PURPOSE OF THE STUDY In this study, we retrospectively reviewed a consecutive case series of first metatarsophalangeal (MTP) joint arthroscopies performed in our department over a span of six years. This study aimed to evaluate the efficacy and safety of arthroscopic treatment for various first MTP joint pathologies. MATERIAL AND METHODS A total of 36 patients that underwent first MTP joint arthroscopy between January 2014 and December 2019 were reviewed. The mean age at the time of surgery was 38.3 years (range, 14-65), with no gender predominance (19 males). All arthroscopies were performed by a single surgeon using a 2.7 mm arthroscope with a 30° viewing angle as well as other standard instruments with a diameter equal to or smaller than 3.5 mm. Postoperative results were assessed by a satisfaction questionnaire obtained during the telephone interview. For patients with sesamoid bone pathology ability to return to sports activities was also evaluated. RESULTS The far most common indication, in even twenty-nine patients, was hallux rigidus, five patients were treated for nonunion of sesamoid bone fracture, one patient had an osteochondral defect of the first metatarsal head and one was treated due to the development of arthrofibrosis following the open corrective procedure of hallux valgus. The mean follow-up was 31.2 months. Thirty-four patients responded to the satisfaction questionnaire. Thirty patients (88.2%) were either satisfied or very satisfied with the procedure and thirty-one (91.2%) of them stated that they would undergo the same procedure again. The satisfaction rate for patients with early stages of hallux rigidus (grade 1 and 2) was 90.4%. Only one patient in this group (2.8%) required open revision surgery due to recurrence of pain and joint stiffness. All patients with nonunion of sesamoid bone fracture were very satisfied with the procedure, and three out of four patients (75%) who were also competitive athletes resumed their sports activity at the same or improved level after the arthroscopy. Regarding arthroscopy-related complications we observed four cases (11.1%) of iatrogenic injury to dorsal sensory nerves of the great toe, resulting in only one permanent sensory impairment. DISCUSSION Considering the high satisfaction rate and low rate of complications in our study, as well as those published in the literature, we can suggest that arthroscopy of the first MTP joint is a safe and effective procedure. CONCLUSIONS Arthroscopy of the first MTP joint certainly has a place in the treatment of some pathological conditions of the first MTP joint, and in our opinion, it should be first-line surgical therapy for the initial stages of hallux rigidus and sesamoid bone pathology. Key words: arthroscopy, metatarsophalangeal joint, great toe, hallux rigidus, cheilectomy, sesamoid bone, sesamoidectomy.
PURPOSE OF THE STUDY The aim of this study was to determine the exact localization of the histopathological process (bone, bone-tendon junction or tendon), and to determine whether the underlying pathologic process is predominantly of inflammatory or degenerative nature, then to evaluate the outcome of the surgical treatment of patellar tendinopathy. MATERIALS A prospective cohort study was performed in order to analyze the outcome of surgical treatment of patellar tendinopathy, as well as to document histopathological changes in bone, bone-tendon junction, and in the patellar ligament in 34 professional athletes treated with patellar apicotomy. All the patients included in the study were classified as stage 3 according to Blazina and showed no improvement after at least 6 months of conservative treatment. The postoperative follow-up was from 1 to 8 years with a mean value of 4.7 years. METHODS The postoperative results were analyzed using a semiquantitative scoring system where the functional outcome was classified as very good if the athlete returned to his sporting activity without any negative side effects, good if the athlete resumed his sporting activities with modest painful sensations present only at the maximum level of physical exertion, and poor if any reduction of athletic activity was present. In twenty patients a histopathological examination of resected bone and tendon tissue was performed. The specimens were stained with hematoxylineosin and examined under a light microscope using polarization. Special stains used were Alcian blue, to detect any increase in ground substance, and Prussian blue which enhances conspicuity of hyaline degeneration and enables detection of hemosiderin. Immunohistochemistry was performed in order to analyze presence of blood vessels, leukocytes and histiocytes.
- MeSH
- dospělí MeSH
- lidé MeSH
- ligamentum patellae chirurgie patologie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- patela patologie MeSH
- poranění z opakovaného přetěžování chirurgie patologie MeSH
- sportovní úrazy chirurgie patologie MeSH
- tendinopatie chirurgie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
The aim of this case report is to present an unusual double synovial cyst that arose from the proximal tibiofibular joint compressing the peroneal nerve in the peroneal tunnel and was unrecognized at the beginning. According to the review of literature back to 1891, only 62 cases of cysts originating from the proximal tibiofibular joint (PTFJ) have been described. We report a case of a 32 year old male patient who was admitted to the Department of Orthopaedic Surgery because of a classic peroneal tunnel syndrome of the left leg. On the lateral side of the proximal third of his left leg a tumefaction of 12 x 2.5 cm was visible. The sonography showed a characteristic image of the para-articular synovial cyst of the left knee. A surgical extirpation of the synovial cyst and decompression of the peroneal nerve in the peroneal tunnel were performed. PHD confirmed a classic synovial cyst. Postoperatively, the symptoms of the peroneal nerve compression disappeared. Three years after the first surgical intervention the patient was readmitted to the Department because of quite similar problems, only the neurological symptoms were less intensive than during the first admittance. This time the performed MR imaging showed a double synovial cyst originating from the proximal tibiofibular joint. The surgical treatment consisted of a total extirpation of both cysts including the narrow stalks of communication with the PTFJ. The joint was opened and a synovectomy was done using an electrocauter and a sharp curette. Regular check-ups were done every 6 months and twice during the control period of 4 years, as was the MR imaging control. MRI findings 4 years after the second surgical intervention were normal. Clinical findings after 7 years were normal and we are sure that the recidivation of the synovial cyst excluded. The MRI diagnostics was crucial for an adequate surgical treatment and the relief of the peroneal tunnel syndrome symptoms.
- MeSH
- dospělí MeSH
- fibula patologie MeSH
- kolenní kloub patologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nervus peroneus MeSH
- synoviální cysta diagnóza chirurgie komplikace MeSH
- úžinové syndromy etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
