CAMAGÜEY.- Today's consultation is something sui generis if we take into account that we generally address a specific condition in each one of this section, while on this occasion we approach Dr. C Alejandro Alvarez López, Professor and Senior Researcher, and Second Degree specialist in Orthopedics and Traumatology, from the Eduardo Agramonte Piña Pediatric Hospital, in this city, to address the issue of Arthroscopy, a surgical procedure in children.

— What are the conditions that classify for this type of surgery?

— It has its indications according to the affected joint.

— Can you name some related to joints?

— Of course, but I will emphasize the knee because it is where we do arthroscopy in children in Camagüey. In any case, in the case of the elbow we have bone and soft tissue contractures, assistance in the reduction of fractures, osteochondritis dissecans, assistance in the correction of deformities and septic arthritis; in the wrist when there is a rupture of the triangular fibrocartilaginous complex, chronic pain, non-specific synovitis, intra-articular ganglions and septic arthritis; in the hip due to idiopathic femoroacetabular compression or secondary to Legg-Calvé-Perthes disease, hip dysplasia, displaced upper femoral epiphyseal, sequelae of septic arthritis, hereditary multiple exostoses, giant cell synovial tumor, idiopathic chondrolysis, septic arthritis , free articular bodies, injuries to the acetabular labrum.

"In the ankle it is used when there is posterior compression of the ankle, osteochondral fractures, ankle instability, assistance in the reduction of fractures and septic arthritis.

"As I said before, the conditions most treated by this route here are in the knee joint due to chondromalacia of the patella, synovial plica, recurrent patella luxations, loose joint bodies and meniscus injuries."

— Is this surgical behavior accepted and if so, why?

— Yes, indisputably, because we explain the advantages, and in each case that the family of the affected child goes to the hospital, and we discussed in detail with them".

- Mention those advantages...

— The incisions in the skin are small, day surgery (ambulatory), that is, it does not require hospital admission for more than 24 hours, there is greater access to the joint, it allows complex techniques to be performed, surgical time is shorter, as well the combination with other procedures, and a rapid incorporation into rehabilitation.

- Some disadvantages?

— Sure, but not related to the beneficiary. The learning curve is long in time and complexity of the procedures, and the equipment, instruments, and training are highly expensive.

— In accordance with the above, it can be inferred that there is a wide possibility of accessing this surgical procedure in children, at least if the knee is involved?

- That's how it is. There are multiple conditions of this joint that can be effectively treated by this procedure. Once the appropriate equipment and training is available, the resources necessary for the intervention are minimal, we are referring to the use of sutures, gauze and casts, the latter rarely justified after the intervention.

— If you take into account the children operated on in this way, what has been the result in general?

— In all of them it has been satisfactory. This is evidenced not only in the results of the intervention but also in the request by patients and relatives when the condition is bilateral. Many of the entities operated on arthroscopically are bilateral, but very rarely they present simultaneously, hence it is common to intervene in one joint and then the other.

— Among those operated on, are there records of the most frequent ages?

— Based on the results obtained to date, the ages of patients who need this procedure are above 11 years, which is also related to the most frequent ages of presentation of entities that affect the joint.

— What is the path for the patient to reach the specialized consultation?

— Patients can go to the primary or secondary care services, which after the physical examination are referred to the Orthopedics and Traumatology clinic located in the outpatient department of the Eduardo Agramonte Piña Pediatric Hospital, on Tuesday mornings.

— Is it possible to avoid some of the conditions mentioned?

— In general, no, these ailments appear during the growth of the child and there are constitutional and anatomical factors that predispose to this condition.

Translated by Linet Acuña Quilez