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1.
Bull Hosp Jt Dis (2013) ; 82(1): 4-9, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38431970

RESUMO

Posterior cruciate ligament (PCL) injuries are a rare form of knee injury often seen in the setting of high energy polytraumas; however, these injuries can occur in isolation as well. Often, the posterolateral corner (PLC) is involved, which imparts further posterior translational and rotational instability to these injuries. While non-operative management is certainly a reliable option for low grade isolated PCL tears, high grade injuries with concomitant PLC involvement, additional intra-articular pathologies requiring operative management, multiligamentous injuries, or patients who have failed non-operative management require PCL repair or reconstruction. The current review focuses on the many facets of PCL reconstruction, including single versus double bundle reconstruction, tibial slope implications, graft selection, multiligamentous injury considerations, tunnel management, and onlay versus inlay tibial footprint creation. We conclude with a proposed algorithm in the management of this injury.


Assuntos
Traumatismos do Joelho , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Humanos , Reconstrução do Ligamento Cruzado Posterior/efeitos adversos , Algoritmos , Ligamento Cruzado Posterior/cirurgia , Tíbia
2.
Sultan Qaboos Univ Med J ; 24(1): 115-118, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38434460

RESUMO

The combination of plate and intramedullary nailing has been established as the treatment of proximal tibial fractures. Nevertheless, at the distal end of the tibia, the application of the plate-assisted intramedullary nailing is rarely applied as a therapeutic technique. This technical note demonstrates the use of the reduction plating technique for nail insertion as the management of distal tibia fractures.


Assuntos
Fixação Intramedular de Fraturas , Fraturas da Tíbia , Humanos , Tíbia , Fraturas da Tíbia/cirurgia
3.
Zhongguo Gu Shang ; 37(2): 148-52, 2024 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-38425065

RESUMO

OBJECTIVE: To investigate the risk factors for delayed union of extra-articular fractures of the middle and lower third of the tibia treated by locking plate. METHODS: Total of 135 patients of extra-articular fractures of the middle and lower third of the tibia from January 2013 to December 2018 were retrospectively analyzed, including 85 males and 50 females, ranged from 19 to 80 years old. All cases were treated with locking plates. The patients were divided into union group and delayed union group according to the condition of fracture union. The risk factors of delayed healing were determined by univariate analysis of 14 factors that might affect fracture healing first, then the factors with significance were analyzed by binary Logistic regression. RESULTS: There were 13 patients of delayed union, and the rate of delayed union was 9.63%. Univariate analysis showed that delayed union was associated with age, smoking, reduction method, anemia and time of preoperative preparation. Regression analysis showed that age[OR=0.849, 95%CI(0.755, 0.954), P=0.006], smoking[OR=0.020, 95%CI(0.002, 0.193), P=0.001], reduction method[OR=23.924, 95%CI(2.210, 258.943), P=0.009], anemia[OR=0.016, 95%CI(0.001, 0.289), P=0.005] were the contributory factors for delayed union. CONCLUSION: Young age, smoking, closed reduction and anemia are the risk factors for delayed union of extra-articular fractures of the middle and lower third of the tibia treated by locking plate.


Assuntos
Anemia , Fraturas da Tíbia , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Placas Ósseas , Consolidação da Fratura , Fatores de Risco , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos
4.
Zhongguo Gu Shang ; 37(2): 173-8, 2024 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-38425069

RESUMO

OBJECTIVE: To explore the efficacy of high tibial osteotomy (HTO) combined with medial meniscus centralization in knee osteoarthritis. METHODS: A total of 26 patients who underwent surgery from October 2018 to October 2020 were reviewed. Among them, 14 patients underwent high tibial osteotomy combined with arthroscopic meniscus centralization surgery were centralized group, including 8 males and 6 females, with an average age of (50.2±1.4) years old and follow-up time of (16.8±4.0) months. Twelve patients with high tibial osteotomy were in the control group, including 6 males and 6 females, with an average age of (50.9±1.8) years and follow-up time of (19.0±4.8) months. Operation time, the knee Lysholm score, knee 2000 IKDC score, MRI, femoral tibial angle(FTA), hip knee ankle angle (HKA), and intraoperative and postoperative complications were recorded. RESULTS: All the incisions healed without any complication. The operation time in the centralized group was longer than that in the control group[(65.0±2.1)min vs(52.0±2.1)min, P<0.05]. The medial meniscus extrusion reduction value in the centralized group was significantly reduced compared with the control group[(2.8±1.4) mm vs (1.1±2.2) mm, P<0.05]. The FTA, HKA, knee Lyshlom score, and 2000 IKDC score between two groups were no significantly (P>0.05). Postoperative knee Lyshlom score and knee 2000 IKDC score improved in both groups(P<0.05). CONCLUSION: HTO combined with centralization of medial meniscus can improve the reduction of medial meniscus and improve knee function. The medium and long-term curative effect still needs long-term follow-up of more cases.


