Large Loose Body Research Articles

SURGICAL REMOVAL OF A LARGE LOOSE BODY IN THE SUBACROMIAL SPACE : A CASE REPORT.

Synovial chondromatosis is a rare condition characterized by the presence of osteocartilaginous loose bodies in articular joints, bursae, or tendon sheaths. Multiple case reports describe synovial chondromatosis in the knee, hip, elbow, wrist, ankle, and shoulder with the shoulder being the least common of these joints to be affected. All reports describe multiple small loose bodies but rarely describe of a single large loose body .We present a case of a 65 year old fe male patient who presented to us with with painless swelling over the right shoulder with radiological ndings of large loose body in the subacromial space and subdeltoid region. After no improvement with conservative treatment subtotal synovectomy and removal of loose body of size 2.5cm was done via anterior approach . At her 1 year follow-up examination she remained asymptomatic and there was no clinical or radiographic evidence of recurrence.

Is It Water On The Knee?! Operation!

HISTORY: A 53-year-old male with history of knee osteoarthritis presented with worsening right knee pain 2.5 months following MVA. He also noted a mobile mass over the superior lateral knee. There was no relief with NSAIDs or rest. PHYSICAL EXAMINATION: Antalgic gait with crutches. Right knee with moderate effusion, limited range of motion to 100 degrees flexion and 10 degrees extension with crepitus, tenderness to palpation over the lateral joint line with a palpable mass superior to the lateral femoral condyle. Positive McMurray’s test. DIFFERENTIAL DIAGNOSIS: 1. Osteoarthritis flare2. Meniscal tear3. Avulsion fracture of the femur4. Crystalline arthropathy5. Synovial osteochondromatosis TEST AND RESULTS: Right Knee X-Ray: Linear bony density along the medial femoral condyle, suspicious for an acute to subacute avulsion fracture. Stable findings of synovial osteochondromatosis. Synovial Fluid Analysis: No organisms or crystals identified. Right Knee MRI without contrast: Tricompartmental osteoarthritis with secondary synovial osteochondromatosis with large calcified intra-articular body within the suprapatellar recess measuring 4.7 cm. Moderate joint effusion. Moderate synovitis. Medial and lateral complex meniscal tears. Pellegrini-Stieda lesion, compatible with sequela of prior MCL injury without periligamentous edema. FINAL WORKING DIAGNOSIS: Synovial osteochondromatosis with a large loose body with underlying osteoarthritis and medial and lateral complex meniscal tears. TREATMENT AND OUTCOMES: Aspiration was performed for 47 cc serous synovial fluid followed by intra-articular corticosteroid injection. At 3 week follow-up visit, the patient noted 50% improvement in pain, but recurrent effusion and increased buckling. Case was discussed with an orthopedic surgeon and recommendation was made for loose body excision and possible total knee arthroplasty. After discussion, the patient preferred to avoid surgery and continue conservative care with bracing and physical therapy.

Arthroscopic management of neglected complex knee injury

<p>Meyers and mckeevers type IV comminuted pattern of avulsion fracture of the anterior tibial eminence is not an uncommon injury, however its association with root avulsions of lateral and medial meniscus is very rare combination of injury and the management of the neglected case of this complex knee injury is challenging. A 43-year-old gentleman who came with a history of pain, recurrent instability, locking of his right knee for 2 weeks with restricted activity of daily living. He also had a road traffic accident 5 years ago. He was evaluated clinically, radiologically by X Rays and MRI Scan which revealed complete tear of anterior cruciate ligament (ACL) with loose fragments, root tear anterior horn lateral meniscus and posterior horn tear with posterior root avulsion of the medial meniscus. He was managed with arthroscopic removal of large loose body with other loose bony fragments, ACL Reconstruction with hamstring autograft, anterior root repair of lateral meniscus with pull out sutures, with all inside repair of posterior horn tear of medial meniscus using fast-fix 360 device (Smith and Nephew, Andover, MA). At 4 years follow-up the patient was analysed clinically, and the functional outcome was measured with international knee documentation committee (IKDC) and knee injury and osteoarthritis outcome score (KOOS) Scoring system which showed good outcome. Patient has returned to his pre-injury activity level with no limitation of his activity of daily living. There is no set protocol of managing these kinds of neglected complex knee injury. Sometimes you need to think out of the box. A thorough knowledge of anatomy and pathomechanics of knee combined with appropriate technique of repair to save the meniscus and reconstruction of ACL and rehabilitation can yield good result.</p>

Numerical Simulation and Reinforcing Technology Research on Collapse of Weak Interlayer Shaft

The three-level shaft of the mixed pit shaft of Yixin Mine, built in 1983, failed continuously due to the influence of geological structure and the effect of water, which formed a collapsed space with a length of 18m,a depth of 12m,and a height of 12m at the level of -255m and to the southwest end. The 54m pit shaft below the -258m elevation of the pit shaft was filled with collapsed rocks forming a large loose body. The comprehensive processing plan for falling grouting and anchoring was proposed according to the geological conditions of the vertical shaft of the mixed pit shaft, adopting three-dimensional numerical simulation software as well as calculating the mechanical state of the vertical pit shaft surrounding rocks and using 3 to 5 parameters of Williams-Warnke failure criterion.

