1,721,149 research outputs found
Vertebroplasty and Kyphoplasty: Reasons for Concern?
No full textTwo different minimally invasive percutaneous vertebral augmentation methods for cement application into the vertebral body for the management of symptomatic compression fractures without neurologic impairment have been developed, namely, vertebroplasty and kyphoplasty. In vertebroplasty, polymethylmethacrylate cement is injected percutaneously into a collapsed vertebral body. Kyphoplasty involves placing an inflatable bone tamp percutaneously into a vertebral body. The inflation of the bone tamp with fluid allows restoration of vertebral height and correction of the kyphosis. After deflation, the cavity that has been produced is filled by injection of polymethylmethacrylate. This article provides an overview of the state of the art in vertebroplasty and kyphoplasty, discussing the indications, techniques, results, and pitfalls
Novel approaches for the management of tendinopathy.
No full textTendinopathy is a failed healing response of the tendon. Despite an abundance of therapeutic options, very few randomized prospective, placebo-controlled trials have been carried out to assist physicians in choosing the best evidence-based management. Eccentric exercises have been proposed to promote collagen fiber cross-link formation within the tendon, thereby facilitating tendon remodeling. Overall results suggest a trend for a positive effect of eccentric exercises, with no reported adverse effects. Combining eccentric training and shock wave therapy produces higher success rates compared with eccentric loading alone or shock wave therapy alone. The use of injectable substances such as platelet-rich plasma, autologous blood, polidocanol, corticosteroids, and aprotinin in and around tendons is popular, but there is minimal clinical evidence to support their use. The aim of operative treatment is to excise fibrotic adhesions, remove areas of failed healing, and make multiple longitudinal incisions in the tendon to detect intratendinous lesions and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New operative procedures include endoscopy, electrocoagulation, and minimally invasive stripping. The aim of these techniques is to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. Randomized controlled trials are necessary to better clarify the best therapeutic options for the management of tendinopathy
Minimally invasive hallux valgus correction.
No full textThe most common complication following minimally invasive surgery (MIS) foot procedures is recurrence of the deformity, likely a direct consequence of incorrect selection of the procedure, incorrect surgical technique, or underestimated healing time of the osteotomy. This article describes our surgical MIS for hallux valgus correction, including the postoperative management, and reviews the literature on MIS for hallux valgus correction. The reports on such techniques are few, and mainly case series are reported. More adequately planned and executed randomized prospective clinical trials are needed. Historical attempts, indications, preferred surgical techniques, and complications are discussed
Complications after surgery or nonoperative treatment for acute achilles tendon rupture.
No full textLetter to the editor: Minimally invasive paratenon release for non-insertional Achilles tendinopathy.
No full textMinimally invasive locked plating of distal tibia fractures is safe and effective.
No full textDistal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2-4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7 degrees . No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20 degrees compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence
Bilateral mini-invasive adductor tenotomy for the management of chronic unilateral adductor longus tendinopathy in athletes.
No full textBACKGROUND:
To date, the best management of chronic groin pain related to adductor longus tendinopathy has not been defined. Although there have been some studies investigating the effectiveness of adductor longus tenotomy, none have investigated bilateral adductor tenotomy for unilateral tendinopathy.
HYPOTHESIS:
The use of bilateral percutaneous adductor tenotomy for the management of chronic unilateral groin pain as a result of adductor longus tendinopathy will result in improvement of overall function and facilitate a return to athletic activity.
STUDY DESIGN:
Case series; Level of evidence, 4.
METHODS:
During the period from 2004 to 2007, we prospectively enrolled 29 consecutive athletes (26 male and 3 female; median age, 28 years) with chronic groin pain from unilateral adductor longus tendinopathy who underwent bilateral adductor tenotomy. Functional outcome and health status were assessed with the Hip Disability and Osteoarthritis Outcome Score (HOOS), Short Form Health Survey (SF-36), and European Quality of Life-5 Dimensions scale (EQ-5D). The ability to participate in sport before and after surgery and the time to return to training and return to sport were also recorded. The median follow-up after surgery was 36 months.
RESULTS:
All questionnaires showed a statistically significant improvement (P < .0001) after surgery. At the time of latest follow-up, 20 of 29 patients (69%) returned to their preinjury level of sport and 2 of 29 patients (7%) to higher levels compared with preinjury status. However, 4 of 29 patients (14%) returned to sport at lower levels than those of preinjury status, and 3 of 29 patients (10%) ceased to participate in sport. The median time to return to training was 11 weeks and to return to sport was 18 weeks.
CONCLUSION:
Bilateral mini-invasive adductor tenotomy can be an effective treatment for athletes suffering from unilateral chronic groin pain associated with adductor longus tendinopathy refractory to nonoperative management
Bovine xenograft locking Puddu plate versus tricalcium phosphate spacer non-locking Puddu plate in opening-wedge high tibial osteotomy: a prospective double-cohort study.
No full textPURPOSE:
The aim of the study was to compare clinical and radiographic outcomes of opening-wedge high tibial osteotomy (HTO) augmented with either xenograft or tricalcium phosphate spacer for the management of medial compartment osteoarthritis (OA) with genu varum.
METHODS:
Between 2004 and 2007, we prospectively enrolled 52 patients with medial compartment knee OA who underwent opening-wedge HTO fixed with locking Puddu plate and xenograft (n = 26) or non-locking Puddu plate and tricalcium phosphate spacer (n = 26). The alignment of the lower limb was assessed by measuring the hip-knee-ankle (HKA) angle. Clinical outcomes were assessed with the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, SF-36 and European Quality of Life-5 Dimensions scale. All patients were followed up at six weeks and at three, six, 12 and 24 months post-operatively. Clinical outcomes were assessed preoperatively and at 24 months post-operatively.
RESULTS:
All clinical scores improved significantly in both groups after surgery, without any significant difference between the two groups. Immediately after surgery, the HKA angle went from 9.1 ± 5.2° in varus to 3.1 ± 4.8° in valgus (P = 0.01) in the xenograft group, and from 8.5 ± 5.9° in varus to 3.4 ± 4.2° in valgus (P = 0.01) in the tricalcium phosphate group. At the last follow-up, the tricalcium phosphate group showed a significant loss of correction (P = 0.03).
CONCLUSIONS:
HTO performed with xenograft locking plate and tricalcium phosphate non-locking plate constructs showed good clinical outcomes. However, the xenograft locking plate construct is superior to the tricalcium phosphate spacer non-locking plate to prevent the loss of correction in the middle term
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