralysis and atrophy of the fibula and tibia muscles. The main clinical symptoms are: ankle joint unable to extend back, toe unable to extend back, foot droop, walking in a steppage gait, and foot dorsal skin sensation having decreased or disappeared. If treatment is not timely, severe cases may result in atrophy of the anterior tibia and lateral calf muscles. The risk factors for CPNP include mechanical stretching of the nerve, disruption of the blood supply to the nerve, and compression of the nerve. The CPNP should be treated in a timely manner and according to the cause. Its function should be restored as soon as possible to avoid serious adverse consequences. It has negative effects on patients' life and physical and mental health. To our knowledge, this is the first study to describe CPNP due to a giant fabella after TKA. CASE PRESENTATION: The present study reported on a 70-year-old female patient. The patient underwent a primary TKA of the right knee for osteoarthritis. Relevant examinations were conducted and the operation went smoothly. Three hours postoperation, a right partial CPNP was observed, with progressive aggravation over time. On palpation, there was a 2 × 2-cm fixed hard mass in the posterolateral aspect of the right knee, with mild tenderness to deep palpation. Radiographs demonstrated that a giant fabella was located at the posterolateral condyle of the right femur. Fabellectomy and neurolysis of the common peroneal nerve were performed. The peroneal nerve palsy resolved gradually after the operation. At 8-month follow up after fabellectomy and neurolysis, the function of the common peroneal nerve had fully recovered. CONCLUSIONS: The presence of giant feballa pressing on the common peroneal nerve should be considered when common peroneal nerve palsy occurs after TKA. Surgical exploration and release compression should be performed in a timely manner.


Assuntos
Artroplastia do Joelho , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Ossos Sesamoides/anormalidades , Ossos Sesamoides/cirurgia , Idoso , Feminino , Humanos
4.
Biomed Res Int ; 2020: 9658916, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32685550

RESUMO

The hallucal sesamoid bones (HSBs), having an important role in reducing load per unit area on the first metatarsal head, can be injured commonly which also affected the first metatarsophalangeal joint and the surrounding structure. Meanwhile, differences among each HSB type may be a major factor affecting the occurrence and development of HV. So far, many researchers had learned that there are three different conditions in hallucal sesamoid bone affecting the choice of clinical surgery corresponding to different solutions in clinic. Thus, it is necessary to study the anatomical morphological characteristics of the HSB which can be helpful in clinical diagnosis and treatment, especially hallux valgus (HV). 150 X-ray and three-dimensional (3D) computed tomographic (CT) images consist of 72 left and 78 right metatarsals were applied in this anatomic study between two variables and showed by a simple scatter plot. The first metatarsophalangeal joint is divided into four different types: type I (no HSB, 1.3%), type II (with one HSB, 0.07%), type IIIa (with two HSBs when THB is bigger, 28%), type IIIb (with two HSBs when FHB is bigger, 65.3%), and type IV (with three HSBs, 4.7%). There was no statistical difference between the left and right sides, except HVA, Meary, and pitch (P < 0.05); all a, b, c, d, and i have statistical difference between male and female (P < 0.05). Meanwhile, HVA and IMA and HVA and type group have a significant correlation. In summary, HVA and IMA and HVA and classification of HSBs have significant correlations. The classification and location of HSBs can be an important basis to choose operation methods and postoperation evaluation.


Assuntos
Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Ossos Sesamoides , Tomografia Computadorizada por Raios X , Feminino , Hallux Valgus/classificação , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Pessoa de Meia-Idade , Ossos Sesamoides/diagnóstico por imagem , Ossos Sesamoides/cirurgia
5.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32675008

RESUMO

The fabella is a sesamoid bone present in 30% of the population and, in the majority of cases, it is shown in the proximal head of the lateral gastrocnemius articulating with the lateral femoral condyle. Fabella syndrome is an uncommon disease and it must be considered when dealing with posterolateral pain that increases with extension of the knee. Because of its rarity and underdiagnosis, the literature reports few articles relating to its therapeutic management. The articles reviewed demonstrate that conservative treatment has high recurrence rates, surgical excision being the most effective treatment to eradicate symptoms. We found exceptional articles in the literature related to the surgical treatment of fabella syndrome in professional athletes. In this article we report the surgical experience of a 21-year-old elite swimmer who achievedcomplete pain relief and fast recovery after surgical excision of the fabella.