Hip Arthroscopy for Synovial Chondromatosis: Tips and Tricks

Hip arthroscopy is an important diagnostic and therapeutic tool in the management of synovial chondromatosis. Removal of osteochondral fragments (OCFs) from the central and peripheral compartments is crucial for the relief of mechanical symptoms and subsequent joint destruction. Direct access to the central compartment is often limited because of the ball-and-socket morphology and limitation of traction. We present our surgical technique for removing OCFs and a new method for the removal of a large loose body using a nitinol stone retrieval basket. The technique facilitates removal of difficult-to-access fragments from the central compartment. Moreover, this technique allows removal of far-medial OCFs from the peripheral compartment.

Fixation of a Chondral Fragment of the Knee in an Adult

Chondral or osteochondral fractures of the patella or femoral trochlea are not uncommon. If the osteochondral fragment has sufficient subchondral bone, fixation of the fragment has been a treatment of choice1. However, partial or full-thickness chondral fracture has been managed in a different manner since cartilage itself has poor healing potential. Options to manage partial or full-thickness chondral injury include debridement, microfracture, drilling, osteochondral graft, and chondrocyte implantation. Fixation of a chondral fragment is not a standard method of treatment, especially in adults. There have been a few case reports of chondral fracture managed by fixation of a fragment in children or adolescents2,3. We present a case in which a full-thickness chondral fracture in an adult was treated with fixation of the fragment with a good short-term result. To our knowledge, this is the first report of a chondral fracture in an adult that was successfully treated by fixation, and was verified histologically. The patient was informed that data concerning this case would be submitted for publication, and he provided consent. A twenty-six-year-old man presented with sudden onset of pain in the right knee that had occurred during a sprint eight days earlier. Physical examination showed a knee effusion with limited motion because of the pain. There was no ligamentous laxity and no patellar instability. Radiographs showed no abnormality except soft-tissue swelling. A magnetic resonance image (MRI) showed a 0.5 × 1-cm chondral defect on the medial facet of the patella and a 1.7 × 1.6-cm chondral defect on the anteromedial femoral trochlea, with a signal change of the underlying subchondral bone that was consistent with a bone bruise (Figs. 1-A and 1-B). There was a large loose body in the suprapatellar pouch and a small loose body in the medial gutter. The medial …

A COMBINATION OF PIGMENTED VILLONODULAR SYNOVITIS AND SYNOVIAL CHONDROMATOSIS PRESENTING AS A LARGE LOOSE BODY IN KNEE

AbstractIntra-articular calcific lesions of knee usually manifest as loose bodies with symptoms of recurring episodes of locking and restriction of movement. These loose bodies are a consequence of trauma or degeneration of structures in the joint and occasionally may be of inflammatory or neoplastic condition of the synovium.Here we present our case as a rare form of presentation where in our patient had a large loose body in the knee with chronic pain and swelling and restriction of the movements of knee. Arthrotomy, loose body excision and total synovectomy of the knee confirmed coexistence of a dual lesion of synovial chondromatosis of the Hoffa's fat pad with diffuse pigmented villonodular synovitis of the knee joint. The patient made an uneventful recovery and full range of knee movement was restored by end 3 months. These benign conditions have inherent risk of recurrence, and in our case, till the last follow up at 14 months after surgery, he has remained asymptomatic with no clinico radiological evidence of any recurrence.

Research on Slope Deformation Regularity of the Badong Formation in the Three-Gorges Reservoir Area

The Three-Gorges Reservoir area is characterized by widely distributed strata of Badong Formation, in which large size landslide and deep-reaching loose geological body are likely to form. Therefore, it is significant to reveal the mechanism and patterns of the large size landslide in Badong Formation for better understanding of the development of the nature of deformation and process of formation of the deep-reaching loose stratum slope. In this paper, the geological characteristics of the rock mass of the Badong Formation are concluded on the basis of systematic explanation of the space variation of the lithology combinations and space variation of structural deformation of the Badong Formation in the Three-Gorges Reservoir area. To demonstrate the basic law of long-term deformation of the Badong Formation slopes and the patterns of later stage reform and landslide evolution, the authors exemplify the Huangtupo landslide that is typical in the Badong Formation.

