Abstract Tenosynovial giant cell tumors (TGCTs) are tumors of the tendon sheath and are usually seen proximal to the wrist joint or in fingers, contrary to this case, as seen in the hypothenar region. It is primarily caused by a mutation in the synovial membrane’s stromal cells, which results in an overexpression of colony-stimulating factor. A 34-year-old male presented with swelling over the right hand palmar aspect over the hypothenar eminence which was gradually progressive in nature. The site and local examination of swelling seemed to have pertaining with TGCT, fibroma of tendinous sheath, cyst, rheumatoid nodule, or neuroma. Radiological tests were performed, and contrast magnetic resonance imaging image showed soft tissue density peri-articular mass. Fine-needle aspiration cytology was performed which confirmed the diagnosis as giant cell tumor of the tendon sheath/TGCT. Excision biopsy was performed. This case is an unusual presentation of TGCT in an unusual location, which turned into a diagnostic dilemma on clinical and radiological assessment. It was only after the gold standard histopathological report that the diagnosis of TGCT was reached and confirmed, followed by appropriate management.
Abstract Background: Anterior cruciate ligament reconstruction (ACLR) is known to restore good-to-excellent functional knee stability. Despite this, high percentage of patients fails to achieve preinjury sports level. Kinesiophobia (the fear of movement) has been reported to be one of the major causes of limitation to return to sports. Western studies have shown the timing of surgery influences the level of kinesiophobia postoperatively but studies on the Indian population are lacking. Objective: The study aims to ascertain the prevalence of postoperative kinesiophobia among patients undergoing ACLR and identifying the risk factors associated with kinesiophobia using the Tampa Scale for Kinesiophobia score, K-SES (Knee self efficacy Scale), and Visual analog Scale (VAS). Study Design: This was an observational cohort analysis. Materials and Methods: Patients attending the outpatient department from January 2018 to June 2022 for ACLR were included in the study. Patient characteristics (age, sex, and body mass index), pain intensity level (VAS score), and knee self-efficacy scale were used as potential predictor variables for kinesiophobia, which was independently evaluated by Tampa Scale at 48 h postoperative, 2 weeks postoperative and at 6 weeks post-ACLR. Results: The mean Tampa Scale scores reduced from 61.87 preoperatively to 21.3 at 6 weeks postoperatively. Mean self-efficacy scale scores at 48 h, 14 days, and 6 weeks were found to be 12.6, 25.51 and 34.7, respectively. VAS mean pain intensity scores at 48 h, 14 days, and 6 weeks were 4.57 ± 1.07, 1.74 ± 0.72, and 0.39 ± 0.49, respectively. Greater decline in pain intensity scores between 48 h and 14 days was observed than between 14 days and 6 weeks. Conclusions: The prevalence of kinesiophobia decreases during postoperative rehabilitation, but high kinesiophobia is still present in a large portion of the patients after ACLR. The Tampa Scale of Kinesiophobia scoring has been found to be very accurate in identifying and segregating people who have kinesiophobia, as well as significant in measuring these risk factors associated with recovery after ACL reconstruction, providing a better approach to understanding the effect of treatment and measuring risk factors.
Abstract Context: Anterior ankle impingement (AAI) is a frequent cause of chronic distal limb pain and restricted range of motion. Aims: This study evaluated the clinical, functional, and radiological efficacy of arthroscopic debridement for AAI. Settings and Design: A quasi-experimental prospective study was conducted on 30 patients at Suez Canal University Hospitals presenting with refractory ankle pain. Materials and Methods: Assessment tools included the Visual Analog Scale, foot functional index (FFI), and Scranton and McDermott Classification. Patients were monitored at 1, 3, and 6 months postoperatively. Statistical Analysis Used: Data were analyzed using the SPSS software version 20 (IBM Corporation, Armonk, NY; USA). Paired t -tests and the Wilcoxon signed-rank test were utilized to compare the longitudinal quantitative parametric and nonparametric data, respectively, with significance set at P < 0.05. Results: Soft-tissue impingement was identified as the predominant pathological type. Following the 6-month intervention period, median FFI subscale scores demonstrated highly significant improvements ( P < 0.001): the pain subscale decreased from 6 to 3, disability from 7 to 4, and activity limitation from 6 to 2. An overall improvement in the total FFI score was observed in 93.33% of the cohort. Postoperative complications were infrequent and primarily minor, with arthrofibrosis and transient neurological symptoms each occurring in 6.67% of patients. Conclusions: Arthroscopic management of AAI, whether involving osseous or soft-tissue impingement, is a highly effective therapeutic approach. It is associated with significant improvement in analgesic and functional parameters and maintains a favorable safety profile with a low incidence of minor postoperative complications.
