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Background: Given the boom in sports in school age, its intensity and the increase in sports in females, we are experiencing a boom in sports injuries characteristic of "adults" in growing patients, the anterior cruciate ligament being an injury with possible serious consequences., Methods: To show the surgical technique "without bone tunnels" by Micheli-Kocher in anterior cruciate ligament reconstruction in growing patients based on our results in 20 patients., Results: Since 2017 we have performed the technique "without bone tunnels" by Micheli-Kocher in 30 patients, 20 of whom have been followed up for more than 2 years. In our study, we have observed a return to previous sports activity in more than 90% of the patients, with only one patient undergoing reoperation due to a new rupture of the plasty. The results on the IKDC scales show an improvement in mean score from 42 points preoperatively to 84 postoperatively and on the Lysholm scale from 48 preoperatively to 94 postoperatively., Conclusions: The technique "without bone tunnels" by Micheli-Kocher is a technique indicated in patients under 12 years of age and Tanner stage 2 or less. It is a technique of moderate complexity with excellent results in recovery from previous sports activity and knee stability., (Copyright © 2024 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Degloving soft-tissue injuries are serious and potentially devastating medical conditions where an early recognition is a crucial step for a favorable outcome. One of the most important types is Morel-Lavallée lesions (MLL); a significant soft-tissue injury associated with pelvic trauma (30%) and thigh (20%), located over the greater trochanter., Material and Methods: In this retrospective study we selected adult patients diagnosed with MLL between 2010 and 2019 at our trauma center. We then identified 9 cases and followed them up for a minimum of two years. CT scans were performed to measure the size of the degloved zone., Results: we did not found direct relationship between greater dimensions of MLL injury and the need for an increase of days to return to work. We rather identified an association between bigger dimensions of MLL injury and higher energy trauma. These patients waited an average of 133 days to return to work after being injured; which is a longer period compared to non-op patients., Discussion: MLL lesions generally take several days to develop and many may be missed on initial evaluation. Once identified, compression dressings should be applied, especially when diagnosed acutely. Early identification would lead to early operative debridement. Also, drainage should be performed, since the pathophysiology of the injury will result in the failure of observation or simple aspiration., Conclusion: MLL diagnosis and treatment must be identified as early as possible. We didn't find a correlation between MLL size and the treatment performed. In our study all patients returned to their jobs and normal life. Patients following conservative treatment take longer time to recover and could require more patient's implication, but -at least- would avoid possible surgical complications., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Few studies have approached in a long-term follow-up of meniscal repair at an amateur level, specially studying variables as a quality of life and failure rate. The purpose of this review is to study medium to long-term clinical results in patients at amateur sports patients, that have required meniscal sutures at our center, with or without ACL reconstruction. We evaluate the objective function of the knee, as well as patients' return to sports activities, quality of life, and the rate of failed repair and study of the possible reasons., Methods: This was an observational retrospective study. Ninety-two patients who regularly perform amateur sports activities (Tegner 4 to 7) were assessed, with a minimum follow-up period of 2 years, divided into 2 groups: group 1, isolated meniscal suture (43 cases) and group 2, associated to ACL reconstruction (49 cases). Each patient made this test in 2019: Lysholm and Tegner (validated for Spanish) before a knee injury and after surgery, motivation to return to sports activity (Likert scale with 3 items: low, regular, or high), and quality of life through SD-12 test., Results: High return to amateur sports rate (92%) was even higher in the isolated meniscal repair group in comparison to the group with associated ACL. We have not found statistically significant differences between sports return and age, gender, injured meniscus, chondral injuries, preoperative Tegner score, or motivation. No significant differences in physical or mental health fields between both groups. Meniscal repair failed in 12 patients (13%). Higher rate of failure in isolated bucket-handle tear injuries (p < 0.0062). No statistically significant association was found between the other variables studied., Conclusions: Good results with 92% of sports return, low rate of complications, and low retear rate, even lower when is associated with ACL reconstruction and in external meniscus repair, and high values at SF-12 between 2 groups.

The aim of the present study is to evaluate the use of the Less Invasive Stabilization System (LISS) plate for distal femoral fractures, examining variables such as type of fracture and length of plate. A retrospective study of 30 patients with a distal femoral fracture, treated with a distal femur LISS plate (Synthes) was performed. Average age was 71 years old (20-101). According to the AO classification, 16 fractures were type A, 5 type B, and 9 type C. The consolidation index and clinical outcomes measured with Knee Society Score (KSS) questionnaire were evaluated. Fracture consolidation took an average time of 16 weeks (14-20). Mean KSS was 77,3 (50-97) at the 2-year follow-up visit, observing better outcomes on type C fractures (84,25). According to the KSS score, only two cases were described with bad functional outcomes (6%). Distal femur fractures treated with the LISS plate achieved 94% of good and acceptable outcomes. Unlike the previously published, the best results were obtained with AO type C fractures, probably associated to the lower age (mean 53 years old) and better functional recovery capacity of this group.

