INTRODUCTION Until recently, it was believed that attention deficit hyperactivity disorder (ADHD) was exclusively a pediatric condition. 1 However, current research indicates that 60% to 70% of children diagnosed with ADHD continue to manifest symptoms into adulthood. 2 Persistence of symptoms of ADHD can have a pressing impact on the safety and personal relationships of patients, as well as having secondary effects in adulthood such as lost days of productivity and continual negative feedback or social and educational disadvantages. 3 A recent study that used the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for ADHD, which was conducted in both developed and underdeveloped countries, estimated that the worldwide prevalence of ADHD was 3.4% and showed that it was higher among underdeveloped countries. 4 Currently, there are no biomarkers available for diagnosing ADHD. All diagnoses require careful assessments by clinicians through interviews and appropriate classification criteria. 5 Two diagnostic tools are used today to classify this disorder: DSM-5 and the International Statistical Classification of Diseases and Related Health Problems (ICD-10). These two diagnostic tools define ADHD as a hyperkinetic disorder, a disorder characterized by inattention, hyperactivity and impulsivity with onset in childhood or adolescence. It is believed that the current diagnostic criteria (both DSM-5 and the ICD-10) are inadequate for evaluation of adults because they focus on early childhood problems and they do not fully account for developmental and maturation changes. 6 The symptoms and functional impairments identified among adults for making a diagnosis of ADHD tend to be different from those observed among children.
Objective: This study sought to evaluate the results of 10 athletes diagnosed with posterior ankle impingement syndrome (PAIS) treated with arthroscopy between 2016 and 2017 by the Sports Traumatology Center of our University. Methods: Patients were evaluated with regard to the presence of associated lesions, the etiology of PAIS, and treatment outcomes using a visual analog scale (VAS) and the American Foot and Ankle Society (AOFAS) scores. All cases were treated using an arthroscopic approach to the posterior ankle. Results: Six patients presented with ankle instability and were treated with Brostrom-Gould ligament repair as an adjuvant procedure. One patient had sinus tarsi syndrome, and this space was debrided. Injury of the peroneus brevis tendon was identified in two cases, and Achilles tendinopathy was identified in one individual. Only three patients did not receive adjuvant treatment. During surgery, five cases of trigonal processes, three cases of Stieda process, one case of hallux saltans, and one case of accessory ossicle of the fibula were identified as the causes of the impingement. The mean VAS score was 1.28 (0.6-2.5), and the mean AOFAS score was 88.6 (72-100). No complications were reported. Conclusion: Arthroscopic resection of the cause of the impingement, alone or in combination with the treatment of secondary conditions, was used to effectively treat pain and reestablish function. Level of Evidence IV; Therapeutic Studies; Case series.
Objective: The objective of this study was to evaluate preliminary clinical and radiographic outcomes of a case series of patients with ankle osteoarthritis undergoing anterior tibiotalar arthrodesis using anterior plate and cannulated screws as a form of fixation. Methods: We retrospectively assessed the clinical and radiographic outcomes of eight cases treated with this technique in our service between 2014 and 2017, using the American Orthopedic Foot and Ankle Score (AOFAS) questionnaire and radiographic evaluation in two orthogonal views with ankle weight bearing, evaluated at one year after surgery. Results: We obtained AOFAS scores between 38 and 92 in the late postoperative period and a consolidation rate of 87.5% (seven cases). There was consolidation failure in one case, which resulted in plate loosening and the need for reoperation. Only one of the patients presented superficial surgical wound complication, treated only with serial dressings. There were no neurovascular complications. Conclusion: The present study obtained adequate preliminary outcomes with the use of the demonstrated technique, indicating a possible advantage of the same in relation to conventional techniques and the possibility of using lower-cost surgical materials. Level of Evidence IV; Therapeutic Studies; Cases Series.