Arthroscopic removal of large loose body: an improved technique

Arthroscopic removal of large loose body: an improved technique

Arthroscopic removal of large loose body: an improved technique

Figure 4 Removal of loose body once reduced Figure 2 Loose body grasped with tool TECHNIQUE Three arthroscopy portals are made: one for viewing, one for grasping the loose body and one for introduction of a shaver. While the scrub nurse holds the camera, the surgeon grasps the loose body and manipulates it to the shaver (Figs 1 and 2). The loose body is then reduced to a suitable size (Fig 3) to enable safe removal through a standard arthroscopic portal (Fig 4).

Arthroscopic Management of Osteochondritis Dissecans of the Capitellum: Mid-term Results in Adolescent Athletes

The optimal treatment of osteochondritis dissecans (OCD) of the capitellum in adolescent athletes remains challenging. The purpose of this study was to investigate the mid-term results of arthroscopic treatment of OCD of the capitellum in a series of adolescents. We identified 25 consecutive patients at our institution that underwent arthroscopic treatment for OCD of the capitellum since 1999. Ten elbows were treated by arthroscopic debridement and drilling alone, whereas 12 elbows required additional mini-arthrotomies for bone grafting or the removal of large loose bodies after arthroscopy. The clinical charts and operative reports of these patients were retrospectively reviewed for relevant clinical information including age, sport, character of symptoms, preoperative and postoperative range of motion, return to sport, and postoperative complications. Twenty-one patients (22 elbows) were reached to determine their current elbow function and athletic activity using the Single Assessment Numerical Evaluation score. The average age of the patients in our series was 13.1 years. All patients participated in organized athletics that involved the upper extremity and had undergone an average of 10.2 months of nonoperative treatment before surgery. At a mean follow-up of 48 months, the patients gained an average of 17 degrees of extension and 10 degrees of flexion after surgery. Both the improvement in flexion and extension were statistically significant compared with the preoperative range of motions (P=0.001, P=0.01). When patients were asked to rate their elbow function from 0% to 100% using the Single Assessment Numerical Evaluation score, the average rating was 87%. Eighteen of 21 patients (86%) returned to participate in their sport at their preinjury level. Arthroscopic management of capitellar OCD in adolescent athletes results in significantly improved range of motion and a high rate of return to athletics. Accompanying arthrotomy may be required for large loose body removal or bone grafting.

A LARGE INTRA-ARTICULAR LOOSE BODY IN THE METACARPOPHALANGEAL JOINT OF THE MIDDLE FINGER MIMICKING A CALCIFIED TUMOROUS LESION: A CASE REPORT

We will report on a case with a large intra-articular loose body in the metacarpophalangeal (MP) joint of the middle finger in a 30-year-old-male, which was mimicking a calcified tumourous lesion adjacent to the palmar side of the metacarpal head. It was easily removed through the palmar approach.

A newly described hereditary cartilage debonding syndrome

We describe a hereditary chondropathy characterized by extreme cartilage friability and cartilage-bone debonding, which has not previously been described in the literature. We also describe initial studies into the molecular basis of this disorder. Affected family members had multiple shoulder, hip, and knee arthropathies, beginning in the pre-teen years and continuing into adulthood. Various diagnoses had been suggested, including spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, Legg-Calvé-Perthes disease, and Osgood-Schlatter disease. The affected proband father, his 3 affected children, and unaffected family members provided blood samples, which were examined for single-nucleotide polymorphisms (SNPs) in the chromosome 2 region that included the Frizzled-related protein gene, a soluble Wnt protein signaling antagonist that influences bone and cartilage development. All affected individuals showed clear similarities, including effusions, large loose bodies, and bubbling and delamination of the cartilage with exposure of subchondral bone. All affected individuals exhibited radiographic changes in the hip, showing femoral head flattening and secondary degenerative arthritis, accompanied by abnormalities in the physical properties of the cartilage that were evident upon arthroscopic examination. Two SNPs were identified in subjects with the hereditary cartilage debonding syndrome. Examination of the siblings and parents of the proband demonstrated, however, that both SNPs were present in the unaffected mother and in 2 of 4 unaffected siblings of the proband. The clinical findings reported here represent a newly defined clinical syndrome characterized by marked cartilage friability and osteochondral debonding. Because the SNPs are present in the general population, and because unaffected members of this family carry the SNPs, these polymorphisms alone are insufficient to result in the observed phenotype.

Locking of Elbow due to Large Loose Body

Locking of Elbow due to Large Loose Body