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Background: Peroneal nerve neuropathy due to compression from tumors or tumor-like lesions such as ganglion cysts is rare. Few case series have been published and reported local recurrence rates are high, while secondary procedures are frequently employed.Questions/purposes: (1) What are the demographics of patients with ganglion cysts of the proximal tibiofibular joint, and what proportion of them present with intraneural cysts and peroneal nerve palsy? (2) What Musculoskeletal Tumor Society (MSTS) scores do patients with this condition achieve after decompression surgery with removal of the ganglion cyst, but no arthrodesis of the tibiofibular joint? (3) What proportion of patients experience local recurrence after surgery?Methods: Between 2009 to 2018, 30 patients (29 primary cases) were treated for chronic peroneal palsy or neuropathy due to ganglion cysts of the proximal tibiofibular joint at two tertiary orthopaedic medical centers with total resection of the cystic lesion. MRI with contrast and electromyography (EMG) were performed preoperatively in all patients. The minimum follow-up for this series was 1 year (median 48 months, range 13 to 120); 14% (4 of 29) were lost to follow-up before that time. The MSTS score was recorded preoperatively, at 6 weeks postoperatively, and at most-recent follow-up.Results: A total of 90% of the patients were male (26 of 29 patients) and the median age was 67 years (range 20 to 76). In all, 17% (5 of 29) were treated due to intraneural ganglia. Twenty-eight percent (8 of 29) presented with complete peroneal palsy (foot drop). The mean MSTS score improved from 67 ± 12% before surgery to 89 ± 12% at 6 weeks postoperative (p < 0.001) and to 92 ± 9% at final follow up (p = 0.003, comparison with 6 weeks postop). All patients improved their scores. A total of 8% (2 of 25 patients) experienced local recurrence after surgery.Conclusion: Ganglion cysts of the proximal tibiofibular joint occurred more often as extraneural lesions in older male patients in this small series. Total excision was associated with improved functional outcome and low risk of neurologic damage and local recurrence, and we did not use any more complex reconstructive procedures. Tendon transfers may be performed simultaneously in older patients to stabilize the ankle joint, while younger patients may recover after decompression alone, although larger randomized studies are needed to confirm our preliminary observations.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR] more...

Background: Introduction: Isolated scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) is a relatively common condition. Scaphotrapeziotrapezoidal arthrodesis is the traditional treatment, while excisional arthroplasty with the use of flexor carpi radialis (FCR) or polycarbon implants represents a promising alternative surgical management. The present study aims to assess a novel alternative technique of excisional arthroplasty with the use of palmaris longus (PL) tendon as interposition material. Materials: The present research is a retrospective observational study. Patients suffering from symptomatic isolated STT OA, without midcarpal instability and treated with excisional arthroplasty with the use of PL tendon as interposition material, were evaluated. Five patients (two males and three females) with mean age of 63.8 years [standard deviation (SD)=16.9] were included. The mean follow up was 56.4 months (SD=9.8). In order to quantify the clinical results, we used the preoperative and postoperative visual analogue scale (VAS) score at rest and during activity, abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and postoperative ROM. Results: The postoperative VAS score at rest and during activity showed a decrease of 86.2% and 62.5%, respectively, when compared to the preoperative one. Regarding postoperative ROM at final follow-up, patients had a mean wrist flexion 71° compared to 78° of the contralateral hand, while the mean extension was found to be 57° compared to 66° of the contralateral side. Conclusions: The evaluated novel technique with the use of PL tendon as interposition material seems to offer satisfying results, while allowing to keep the FCR tendon intact. More studies comparing these techniques are of utmost importance to conclude which is the optimal treatment. [ABSTRACT FROM AUTHOR] more...

Anterior shoulder dislocations following an epileptic event are considered rare. An extremely rare case of a 41 year old female suffering from bilateral anterior shoulder dislocation with concomitant greater tuberosities fractures after an epileptic seizure is presented. The patient presented to the out-patient orthopaedic clinic due to persistent pain and restriction of shoulders movement, 4 weeks after an epileptic seizure. Clinical examination and radiological evaluation established the diagnosis of bilateral anterior shoulder dislocation with concomitant greater tuberosities fractures. Closed reduction was performed under general anesthesia. There are 12 such cases in the literature, including the present one. Thirty percent of these cases had a delayed diagnosis. It is of paramount importance to have a high clinical suspicion for myoskeletal injuries and especially for shoulder dislocations following an epileptic episode, even in the absence of a traumatic event. more...

Osteoarthritis (OA) is a slowly progressive degenerative joint disease that is associated with joint space narrowing, osteophyte formation and subchondral sclerosis. Despite extensive effort actual breakthroughs in the field of genetic or biochemical biomarkers of OA are limited. As secretory apolipoprotein J/clusterin (sCLU) has been implicated in both inflammatory and apoptotic molecular processes which contribute to the OA phenotype, the sCLU concentration in human serum and synovial fluid during advanced primary knee and hip OA was analysed. Elevated sCLU protein levels were shown in these two biological fluids. sCLU mRNA expression was also studied in normal cartilage and in advanced primary knee and hip OA samples. A significant up-regulation of sCLU mRNA expression (~25-fold) was found in samples collected from the tibial bone that was osteotomized during total knee arthroplasty in patients with primary knee OA, as compared to healthy tissue samples collected from the femoral head of macroscopically normal cartilage during the surgical treatment of subcapital fractures. By studying sCLU mRNA expression levels in samples collected during total hip arthroplasty in patients with advanced primary hip OA, an additional up-regulation of the sCLU mRNA expression (~4-fold), as compared to advanced primary knee OA, was found. Taken together, these observations indicate that the sCLU protein or mRNA expression level may be of a significant diagnostic and/or prognostic value during OA progression. more...