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The infrapatellar branch of the saphenous nerve (SN) is a widely described anatomic and functional structure; however, its relevance in daily clinical practice is underestimated. All surgical procedures performed on the anteromedial aspect of the knee are associated with a risk of iatrogenic injury to this nerve, including knee arthroscopy, knee arthroplasty, tibial nailing, etc. We present the case of a saphenous nerve neuroma after treatment with radiofrequency thermal ablation due to a knee pain problem. After conducting an anaesthetic suppression test, we decided to perform a denervation of the medial saphenous nerve in Hunter's canal. We performed surgery on the anteromedial aspect of the knee. The distal end of the medial SN was coagulated with a bipolar scalpel. The proximal end of the nerve was released proximally, and a termino-lateral suture was made at the free end of the nerve after creating an epineural window to inhibit its growth. A double crush was produced proximally to the suture site to create a grade II-III axonal injury. Autologous plasma rich in growth factors (PRGF) was used to reduce potential post-surgical adhesions and to stimulate regeneration of the surgical lesions. One year after surgery, the patient was living a completely normal life. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore and assess office-based ultrasound-guided intraosseous and intra-articular infiltrations of plasma rich in growth factors (PRGF) in patients with moderate and severe knee osteoarthritis (KOA). Seventy-nine patients (30 women and 49 men) with grade 3–4 KOA according to the Kellgren–Lawrence classification participated in the study. All patients were treated with a minimally invasive technique using local anesthesia WALANT (wide-awake local anesthesia no tourniquet) in the ambulatory setting. A PRGF intra-articular infiltration and two intraosseous infiltrations in the tibial plateau and femoral condyle were performed weekly for a total of three sessions. The evaluation of the results was carried out using knee injury and osteoarthritis outcome score (KOOS) at baseline and post-treatment. After a follow-up period of 11 months (median) [interquartile range, 7–14], all the KOOS domains showed statistically significant improvement (p < 0.001). Moreover, 88% of the patients showed a pain reduction of at least 10 points (minimally clinically important improvement) from pre- to post-treatment. Our retrospective study using the in-office procedure of ultrasound-guided combination of intra-articular and intraosseous infiltrations of PRGF is a safe and efficacious approach for the treatment of grade 3–4 knee osteoarthritis. [ABSTRACT FROM AUTHOR]

The reconstruction of a chronic proximal hamstring tear is a challenging pathology that posits difficulties to surgeons due to the distal retraction of the hamstring tendon stumps and the entrapment of the sciatic nerve within the scar formed around the torn hamstring tendon. We describe a novel surgical technique using a semitendinosus tendon allograft sutured in a "V inversion" manner, thereby avoiding an excess of tension and length of the new reconstructed hamstring tendons. In addition, and in order to speed up the healing process and avoid new sciatic entrapment, we assisted the surgery with liquid plasma rich in growth factors (PRGF) injected intraosseously, intratendinously and within the suture areas, as well as wrapping the sciatic nerve with a PRGF membrane. In conclusion, this novel approach offers mechanical and biological advantages to tackle the large retraction of hamstring stumps and the entrapment of the sciatic nerve within the scar. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the study was to determine whether ultrasound (US)‐guided surgery is a viable type of surgery for performing an effective release/decompression of the constricting structures that are responsible for focal nerve compression in tarsal tunnel syndrome. Methods: Ultrasound guidance was used on cadaveric specimens to delineate the anatomic course of the nerves and vessels in the medial ankle that comprise the structures involved in tarsal tunnel syndrome. Ultrasound guidance was used on cadaveric specimens and assisted in delineating a safe surgical zone to adequately and effectively release these constrictive structures of the proximal and distal tarsal tunnels. The US‐guided tarsal tunnel release/decompression was performed through 2 small 1‐ to 2‐mm portals. After US‐guided release, anatomic dissection was used to check the efficacy (release of the flexor retinaculum and deep abductor hallucis muscle) and safety (absence of neurovascular or tendon injury) of the procedure. Results: In 12 fresh cadaveric specimens, US‐guided release of the tibial nerve (proximal tarsal tunnel) and its branches (distal tarsal tunnel) at the medial ankle was effective in all 12 specimens (100% release rate), without any signs of compromise or injury into the neurovascular structures. Conclusions: Ultrasound‐guided tarsal tunnel release is a feasible surgical procedure that can be safe and effective with the proper training, although further investigation is warranted. This type of surgery may promote faster recovery with less postoperative morbidity, including pain, but this will be the subject of a further investigation. [ABSTRACT FROM AUTHOR]