Introduction: Sinus tarsi syndrome (SST) can be understood as a set of conditions that affect this anatomical region and manifest as common signs and symptoms. When the nonsurgical approach fails, subtalar arthroscopic debridement is a viable alternative with high rates of good outcomes. The objective of this study is to report the outcomes of subtalar arthroscopic debridement in 8 patients with SST refractory to conservative treatment. Methods: This is a retrospective study with 8 patients diagnosed with SST who underwent subtalar arthroscopic debridement of the sinus tarsi from January 2015 to January 2017, after 6 months of conservative treatment. All patients filled out an epidemiological questionnaire and underwent functional evaluation using the pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale preoperatively and at the final evaluation, after an average of 12 months (6-24 months). Results: All patients presented with intense synovitis in the region. Seven patients had remnants of talocalcaneal ligaments, and 6 had remnants of cervical ligaments. The AOFAS score increased by a mean of 30 points (from 51.75 preoperatively to 82.62 at the final evaluation), and the VAS decreased by a mean of 5 points (from 7.37 preoperatively to 2.12 at the final evaluation); these differences were significant, at p=0.043 and p=0.032, respectively. Six patients described the outcome as excellent, and 2 described it as good. No complications were reported. All patients resumed sports activities after 6 months of follow-up. Conclusion: Subtalar arthroscopic debridement is an effective and safe alternative in the treatment of SST refractory to conservative treatment. Further prospective studies are necessary to prove the outcome of this technique.
Introduction: Chronic Achilles tendon injuries require surgical treatment to improve tendon function. The minimally invasive technique described in this study reduces damage to the fascia and rigid fixation. Objective: To evaluate the clinical and functional outcomes of the reported technique using functional tests, anthropometric measurements and questionnaires. Methods: We evaluated 13 patients who underwent surgical treatment using the minimally invasive technique from 2013 to 2017, after at least 12 months of postoperative follow-up. The patients were subjected to the straight leg raise test to evaluate strength function; we measured the calf circumference and the tibiotarsal angle, and the Achilles Tendon Total Rupture Score (ATRS) and visual analog scale (VAS) were administered. We used parametric tests for statistical analysis. Results: We obtained a 15.4% complication rate (2 patients). We observed differences between healthy and treated limbs when assessing the tibiotarsal angle (a 20% loss of ankle length) and the leg circumference (a 3% decrease in linear measurement). We observed a 36% loss of muscle stretch in functional tests. Conversely, we observed excellent results in the subjective functional assessment using the ATRS (a mean of 82.8 points and a median of 98 points). Conclusion: Surgical treatment of chronic Achilles tendon injuries using the minimally invasive reconstruction technique is associated with an important postoperative objective functional loss. However, this functional loss is not correlated with subjective outcomes assessed using questionnaires in the postoperative follow-up of this technique, which indicates satisfaction and subjective functionality.
Introduction: Ledderhose's disease (plantar fibromatosis) is an uncommon condition that usually affecting men older than 40 years of age and causes major discomfort and disability. The low response to conservative treatment and the progression of surgical techniques have motivated some professionals to resume considering surgical resolution for this disease. Our study describes the outcomes of a series of cases treated with resection of the affected band. Methods: This is a retrospective study with 14 patients (17 feet) diagnosed with plantar fibromatosis of the medial fascia that was refractory to conservative treatment and was treated surgically from December 2016 to November 2018. All patients were evaluated for improvement in symptoms, for major and minor complications and for relapse during the study period. Results: Our sample consisted of 9 men and 5 women with a mean age of 40.6 years (15-63 years). All patients showed medial fibromatosis and underwent subtotal fasciotomy of the medial fascial band with margins of at least 2 cm. Of the 17 feet, 5 showed relapse (29%) and only 2 required reintervention. Three patients (17%) developed surgical wound dehiscence, although all patients progressed to surgical wound closure with no need for surgical intervention. Two feet showed signs of medial plantar nerve injury, although the branch of the nerve was wrapped in fibromatosis and was also resected in those cases. Conclusion: Partial plantar fasciotomy is an alternative for the treatment of Ledderhose's disease. Our series showed outcomes in line with those reported in the literature in terms of relapse and postoperative complications. The moderate relapse and reoperation rates should be considered when this procedure is indicated.
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