Severe hypertrofic ossification after a shoulder arthroscopy: a rare clinical presentation

Periarticular ossification is a well-known complication after orthopedic surgical procedures, with a predilection of the hip and elbow, and an incidence around 30%-40%(6). Heterotopic ossification is a rare complication after shoulder arthroscopy and is rarely clinically significant. To our knowledge only one series of patients with heterotopic ossification starting from the acromion with comparable radiographic findings and symptoms after shoulder arthroscopy has been described.We report a case of a 65-year old caucasian man with a slow and painful revalidation after arthroscopic shoulder surgery encompassing rotator cuff repair, biceps tenotomy and acromioplasty, with recurrence of impingement symptoms unresponsive to conservative therapy, physiotherapy and one corticosteroid infiltratrion. He developed a severe heterotopic ossification starting from the insertion of the deltoid to the acromion  and of the coraco-acromial ligament. This was succesfully treated by arthroscopic excision of the ossifying lesion of the acromion and postoperative prophylactic therapy with nonsteroidal anti-inflammatory drugs as secondairy prevention

10-year results of the Nesovic procedure combined with adductor release for groin pain in 33 competitive athletes.

Purpose:The aim of this study is to evaluate a surgical treatment for groin pain in athletes.Methods:We present 10 years results of 33 patients operated on between April 2002 and May 2006 diagnosed with a “sports hernia”. The injury was treated with a bilateral abdominal procedure according to Nesovic combined with a bilateral adductor release after unsuccessful conservative treatment. There were 32 male patients between 18 and 43 years and one female patient aged 25 years with a mean age of 28.8 at time of surgery. All procedures were bilateral. Patients were seen in the postoperative clinic and a questionnaire was collected after 2 years and 10 years.Results:Within 16 weeks, 30 patients (90,9 %) returned to the same or a higher level of sports activities. 10 years after surgery 31 patients (93,9%) remained free of pain. 1 patient has minor pain after training (VAS 0-1) and only 1 patient still experiences pain (VAS ≥5) after heavy work. 19 of 20 patients (95%, 57% of total cohort) were pain free to the end of their sporting careers.

The use of regression analysis in determining reference intervals for low hematocrit and thrombocyte count in multiple electrode aggregometry and platelet function analyzer 100 testing of platelet function

Low platelet counts and hematocrit levels hinder whole blood point-of-care testing of platelet function. Thus far, no reference ranges for MEA (multiple electrode aggregometry) and PFA-100 (platelet function analyzer 100) devices exist for low ranges. Through dilution methods of volunteer whole blood, platelet function at low ranges of platelet count and hematocrit levels was assessed on MEA for four agonists and for PFA-100 in two cartridges. Using (multiple) regression analysis, 95% reference intervals were computed for these low ranges. Low platelet counts affected MEA in a positive correlation (all agonists showed r2 ≥ 0.75) and PFA-100 in an inverse correlation (closure times were prolonged with lower platelet counts). Lowered hematocrit did not affect MEA testing, except for arachidonic acid activation (ASPI), which showed a weak positive correlation (r2 = 0.14). Closure time on PFA-100 testing was inversely correlated with hematocrit for both cartridges. Regression analysis revealed different 95% reference intervals in comparison with originally established intervals for both MEA and PFA-100 in low platelet or hematocrit conditions. Multiple regression analysis of ASPI and both tests on the PFA-100 for combined low platelet and hematocrit conditions revealed that only PFA-100 testing should be adjusted for both thrombocytopenia and anemia. 95% reference intervals were calculated using multiple regression analysis. However, coefficients of determination of PFA-100 were poor, and some variance remained unexplained. Thus, in this pilot study using (multiple) regression analysis, we could establish reference intervals of platelet function in anemia and thrombocytopenia conditions on PFA-100 and in thrombocytopenia conditions on MEA