Assuntos
Articulação do Joelho/anormalidades , Articulação do Joelho/cirurgia , Ossos Sesamoides/anormalidades , Ossos Sesamoides/cirurgia , Atletas , Humanos , Masculino , Natação , Síndrome , Adulto Jovem
6.
J Foot Ankle Surg ; 59(3): 594-597, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32354515

RESUMO

Avascular necrosis of a sesamoid bone is a rare and incompletely understood entity. Furthermore, associated lesions secondary to sesamoid pathology have seldom been described in the literature. We report a case of avascular necrosis of the medial sesamoid, accompanied by severe synovitis of the first metatarsophalangeal joint, that was successfully managed with arthroscopic synovectomy and open excision of the sesamoid.


Assuntos
Artroscopia , Articulação Metatarsofalângica , Osteonecrose/cirurgia , Ossos Sesamoides/cirurgia , Sinovectomia , Feminino , Humanos , Osteonecrose/diagnóstico por imagem , Osteonecrose/etiologia , Adulto Jovem
7.
Clin Podiatr Med Surg ; 37(2): 287-293, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146984

RESUMO

Nonunion rate of first metatarsophalangeal joint (MTP) joint arthrodesis is reportedly less than 6%, regardless of fixation type. Robust modern plating constructs aim to decrease incidence of nonunion while also allowing early postoperative weight-bearing. Quicker transition to weight-bearing postoperatively increases patient adherence, decreases adjacent joint stiffness, and reduces risk of deep vein thrombosis in the postoperative period. The purpose of this study was to investigate the effect tibial sesamoid fixation has on first MTP joint arthrodesis.


Assuntos
Artrodese , Fixação Interna de Fraturas , Articulação Metatarsofalângica/cirurgia , Ossos Sesamoides/cirurgia , Tíbia/cirurgia , Suporte de Carga/fisiologia , Idoso , Cadáver , Feminino , Hallux Rigidus/cirurgia , Humanos , Masculino , Articulação Metatarsofalângica/fisiopatologia , Pessoa de Meia-Idade
8.
Foot (Edinb) ; 43: 101656, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32078908

RESUMO

BACKGROUND: Lateral hallucal sesamoidectomy is an infrequently performed procedure indicated for patients with sesamoid pathology failing conservative treatment. Concerns exists regarding patient satisfaction, plantar scar pain, hallux malalignment and metatarsophalangeal joint (MTPJ) movement restriction following sesamoidectomy. This study aims to assess patient satisfaction after lateral hallucal sesamoidectomy via the plantar approach. METHODS: In this retropective study with prospective follow-up, all patients who underwent lateral hallucal sesamoidectomy between January 2004 and December 2017 were reviewed. Twelve patients (14ft.) were available for final assessment. Outcome measures were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale and the Self-Reported Foot and Ankle questionnaire (SEFAS). Patients were assessed clinically and radiologically. The average postoperative follow-up was 111.5 months (range 28-177 months). RESULTS: All patients reported excellent outcome scores with a mean SEFAS score of 46.08 (range 43-48) and a mean AOFAS score of 92.33 (range 78-100) at final follow-up. All twelve patients reported their outcome as being excellent. No malalignment was noted clinically, however, three patients had a noticeable increase in the gap between the hallux and second toe when compared to the contralateral side. Range of motion at the MTPJ was preserved with a mean dorsiflexion of 80.83° (range 70-90°) and a mean plantarflexion was 25.83° (range 0-30°). None of the patients experienced any pain, discomfort or irritation related to the plantar scar. One patient developed neuroma like symptoms in the first web space. CONCLUSION: Lateral hallucal sesamoidectomy via a plantar approach is an effective and reliable treatment option as demonstrated by the high levels of patient satisfaction, preservation of function, excellent PROM scores and limited complications in this study. LEVEL OF EVIDENCE: Level 4.