Assuntos
Osteoartrite do Joelho , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Resultado do Tratamento , Articulação do Joelho/cirurgia , Tíbia/cirurgia , Osteotomia , Estudos Retrospectivos
5.
PLoS One ; 19(3): e0299649, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38470904

RESUMO

PURPOSE: The research objective of this study is to use finite element analysis to investigate the impact of anterior cruciate ligament (ACL) injury on medial unicompartmental knee arthroplasty (UKA) and explore whether patients with ACL injuries can undergo UKA. METHODS: Based on the morphology of the ACL, models of ACL with diameters ranging from 1 to 10mm are created. Finite element models of UKA include ACL absence and ACLs with different diameters. After creating a complete finite element model and validating it, four different types of loads are applied to the knee joint. Statistical analysis is conducted to assess the stress variations in the knee joint structure. RESULTS: A total of 11 finite element models of UKA were established. Regarding the stress on the ACL, as the diameter of the ACL increased, when a vertical load of 750N was applied to the femur, combined with an anterior tibial load of 105N, the stress on the ACL increased from 2.61 MPa to 4.62 MPa, representing a 77.05% increase. Regarding the equivalent stress on the polyethylene gasket, a notable high stress change was observed. The stress on the gasket remained between 12.68 MPa and 14.33 MPa in all models. the stress on the gasket demonstrated a decreasing trend. The equivalent stress in the lateral meniscus and lateral femoral cartilage decreases, reducing from the maximum stress of 4.71 MPa to 2.61 MPa, with a mean value of 3.73 MPa. This represents a reduction of 44.72%, and the statistical significance is (P < 0.05). However, under the other three loads, there was no significant statistical significance (P > 0.05). CONCLUSION: This study suggests that the integrity of the ACL plays a protective role in performing medial UKA. However, this protective effect is limited when performing medial UKA. When the knee joint only has varying degrees of ACL injury, even ACL rupture, and the remaining structures of the knee joint are intact with anterior-posterior stability in the knee joint, it should not be considered a contraindication for medial UKA.


Assuntos
Lesões do Ligamento Cruzado Anterior , Artroplastia do Joelho , Humanos , Lesões do Ligamento Cruzado Anterior/cirurgia , Análise de Elementos Finitos , Articulação do Joelho/cirurgia , Tíbia/cirurgia , Contraindicações , Fenômenos Biomecânicos
6.
Sci Rep ; 14(1): 5967, 2024 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-38472263

RESUMO

To gain a more meaningful understanding of bone regeneration, it is essential to select an appropriate assessment method. Micro-computed tomography (Micro-CT) is widely used for bone regeneration because it provides a substantially higher spatial resolution. Dual-energy computed tomography (DECT) ensure shorter scan time and lower radiation doses during quantitative evaluation. Therefore, in this study, DECT and Micro-CT were used to evaluate bone regeneration. We created 18 defects in the tibial plateau of the rabbits and filled them with porous polyetheretherketone implants to promote bone regeneration. At 4, 8, and 12 weeks, Micro-CT and DECT were used to assess the bone repair in the defect region. In comparison to Micro-CT (152 ± 54 mg/cm3), the calcium density values and hydroxyapatite density values obtained by DECT [DECT(Ca) and DECT(HAP)] consistently achieved lower values (59 ± 25 mg/cm3, 126 ± 53 mg/cm3). In addition, there was a good association between DECT and Micro-CT (R = 0.98; R2 = 0.96; DECT(Ca): y = 0.45x-8.31; DECT(HAP): y = 0.95x-17.60). This study highlights the need to use two different imaging methods, each with its advantages and disadvantages, to better understand the bone regeneration process.


