The complication rate of ankle arthroscopy (AA) ranges from 3.5% to 14%. To avoid such complications, it is essential to have a thorough understanding of the anatomy of the ankle, to perform the procedure very carefully and with appropriate instrumentation, and to use a non-invasive distraction technique. The most frequent complications are neurological (cutaneous nerve injuries), which are usually caused by direct injury during arthroscopic portals or by a distracting pin when using an invasive distraction technique. They usually resolve spontaneously within a few months. The iatrogenic formation of a pseudoaneurysm is a severe but extremely rare complication (an incidence of 0.008%). There are several treatments for pseudoaneurysms: external compression; direct thrombin injection, surgical intervention (resection of the damaged segment of the artery and reconstruction with a reversed long saphenous vein interposition graft), and endovascular embolisation. Other rare complications include wound infections (localised superficial infection), problems at the portal incisions (prolonged portal drainage, residual pain in the portal, portal scar dehiscence, cyst at the portal site), type I complex regional pain syndrome, instrument breakage, painful scars and nodules, and a number of other rarer complications. In conclusion, when performing AA, it is important to remember the potential complications and try to avoid them. When they do occur, it is essential to diagnose and treat them appropriately.

Complications of ankle arthroscopy: frequency, prevention, and treatment.

INTRODUCTION
People with haemophilia (PWH) not administered primary haematological prophylaxis since childhood, that is, those treated haematologically on demand or not treated at all, often experience the degeneration of the ankles, leading to pain and functional impairment.


AIM
To analyse the outcomes and complications of arthroscopic ankle surgery performed on PWH.


METHODS
For this narrative review of the literature, a search was conducted in PubMed on 2, December 2023, using the keywords "haemophilia", "ankle" and "arthroscopy". Of the 29 articles identified, 15 specifically related to ankle arthroscopy in PWH were selected (inclusion criterion). The remaining articles did not meet this requirement (exclusion criterion) and were therefore eliminated.


RESULTS
Arthroscopic procedures (arthroscopic synovectomy, debridement and arthrodesis of the ankle) are increasingly used in the surgical treatment of haemophilic ankle arthropathy. Although arthroscopic ankle surgery offers good outcomes in patients with haemophilia, the procedure is not free of complications, which range from 7.9% for arthroscopic ankle debridement to 13.1% in arthroscopic ankle synovectomy and 17.8% in arthroscopic ankle arthrodesis, respectively. The non-union rate of arthroscopic ankle arthrodesis is 7.1% (2/28).


CONCLUSION
Although arthroscopic interventions in the haemophilic ankle (synovectomy, debridement, arthrodesis) offer good functional outcomes, they are associated with a non-negligible rate of complications. Arthroscopic ankle surgery in PWH is major surgery and should be treated as such.

Arthroscopic ankle surgery in people with haemophilia.

BACKGROUND: The multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is a rare adult onset subvariant of the chronic inflammatory demyelinating polyneuropathy (CIDP). The latter affects 1-9 cases per million adults and may pose a diagnostic challenge (antibody and electrophysiological overlap). The hallmark of the disease spectrum is an immune mediated structural myelin breakdown. Urgent differentiation of MADSAM from the other variants of CIDP is indicated due to its distinct pathogenesis, management, and long-term therapy response to immunomodulators. The disease presents with progressive asymmetrical motor and sensory deficits initially located typically in one limb. Rarely the disease manifests with cranial nerve involvement. The prognosis of patients suffering from MADSAM is reliant on rapid diagnosis and therapeutic response, but neurological deficits reside. Due to its rarity and diagnostic challenge, misdiagnosis is common.
THE CASE: A 84 years old Caucasian male diagnosed with multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) presented to our department with progressive neurological deficits. His neurological examination and history revealed paresthesia, hypesthesia, diminished vibration sense (pallhypesthesia), distally pronounced paresis in the upper extremities with a wrist drop on the left hand. Gait examination exposed coordination deficits. The history of the patient and the initial presentation of the disease in 1998 exemplifies the diagnostic challenge of MADSAM, due its mimicry of other diseases, like multifocal motor neuropathy (MMN). The initial symptoms were asymmetrical motor and sensory deficit starting at the upper extremities. Before the patient presented to our facility, he was diagnosed with neuroborreliosis and treated accordingly. The correct diagnosis was set at our department according to clinical presentation, nerve conduction velocity parameters and conduction block during electroneurography, typical changes in nerve ultrasound suggesting an inflammatory neuropathy and fasciculations of the gastrocnemius muscle. After an ineffective steroid therapy and long standing intravenous immunoglobulins the patient is now on a therapeutic scheme of 1000mg Rituximab (CD20 Ab) every 6 months and 1000mg Mycophenolatmofetil. The patient subjectively reports improvement of his status and slower progression of the disease since the Rituximab paradigm. Furthermore, an evident atrophy of the orbicularis oculi muscle was now noted during follow up examination, which highlights facial nerve involvement.
CONCLUSION: This case exemplifies the challenge of diagnosing the multifocal acquired sensory and motor neuropathy, but prompt diagnosis and therapeutic intervention is associated with a better prognosis and slower progression of the disease in patients suffering from MADSAM.

Multifocal Acquired Demyelinating Sensory and Motor Neuropathy (MADSAM) with Cranial Nerve Involvement. Case Report

Complex regional pain syndrome (CRPS) is a challenging disorder occurring in patients most often after trauma or surgery. Its treatment is very complex, and even then, no treatment is fully effective. Capsaicin is a well-accepted treatment for neuropathic pain. However, its use in CRPS is controversial, with few studies having been published on it. In this case report, we describe the case of a female patient with CPRS type II, whose treatment with topical capsaicin resulted in great functional improvement. The patient was referred to the Pain Medicine Unit due to a CRPS type II due to trauma in her right wrist. She complained of severe pain in the median nerve territory of her dominant hand, associated with hyperalgesia, allodynia, burning, and electric shock sensation, resulting in functional disability. Electromyography was compatible with severe axonal injury of the right median nerve of the wrist. After conventional therapies were tried with no improvement, treatment with a capsaicin 8% patch was proposed. A functional improvement was observed after two applications of the capsaicin treatment, allowing the patient to regain activity in her hand. This shows that although evidence for capsaicin use in CRPS treatment is scarce, it can be a viable alternative for some patients.

/pdf/complex-regional-pain-syndrome-is-there-a-role-for-capsaicin-3u54761q.pdf

Complex Regional Pain Syndrome: Is There a Role for Capsaicin?

Lewis-Sumner syndrome (LSS) is a rare immune-mediated neuromuscular disorder. It shares some clinical and pathological features with chronic inflammatory demyelinating polyneuropathy (CIDP). We report on the anaesthetic management of a patient with LSS. There are several concerns when anaesthetizing patients with demyelinating neuropathies, the main ones being the post-operative worsening of symptoms and respiratory depression related to muscle relaxants. In our experience, the rocuronium effect was prolonged and an even lower dosage (0.4 mg/kg) was sufficient for intubation and maintenance. Sugammadex allowed total reversion of neuromuscular block and no respiratory complications occurred. In conclusion, the combination of lower dose rocuronium and sugammadex was safely used in a patient with LSS.

/pdf/perioperative-management-of-lewis-sumner-syndrome-2ahlny6j.pdf

Perioperative Management of Lewis-Sumner Syndrome.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Filipa Maldonado

Author Tools

Chat about Author

Papers

Complex Regional Pain Syndrome: Is There a Role for Capsaicin?

Perioperative Management of Lewis-Sumner Syndrome.