Assuntos
Doenças Ósseas/cirurgia , Fraturas Ósseas/cirurgia , Hallux , Ossos Sesamoides/lesões , Ossos Sesamoides/cirurgia , Adulto , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/fisiopatologia , Feminino , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Recuperação de Função Fisiológica , Estudos Retrospectivos , Adulto Jovem
9.
JBJS Case Connect ; 10(4): e20.00388, 2020 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-33449548

RESUMO

CASE: A 22-year-old man sustained closed dislocation of the hallucal interphalangeal joint (HIPJ). Painful limitation of movements persisted 2 months after closed reduction. Magnetic resonance imaging revealed dislocation of the hallucal interphalangeal joint sesamoid (HIPJS) from its intra-articular attachment on the superior surface of the plantar plate to an extra-articular subcutaneous location, plantar and lateral to the flexor hallucis longus tendon. The HIPJS was enucleated through a plantar approach, and the foot remains pain-free 18 months later. CONCLUSIONS: This case represents an unusual combination of HIPJ dislocation and extra-articular dislocation of its sesamoid. Raised awareness of the HIPJS, its normal anatomical location, and configuration will avoid delayed diagnosis.


Assuntos
Luxações Articulares/diagnóstico por imagem , Ossos Sesamoides/lesões , Articulação do Dedo do Pé/lesões , Humanos , Luxações Articulares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Radiografia , Ossos Sesamoides/diagnóstico por imagem , Ossos Sesamoides/cirurgia , Articulação do Dedo do Pé/diagnóstico por imagem , Articulação do Dedo do Pé/cirurgia , Adulto Jovem
10.
J Foot Ankle Surg ; 58(6): 1095-1099, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31562061

RESUMO

Relationships between hallux valgus (HV) and other measurements within the first ray have been extensively studied. It is becoming more popular to correct HV deformity with tarsometatarsal joint arthrodesis while internally (varus) rotating the first metatarsal. This, in turn, reduces the sesamoid position when viewed in the dorsoplantar projection on radiographs. However, it has been shown that not all HV deformities have pathological external (valgus) rotation of the first metatarsal. In this study, we explored the relationships between frontal-plane rotations of the first metatarsal as well as the sesamoids, and other factors not limited to the first ray, to better understand the pathological process of HV deformity and to assist in surgical planning. We found that when adjusting for these covariates, the only factor associated with first metatarsal external rotation was having less metatarsus adductus. Sesamoid rotation, on the other hand, was independently associated with the HV angle, tibial sesamoid position, and medial column collapse. When surgically treating HV, correction of sesamoid rotation may need to be prioritized.


Assuntos
Artrodese/métodos , Hallux Valgus/cirurgia , Ossos do Metatarso/diagnóstico por imagem , Radiografia/métodos , Ossos Sesamoides/diagnóstico por imagem , Feminino , Seguimentos , Hallux Valgus/diagnóstico , Humanos , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Ossos Sesamoides/cirurgia
11.
Vet Surg ; 48(7): 1181-1187, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31456256

RESUMO

OBJECTIVE: To describe the presence of fragments in the dorsal proximal interphalangeal (PIP) joint and to report flat racing performance after surgical treatment. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Thirty-nine affected thoroughbred flat racehorses and 169 age- and sex-matched maternal siblings. METHODS: Medical records from 2000 to 2015 were reviewed for thoroughbred horses that underwent arthroscopic removal of osteochondral fragments in the dorsal aspect of the PIP joint. The horses' 2-year-old year, 3-year-old year, and career athletic performances were compared with their matched siblings. RESULTS: Thirty-nine thoroughbred horses were included, varying in age from 4 months to 4 years, with osteochondral fragments in 42 PIP joints. Hind limbs (92%) were more commonly affected than forelimbs (8%). Fragments were located within the origin of the collateral ligament of the distal sesamoid (navicular) bone. After surgery, the likelihood of starting a race did not differ between treated horses (27/39 [69%]) and maternal siblings (129/169 [76%], P = .15). Race earnings did not differ between treated horses and their siblings during their 2-year-old year (P = .66), 3-year-old year (P = .43), or career (P = .60). CONCLUSION: Removing osteochondral fragments from the origin of the collateral ligament of the distal sesamoid bone did not impair the ability to race or earning potential for affected thoroughbred racehorses compared with their maternal siblings. CLINICAL SIGNIFICANCE: Fragments from the dorsal aspect of the PIP joint in racehorses can be removed arthroscopically resulting in a good clinical outcome and future flat racing performance comparable to matched controls.


