Objectives: To describe a rare case of significant vascular injury that occurred following the harvest of hamstring tendon graft for anterior cruciate ligament reconstruction, with the need of repair.
Case report: A 30-year-old male soccer player presented with significant swelling and acute pain two hours after anterior cruciate ligament (ACL) reconstruction. Clinical examination and MRI scan showed bleeding, and a large hematoma in the middle of the left thigh. Hemorrhagic contention was only possible after a secondary repair, where a vessel of the sartorius muscle was bleeding profusely 12 hours after the primary surgery.
Discussion: The presence of a large number of vessels on the medial side of the knee associated with blind flexor tendons graft hamstring is cause of vascular injury during removal of the hamstring graft.
Conclusion: Although uncommon, graft hamstring of flexor tendons can have devastating consequences if some hemostasis procedures are not correctly applied.
Leung Ping Chung*
Introduction: Knee pain is one of the commonest disabling diseases of the elderly people. It has been taken for granted that it is a degenerative problem related to curtilage thinning, and the pathology does not involve much inflammatory process. Osteoarthritis is therefore the most popular term used.
Causes of osteoarthritis of the knee: Apart from in-born structural varieties that affects the function of the knee joint, many other causes have been described: "cartilage derived", "ligament derived", "meniscal derived", "bone derived" and "synovial derived" pathologies, all basing on structural changes involved.
There is an important dynamic mechanism that maintains a balanced functional position between the medial and lateral compartments of the knee joint irrespective of existing structural imperfections: the proprioceptive afferent receptor -cerebral autonomous output circuit. Proprioceptive receptors in the muscles, tendons, and joint capsules are detecting all the time the detail positions of the joint components in relation to the standing posture of the individual. They send messages up to the brain so that outputs of muscular adjustments are sent down to initiate chain reactions to maintain the joint in balanced harmony irrespective of structural imperfections.
Evidences of the proprioceptive protection of joints through an autonomous neurological circuit have been proven anatomically, clinically, and also through studies on other joints e.g. the trapezio-metacarpal joint of the thumb.
Discussion: It is therefore appropriate to introduce training activities to boost up the balancing dynamics around the knee joint, particularly for the early clinical presentations of osteoarthritis to prevent deterioration; and also before and after appropriate structural corrections, in order to maintain its functional integrity.
Athanasios N Ververidis, Konstantinos Paraskevopoulos*, Anthimos Keskinis, Georgios Papadopoulos and Konstantinos Tilkeridis
Introduction: Bone Marrow Edema Syndrome (BMES) is a self-limited condition that can affect young or middle-aged women or men. It is manifested by sudden onset of pain localized in the affected region. Extracorporeal shock wave therapy (ESWT) has been utilized in several orthopaedic conditions including avascular necrosis and due to the subsequent promising outcomes; it was attempted on patients suffering from BMES as a non-operative option of treatment. The aim of our mini review paper was to describe BMES and discuss the current studies that were conducted regarding the utilization of ESWT as a non-invasive method of treatment in patients with BMES.
Material and Methods: A review of the literature was conducted using Pubmed, Scopus and Google scholar with the terms “extracorporeal shock wave” OR “extracorporeal shockwave” AND “bone marrow edema syndrome” OR “transient osteoporosis” to gather all current knowledge regarding BMES and ESWT. In total, 6 studies concerning BMES and treatment with ESWT were identified between November 2014 and April 2020 and were further analyzed in the discussion section.
Results: A total of 177 patients who were treated with ESWT in the context of BMES either in the hip joint (74 patients) or in the knee joint (103 patients) were identified in the literature. All of the 177 patients who suffered from BMES had been successfully treated with ESWT. Specifically, in 3 studies which had compared the use of ESWT with patients who received a variety of pharmacological agents including analgesics, bisphosphonates and alprostadil (control group), the results showed higher functional improvement, higher recovery rates, as well as higher reduction of Bone Marrow Edema (BME) on MRI in favor of ESWT group.In 1 study, comparing the use of ESWT with core decompression, ESWT had better results regarding the aforementioned parameters. In another 2 observational studies, ESWT had been successfully utilized and achieved statistically significant improvement in functional and pain scores, as well as reduction of BME on MRI.
Conclusion: ESWT has been used in off-label in patients with BMES with promising results, as it seems to achieve rapid pain relief and functional improvement, hence it may be a potential regimen for the rapid recovery of BMES. Due to the small number of studies, no evidenced based recommendations can be given.
Reza Noktehsanj, Aidin Arabzadeh*, Turaj Rahmani, Hamed Zandian, Reza Mirzazadeh, and Seyyed-Mohsen Hosseininejad
Efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis (PF) is under debate in spite of applying in treatment. We aimed to investigate the efficacy of extracorporeal shock wave therapy in decreasing plantar fasciitis heel pain.
Methods: Eighty patients fulfilled the inclusion criteria; 77 agreed to participate the study. Patients randomly divided into 2 groups of treating with NSAID and NSAID+ESWT and assessed in to periods of 4 and 8 weeks with a focus on ESWT effectiveness.
Results: Visual analog score decreased significantly after eight weeks of treatment with ESWT+NSAID in comparison with NSAID group alone. (p<0.05)
Conclusion: ESWT reduced pain of PF in our study. So it could be used as treatment options.
Extracorporeal shock wave therapy (ESWT) is one of the most common recommended electrotherapeutic modalities for the management of chronic Achilles Tendinopathy (AT). However, the term chronic AT is not clear in the literature. The term chronic AT is ranged in the literature from 4 weeks to 6 months after the first onset.