This case report discusses a rare case of secondary tenosynovial chondromatosis of the flexor hallucis longus (FHL). Synovial chrondomatosis is a rare, benign proliferative cartilaginous lesion arising from the synovial tissue or bursal lining of or near joints. When it is extra-articular, it is considered tenosynovial chondromatosis. The diagnosis is often delayed given the rarity of presentation and non-specific symptoms. The case was highly unusual in that hindfoot pain was caused by several centimetre-sized osteochondral bodies within the FHL tendon sheath. Anterior cheilectomy was performed. The patient returned to full activity following surgery without recurrence of the disease. The condition can be successfully treated operatively.

Background: Deciding to perform a distal clavicle excision for acromioclavicular joint arthritis, especially in conjunction with other arthroscopic shoulder procedures, is challenging for surgeons. Studies have reported mixed results on the value of magnetic resonance imaging (MRI) in decision making. Purpose: We sought to correlate MRI findings with clinical symptoms and the surgeon’s decision to perform a distal clavicle excision. Methods: We compared MRI, clinical examination, and MRI findings of 200 patients who underwent distal clavicle excision for symptomatic acromioclavicular joint arthritis with 200 patients who underwent arthroscopic shoulder procedures for other reasons. Univariate statistics were used to determine correlations between physical examination findings, MRI findings, and the decision to perform distal clavicle excision. A binary logistic regression model was used to determine independent predictors of need for distal clavicle excision. Results: There was no difference in mean age, sex, and race between groups. Advanced acromioclavicular joint osteoarthritis was strongly correlated with positive physical examination findings. Bony edema correlated strongly with tenderness at the acromioclavicular joint but not pain with cross-body adduction testing. There was no association between higher MRI grade of osteoarthritis and the need for distal clavicle excision. Regression analysis identified both physical examination findings and bony edema on MRI as independent predictors of the need for distal clavicle excision. Conclusion: In the setting of positive clinical examination findings and bony edema of the distal clavicle, surgeons should feel reassured that distal clavicle excision is likely indicated.

Introduction This article describes the surgical component of the Continuing Promise 2018 (CP-18) medical training and military cooperation mission. We report on the surgical experience and lessons learned from performing peacetime ambulatory surgeries in a tent-based facility constructed on partner nation territory. Methods This CP mission was unique in utilizing a land-based expeditionary surgical facility. Institutional Review Board approval was obtained to collect prospective deidentified patient data and aggregate information on all surgical cases performed. Specific aims of this study included describing surgical patient characteristics and evaluating conservatively selected cases performed in this environment. Body mass index (BMI) was used as a crude screening tool for perioperative risk to assist patient selection. Our secondary aim was to report lessons learned from preparation, logistics, and host nation exchanges. The team coordinated medical credentialing and documentation of all medical supplies with each host nation. Advance teams collaborated with local physicians in country to arrange training exchanges and identify surgical candidates. Results The mission was conducted from February to April 2018. Only two of five planned partner nation visits were completed. The surgical facility supported 78 procedures over 14 surgical days, averaging over six cases performed per core surgical day. Patients were predominantly female, with a mean age of 25.4 and a mean BMI of 31.1. The average surgical time was 37.5 minutes, the average anesthesia time was 70 minutes, and the average recovery time was 47.6 minutes. No significant complications or adverse events were noted. Conclusions CP-18 was the first CP mission to perform elective ambulatory surgery on foreign soil using a tent-based facility in a noncombat, nondisaster environment instead of a hospital or amphibious ship. This mission demonstrated that such a facility may be employed to safely perform low-risk ambulatory surgeries on carefully selected patients. The Expeditionary Medical Unit, coupled with the fast transport vessel enabled rapid expeditionary surgical facility setup with significant military and disaster relief applications. Expansion of surgical indications should be performed carefully and deliberately to avoid complications and damage to international relationships.