Assuntos
Ligamentos Colaterais , Fraturas Ósseas/veterinária , Doenças dos Cavalos/cirurgia , Articulações/cirurgia , Ossos Sesamoides/patologia , Animais , Artroscopia/veterinária , Feminino , Membro Anterior/cirurgia , Fraturas Ósseas/cirurgia , Membro Posterior/cirurgia , Cavalos , Masculino , Estudos Retrospectivos , Ossos Sesamoides/cirurgia , Resultado do Tratamento
12.
Foot Ankle Int ; 40(12): 1375-1381, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31434509

RESUMO

BACKGROUND: The purpose of this study was to evaluate patients for intermediate-term pain relief, functional outcome, and changes in hallux alignment following isolated, complete fibular sesamoidectomy via a plantar approach for sesamoid-related pain recalcitrant to conservative treatment. METHODS: A retrospective query of a tertiary referral center administrative database was performed using the Current Procedural Terminology code 28135 for sesamoidectomy between 2005 and 2016. Patients who underwent an isolated fibular sesamoidectomy were identified and contacted to return for an office visit. The primary outcome measure was change in visual analog pain score at final follow-up. Secondary measures included satisfaction, hallux flexion strength, hallux alignment, pedobarographic assessment, and postoperative functional outcome scores. Patients who met the 2-year clinical or radiographic follow-up minimum were included. Ninety fibular sesamoidectomies were identified. Thirty-six sesamoidectomies met inclusion criteria (median 60-month follow-up). The average patient was 36 years old and underwent sesamoidectomy 1.1 years after initial diagnosis. RESULTS: Median visual analog scale scores improved 5 (6 to 1) points at final follow-up (P < .001). Final postoperative mean hallux valgus angle did not differ from preoperative values (10.5 degrees/8.5 degrees, P = .12); similarly, the intermetatarsal angle did not differ (8.0 degrees/7.9 degrees, P = .53). Eighty-eight percent of patients would have surgery again and 70% were "very satisfied" with their result. Hallux flexion strength (mean 14.7 pounds) did not differ relative to the contralateral foot (mean 16.1 pounds) (P = .23). Among the full 92 case cohort, 3 patients underwent 4 known reoperations. CONCLUSION: Fibular sesamoidectomy effectively provided pain relief (median 5-year follow-up) for patients with sesamoid pathology without affecting hallux alignment. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Hallux/fisiopatologia , Ossos Sesamoides/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Estudos Retrospectivos , Adulto Jovem
13.
Vet Comp Orthop Traumatol ; 32(6): 440-446, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31279325

RESUMO

OBJECTIVE: The aim of this study was to to determine the comparative stiffness following repair of an axial sagittal fracture model in equine distal sesamoid bones using either a single 3.5-mm or 4.5-mm cortical bone screw placed in lag fashion. STUDY DESIGN: The present study was an in vitro biomechanical study. RESULTS: The mean (±standard deviation) stiffness value for the 4.5-mm screw-bone construct (522.49 N/mm ± 168.21) was significantly greater than the 3.5-mm screw-bone construct (408.46 N/mm ± 131.13) (p = 0.047). This represents a 28% difference in mean stiffness. CONCLUSIONS: In vitro, the 4.5-mm screw-bone construct creates a stiffer repair of fractured distal sesamoid bones by a margin of 28%. The 4.5-mm cortical bone screw may better withstand forces imparted on the distal sesamoid bone sustained during anaesthetic recovery, normal weight bearing and athletic exercise, thereby minimizing the risk of implant failure.


