Background: Lateral epicondylitis (LE) is one of the most diagnosed elbow pathologies. The purpose of this study was to determine the diagnostic test accuracy of a new test (selfie test) for the diagnosis of LE. Methods: Medical data were collected from adult patients who presented with LE symptoms and ultrasound findings that supported the diagnosis. Patients underwent a physical examination, including provocative tests for diagnosis as well as the selfie test, and were asked to fill out the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire and subjectively rate the activity of their affected elbow. Results: Thirty patients were included in this study (seventeen females, 57%). The mean age was 50.1 years old (range of 35 to 68 years). The average duration of symptoms was 7 ± 3.1 months (range of 2 to 14 months). The mean PRTEE score was 61.5 ± 16.1 (range of 35 to 98), and the mean subjective elbow score was 63 ± 14.2 (range of 30 to 80). Mill’s, Maudsley’s, Cozen’s, and the selfie tests had sensitivities of 0.867, 0.833, 0.967, and 0.933, respectively, with corresponding positive predictive values of 0.867, 0.833, 0.967, and 0.933. Conclusions: The selfie test’s active nature, which allows patients to perform the assessment themselves, could be a valuable addition to the diagnostic process, potentially improving the accuracy of the diagnosis of LE (levels of evidence: IV).

Objective: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a reliable procedure for treating various pathologies related to this joint. However, non-union is a common and debilitating complication of the procedure. The purpose of this study was to assess whether the use of a mechanical reamer to prepare the joint surface increases the risk of non-union compared to traditional manual osteotomy. Methods: A retrospective study of all patients who underwent their first MTPJ arthrodesis surgery in our medical center between 2010 and 2015. The articular surface preparation of the MTPJ was either manually performed (Group 1) or mechanically conducted with reamers (Group 2). Data regarding demographic characteristics, indications for surgery, osteosynthesis methods, and post-operative complications, including non-union, infection, and revision rates, were collected for all patients. Results: A total of 83 patients with 92 primary first MTPJ arthrodesis (44 cases in Group 1 and 48 cases in Group 2) were included with a mean follow-up time of 45.3 months (SD 16.8). The two groups were comparable in terms of age, gender, comorbidities, indication for surgery, and follow-up time. The non-union rate was 15.9% in Group 1 and 25% in Group 2 (p = 0.28). Group 2 showed a significantly higher rate of revision surgery compared to Group 1 (43.7% vs. 22.7%, p = 0.03). Conclusions: The mechanical reamer group had a higher non-union rate and a significantly higher rate of revision surgery compared to low-energy manual joint preparation. In light of these findings, the use of mechanical reamers for joint preparation in the first MTPJ arthrodesis was discontinued at our medical center.

Background Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This study presents a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs. Methods In this retrospective study conducted between 2018–2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded. Results All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased significantly (p-value = 0.02) with significant reduction in viable tissue, (p-value = 0.03). Four patients required additional CRAs. Only one patient’s tumor did not reduce in size. According to the SIR adverse event classification guidelines, one participant experienced a mild complication. SF36 physical and mental scores improved significantly (p-value = 0.002, p-value < 0.000, respectively). Conclusion These findings demonstrate the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to safely treat EDTs. This navigation approach may be implemented in other soft tissue procedures requiring precision navigated surgery.

Appropriate post-operative (post-op) pain control has been shown to reduce length of stay and facilitate day case surgery. Periacetabular injection of bupivacaine is effective in pain reduction after hip arthroscopy. This study aims to evaluate the anterior superior iliac spine (ASIS) as an anatomical landmark to facilitate needle insertion prior to fluoroscopy. The meeting point derived from a vertical line one fingerbreadth distal to the ASIS and a longitudinal line from the greater trochanter (GT) was used as a landmark in 30 consecutive hip arthroscopy patients for periacetabular analgesia. The distance between the tip of the needle and the acetabular roof was measured via fluoroscopy. Needle location was corrected if needed, followed by periacetabular bupivacaine injection (at anterior, lateral and posterior joint aspects). Post-op pain was measured using the Visual Analog Scale (VAS) 4–6 h post-op and at discharge. The ASIS and GT were identified and used for periacetabular analgesia landmarks in all cases. Results revealed that 93.3% of needle entries fell within 10 mm of the lateral acetabular rim and only one case had fallen distal to it. The post-op mean VAS score was 1.03 (range 0–6, standard error – 0.30, median = 0). At hospital discharge, 90% (27/30 of patients) reported VAS score ≤ 5. Twenty-six of the 30 patients were discharged on the same day as the operation (remaining four patients stayed due to accommodation/traveling issues). The ASIS and GT can be used as an anatomical landmark for periacetabular analgesia in hip arthroscopy with reproducible needle location, significant analgesic effect and minimal radiation.

Osteoid osteoma often requires surgical intervention following conservative treatment failure. While traditional radiofrequency ablation (RFA) is effective, poor prognostic factors such as tumor size, anatomical location, patient age, sex, and previous interventions may negatively influence outcomes. Cone Beam Computed Tomography (CBCT)-navigated RFA could mitigate these negative predictors by enhancing procedural accuracy; however, its specific impact on these factors remains under-investigated. This retrospective study included 127 patients (median age 20, IQR: 16-25) undergoing CBCT-navigated RFA for osteoid osteomas from 2015 to 2021. Outcomes assessed were treatment failure, recurrence rates, pain relief (Visual Analog Scale [VAS]), functional improvement (Eastern Cooperative Oncology Group [ECOG] status), and postoperative complications classified by the Society of Interventional Radiology (SIR) criteria. Multivariate logistic regression and statistical analyses were conducted to evaluate the influence of previously identified poor prognostic factors on outcomes. Significant long-term pain relief occurred in 97 % of patients, with median VAS scores improving from 9 to 0 postoperatively (p < 0.01). Median ECOG scores improved significantly from 1 to 0 (p < 0.01). Overall treatment failure was observed in 11(8.7 %) patients, including symptomatic recurrence (4, 3.1 %), minor peripheral nerve complaints (3, 2.36 %), limited range of motion (3, 2.36 %), and Metatarsal Fracture (1, 0.8 %). Adult age was the only factor significantly associated with treatment failure (OR = 1.117, p = 0.036), whereas tumor size, anatomical location, biological sex, and prior interventions showed no significant associations. CBCT-navigated RFA effectively reduces the negative impact of traditionally poor prognostic factors, achieving high success rates with minimal complications. While older age remains a modest predictor of poorer outcomes, the absence of significant associations with other previously identified risk factors underscores the enhanced precision and clinical value of CBCT navigation.