1/27. Do B cells influence disease progression in chronic synovitis? Lessons from primary hypogammaglobulinaemia.We describe a 62-yr-old male patient with primary hypogammaglobulinaemia (PH) who fulfilled the 1987 American Rheumatism association/American College of rheumatology revised diagnostic criteria for rheumatoid arthritis (RA) but, despite persistent symmetrical synovitis, did not develop erosions. virology studies and blood and synovial fluid (SF) cultures were consistently negative; a search for crystals in the SF was unrevealing. Peripheral blood (PB) B cells were absent, whilst the PB CD3( ) cell count was normal. The ratio of naive (CD45RA( )) to memory (CD45R0( )) cells was also normal (1:1) but the CD4:CD8 ratio was reversed. To our knowledge, this is the first report which combines the immunophenotypic analysis of the PB with that of the SF and synovial membrane (SM). This confirmed the absence of B cells and the reversed CD4:CD8 ratio. However, as in other chronic arthropathies, the SF and SM cellular infiltrate consisted almost exclusively of memory T cells, consistent with the preferential localization of this subset to inflamed tissues. This case indicates that synovitis can proceed persistently in the absence of B cells and that the migratory mechanisms of T cells are not altered. However, the case suggests that the absence of B cells and negativity for rheumatoid factor, combined with an increased presence of CD8( ) (suppresser/cytotoxic) T cells in the joint, might contribute to the non-erosive nature of the synovitis.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/27. A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction.The cyclops lesion is a fibrous nodule with central granulation tissue located anterolateral to the tibial tunnel after intra-articular reconstruction of the anterior cruciate ligament (ACL) that has been shown to be a cause of failure to regain full extension in the early postoperative period. We present the case of a 23-year-old woman who had undergone arthroscopic ACL reconstruction with a patellar tendon autograft 4 years prior to presentation. Following her reconstruction, she regained full range of motion and returned to collegiate cheerleading. At presentation, she complained of a gradual loss of full extension and joint-line pain with terminal extension. On examination, her graft was stable and she lacked 3 degrees of extension. magnetic resonance imaging documented a 1-cm mass of low signal intensity immediately anterior to the ACL graft within the intercondylar notch. At arthroscopy, a large amount of thick, immobile scar tissue was found immediately anterior to the ACL, consistent with a cyclops lesion. The lesion was debrided and the patient did well postoperatively. patients who present with delayed-onset loss of extension after ACL reconstruction should undergo careful evaluation including radiographs and magnetic resonance imaging. If a cyclops lesion is diagnosed, arthroscopic resection should be undertaken.- - - - - - - - - - ranking = 278.2176771366keywords = ligament (Clic here for more details about this article) |
3/27. Synovitic cyclops syndrome caused by a Kennedy ligament augmentation device.The cyclops lesion at the tibial attachment of the reconstructed ligament has been known to cause loss of knee extension. We present a case of knee extension loss because of a cyclops lesion caused by Kennedy ligament augmentation device synovitis at 10 years after ACL reconstruction in a 33-year-old man.- - - - - - - - - - ranking = 333.86121256392keywords = ligament (Clic here for more details about this article) |
4/27. Posterior approach for arthroscopic treatment of posterolateral impingement syndrome of the ankle in a top-level field hockey player.A case history of a 25-year-old field hockey player, a member of the German National Field hockey Team, is presented. The patient could not remember any specific ankle injury, but since the World Indoor Championship in February 2003, he experienced significant but diffuse pain around the posterior ankle, especially while loading the forefoot in hockey training and competition. For 2 months, the patient was unable to run. Conservative treatment failed, and surgery was performed. Posterior ankle arthroscopy revealed a frayed posterior intermalleolar ligament and meniscoid-like scar tissue at the posterolateral ankle, indicating a posterolateral soft tissue ankle impingement syndrome. A concomitant inflammation of the posterolateral ankle and subtalar synovium was present. After arthroscopic resection and early functional aftertreatment, the patient returned to full high-level sports ability within 2 months.- - - - - - - - - - ranking = 55.643535427319keywords = ligament (Clic here for more details about this article) |
5/27. Successful use of ReFacto continuous infusion in two paediatric patients with severe haemophilia A undergoing orthopaedic surgery.In this report we describe the successful use of B-domain-deleted recombinant factor viii (ReFacto) administered by continuous infusion during orthopaedic procedures in two children with severe haemophilia A. Both patients underwent ankle synovectomy and in patient 2, a medial patello-femoral ligament repair was performed in the same operative session. Patient 2 developed septic arthritis A in his knee joint and arthroscopic joint irrigation and debridement was performed 2 weeks after the initial procedure. Surgical cover was initiated with a bolus dose of ReFacto 50 IU kg(-1) followed by continuous infusion at 3.3-4.8 IU kg(-1) h(-1) which was maintained for up to 9 days postoperatively. Patient 2 received an additional bolus dose of 15 IU kg(-1) during the infusion period. All procedures were performed without haemostatic complications and long-term orthopaedic outcomes were good in both patients.- - - - - - - - - - ranking = 55.643535427319keywords = ligament (Clic here for more details about this article) |
6/27. Granulomatous synovitis after intraarticular Hylan GF-20. A report of two cases.Intraarticular hyaluronan injections are used to treat osteoarthritis of the knee. Acute painful swelling with a joint effusion develops locally after the injection in about 10% of cases but resolves spontaneously. Crystals are identifiable in some patients, but the mechanism in crystal-negative cases remains unknown. We report knee arthritis with inflammatory joint fluid free of organisms and crystals in two patients after Hylan GF-20 treatment for femorotibial osteoarthritis. synovial membrane histology disclosed granulomatous synovitis with epithelioid histiocytic and multinucleate giant cells but no visible foreign bodies. These two cases suggest that crystal-negative arthritis after Hylan GF-20 injection may be ascribable to granulomatous synovitis of the foreign-body giant-cell type.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
7/27. Intracarpal synovitis related to Dacron interposition after trapeziectomy: a report of three cases.To prevent the mechanical consequences of trapeziectomy, interposition devices are promoted, such a Dacron spacer. We report three cases of osteolysis and synovitis related to the use of such a device. This phenomenon occurred 4 months after insertion and required revision surgery after 9 months of follow-up because of pain and extensive osteolysis of the carpal bones. Revision consisted of an extended synovectomy, removal of the broken Dacron followed by a ligamentoplasty using the Flexor Carpi Radialis. Two years after revision surgery the result was satisfactory, with no recurrence of pain or osteolysis. The Dacron device did not demonstrate improvement in clinical results after short-term follow-up when compared to conventional ligamentoplasty. We recommend cautious use of the Dacron device at trapeziectomy and attention must be paid to follow up of the patient.- - - - - - - - - - ranking = 111.28707085464keywords = ligament (Clic here for more details about this article) |
8/27. Premature rupture of the membranes: a cause for neonatal osteomyelitis?osteomyelitis is rare in the neonatal period. Many etiologic factors for causing neonatal osteomyelitis have been discussed in the literature; however, premature rupture of the membranes has never been emphasized. We report on a neonate with osteomyelitis of the right humerus infected with an uncommon pathogen, klebsiella pneumonia. In the absence of any perinatal disease, premature rupture of the membranes was suggested to be the cause of the illness. The infant was initially regarded as having Erb palsy because of the absence of systemic symptoms and lack of perinatal high-risk factors. Antibiotic administration was delayed for 3 weeks. Luckily, nearly complete recovery was noted after 2 months of follow up. We emphasize the importance of considering osteomyelitis in a newborn infant with limb palsy, particularly in the presence of premature rupture of the membranes of the mother. We also discuss the results of the microbial examination and significance of magnetic resonance imaging in neonatal osteomyelitis.- - - - - - - - - - ranking = 7keywords = membrane (Clic here for more details about this article) |
9/27. Scapholunate dissociation associated with crystal induced synovitis.We report the development of scapholunate ligament rupture after episodes of gout in 2 patients and in association with chondrocalcinosis in another. One patient required surgical fusion for alleviation of pain. The diagnosis should be considered in patients with prolonged wrist pain refractory to conventional therapies for crystal induced arthritis.- - - - - - - - - - ranking = 55.643535427319keywords = ligament (Clic here for more details about this article) |
10/27. Extensor pollicis longus tendon rupture as a result of scapholunate dissociation: a case report.A 39-year-old patient was presented with, to our knowledge, the first ever diagnosed case of extensor pollicis longus (EPL) tendon rupture as a result of scapholunate (S-L) dissociation. Arthroscopic findings showed that the dorsal aspect of the S-L ligament was ruptured and severe synovitis was revealed around the S-L joint. Direct observation revealed synovium at the rupture site of the EPL tendon. After careful resection of this synovium, an aperture in the S-L joint was observed. Thus, it was considered that the synovium in the S-L joint was connected to the rupture site of the EPL tendon, passing through the dorsal capsule of the S-L joint. The ruptured EPL tendon was reconstructed with extensor indicis proprius tendon transfer, and S-L dissociation was treated with a bone-retinaculum-bone autograft taken from the third dorsal compartment region.- - - - - - - - - - ranking = 55.643535427319keywords = ligament (Clic here for more details about this article) |
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