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Post-operative pain in the palm and scar area is the most common complication after carpal tunnel release and injury to the terminal branches of the palmar cutaneous nerve is generally considered one of the causes for this complication. The Authors performed an intraoperative study preserving the terminal branches of the palmar cutaneous branch of the median nerve and verifying the frequency, location and direction of the branches that cross an interthenar incision.Eighty-five consecutive patients (57 F - 28 M, mean age 66 y) underwent carpal tunnel release between February and June 2021. The cutaneous branches crossing the incision were identified and preserved by careful dissection. Subsequently they were counted and classified by their direction and distance from the proximal border of the transverse carpal ligament.Sensory branches were found in 40 % of cases (34/85) and their origin was observed at an average of 1.05 cm (0-1.8 cm) distal from the proximal border of the carpal tunnel. A total of 44 branches were observed of which 23 branches crossed the incision with a transverse course and 21 with an oblique, generally proximal-distal radio-ulnar course. The subcutaneous layer overlying the distal third of the transverse carpal ligament was found to be devoid of sensory branches, therefore it can be considered a relatively safe area.Isolation and protection of palmar sensory branches is important for improving carpal tunnel release results. This goal can be more easily achieved by locating the skin incision on the distal third of the transverse carpal ligament, where the sensory branches have a lower frequency, possibly associated with a second proximal incision (biportal technique) to better visualize the proximal portion of the ligament and antebrachial fascia.ZIEL: Postoperative Schmerzen an der Handfläche und im Narbenbereich sind die häufigste Komplikation nach Karpaltunnelspaltung. Eine Verletzung der terminalen Äste des N. cutaneus palmaris gilt generell als eine der Ursachen für diese Komplikation. Die Autoren führten eine intraoperative Studie durch, in der sie die terminalen Äste des Ramus cutaneus nervi mediani erhielten und Häufigkeit, Ort und Richtung der die interthenare Inzision überkreuzenden Äste verifizierten.Fünfundachtzig konsekutive Patienten (57 Frauen und 28 Männer, mittleres Alter 66 Jahre) unterzogen sich zwischen Februar und Juni 2021 einer Karpaltunnelspaltung. Die die Inzision überkreuzenden kutanen Äste wurden identifiziert und durch vorsichtige Dissektion erhalten. Anschließend wurden sie gezählt und nach ihrer Richtung und ihrem Abstand von der proximalen Grenze des Ligamentum carpi transversum klassifiziert.Sensorische Äste wurden in 40 % der Fälle (34/85) nachgewiesen. Ihr Ursprung fand sich im Durchschnitt 1,05 cm (0–1,8 cm) distal der proximalen Grenze des Karpaltunnels. Insgesamt wurden 44 Äste nachgewiesen, von denen 23 transversal und 21 oblique und generell proximodistal-radioulnar verlaufend die Inzision überkreuzten. In der subkutanen Schicht über dem distalen Drittel des Ligamentum carpi transversum fanden sich keine sensorischen Äste. Daher kann dies als ein relativ sicherer Bereich betrachtet werden.Die Isolation und der Schutz palmarer sensorischer Äste sind wichtig für die Verbesserung der Ergebnisse einer Karpaltunnelspaltung. Dieses Ziel kann leichter erreicht werden, wenn die Hautinzision über dem distalen Drittel des Ligamentum carpi transversum erfolgt, wo sensorische Äste weniger häufig vorkommen, möglicherweise in Verbindung mit einer zweiten proximalen Inzision (biportale Technik) zur besseren Darstellung des proximalen Anteils des Ligaments und der Antebrachialfaszie.

Background: Percutaneous procedures have been used recently to treat insertional Achilles tendon problems. The present study reports our results of this treatment approach. Methods: Patients undergoing percutaneous calcaneoplasty for insertional Achilles tendon problems were retrieved. Patients completed the visual analog scale (VAS) for pain and the Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire before the operative procedure and at the last follow-up. At the last follow-up, we asked the patients whether they were completely satisfied, moderately satisfied, or unsatisfied after the procedure. Complications were also recorded. Results: A total of 27 patients were enrolled. The average follow-up was 26.5 months (range 6-68). The mean age of patients was 56.2 years (24-82). The mean VAS score before surgery was 8.1 ± 0.9 decreasing by the last follow-up to 2.4 ± 2.3 ( P < .0001). The mean VISA-A score improved from 20.7 ± 5.4 to 75.7 ± 25.5 at last follow-up, an improvement of 55% ( P < .0001). At the last follow-up, 84.5% (22 of 27) patients were completely satisfied with the procedure, 7.4% (2 of 27) moderately satisfied, and 11.1% (3 of 27) were not satisfied. These last 3 patients presented recurrence of symptoms, requiring revision surgery. Conclusion: For the selected patients, we found percutaneous calcaneoplasty to be an effective treatment for insertional Achilles tendon problems Level of Evidence: Level III, retrospective study.

We report the case of a 66-year-old male patient with massive ossification of the distal portion of the Achilles tendon, as a late consequence of a surgical release for club foot conducted in his childhood. The singularity of the case report derives from its clinical features: the bone mass was of abnormal dimensions, almost substituting the entire tendon; the condition had always been asymptomatic, without deficits in range of motion, in absence of either pain or biomechanical defects with age. In fact, the condition was diagnosed just recently as a consequence of a tear. Despite an ultrasound diagnosis after the injury, only during the surgical treatment, a proper evaluation of the entity of the pathology was possible. Although the ossification of Achilles tendon is a rare clinical condition with a complex multifactorial etiology, in our case report, some of the elements in the patient’s medical history could be useful for the pathogenesis and early diagnosis of the disease. The aim of this case report is to emphasize the importance both of a correct evaluation of clinical history and of an accurate diagnosis, in order to conduct a proper management of this pathology.

Background Osteocondrithis dissecans (OCD) is an acquired disease due to a subcondral bone ischaemia that affects generally the medial femoral condyle as well as above lying cartilage. Though the incidence of OCD is only 6/10,000 in the general population, in the later stages of disease, OCD fragment can break off inside the articular cavity it is the most Frequently reported cause of free endoarticular body. The etiology has been hypothesized as being multi-factored due to traumas or microtraumas along with metabolic, endocrine and genetic disorders leading to subchondral ischemia . Description of case A 15-year old male amateur soccer player presented to our department complaining of recurrent episodes of pain at rest in both knees, swelling and articular blockage occurring over the past 3 years. RX and MRIrevealed bilateral lesions on both medial condyles. A ONE-STEP surgical technique was performed that incorporated the drawing of mesenchymal staminal cells (MSCs) and their implantation. Conclusion This case report deals with a rare case of bilateral OCD of the knee treated with the latest technique in regenerative medicine. At 6-month follow up there was a complete return of muscular tonality in both knees andthe patient was allowed to return to light physical activity. These results are noteworthyfor the fact they were obtained from a combined surgical approach that when compared toalternative approaches lead to a shorter hospital stay and a reduced hospital burden. Each of the osteochondral lesions was evaluated from imaging results and arthroscopic findings.