We present the case of a healthy patient who sustained a spiderbite in the elbow and developed a non-infectious necrotizing fasciitis in the affected limb. Female patient aged 24 pain reported a spiderbite received some 72 h previously in Mexico (the spider was identified as a brown recluse spider-Loxosceles reclusa). Under the suspected diagnosis of necrotizing fasciitis urgent surgery was indicated. During her hospital stay, the patient required three additional surgical procedures, and was discharged from hospital 30 days after admission. Spider bites in the limb may be limb-threatening and life-threatening. Emergency doctors should be aware of this possibility, because spiders can be unintentionally transported all over the world.

Introduction: Hypertrophy of the tensor fascia lata muscle (HTFLM) is a rare complication after total hip arthroplasty (THA) and is a potential source of pain, palpable mass, or both., Materials and Methods: We retrospectively analyzed 1285 primary THAs and 482 THA revisions (THAR) performed at our center from 2008 to 2014. Among these, five patients had HTFLM (average age 68.8 years). The type of surgery and symptoms were evaluated, as were imaging studies (CT or MRI) of both hips (10 hips), and functional outcomes with the Merle d'Aubigné score., Results: The suspected diagnosis was established at an average of 30.2 months after surgery. Four cases occurred after THA and one case after THAR. A modified Hardinge approach was used in four cases and a Röttinger approach in one case. Two cases had pain and palpable mass in the trochanteric region and three cases only pain. The asymmetric HTFLM of the THA side against the nonsurgical side was confirmed by measuring the cross section of the tensor fascia lata muscle on imaging. The sartorius muscle was measured for reference in each case. The Merle d'Aubigne scale had a mean value of 16.6 (range 13-18) at 38 months after the procedure., Conclusions: HTFLM after THA is a benign condition that could be mistaken for a tumor when presenting as a palpable mass. We propose that it should be considered in the differential diagnosis of pain in the lateral aspect of hips that have previously undergone THA.

A retrospective study was performed to evaluate the cement mantle in two groups of patients treated with the acetabular components of cemented Exeter total hip arthroplasties (THAs). Two groups of 20 patients were compared: Group 1 received non-flanged acetabular cemented cups (Contemporary, Stryker) and Group 2 received flanged acetabular cemented cups (X3 Rim Fit, Stryker). Cups in Group 2 were implanted after using a rim cutter device. Group 2 showed better penetration of cement in zone 1 (10.76 mm compared with 2.93 mm; p = 0.008) and a thicker cement mantle in zone 1 (3.57 mm compared with 2.89 mm; p = 0.04). More cups in Group 2 had a cement mantle thickness less than 3 mm (30 % in Group 1 compared with 70 % in Group 2; p = 0.0039). No other radiological differences were observed. These results favor the use of a rim cutter device and flanged cup to improve the cement mantle for the acetabular components of cemented Exeter THAs. However, the improvements were less than expected. In view of the results of previous studies, further research is therefore needed to assess the value of this approach in improving the acetabular cement mantle.

Acute vascular injuries have been described in relation to high-energy trauma accidents or in patients undergoing surgery in the femoral area. We describe a healthy patient who sustained a direct, low-energy contusion in the thigh and presented haemodynamic instability. Arteriography was used to locate the point of bleeding, and embolisation and vessel occlusion were carried out to stop the haemorrhage. The genetic study identified the COL3A1 gene mutation; accordingly, the patient was diagnosed with the Ehlers-Danlos syndrome type IV (vascular type).

Introduction: The aim of this study was to evaluate mid-term return to recreational sport in general population and identify factors related with sports return., Methods: Retrospective evaluation of 99 recreational sports players (Tegner score of 6) with ACL arthroscopic reconstructions with hamstring autograft, between 2006-2011. 74 male and 25 female with middle age of 30 years (14-52). We made a questionnaire focused on sports level before injury and after surgery, and different scales: Lysholm, Tegner Activity Level, IKDC and a Likert scale for quantify their motivation for return to sports., Results: With a medium follow-up of 36 months, 90 patients (91.9 %) had returned to recreational sport. 51 (51.52 %) had returned to sports at the same level, and these are those with lower BMI (average 23), higher IKDC and Lysholm scores (p < 0.01) and also they believe that sport is an important activity. Only 9 % of patients left sports. They were principally male athletes (88 %), with higher medium age (32), lesser time between injury and surgery (22 months), higher BMI (26), in comparison with athletes that return to sports., Conclusions: The results suggest good mid-term return to recreational sports in general population. The following factors had a statistically significant influence on the return to sports activity: type of sport, sex and functional state of the operated knee (IKDC-Lysholm). Psychological and social factors may have a fundamental influence on return to sports activity.