Arthroscopic Identification and Management of Recurrent Iliopsoas Impingement After Total Hip Arthroplasty

Arthroscopic release of the iliopsoas tendon for iliopsoas impingement (IPI) after total hip arthroplasty (THA) at the lesser trochanter gives good results. However, where IPI then recurs, due to adhesions between the healing iliopsoas tendon and the surrounding soft tissue, and nonoperative measures have failed, a revision THA procedure is usually considered. We propose a technique of arthroscopic visualization of the recurrent IPI and a subsequent psoas tenotomy at the level of the hip joint using an outside-in capsulotomy approach. This secondary tenotomy, located proximally directly at the level of the recurrent impingement, allows relief of the painful symptoms without compromising the muscle function of the iliopsoas and precludes the need for a complex THA revision.

Diaphyseal tibiofibular synostosis in professional athletes: Report of 2 cases

Anterior leg pain is common in professional athletes and tibiofibular synostosis is reported to be a rare cause of anterior compartment pain or ankle pain related to sports activities. The management and appropriate treatment of this condition in professional athletes is controversial and the literature on the topic is sparse. Distal synostosis is usually related to ankle sprain and syndesmotic ligament injury, and proximal synostosis has been linked to leg length discrepancy and exostosis. Mid-shaft synostosis is even less common than proximal and distal forms. We present the treatment of mid-shaft tibiofibular synostosis in 2 cases of professional athletes (soccer and basketball player), along with a review of the literature. When diaphyseal synostosis is diagnosed, first-line conservative treatment, including ultrasound-guided steroid injection is recommended. However, if it does not respond to conservative management, surgical resection may be indicated to relieve symptoms.

Pharmacological and phytochemical studies of callus culture extracts from Alternanthera brasiliana

This work describes the establishment of callus cultures of Alternanthera brasiliana, a Brazilian medicinal plant used to treat several ailments. In addition the two extracts, exhibiting best yields, were chemically analysed and evaluated as antinociceptive agents in two classical models of pain in mice: the writhing test and the formalin test. The results show that the highest biomass accumulation was observed in callus grown in media with higher concentrations of growth regulator of 2,4-D. Both extracts studied exhibited antinociceptive effects in mice, being more effective than the plant extracts. The pharmacological action seems to be related to the presence of steroids and/or terpenes.