Abstract Background: Bipolar hemiarthroplasty (HA) is a standard treatment for displaced femoral neck fractures in the elderly, offering reliable long-term survivorship. However, mechanical fracture of the femoral component is a rare, technically demanding complication with poorly defined revision strategies. Aims and Objectives: To evaluate the clinical presentation, surgical strategies, and short-term outcomes of revision procedures in patients with fractured bipolar hip prostheses. Materials and Methods: This retrospective study reviewed six consecutive patients (five males and one female; mean age: 68 ± 11 years) who presented with fractured bipolar stems between 2022 and 2024. Failures occurred at a mean of 8.5 years postindex surgery following low-energy falls. Five cemented stems fractured at the shaft, while one uncemented stem failed at the trunnion. No clinical or laboratory evidence of infection was found. All patients except one underwent conversion to total hip arthroplasty (THA). To facilitate difficult implant extraction, an extended trochanteric osteotomy (ETO) was utilized in four cases. Femoral reconstruction was achieved using diaphyseal-engaging revision stems in five patients and a cemented polished tapered stem in one. Results: The mean operative time was 128 ± 11 min. At a 12-month mean follow-up, all osteotomies had united, and radiographs confirmed stable components without loosening. No complications, such as infection or dislocation, were observed. Functional outcomes, measured by the Harris Hip Score, were excellent in one patient, good in four, and fair in one. Conclusion: While uncommon, bipolar stem fractures necessitate complex revision. Conversion to THA or HA using appropriate strategies – including timely use of ETO and diaphyseal fixation – is a safe approach that yields favorable early functional outcomes for these challenging cases.
Abstract Lipoma arborescens (LA) is a rare intra-articular lesion characterized by diffuse villous lipomatous proliferation of the synovium. While it predominantly affects the knee, it is often misdiagnosed due to its nonspecific presentation and overlapping features with other synovial disorders. Given its rarity, particularly in young adults, this case report highlights the importance of early recognition and appropriate management to prevent long-term joint damage. The present case is distinctive due to the unusually young age of the patient, the 6-year untreated duration, and significantly elevated inflammatory markers, all of which created a diagnostic challenge not commonly described in previous literature. A 23-year-old male presented with a 6-year history of progressive knee swelling and pain. He had undergone multiple aspirations at another center with no lasting relief. Examination revealed a diffuse swelling over the anteromedial knee with tenderness and restricted motion (0°–90°). Imaging demonstrated joint effusion, nodular synovial thickening, and fat proliferation, raising suspicion for LA. Histopathological findings confirmed the diagnosis, showing mature adipocytes with characteristic “tree-like” projections within the synovium. The patient underwent arthroscopic synovectomy using an aggressive shaver and radiofrequency ablation, resulting in significant symptom improvement. Postoperative rehabilitation was initiated to restore joint function and mobility. This case underscores the importance of considering LA in young patients with chronic knee swelling and recurrent effusions. Magnetic resonance imaging remains the diagnostic modality of choice, and arthroscopic synovectomy with adjunctive radiofrequency ablation offers an effective treatment approach. Timely intervention is crucial to prevent secondary osteoarthritis and functional impairment. This case adds to the orthopedic literature by emphasizing advanced imaging and minimally invasive surgical techniques in the management of this rare condition.