Background: Corticosteroid infiltration (CI) is commonly used for treatment of plantar fasciosis. In recent years, however, interest has grown in the use of intratissue percutaneous electrolysis (EPI) for the treatment of tendinopathies. The aim of our study was to compare the effectiveness of the above techniques in the treatment of plantar fasciosis. Methods: The results achieved over a period of 1 year following the use of these techniques to treat plantar fasciosis were examined. There were 64 patients; 32 of whom were treated with ultrasound-guided EPI and 32 with ultrasound-guided CI. A clinical examination was performed and ultrasound taken before treatment and at 3, 6, and 12 months. Clinical assessments were made using a visual analog scale (VAS) to record pain and the Foot and Ankle Disability Index (FADI) to evaluate function. Ultrasound was used to determine the thickness of the plantar fascia. Results: Both the ultrasound-guided EPI and CI techniques were associated with significant clinical and echographic improvements at 12 months post-treatment (P < .001). Conclusion: Both techniques were effective in the treatment of PF, providing excellent VAS pain and FADI results at 12 months. However, CI required fewer patient visits and appeared to provide somewhat better VAS and FADI results. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: The increasing number of revision knee arthroplasty result in the more frequently use of a constraint implant but results from previous reports are difficult to interpret. The purpose of this study was to compare the long-term outcomes of superficial cemented versus metaphyseal cemented in revision total knee arthroplasty with a condylar constrained arthroplasty. Methods: The study was a retrospective analysis of clinical and radiographic outcomes in a series of revision total knee arthroplasties performed with a constrained condylar knee prosthesis and press-fit modular stems. We hypothesized that the clinical and radiographic outcome of surface cementation would be inferior to that of metaphyseal cementation. Fifty-two consecutive revision cases were followed for a median of 8.2 years (range, 6 to 10 years). Results: Substantial improvements in range of motion and Knee Society score were achieved in all patients, although these were not significant between groups. Significantly more radiolucent lines were visible on the tibial component with surface cementation than with metaphyseal cementation, although the clinical differences were not relevant. Conclusions: Radiologic outcome was better in revision total knee arthroplasty using metaphyseal cemented revision and components with press-fit cementless stems than in the surface cementation-based approach; however, the difference was not clinically relevant. [ABSTRACT FROM AUTHOR]

Massive acetabular bone loss (more than 50% of the acetabular area) can result in insufficient native bone for stable fixation and long-term bone ingrowth of conventional porous cups. The development of trabecular metal cages with osteoconductive properties may allow a more biological and versatile approach that will help restore bone loss, thus reducing the frequency of implant failure in the short-to-medium term. We report a case of massive bone loss affecting the dome of the acetabulum and the ilium, which was treated with a trabecular metal cage and particulate allograft. Although the trabecular metal components had no intrinsic stability, they did enhance osseointegration and incorporation of a non-impacted particulate graft, thus preventing failure of the reconstruction. The minimum 50% contact area between the native bone and the cup required for osseointegration with the use of porous cups may not hold for new trabecular metal cups, thus reducing the need for antiprotrusio cages. The osteoconductive properties of trabecular metal enhanced allograft incorportation and iliac bone rebuilding without the need to fill the defect with multiple wedges nor protect the reconstruction with an antiprotrusio cage. [ABSTRACT FROM AUTHOR]

