Osteoarthritis (OA) is a progressive disease that causes functional impairment of the joints. Chronic forms of knee OA have been increasing worldwide, limiting patients' quality of life. Recent studies have sought to increase effectiveness and quality in the development of new therapies, such as platelet-rich plasma, hyaluronic acid, stem cells, and nuclear factor κB, aimed principally at reducing proinflammatory activity, pain, and degeneration of the knee joints. The goal of this review is to present an update on biological therapies for knee OA and to provide guidance for future OA studies.
Objective: To identify the prevalence of ankle and foot disorders in patients with subtle cavus foot (SCF). Methods: This was a retrospective case series. Patients with lower limb disorders who upon clinical examination were also diagnosed with SCF were evaluated. Patients diagnosed with disorders that could lead to this deformity, such as trauma sequelae and neurological disorders, and those with the presence of cavovarus foot with severe deformity were excluded. Correlations between ankle and foot disorders and the presence of SCF were evaluated. Results: A total of 119 patients (67 males/52 females) were evaluated, totalling 238 feet. One hundred forty-one feet had subtle cavus, and 97 feet had physiological alignment. Of the 141 SCF, 76 feet were right feet, and 65 were left feet. Twenty-two patients had bilateral SCF. One undred forty complaints were identified, which led to 18 diagnoses: ankle instability (37 cases/26.2%), peroneal tendon tendinopathy (31 cases/22.0%), plantar fasciitis (18 cases/12.8%), Achilles tendon tendinopathy (10 cases/7.1%), osteochondral talar lesion (7 cases/5.0%), mechanical metatarsalgia (6 cases/4.3%), hallux sesamoid disorders (5 cases/3.5%), Morton’s neuroma (5 cases/3.5%), hallux valgus (5 cases/3.5%), pain in the lateral side of the foot (4 cases/2.8%), anterior impact (3 cases/2.1%), pain in the medial side of the tibia (2 cases/1.4%), plantar plate injury (2 cases/1.4%) and other disorders with a prevalence <1%. Conclusion: We found a clear correlation between SCF and acute and chronic ankle instability, peroneal and Achilles tendon tendinopathy and plantar fasciitis. Level of Evidence IV; Therapeutic Studies; Case Series.
Objective To determine the current clinical practice in Latin America for treating midshaft clavicle fractures, including surgical and non-surgical approaches.Methods A cross-sectional study using a descriptive questionnaire. Shoulder and elbow surgeons from the Brazilian Society of Shoulder and Elbow Surgery and from the Latin American Society of Shoulder and Elbow were contacted and asked to complete a short questionnaire (SurveyMonkey®) on the management of midshaft fractures of the clavicle. Incomplete or inconsistent answers were excluded.Results The type of radiographic classification preferably used was related to description of fracture morphology, according to 41% of participants. Allman classification ranked second and was used by 24.1% of participants. As to indications for surgical treatment, only the indications with shortening and imminence of skin exposure were statistically significant. Conservative treatment was chosen in cortical contact. Regarding immobilization method, the simple sling was preferred, and treatment lasted from 4 to 6 weeks. Although the result was not statistically significant, the blocked plate was the preferred option in surgical cases.Conclusion The treatment of midshaft clavicle fractures in Latin America is in accordance with the current literature.
Background: Bipartite talus is a rare entity. The etiology is uncertain. The definition is a large bone fragment that occupies the posterior portion of the talus and reaches the posterior subtalar joint. Case Report: We report a symptomatic bipartite talus in a female patient, 41 years old, treated with arthroscopic resection. Discussion: Posterior hindfoot arthroscopy has gained more popularity in the treatment of foot and ankle pathologies. Indeed, this is a secure and useful tool for the surgeon. In this report, we described the use of this technique for resection of a large bone fragment (bipartite talus). Conclusions: We present in detail the arthroscopic resection of a bipartite talus. This is an unusual pathology and a differential diagnosis for posterior impingement. We believe that arthroscopic resection of the bone fragment of the bipartite talus is a safe procedure, with less morbidity for the patient, compared with open resections. Level of Evidence: Level V—technique description.
Resumo Objetivo Avaliar os resultados obtidos do tratamento cirúrgico das fraturas maleolares do tornozelo associadas a lesão da sindesmose tibiofibular distal (STFD) submetidas a procedimento cirúrgico convencional de fixação da fratura e fixação da STFD pelo suture button (SB). Métodos Avaliou-se retrospectivamente 49 pacientes com uma média de idade de 45 anos e seguimento médio de 34,1 meses. A avaliação clínica e funcional foi baseada na escala visual analógica (EVA) e na escala American Foot and Ankle Society Score (AOFAS, na sigla em inglês) para tornozelo e retropé, retorno às atividades da rotina e retorno ao esporte. Resultados As médias pós-operatórias das escalas AOFAS e EVA foram, respectivamente, 97,06 (índice de confiança [IC 95%: 95,31 – 98,81] e 0,16 [IC 95% 0,04 – 0,29]. Todos os pacientes retornaram às atividades prévias do cotidiano, sendo que apenas 12 apresentaram algum sintoma residual. Não se verificou instabilidade pós-operatória em nenhum paciente. Ao todo, 46 pacientes retornaram às atividades desportivas e, destes, apenas 1 não retornou ao nível prévio à lesão. Apenas dois pacientes apresentaram alterações relacionadas ao SB. Não houve relato de insatisfação. Conclusão Em fraturas maleolares do tornozelo com lesão da STFD, a fixação da sindesmose com o SB demonstrou excelentes resultados pós-operatórios. Nível de Evidência IV, série de casos retrospectiva.
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