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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to present the indications, technique, and results for subtalar arthroscopy in 50 consecutive patients. In each case, ankle arthroscopy was performed concomitantly to assess the exact source of the patient's pain. Surgical indications included chronic pain, swelling, buckling, and/or locking that failed conservative treatment. Arthroscopy of the ankle and subtalar joints were performed using both 2.7- and 1.9-mm arthroscopes through standard and accessory portals; distraction was used in all cases. All patients were followed-up for an average of 48 months (range, 36 to 70 months). Group 1 included 21 patients (42%) with chronic lateral ankle pain following an inversion injury. In this group, the subtalar joints were completely normal and the pathology was found to be limited only to the ankle joint. In group 2, 29 patients (58%) had the following diagnoses at arthroscopy: synovitis, 7; degenerative joint disease, 5; subtalar dysfunction, 5; chondromalacia, 4; nonunion of os trigonum, 4; arthrofibrosis, 2; loose bodies, 1; and osteochondral lesions of the talus, 1. Overall, the results were 86% good-to-excellent in group 2.
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PMID:Subtalar arthroscopy: indications, technique, and results. 962 Jun 48

During 1977 to 1986, 106 patients had isolated patellar prostheses, with both patellar and femoral components, inserted in 20 different hospitals in Sweden. At follow up, 7 years (range 3 to 14 years) after operation, 9 patients had died so that 97 patients with operations on 113 knees were included in this study. Thirty-three (38 knees) had been operated on before or after a prosthesis had been inserted. At follow-up, 75% were satisfied with the operation; 83% had improved, 59% could walk without an aid and 44% had no, or only occasional, pain in the knee. These results encourage the use of an isolated patellar prosthesis in cases of advanced and disabling localised patellar arthrosis. There is no place for this operation in the treatment of chondromalacia.
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PMID:The use of isolated patellar prostheses in Sweden 1977-1986. 972 3

The meniscoid lesion is a frequent but not well known cause of persistent pain in the anterior part of the upper ankle in sports traumatology. It has been described as portions of hyalinized tissue following an inversion sprain of the ankle. Trapping of this formation between the lateral cheek of the talus and the fibula is supposed to be responsible for pain and other symptoms reported by the patient. In 59 arthroscopic procedures on the ankle joint in athletes, meniscoid lesions were seen in 19 cases. Only 1 of these 19 patients showed lateral and anterior instability, and frequent clinical symptoms were swelling and trapping. Intraoperatively, all meniscoid lesions were combined with synovitis. Chondromalacia and osteophytes were seen several times. After an average follow-up period of 12 months, 14 patients could be examined. Twelve of the athletes returned to full sports activity; 10 were very satisfied, 2 satisfied, and 2 unsatisfied. Nine patients did not complain of any swelling, 4 did so on rare occasions, and 1 complained persistently. No pain was reported 10 times, improvement of pain 3 times, and continuing persistent pain 1 time, probably because of simultaneous chondromalacia and osteophytes. These were found more frequently in patients with a longer case history and unsuccessful conservative treatment, so that early arthroscopic surgery is recommended.
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PMID:Ankle joint arthroscopy for meniscoid lesions in athletes. 975 73

The patellofemoral joint is a complex articulation based on its dependence on both dynamic and static restraints for stability. Classification of patellofemoral disorders has been frought with confusion. However, progress has been made in the classification and understanding of these disorders by improved understanding of the biomechanics of the joint and by clarification of the terminology to describe patellofemoral pathology. The term chondromalacia patella, although once used as an all-inclusive term for anterior knee pain, is now widely accepted as a term used to describe pathologic lesions of the patellar articular cartilage found at arthroscopy or arthrotomy. An adequate classification system should aid in proper diagnosis and treatment of specific problems. If properly devised, it should also aid in the comparison of results between different treatment centers. In addition, it should be a system that is simple and useful in the clinical setting with minimal use of complicated imaging techniques. From a clinical perspective, patellofemoral problems in the skeletally mature patient fall into three broad categories: 1) patellofemoral instability, i.e., subluxation or dislocation; 2) patellofemoral pain with malalignment but no episodes of instability; and 3) patellofemoral pain without malalignment. The myriad of patellofemoral disorders then fall into subclassifications of these categories. Treatment algorithms can be broadly developed based on the general category, with specific treatments based on the subclassification. In this paper, the authors will present a review of the pertinent literature documenting patellofemoral classification systems and develop concepts of clinical classification of patellofemoral disorders based on the three categories described above.
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PMID:Clinical classification of patellofemoral pain and dysfunction. 980 78