Assuntos
Regeneração Óssea , Tíbia , Animais , Coelhos , Microtomografia por Raio-X
7.
Sensors (Basel) ; 24(5)2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38475232

RESUMO

Aseptic loosening is the dominant failure mechanism in contemporary knee replacement surgery, but diagnostic techniques are poorly sensitive to the early stages of loosening and poorly specific in delineating aseptic cases from infections. Smart implants have been proposed as a solution, but incorporating components for sensing, powering, processing, and communication increases device cost, size, and risk; hence, minimising onboard instrumentation is desirable. In this study, two wireless, battery-free smart implants were developed that used passive biotelemetry to measure fixation at the implant-cement interface of the tibial components. The sensing system comprised of a piezoelectric transducer and coil, with the transducer affixed to the superior surface of the tibial trays of both partial (PKR) and total knee replacement (TKR) systems. Fixation was measured via pulse-echo responses elicited via a three-coil inductive link. The instrumented systems could detect loss of fixation when the implants were partially debonded (+7.1% PKA, +32.6% TKA, both p < 0.001) and fully debonded in situ (+6.3% PKA, +32.5% TKA, both p < 0.001). Measurements were robust to variations in positioning of the external reader, soft tissue, and the femoral component. With low cost and small form factor, the smart implant concept could be adopted for clinical use, particularly for generating an understanding of uncertain aseptic loosening mechanisms.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Humanos , Falha de Prótese , Reoperação/métodos , Tíbia/cirurgia , Articulação do Joelho/cirurgia , Desenho de Prótese
8.
J Biomech ; 165: 112025, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38431987

RESUMO

High amplitudes of shock during running have been thought to be associated with an increased injury risk. This study aimed to quantify the association between dual-energy X-ray absorptiometry (DEXA) quantified body composition, and shock attenuation across the time and frequency domains. Twenty-four active adults participated. A DEXA scan was performed to quantify the fat and fat-free mass of the whole-body, trunk, dominant leg, and viscera. Linear accelerations at the tibia, pelvis, and head were collected whilst participants ran on a treadmill at a fixed dimensionless speed 1.00 Fr. Shock attenuation indices in the time- and frequency-domain (lower frequencies: 3-8 Hz; higher frequencies: 9-20 Hz) were calculated. Pearson correlation analysis was performed for all combinations of DEXA and attenuation indices. Regularised regression was performed to predict shock attenuation indices using DEXA variables. A greater power attenuation between the head and pelvis within the higher frequency range was associated with a greater trunk fat-free mass (r = 0.411, p = 0.046), leg fat-free mass (r = 0.524, p = 0.009), and whole-body fat-free mass (r = 0.480, p = 0.018). For power attenuation of the high-frequency component between the pelvis and head, the strongest predictor was visceral fat mass (ß = 48.79). Passive and active tissues could represent important anatomical factors aiding in shock attenuation during running. Depending on the type and location of these masses, an increase in mass may benefit injury risk reduction. Also, our findings could implicate the injury risk potential during weight loss programs.


Assuntos
Composição Corporal , Corrida , Adulto , Humanos , Tíbia , Índice de Massa Corporal , Abdome , Absorciometria de Fóton
9.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38452160

RESUMO

CASE: A 16-year-old boy presented with a recurrent distal femur aneurysmal bone cyst accompanied by a combined sagittal knee deformity (20° of femoral antecurvatum and 26.8° of tibial recurvatum) and limb shortening. After preoperative planning, the treatment involved new intralesional curettage, phenolization, and bone allograft filling. Additional procedures included distal extension femoral osteotomy with plate fixation, and proximal tibial osteotomy with, gradually corrected through a hexapod frame. At 2-year follow-up, lower limbs exhibited normoalignment and equal length. CONCLUSION: Complex knee deformities may occur with tumoral lesions around the knee but can be effectively addressed through double osteotomy and application of a hexapod frame.


Assuntos
Cistos Ósseos Aneurismáticos , Deformidades Articulares Adquiridas , Masculino , Humanos , Adolescente , Cistos Ósseos Aneurismáticos/complicações , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/cirurgia , Deformidades Articulares Adquiridas/complicações , Deformidades Articulares Adquiridas/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fêmur/anormalidades , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Articulação do Joelho/cirurgia
10.
Sci Rep ; 14(1): 5597, 2024 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-38454143