Background and purpose The most reliable results when treating an infected total knee arthroplasty have been obtained with a two-stage reimplantation protocol. We have used a simple technique for hand-made spacers and now report the outcome. Patients and methods 30 patients with an infected total knee arthroplasty (TKA) were treated with a 2- stage reimplantation protocol. Spacers were built and customized to the type of defect using only 2 retractors and a high-speed tip burr. Partial weight bearing and discharge from the hospital were encouraged in the time between surgeries. 29 of 30 patients (97%) had successful reimplantations and they were followed for an average of 3 (2-5) years. Results Range of motion with the articulating spacer averaged 80° (55-100) and 21 of the 30 patients achieved motion greater than 75°. At the latest follow-up, there were no reinfections. According to the Knee Society score (KSS), the results were considered excellent or good in 25 patients, and fair or poor in 4 of the 29 patients with reimplantations. Motion after reimplantation averaged 107° (90-120). Interpretation One of the key factors related to a successful outcome with a two-stage reimplantation procedure is to keep the joint mobile and functional in the time between surgeries. Hand-made articulating spacers retain most of the advantages of more complex spacers in terms of mobility, pain, bone loss, success, or re-infection rate—with the major advantages of price and universal availability. Limitations related to this technique include potential knee instability, the need to walk with an orthosis, and the risk of subluxations. [ABSTRACT FROM AUTHOR]

Coverage of soft-tissue defects in the lower limbs, especially open tibial fractures, is currently a frequently done procedure because of the high incidence of high-energy trauma, which affects this location. The skilled orthopedic surgeon should be able to carry out an integral treatment of these lesions, which include not only the open reduction and internal fixation of the fracture fragments but also the management of complications such as local wound problems that may arise. There is a wide variety of muscular or pedicled flaps available for reconstruction of lower limb soft-tissue defects. These techniques are not commonly used by orthopedic surgeons because of the lack of familiarity with them and the potential for flap failure and problems derived from morbidity of the donor site. We present a coverage management update for orthopedic surgeons for complications after an open tibial fracture. We choose and describe the most adequate flap depending on the region injured and the reliable surgical procedure. For proximal third of the tibia, we use gastrocnemius muscle flap. Middle third of the tibia could be covered by soleus muscle flap. Distal third of the tibia could be reconstructed by sural flaps, lateral supramalleolar skin flap, and posterior tibial perforator flap. Free flaps can be used in all regions. We describe the advantages and disadvantages, pearls, and tips of every flap. The coverage of the tibia after a major injury constitutes a reliable and versatile technique that should form part of the therapeutic arsenal of all the orthopedic surgeons, facilitating the integral treatment of complex lower limb injuries with exposed defects. [ABSTRACT FROM AUTHOR]

Background: Infections that occur after the surgical management of pelvic fractures may involve potentially devastating complications. The broader approaches involving soft tissue dissection and a long operative time may increase the infection rate when compared with more conservative approaches. This incidence may be reduced with a better understanding of the approaches, lymph node sparing and antibiotic use. The purpose of this study is to assess the incidence and severity of local infections in a series of adult patients with pelvic ring lesions treated surgically., Material and Methods: This is a prospective observational descriptive study. A total of 49 patients operated on by a single surgeon from 2004 to 2008 were included., Results: Forty-four patients (90%) had no signs of infection during the treatment period. In the remaining 5 cases (10%), 5 episodes of infection were documented., Conclusions: The identification of a local postoperative infection warrants an aggressive and urgent assessment of the patient. The devitalized tissue should be removed and empiric antibiotic therapy should be instituted after taking culture samples. A deep infection rate after pelvic fixation ranging from 0 to 10% has been published. The prevalence is higher among the surgical teams with less expertise. The incidence rate in our review was similar to the one reported in the literature.