Assuntos
Parafusos Ósseos/veterinária , Fraturas Ósseas/veterinária , Cavalos/lesões , Ossos Sesamoides/lesões , Animais , Fenômenos Biomecânicos , Parafusos Ósseos/classificação , Membro Anterior , Fraturas Ósseas/cirurgia , Membro Posterior , Cavalos/cirurgia , Ossos Sesamoides/patologia , Ossos Sesamoides/cirurgia
14.
Phys Sportsmed ; 47(4): 441-447, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31109214

RESUMO

Objective: To describe the evaluation, management and recovery time of hallux sesamoid fractures in young athletes.Methods: A retrospective chart review was performed in a large academic teaching institution over a 5-year period (1/1/2010-12/31/2014). All patients with a sesamoid injury were initially included. Excluded were those patients who: 1) did not receive the diagnosis of hallux sesamoid fracture, had a history of prior foot surgery, or had medical records inadequate for analysis, 2) had missing or unclear diagnostic imaging, 3) were age >21 years, or 4) did not report sports participation. Descriptive statistics were employed to analyze the data.Results: Fifty-eight patients (51 females and 7 males) with a mean age of 15.4 years (range: 9-21) were identified with a total of 59 sesamoid fractures. Dancing (37.9%), running (13.8%), and gymnastics (13.8%) were the most common sports reported among these patients. A greater number of fractures were classified as repetitive stress injuries (83.1%), rather than acute traumatic injuries (16.9%). Fractures were treated conservatively in the majority of cases (89.8%), and only six fractures (10.2%) were treated surgically. Most patients (84.7%) were able to return to sports and activities. The average time from diagnosis/start of treatment to pain-free state/cleared to return to sport was 161.4 days.Conclusion: Diagnosis of sesamoid fractures can be challenging, but overall most patients do well with conservative treatment and are able to return to sports and activities. Providers should keep sesamoid fracture in the differential when evaluating patients with pain in the area around the base of the first toe, especially in dancers, gymnasts, and runners. Understanding that the recovery from a sesamoid fracture can be a prolonged process may help patients develop realistic expectations.


Assuntos
Dança/lesões , Traumatismos do Pé/terapia , Fraturas Ósseas/terapia , Ginástica/lesões , Hallux/lesões , Corrida/lesões , Ossos Sesamoides/lesões , Adolescente , Atletas , Criança , Feminino , Traumatismos do Pé/diagnóstico , Traumatismos do Pé/cirurgia , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Hallux/cirurgia , Humanos , Masculino , Procedimentos Ortopédicos , Estudos Retrospectivos , Ossos Sesamoides/cirurgia
15.
J Med Case Rep ; 13(1): 6, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-30621758

RESUMO

BACKGROUND: The presentation of patients with knee injuries which can have a significant impact on their ability to work and perform activities of daily living is constantly rising. The posterolateral corner of the knee has a complex anatomy of muscles, tendons, and ligaments, with huge variation in the population. The fabella is one such structure, found in the posterolateral corner of the knee, which can serve as a common origin point of various ligaments. CASE REPORT: We present a case report of a 53-year-old white man who presented with atraumatic, posterior knee pain and was found to have a congenital, anomalous band originating from the fabella, causing semimembranosus impingement. This was diagnosed with magnetic resonance imaging; he underwent division of the anomalous band, which resulted in complete resolution of his symptoms. CONCLUSION: We propose that patients who present with posterior knee pain, without any history of trauma, and have no abnormalities on plain radiographs, should undergo magnetic resonance imaging of their knees. This will help in assessing the ligament complex in the posterior compartment of the knee, and exclude impingement of the semimembranosus as an, albeit rare, cause of posteromedial knee pain.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Dor/etiologia , Ossos Sesamoides/anormalidades , Ossos Sesamoides/diagnóstico por imagem , Tendões/anormalidades , Tendões/diagnóstico por imagem , Humanos , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Ossos Sesamoides/cirurgia , Tendões/cirurgia
16.
Foot Ankle Surg ; 25(5): 612-617, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30321940