RESUMO

This study aimed to identify the factors affecting hip-knee-ankle (HKA) angle following Oxford medial unicompartmental knee arthroplasty (MUKA). A retrospective analysis of 200 patients who underwent Oxford MUKA from June 2018 to October 2020 was conducted. Univariate and multivariate analyses were performed to investigate the impact of surgical and radiographic characteristics on the postoperative HKA angle. The mean HKA angle was 9.5 ± 4.3° before surgery and 3.6 ± 3.7° after surgery (p < 0.001). The postoperative HKA angle significantly correlated with the preoperative HKA angle, bearing size, tibial component alignment angle, and BMI (r = 0.71, p < 0.001; r = - 0.24, p = 0.001; r = 0.21, p = 0.004; r = - 0.18, p = 0.011). Multiple linear regression analysis revealed that the preoperative HKA angle (ß = 0.68, p < 0.001), bearing size (ß = - 0.31, p < 0.001), tibial component alignment angle (ß = 0.14, p = 0.003), and BMI (ß = - 0.09, p = 0.047) significantly affected the postoperative HKA angle. In conclusion, larger preoperative varus deformity, smaller bearing size, greater varus alignment of the tibial component, and lower BMI lead to greater postoperative varus alignment of the lower limb in Oxford MUKA. With this concept, surgeons can more accurately predict postoperative lower limb alignment and avoid malalignment in Oxford MUKA.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Estudos Retrospectivos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Extremidade Inferior/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
11.
BMC Musculoskelet Disord ; 25(1): 202, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38454368

RESUMO

BACKGROUND: Posterior tibial slope (PTS) exhibits considerable variability among individuals and is anticipated to influence the accuracy of radiographic measurements related to the knee. Despite this potential impact, there is a lack of prior research investigating how PTS affects the accuracy of these measurements. Therefore, this study aimed to investigate the effect of PTS on the measurement reliability regarding the radiographic parameter of the knee. METHODS: The medical records of patients who took full-length anteroposterior radiographs of the lower limb between January 2020 and June 2022 were evaluated retrospectively. Radiographic parameters related to the knee joint characteristics such as osteoarthritis grade, hip-knee-ankle angle, weight-bearing line ratio, medial proximal tibial angle (MPTA), lateral distal femoral angle, joint-line convergence angle (JLCA), and PTS were measured. Subjects were classified into 3 groups according to PTS (group A, PTS < 4°; group B, PTS ≥ 4° and < 8°; group C, PTS ≥ 8°), and the measurement reliability for the radiographic variables was compared between groups. The intra- and inter-observer agreements were assessed using the kappa coefficients, intra-class correlation coefficients (ICC), and Bland-Altman plots. RESULTS: A total of 175 limbs (86 patients) were included in this study. As the intra- and inter-observer reliability for PTS ranged over 0.9, grouping was performed based on the average of the measured PTSs. The inter-observer reliability of the MPTA and JLCA decreased as the PTS increased (ICCs for MPTA in Groups A, B, and C: 0.889, 0.796, and 0.790, respectively; ICCs for JLCA in Groups A, B and C: 0.916, 0.859, and 0.843, respectively), whereas there were no remarkable differences in other variables. Similar trends were observed in the comparisons of intra-observer reliability and Bland-Altman plots also showed consistent results. CONCLUSION: The larger the PTS, the lower the measurement reliability regarding the radiographic parameters of the knee that includes the joint line, such as MPTA and JLCA. Given the occasional challenge in accurately identifying the knee joint line in patients with a relatively large PTS, careful measurement of radiographic parameters is crucial and utilizing repetitive measurements for verification may contribute to minimizing measurement errors.


Assuntos
Osteoartrite do Joelho , Tíbia , Humanos , Tíbia/diagnóstico por imagem , Estudos Retrospectivos , Reprodutibilidade dos Testes , Osteoartrite do Joelho/diagnóstico por imagem , Extremidade Inferior , Articulação do Joelho/diagnóstico por imagem
12.
BMC Musculoskelet Disord ; 25(1): 201, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38454383

