The combination of a tibial tubercle fracture with patellar tendon avulsion in adolescents is an extremely rare injury that needs to be managed properly. Herein, we report the case of a 15-year-old boy who presented to our department two months after sustaining a tibial tubercle fracture that had been managed with mini-open reduction and internal fixation in another hospital; he had restricted range of motion and complete inability to extend his knee. Clinical and radiological investigations revealed a neglected avulsion of the patellar tendon with marked scarring and severe retraction. The patient underwent patellar tendon reconstruction using the ipsilateral semitendinosus tendon that passed through separate tunnels in the patella and proximal tibia. The postoperative course was uneventful, and one year later the patient had a satisfactory range of motion and a Lysholm score of 90. To our knowledge, a neglected patellar tendon avulsion after tibial tubercle fracture fixation has been reported only once in the literature. The reconstruction of the patellar tendon using an ipsilateral semitendinosus autograft is an excellent surgical technique, especially when severe tendon retraction has occurred.
Osteochondral lesions of the femoral head are rare. For the treatment of these lesions, various jointpreserving procedures, particularly in young, active patients, have been developed. Mosaicplasty is a wellestablished surgical procedure for the knee. However, there is little evidence that this method can also be used to treat osteochondral lesions in the hip. The indication for cartilage procedures continues to evolve for the knee, and a similar strategy may be adopted for the hip joint. Due to limited evidence and a lack of experience, mosaicplasty treatment of these lesions remains challenging, especially in young patients. This study shows that open and arthroscopic management using the knee and femoral head as donor sites yielded good to excellent short-to mid-term outcomes. For osteochondral lesions of the femoral head, mosaicplasty may be a new alternative treatment option, although this needs to be proven with longer follow-ups and in a larger sample of patients.
As reported in contemporary literature, prosthetic joint infection (PJI) caused by Listeria monocytogenes (LM) is a rare infection affecting mainly immunocompromised patients. It is considered a late complication occurring months or years after the arthroplasty that is treated with, or without, implant retention, in one-stage or two-stage surgical procedures, and long-term administration of antibiotics. We reviewed the published studies in the English language and present a case of a patient who underwent total hip arthroplasty (THA) and had been affected by this infection. Our patient was successfully treated with 3 months of antibiotics (ampicillin and TMP/SMX) and a two-stage surgical procedure. The success rates of conservative treatment and one-stage or two-stage procedures are dependent on appropriate patient selection and chronicity of the infection. Ιmmmunocompromised patients are susceptible to PJI caused by LM and should be advised that consumption of unpasteurized dairy products increases the risk of this atypical infection.
Background Cooled radiofrequency ablation (CRFA) and cryoneurolysis (CRYO) are two novel methods of genicular neurolysis to relief pain in symptomatic knee osteoarthritis (KOA). In this study, the two methods will be compared, giving us the opportunity to investigate their efficacy, safety and complications. Methods In this prospective randomized trial 70 patients with KOA will be recruited using a diagnostic block of four genicular nerves. Two groups will be created through software randomization: a CRFA group (35 patients) and a CRYO group (35 patients). The target of the interventions will be four genicular nerves; the superior medial, superior lateral, inferior medial, as well as the medial (retinacular) genicular branch from vastus intermedius. The primary outcome of this clinical trial will be the efficacy of CRFA or CRYO at 2-, 4-, 12-and 24-weeks post-intervention using the Numerical Rating Pain Scale (NRPS). The secondary outcomes are the safety of the two techniques, as well as the clinical evaluation using the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the 7-point scale of Patient Global Impression of Change (PGIC). Discussion These two novel techniques can block pain transmission through genicular nerves in different ways. In contrast to cryoneurolysis, the CRFA method has been well documented in the past. This is the first clinical trial to compare CRFA vs CRYO and draw conclusions about their safety and efficacy. Trial registration ISRCTN87455770 [https://doi.org/10.1186/ISRCTN87455770]. Registered 29/3/2022, first patient recruited 31/8/2022.
Background Knee osteoarthritis is a disease linked to severe pain and disability and several methods have been used to aid alleviate its symptoms, with varying degrees of success. Cooled radiofrequency ablation (CRFA) and cryoneurolysis (CRYON) are two novel methods under investigation for their capacity to control pain in knee osteoarthritis, while keeping a low complication rate. In this study the two methods will be compared with sham surgery, giving us an opportunity to compare their results. Methods In this prospective, randomized, sham-controlled, double-blind trial 60 patients suffering from knee osteoarthritis will be recruited using a diagnostic block of the genicular nerves under ultrasound guidance. Three groups will be created: cooled radiofrequency ablation group (24 patients), cryoneurolysis group (24 patients) and sham group (12 patients), through software randomization. Target of the interventions will be the three main genicular nerves; superior medial, superior lateral and inferior medial as well as the suprapatellar branch. The primary objective of this clinical trial is to evaluate the efficacy of CRFA or CRYON in comparison to sham surgery at 2-, 4-, 12- and 24-weeks post intervention using the Numerical Rating Pain Scale. Secondary objectives will be the safety of the 2 main techniques, as well as the clinical outcomes at 12- and 24-weeks post intervention using the Knee Injury and Osteoarthritis Outcome Score, the Oxford Knee Score and the 7-point scale of Patient Global Impression of Change. Discussion These two novel techniques are able to block the pain transmission through the genicular nerves via different ways. In contrast to cryoneurolysis treatment, where the literature is scarce, the method of CRFA has been well documented in the past. This will be the first clinical trial to compare them to sham surgery and draw conclusions about their safety and efficacy. The main genicular nerves as targets for cryoneurolysis will also be utilized for the first time. The institutional review board (IRB) of our University Hospital has approved the study (11846/05/10/2021) and written informed consent from participating patients would be obtained. Trial registration ISRCTN87455770 https://doi.org/10.1186/ISRCTN87455770
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