Synovial and ganglion cysts are fluid-filled lesions within joints, most often occurring in the periarticular areas of the wrist, knees, and feet.

We present two cases of symptomatic avascular necrosis of distal femur in two multiple sclerosis patients who received Methylprednisolone (15 and 10 grams respectively) for relapses treatment over a period of 28 and 29 months. Both complained knee pain after steroid treatment, in both cases we diagnosed avascular necrosis of distal femur only one year later. These cases illustrate how important is not to underestimate the event of avascular bone necrosis after steroid pulse treatment, even with low cumulative dosages, after a long time interval and in unusual necrosis sites.

Juvenile Idiopathic Arthritis (JIA) is an autoimmune disease that may lead to inflammation of multiple joints at a young age, often complicated by destruction and growth disturbances, including the craniofacial region. The annual incidence is reported as 0.008–0.226 per 1000 children.

Arthroscopic treatment for ankle diseases has proven to be successful as multiple articles describe favorable outcomes, low complication rates and cost-effectiveness [1]. Nonetheless, these articles are most often from North America, Europe and Pacific nations, thus there is a lack of literature supporting these outcomes in the Latin American patient population. The purpose of this study was to describe the early outcomes of a commonly performed procedure focusing in the Latin patient population. We conducted the study on a case series of patients who underwent arthroscopic treatment of Hagelund lesions at a tertiary care center in Medellin, Colombia Outcomes were measured by previously trained personnel decrease bias.

The goal of this study was to report the short-term outcomes of these patients and thus our focus was on the f irst 12 months after surgery. A total of 6 patients had available data for the follow up.

The mean age was 43.1 (SD 21.6), 66.7% of patients were males and all cases had unilateral surgeries. Mean follow up was 10.9 months (range 3- 24.3). 100%of patients stated they would undergo the operation again, with the mean satisfaction on the 10-point scale being 9 (range 7-10). No patient had undergone a second procedure for the same indication. One patient had instability symptoms, but this was not reproducible during the examination. In summary, arthroscopic treatment of Haglund deformity in a Latin patient population yielded satisfactory results.

Anatomic reduction of ankle fractures does not ensure a normal ankle function. This might be related to chondral damage during the fracture or other intra-articular pathology. Arthroscopy in the setting of acute operative management of ankle fractures provides a means to completely assess intra-articular pathology and sometimes even direct therapeutic intervention. To date there is no consensus in the literature regarding the indications for arthroscopy in the setting of ankle fractures. It is our practice to perform an arthroscopic assessment of all ankle fractures requiring surgical intervention. The current study retrospectively evaluated a consecutive series of twenty-two adult patients who underwent routine arthroscopy performed during open reduction and internal fixation of ankle fractures and its correlation with the clinical results at a follow-up of 2 years. The clinical results at 2 year follow-up results demonstrated an average AOFAS score of 82±8. Patients with grade 4 talar damage fared significantly worse (70±8) than both patients with grade 3 talar damage (83±7) and with normal talus structure during arthroscopy 87±9 (5.42, p<0.001).

In conclusion the findings of this limited series seem to indicate that final clinical results at 2 years follow-up correlate with the presence of chondral damage observed during arthroscopy. A randomized clinical trial should be performed in order to assess the possible advantages of ankle arthroscopy as compared with open reduction technique in improving treatment outcomes in ankle fracture fixation.

Background:
The clinical syndrome of “tennis leg” is often associated with a calf hematoma and was originally ascribed to a ruptured plantaris tendon. Recent publications have demonstrated a much higher association of myotendinous injuries of the Medial Head of the Gastrocnemius (MHG), with infrequent injuries to the plantaris, in the setting of calf hematoma. Nevertheless, a purported association between plantaris tendon rupture and calf hematoma persists in some literature and clinical discussions.

Hypothesis/Purpose:
The purpose of our study is to evaluate whether a hematoma or fluid collection between the soleus and MHG muscles after trauma may be caused by an isolated plantaris tendon tear.

Study Design:
Cross-sectional study.

Methods:
IRB approval was obtained for this retrospective review. An institutional radiology database search for MRI examinations of the calf performed over a ten year period returned 710 MRI examinations, 67 of which demonstrated an interfascial hematoma, fluid collection or edema between the MHG and soleus muscles. Each MRI was scrutinized by two fellowship trained musculoskeletal radiologists for integrity of the plantaris, gastrocnemius, and soleus myotendinous structures and intervening fascia. Discrepancies were resolved by consensus.

Results:
62 of the 67 cases demonstrated a visible plantaris tendon and hematoma, fluid collection, or edema interposed between the soleus and MHG muscles. The plantaris was not visible and was presumed to be congenitally absent in five cases. Of the remaining 62 cases, the MHG was abnormal in 62/62 (100%) cases and the plantaris tendon was abnormal in 3/62 (4.8%) cases. Isolated injury to the MHG was observed in 59/62 (95.2%) cases; isolated injury to the plantaris tendon was not observed in any cases (0%).

Conclusion:
Our results demonstrate no association between a hematoma, fluid collection, or edema between the soleus and MHG muscles and a plantaris tendon tear. In concert with previous studies, our results support gastrocnemius injuries as the causative etiology of a calf hematoma in this location following acute trauma.

Clinical Relevance:
A hematoma interposed between the soleus and MHG muscles following acute trauma is not associated with plantaris tendon tears; this historical association should be abandoned.

What is known about this subject:
Medial head gastrocnemius muscle injury is more common than plantaris tendon injuries in cases of “tennis leg.”

What this study adds to existing knowledge:
A hematoma between the soleus and MHG muscles following trauma is not attributable to isolated plantaris tendon injury. In cases of tennis leg, even when the plantaris tendon is injured, a hematoma between the soleus and MHG muscles is attributable to concurrent gastrocnemius injury.