A variable combination of patellar lateral subluxation, patellofemoral dysplasia, patella alta and secondary chondromalacia is the major cause of patellofemoral pain. Specific pathology such as medial plica syndrome or patellar tendinitis are less frequent, but their treatment is easier. A strict radiological protocol most often demonstrates the abnormalities. A CT-scan combined with an arthrogram is another imaging option. The goal of conservative treatment is to bring pain relief. The surgical correction of patellar maltracking can be proposed if conservative treatment fails, but has a high failure rate.
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PMID:[Patellofemoral pain]. 983 55

Anterior knee pain is a frequent musculoskeletal complaint affecting adolescent population with incidence of 36% in 14 years old schoolchildren. Until late sixties anterior knee pain used to be associated with chondromalacia. This review discusses etiology and treatment of anterior knee pain. Various etiologic theories exist ranging from trauma and patellar maltracking to retinacular nerves injury. None of these theories has been generally accepted and etiology of patellofemoral pain remains unclear.
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PMID:[Anterior knee pain syndrome: a historical review]. 985 57

Jumper's knee is an overuse disease. The initial subjective complaints are well-localized pain, usually occurring after physical activities and often at the lower pole of the patella. The diagnosis of jumper's knee is usually easily established after acquiring a detailed history and a carefully performed physical examination, but the lesion can be mistaken for other disorders or injuries, such as bursitis, meniscal injuries or chondromalacia (1) or other causes of the patellofemoral pain syndrome. Today ultrasonography is the method of choice for the evaluation of jumper's knee as it is both time and cost saving, non-invasive, repeatable, accurate and allows a dynamic image of the tendon, guided injections and control of treatment. Conservative therapy is the treatment of choice in the early stages and includes adequate warm-up, stretching of the quadriceps muscle and physical activity with respect to the pain, and ice pack application after activity. When the pain disappears, the training intensity can be increased. NSAID (Non-Steroidal Anti-Inflammatory Drugs) and local peritendinous injections with long-acting steroids can be a helpful and safe adjuvant to the conservative treatment and should be tried before surgery. Surgical treatment is indicated only if a prolonged and well-supervised conservative treatment program fails in chronic jumper's knee (including local injection with steroid) or in acute total rupture. Review papers concerning jumper's knee are already published (2-5), but in this review the importance of ultrasonography to make the diagnosis, to plan therapy and control the treatment and the safety of peritendinous injection with steroid is pointed out. The scientific documentation for the recommanded treatment (conservative, steroid injection and operation) is, however, insufficient. Many more controlled studies are needed. Ultrasonography and placebo-controlled, double-blinded, cross-over studies for treatment with local injection of steroid are ongoing (6, 7).
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PMID:Jumper's knee. Review of the literature. 1022 Aug 39

This is a report of 10 consecutive patients who had subtalar arthroscopy for persistent pain in the subfibular area after open reduction and internal fixation for intra-articular calcaneal fractures. The average period between the injury and the subtalar arthroscopy was 14.3 months (range, 6-36 months). The average follow-up period after subtalar arthroscopy for the patients who did not require further treatment was 16.7 months (average, 11-35 months). All the patients except two had chondromalacia. Three had grade II, three had grade III, and two had grade IV. Five patients had intra-articular adhesion. Two patients had a loose body. The power shaver has been used for debridement of the damaged cartilage and excision of the adhesion. Eight patients (80%) had considerable pain relief and did not require further local injection or surgical management. The two patients who required subtalar fusion had grade IV chondromalacic lesions. Only four patients had improvement in the range of motion of the subtalar joint. The preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score for the whole group was 69.9 points (range, 68-74 points), which was improved postoperatively to 77.2 points (range, 48-90 points). Subtalar arthroscopy for persistent pain after calcaneal fractures should be considered, especially if the radiological examination shows mild degenerative changes in the subtalar joint.
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PMID:Subtalar arthroscopy for persistent subfibular pain after calcaneal fractures. 1043 24

