1/4. Autologous osteochondral grafting for talar cartilage defects.The purpose of this study was to evaluate the clinical results of Osteochondral Autograft Transfer System (OATS) for the treatment of symptomatic osteochondral defects of the talus using standardized outcome analysis. Nineteen patients with symptomatic osteochondral defect (OCD) of the talus were treated with autologous osteochondral grafting. There were six men and 13 women. The average age was 32 years (range, 18 to 48 years). The average duration of symptoms prior to surgery was 4.2 years (range, three months to 12 years). All patients had failed nonoperative treatment, and 13 (68%) patients had failed prior excision, curettage and/or drilling of the lesion. The average size of the lesion prior to autografting was 12 mm x 10 mm (range, 10 x 5 mm to 20 x 20 mm). Donor plugs were harvested from the trochlear border of the ipsilateral femoral condyle. ankle exposure was obtained with a medial malleolar osteotomy in 13 patients, arthrotomy in five patients and lateral malleolar osteotomy in one patient. Clinical evaluations were performed for both the recipient ankle and donor knee using the AOFAS ankle/Hindfoot Scale and Lysholm knee scale, respectively. The average follow-up time was 16 months (range, 12 to 30 months). The average postoperative AOFAS ankle score was 88 (range, 60 to 100). Most patients had occasional mild pain, but excellent function, range of motion, stability and alignment. The average postoperative ankle score for the 13 patients who failed prior surgery was 91 (range, 84 to 100). The average postoperative Lysholm knee score was 97 (range, 87 to 100). Only two patients had mild knee pain. Postoperative radiographs were available for 13 patients. There was no evidence of graft subsidence and all grafts healed. All malleolar osteotomies united. Seventeen (89%) patients said that they would undergo the procedure again. The results of osteochondral autograft transplant for OCD lesions of the talus demonstrate excellent postoperative ankle scores including improvement of pain and function with minimal knee donor site morbidity. Also, our results indicate that this is an effective salvage procedure following failed previous procedures and for patients with longstanding symptoms.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/4. Medial meniscus anterior horn cyst: arthroscopic decompression.Meniscus cysts are mostly seen with meniscus tears, and arthroscopic decompression of cysts is gaining great importance in their treatment. In this study, we present a medial meniscus anterior horn cyst without an accompanying tear in the meniscus. A 33-year-old male patient was seen with pain and a palpable mass in his right knee. He complained that the severity of the pain had increased over the previous year. After the clinical and radiologic examinations, a painless, fixed soft tissue mass averaging 4 x 5 cm was located just medial to tuberositas tibia. The cyst was decompressed arthroscopically. In the 18th month of follow up, the mass had totally disappeared and the patient had no pain. Medial meniscus cysts are seen nine times fewer than lateral meniscus cysts. They are mostly accompanied with meniscal tears. Total meniscectomy with arthrotomy, isolated cyst excision, cyst excision, and partial meniscectomy with arthrotomy and arthroscopic partial meniscectomy with cyst decompression are treatment modalities. Arthroscopic meniscal cyst decompression is an important treatment choice and should always be taken into consideration with low morbidity, short recovery period, low recurrence rate, preservation of range of motion, and permission for early mobilization and rehabilitation of the joint.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/4. mafenide-induced pseudochondritis.Wound infections following burns of the ear can result in the devastating complication of chondritis, requiring resection of cartilage. To prevent this, it has become common practice to dress the burned ear with mafenide acetate. We have observed six hypersensitivity reactions to the mafenide that occurred following several weeks of continuous use of the drug. The reaction mimics chondritis, causing edematous, erythematous, pruritic ears with a profuse serous exudate. There is no associated fever, systemic signs, or pain on motion of the cartilage. Treatment consists of stopping the mafenide. Recovery occurs within 72 hours. Differentiating between chondritis, with its required surgical and antibiotic treatment, and a hypersensitivity reaction is necessary to avoid further iatrogenic injury.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/4. Idiopathic chondrolysis of the hip: management by subtotal capsulectomy and aggressive rehabilitation.Three cases of idiopathic chondrolysis were treated by a subtotal circumferential capsulectomy with follow-up for 3 years and 1 month. Concomitant muscle releases were performed as necessary to relieve joint contractures. Surgery was followed by an aggressive rehabilitation effort. All patients were symptom-free and displayed an extremely satisfactory range of motion. Radiographs revealed reconstitution of the joint space in all cases. We believe that this aggressive management is well justified when one considers the results of previous published reports.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |