Orthopedic Surgery | Manhattan | New York City | Staten Island http://www.regionalorthopedic.com Wed, 16 May 2012 12:18:02 +0000 en hourly 1 http://wordpress.org/?v=3.1.3 (May. 2010) Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis http://www.regionalorthopedic.com/latest-news/may-2010-platelet-rich-plasma-for-managing-calcaneus-tendon-tendinopathy-and-plantar-fasciitis http://www.regionalorthopedic.com/latest-news/may-2010-platelet-rich-plasma-for-managing-calcaneus-tendon-tendinopathy-and-plantar-fasciitis#comments Wed, 16 May 2012 12:18:02 +0000 drmontalbano http://www.regionalorthopedic.com/?p=4348 Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis

Non-surgical treatment of Achilles tendinopathies ad plantar fasciitis has shown good results in up to 90% of cases. However, the remaining 10% of patients with these conditions represent a true challenge for the orthopedic surgeon. New technologies for the development of orthobiologic materials make it possible to use platelet-rich plasma (PRP) as an alternative to treat cases that have been refractory to prior treatment and that have a chronicity exceeding 12 months. Read More…

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Source

Instituto Nacional de Rehabilitación, Ortopedia, Jefatura de la División de Ortopedia Pediátrica y Deformidades Neuromusculares, 4o Piso, Calzada México-Xochimilco Núm. 289, Col. Arenal de Guadalupe, C.P 14389, México, DF. egavito@hotmail.com

Abstract

INTRODUCTION:

Non-surgical treatment of Achilles tendinopathies ad plantar fasciitis has shown good results in up to 90% of cases. However, the remaining 10% of patients with these conditions represent a true challenge for the orthopedic surgeon. New technologies for the development of orthobiologic materials make it possible to use platelet-rich plasma (PRP) as an alternative to treat cases that have been refractory to prior treatment and that have a chronicity exceeding 12 months.

MATERIAL AND METHODS:

Prospective, analytical study. Patients with diagnosis of Achilles tendinopathy, plantar fasciitis or both, with a course of more than 12 months, previously treated with non-surgical alternatives, without any clinical improvement. The AOFAS hindfoot scale was used, together with the Visual Analog Scale (VAS) for pain, and photographic documentation at 2, 4, 8 and 12 months after infiltration. A treatment program that included immobilization, NSAIDs, eccentric exercises for the Achilles-calcaneal-plantar system and strengthening of the sural triceps was established. The statistical analysis included measurements of the central trend and scatter with the SPSS 15.

RESULTS:

A sample consisting of 10 patients (12 feet) that met the diagnostic and inclusion criteria was obtained. Mean age at the time of presentation was 43 years (range 23-56), with females being predominant (70%) and 50% laterality for the right and left feet. The initial AOFAS score was 39 (range 28-68) and the VAS score was 9 (range 7-10). By week 16 the AOFAS score had increased to 97 (range 88-99) and the VAS score was 2 (range 1-4). All patients resumed independent gait.

CONCLUSION:

The use of PRP in patients with Achilles tendinopathy and plantar fasciitis is an effective and safe alternative for the management of patients with a poor response to conventional non-surgical treatment. Other non-surgical modalities are recommended besides PRP for the treatment of these patients to achieve appropriate results.

[Article in Spanish]
López-Gavito E, Gómez-Carlín LA, Parra-Téllez P, Vázquez-Escamilla J.

 

]]> http://www.regionalorthopedic.com/journal-articles/platelet-rich-plasma-for-managing-calcaneus-tendon-tendinopathy-and-plantar-fasciitis/feed 0 Dancer with hip and knee pain http://www.regionalorthopedic.com/case-studies/dancer-with-hip-and-knee-pain http://www.regionalorthopedic.com/case-studies/dancer-with-hip-and-knee-pain#comments Wed, 18 Apr 2012 13:51:50 +0000 drmontalbano http://www.regionalorthopedic.com/?p=4280 This is a 30 something dancer who came to us originally with complaints of left knee pain that was preventing her from dancing. A diagnosis was made of patellafemoral mal- alignment.   She failed initial non-surgical treatment which was physical therapy to strengthen the muscles selectively around the knee to improve patella tracking.

We proceeded with surgical treatment of the condition. The diagnosis made by X-rays, MRI and clinical exam was confirmed at the time of surgery and the patella was noted to be laterally tilted and somewhat translated (image 1). The problem was corrected with purely soft tissue procedure to lengthen the lateral retinaculum and tighten the medial soft tissues using a tissue advancement and suturing technique. The procedure was successful in centering the patella (image 2)  and was accomplished arthroscopically and with a 1 inch incision and no skeletal work.

She recovered well from the surgery and her knee pain resolved. She subsequently developed pain in the hip and having had a satisfactory experience with treatment of her knee condition began treatment of her hip. A diagnosis was made of anterior labrum tearing with FAI (femeroacetabular impingement) with a CAM lesion.  The condition was corrected with an arthroscopic hip procedure.

The ace tabular hyaline cartilage had the characteristic chondrolabral separation associated with FAI and CAM lesions (image 1,2). The labrum was repaired back to the acetabulum rim following preparation of the osseous surface (image 3,4,5). The final step was eliminating the CAM impingement by recontouring the femoral neck to allow acetabular relief (image 5,6,7).  The client recovered well following rehabilitation and has returned to dancing.

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