Sixty-two consecutive cemented modular unicompartmental knee arthroplasties in 51 patients were studied prospectively. At surgery, the other compartments had at most Grade 2 chondromalacia. The average age of the patients at arthroplasty was 68 years (range, 51-84 years). One patient was lost to followup and 10 died with less than 6 years followup. The average followup of the remaining 51 knees was 7.5 years (range, 6-10 years). The preoperative Hospital for Special Surgery knee score of 55 points (range, 30-79 points) improved to 92 points (range, 60-100 points) at followup; 78% (40 knees) had excellent and 20% (10 knees) had good results. The mean range of motion at followup was 120 degrees with 26 knees (51%) having range of motion greater than 120 degrees. One patient underwent revision surgery for retained cement, one patient underwent knee manipulation, and one patient underwent revision surgery at 7 years for opposite compartment degeneration and pain. Radiographically, 26 knees (51%) had at least one partial radiolucency. There were no complete femoral radiolucencies, but there were three complete tibial radiolucencies, all less than 2 mm. No component was loose as seen on radiographs. At final followup, five of the opposite compartments (10%) and three of the patellofemoral joints (6%) had some progressive radiographic joint space loss; this was less than a 25% loss in all but one knee component that was revised. At 6- to 10-years followup, cemented unicompartmental knee arthroplasty yielded excellent clinical and radiographic results. The 10-year survival using radiographic loosening or revision as the end point was 98%. Using stringent selection criteria, unicompartmental knee replacement can yield excellent results and represents a superb alternative to total knee replacement.
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PMID:Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year followup. 1054 98

Recurrent dislocation of the patella is more common in girls than in boys. Although several predisposing factors may exist, patellar dislocation is most commonly associated with familial ligamentous laxity. Many surgical repairs have been described to stabilize the patella. We have found the semitendinosus transfer to the patella to result in a predictable, stable patellofemoral joint without risk of injury to the proximal tibial physis. Between January 1990 and December 1997, 29 children have been treated at the Children's Hospital of Eastern Ontario with a semitendinosus transfer for recurrent dislocation of the patella. Seven children were excluded from the study because of insufficient follow-up; consequently this series consisted of 22 children. Four children underwent bilateral repairs, hence 26 knees that have been operated on with this procedure were included in this study. There were three boys and 19 girls, with an average age at surgery of 14 years and 4 months, ranging from 8 years and 11 months to 17 years and 10 months. The average length of follow-up was 3 years and 2 months, ranging between 2 years and 7 years and 4 months. All children had experienced greater than three episodes of recurrent dislocation of the patella. Pain consistent with patellofemoral syndrome or chondromalacia was present in 17 of 26 knees. On clinical examination, 10 knees exhibited marked ligamentous laxity. There were nine positive patellar apprehension tests, and eight patellae were hypermobile. All children were treated with a semitendinosus transfer to the patella with concomitant tightening of the medial retinaculum and a lateral retinacular release. On long-term follow-up, 23 of the 26 knees (88%) were asymptomatic, and the child had returned to regular activities. Each child completed the Lysholm and the subjective component of the Zarins-Rowe questionnaire to determine the subjective results of the repair procedure. Three children complained of patellofemoral symptoms. One child experienced recurrence of the patellar dislocation, and one child developed medical patellar subluxation.
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PMID:Semitendinosus tenodesis for repair of recurrent dislocation of the patella in children. 1057 43


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