616 Rolison ACSM PVNS скачать в хорошем качестве

616 Rolison ACSM PVNS

Presented by: Mary Lloyd Ireland Professor Dept. of Orthopaedic Surgery and Sports Medicine University of Kentucky Lexington KY www.marylloydireland.com 0:00 Introduction 1:13 Knee Swelling in a 10-year-old, Traumatic or Atraumatic? 1:29 HPI •10-year-old Hispanic female presented with a right knee effusion. She had fallen onto her anterior knee 2 weeks ago while playing basketball, swelling began the next day. At her visit, pain had improved but swelling persisted. No prior knee injuries. •Also had several swollen joints when she was much younger which resolved without treatment. 2:18 Past History •No pertinent PMHx, FHx, SurgHx, SocHx •ROS: WNL 2:26 Exam GEN: Afebrile, NAD MSK: •Severe effusion to right knee •ROM: 20-90 •Ligamentously stable •4/5 Quad strength 2:51 Radiographs No fracture, open growth plates, suprapatellar effusion. 3:10 MRI Very large joint effusion with synovial perforation. Synovial hypertrophy from intraarticular hemorrhage. No bony findings 4:03 Lab Results •ANA: less than 1:80 •ESR: 22 •CBC, CMP, TSH, CRP, RF, anti-CCP: WNL 4:17 Questions? 5:23 DDx •Juvenile Idiopathic Arthritis (JIA) •Pigmented Villonodular Synovitis (PVNS) •Septic Arthritis •Osteochondral fracture •OCD lesion •Bleeding Diathesis (Hemophilia) •Lipoma Arborescens 6:18 Treatment •Given 5+ months of effusion, MRI, bloody aspiration, planned for surgical evaluation 7:20 Operative Findings •Marked amount of synovitis in suprapatellar pouch, medial and lateral gutters, and intercondylar notch, brownish-red in appearance •Biopsies taken and extensive synovectomy performed 7:38 Biopsy Results •Papillary architecture, giant cells and foam cells consistent with pigmented villonodular synovitis 7:58 Final Diagnosis •Juvenile Idiopathic Arthritis (JIA) •Pigmented Villonodular Synovitis (PVNS) •Septic Arthritis •Osteochondral fracture •OCD lesion •Bleeding Diathesis (Hemophilia) •Lipoma Arborescens 8:19 PostOp •Compression and cryotherapy utilized •Swelling resolved 7 weeks post-op •Full ROM and quadriceps strength at 4 months 8:55 Follow-up •At most recent yearly follow-up (2 years PostOp) •No return in swelling •Participating fully in all activities •Normal radiographs •No recurrence of PVNS on her exam 9:45 Questions? 10:18 Bleeding Diathesis disorder family history of factor 7 deficiency 10:53 Olypmic weight lifter - hemophilia 11:45 Effusion problem in children 11:50 Ultrasound discussion 13:00 synovium is everywhere - ACL PCL 14:26 Mechanism of injury - fall 15:00 Patellar Dislocation & Osteochondral Fracture 16:25 Salter Harris Fractures 17:20 Tibial Eminence Fracture