RESUMO

BACKGROUND: The importance of preoperative evaluation of the position and degree of arthritic changes of the medial sesamoid bone before hallux valgus correction is emerging. This is an observational study to evaluate the magnetic resonance imaging (MRI) findings of hallux valgus deformity, and assess the severity of and identify the factors that influence the arthritic changes in medial sesamoid-metatarsal (mSM) joints. METHODS: We reviewed weight-bearing anteroposterior radiographs, forefoot axial radiographs and MR images of 514 feet of 405 patients who underwent hallux valgus correction. On MRI, the degrees of the arthritic changes in the first metatarsophalangeal (MTP) and mSM joints were categorized into 5 classes. Binary logistic regression analysis was performed to identify the factors affecting the arthritic changes. RESULTS: The binary logistic regression analysis showed that advanced age, more lateralized position of medial sesamoid bone on forefoot axial radiograph, and higher MRI grade of arthritic change of the 1st MTP joint were significant factors contributing to medial sesamoid arthritis (P<0.001, 0.001. 0.006, respectively). CONCLUSIONS: Medial sesamoid arthritis can be assessed using MRI. The position of medial sesamoid bone on forefoot axial radiographs can strongly help predict the possibility of mSM joint arthritis. LEVEL OF EVIDENCE: III, observational study.


Assuntos
Artrite/diagnóstico , Hallux Valgus/diagnóstico , Imageamento por Ressonância Magnética/métodos , Articulação Metatarsofalângica/diagnóstico por imagem , Procedimentos Ortopédicos/métodos , Ossos Sesamoides/diagnóstico por imagem , Idoso , Artrite/etiologia , Artrite/cirurgia , Feminino , Hallux Valgus/complicações , Hallux Valgus/cirurgia , Humanos , Masculino , Articulação Metatarsofalângica/cirurgia , Pessoa de Meia-Idade , Radiografia , Ossos Sesamoides/cirurgia , Suporte de Carga
17.
Foot Ankle Surg ; 25(4): 434-440, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30321971

RESUMO

BACKGROUND: The purpose of this study was to compare the clinical and radiographic outcomes between feet with or without postoperative sesamoid reduction of proximal metatarsal chevron osteotomy for moderate to severe hallux valgus deformity. METHODS: All of 110 feet were allocated into two groups (reduction group; 66 feet, non-reduction group; 44 feet) according to the reduction status of sesamoid at 6 months after surgery. The clinical and radiographic results of the two groups were compared preoperatively, 6 months follow-up, and at last follow-up. RESULTS: The overall improvement in clinical outcomes was similar in both groups at average 4-year follow-up. However, the radiographic outcomes and recurrence rate were significantly worse in the sesamoid non-reduction group. CONCLUSIONS: Our results suggested that postoperative incomplete reduction of sesamoid may increase a risk for the recurrence of hallux valgus deformity.


Assuntos
Hallux Valgus/cirurgia , Hallux/cirurgia , Ossos Sesamoides/cirurgia , Adulto , Idoso , Feminino , Hallux/diagnóstico por imagem , Hallux Valgus/diagnóstico por imagem , Humanos , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Osteotomia/métodos , Cuidados Pós-Operatórios , Radiografia , Recidiva , Estudos Retrospectivos , Ossos Sesamoides/diagnóstico por imagem , Resultado do Tratamento
18.
J Foot Ankle Surg ; 57(6): 1186-1190, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30177453

RESUMO

Studies have shown that sesamoidectomy provides good clinical outcomes; however, concern exists regarding complications occurring after resection of 1 or both sesamoid bones. The purpose of the present systematic review was to evaluate the current evidence on sesamoidectomy for the treatment of hallux sesamoid disorders. A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed during October 2017. The included studies were evaluated for the level of evidence and quality of evidence using the Coleman Methodology Score. Variable reporting outcomes data, clinical outcomes, and percentage of patients returning to sports at their previous level were evaluated. Ten studies, totaling 196 feet, were included. The weighted mean patient age was 36.6 ± 11.0 years, and the weighted mean follow-up duration was 45.1 ± 19.3 months. The mean visual analog scale score improved from 6.5 ± 0.3 to 1.2 ± 0.5. The mean postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score was 92.7 ± 2.7. Six studies demonstrated that 94.4% of patients returned to sports, with 90.0% returning to their previous level, at a mean of 11.8 ± 1.8 weeks. The mean hallux valgus angle increased from 13.1° ± 2.1° preoperatively to 14.8° ± 3.7° postoperatively (p = .470), and the mean intermetatarsal angle increased from 8.7° ± 0.8° to 9.7° ± 0.8° (p = .180). Overall complication rate was 22.5% and the revision rate was 3.0%. The present systematic review has demonstrated that sesamoidectomy for hallux sesamoids disorders yields good clinical outcomes and a high rate of return to sports in the short term, albeit with a high complication rate of 22.5%.


Assuntos
Hallux Valgus/cirurgia , Hallux Varus/cirurgia , Ossos Sesamoides/cirurgia , Humanos
19.
Foot Ankle Clin ; 23(2): 219-230, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29729796

RESUMO

Hallux valgus (HV) is not a simple two-dimensional deformity but is instead a three-dimensional deformity that is closely linked to sesamoid position and first metatarsal (MT) pronation. HV may or may not be accompanied by sesamoid subluxation and/or first MT head pronation. Each of these scenarios should be assessed using weighted computed tomography scan preoperatively, and the necessary corrections should be performed accordingly.


Assuntos
Hallux Valgus/cirurgia , Ossos do Metatarso/cirurgia , Ossos Sesamoides/cirurgia , Hallux Valgus/diagnóstico por imagem , Humanos , Ossos do Metatarso/diagnóstico por imagem , Rotação , Ossos Sesamoides/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
J Am Vet Med Assoc ; 252(7): 873-881, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29553909

RESUMO

CASE DESCRIPTION 3 Angus bulls, aged 2 to 3 years, with severe lameness of 2 to 4 weeks' duration and swelling proximal to the coronary band of the affected limb were evaluated after failing to respond to antimicrobial treatment. CLINICAL FINDINGS Septic arthritis of a distal interphalangeal joint (DIPJ) was diagnosed in all 3 bulls on the basis of results of a physical examination, radiographic and ultrasonographic evaluations of the affected foot, and cytologic evaluation of synovial fluid from the affected DIPJ. TREATMENT AND OUTCOME A novel modified abaxial approach was used to resect the infected distal sesamoid bone (navicular bone) and DIPJ of all 3 bulls. A window was created in the abaxial hoof wall that was lateral to and of sufficient size to extract the navicular bone. Following removal of the navicular bone, the DIPJ was debrided and resected and an orthopedic block was applied to the contralateral claw to minimize weight bearing on the infected digit. Two bulls also had a fiberglass cast applied to the affected limb to help immobilize the DIPJ. All 3 bulls recovered without complications, and 2 bulls were no longer lame, whereas the remaining bull was only mildly lame, at 4 to 5 weeks after surgery. CLINICAL RELEVANCE The modified abaxial approach described for surgical resection of the DIPJ allowed extraction of the infected navicular bone without damage to the digital flexor tendons, something that cannot be achieved with other abaxial approaches. This approach is best used for patients without septic tenosynovitis.


Assuntos
Artrite Infecciosa/veterinária , Doenças dos Bovinos/diagnóstico , Casco e Garras/cirurgia , Carne , Animais , Artrite Infecciosa/complicações , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/cirurgia , Artrodese/veterinária , Bovinos , Doenças dos Bovinos/cirurgia , Coxeadura Animal/etiologia , Masculino , Ossos Sesamoides/cirurgia , Tendões/cirurgia
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