RESUMO

OBJECTIVE: To introduce the method and experience of treating critical-sized tibial bone defect by taking large iliac crest bone graft. METHODS: From January 2020 to January 2022, iliac crest bone grafting was performed in 20 patients (10 men and 10 women) with critical-sized tibial bone defect. The mean length of bone defect was 13.59 ± 3.41. Bilateral iliac crest grafts were harvested, including the inner and outer plates of the iliac crest and iliac spine. The cortical bone screw was used to integrate two iliac bone blocks into one complex. Locking plate was used to fix the graft-host complex, supplemented with reconstruction plate to increase stability when necessary. Bone healing was evaluated by cortical bone fusion on radiographs at follow-up, iliac pain was assessed by VAS score, and lower limb function was assessed by ODI score. Complications were also taken into consideration. RESULTS: The average follow-up time was 27.4 ± 5.6 (Range 24-33 months), the mean VAS score was 8.8 ± 1.9, the mean ODI score was 11.1 ± 1.8, and the number of cortical bone fusion in the bone graft area was 3.5 ± 0.5. Satisfactory fusion was obtained in all cases of iliac bone transplant-host site. No nonunion, shift or fracture was found in all cases. No infection and bone resorption were observed that need secondary surgery. One patient had dorsiflexion weakness of the great toe. Hypoesthesia of the dorsal foot was observed in 2 patients. Ankle stiffness and edema occurred in 3 patients. Complications were significantly improved by physical therapy and rehabilitation training. CONCLUSION: For the cases of critical-sized tibial bone defect, the treatment methods are various. In this paper, we have obtained satisfactory results by using large iliac bone graft to treat bone defect. This approach can not only restore the integrity of the tibia, but also obtain good stability with internal fixation, and operation skills are more acceptable for surgeons. Therefore, it provides an alternative surgical method for clinicians.


Assuntos
Fraturas Ósseas , Procedimentos de Cirurgia Plástica , Masculino , Humanos , Feminino , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Ílio/transplante , Fixação Interna de Fraturas , Transplante Ósseo/métodos , Resultado do Tratamento
13.
Clin Biomech (Bristol, Avon) ; 113: 106215, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38428263

RESUMO

BACKGROUND: In total knee arthroplasty, unrestricted kinematic alignment aims to restore pre-arthritic lower limb alignment and joint lines. Joint line orientations of the contralateral healthy proximal tibia might be used to evaluate accuracy of tibial component alignment post-operatively if asymmetry is minimal. Our objective was to evaluate left-to-right asymmetry of the proximal tibial epiphysis in posterior tibial slope and varus-valgus orientation as related to unrestricted kinematic alignment principles. METHODS: High resolution CT images (0.5 mm slice thickness) were acquired from bilateral lower limbs of 11 skeletally mature subjects with no skeletal abnormalities. Images were segmented to generate 3D tibia models. Asymmetry was quantified by differences in orientations required to shape-match the proximal epiphysis of the mirror 3D tibia model to the proximal epiphysis of the contralateral 3D tibia model. FINDINGS: Systematic and random differences (i.e. mean ± standard deviation) in tibial slope and varus-valgus orientation were - 0.8° ± 1.2° and - 0.2° ± 0.8°, respectively. Ninety five percent confidence intervals on the means included 0° indicating that systematic differences were minimal. INTERPRETATION: Since random differences due to asymmetry are substantial in relation to random surgical deviations from pre-arthritic joint lines previously reported, post-operative computer tomograms of the contralateral healthy tibia should not be used to directly assess accuracy of tibial component alignment on a group level without correcting for differences in tibial slope and varus-valgus orientation due to asymmetry.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Fenômenos Biomecânicos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Artroplastia do Joelho/métodos , Epífises/diagnóstico por imagem , Epífises/cirurgia , Osteoartrite do Joelho/cirurgia
14.
Bioinspir Biomim ; 19(3)2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38452389

RESUMO

Bone is an economical material. Indeed, as moving a heavy skeleton is energetically costly, the vertebrate skeleton is adapted to maximise resistance to the stresses imposed with a minimum amount of material, so that bone tissue is deposited where it is needed. Using bone as a source of inspiration should therefore reduce the manufacturing cost (both financial and ecological) and increase the strength (and lifespan) of bioinspired (BI) structures. This study proposes to investigate which adaptive features of the outer shape and inner structure of bone, related to compressive strength, could be used to build BI support structures. To do so, we explain the choice of the bones to be analysed and present the results of the biomechanical analyses (finite element analysis) carried out on virtual models built from the structures of the different bone models and of the mechanical tests carried out on 3D-printed versions of these models. The compressive strength of these direct bone BI columns was compared with each other, and with those of a conventional filled cylindrical column, and of a cylindrical column whose internal structure is BI from the radius of the white rhinoceros. The results of our comparative analyses highlight that the shape of long bones is less effective than a cylinder in resisting compression but underline the relevance in designing BI cylindrical columns with heterogeneous structures inspired by the radius of the white rhinoceros and the tibia of the Asian elephant, and raise the interest in studying the fossil record using the radius of the giant rhinocerotoidParaceratherium.


Assuntos
Osso e Ossos , Fósseis , Animais , Tíbia , Rádio (Anatomia) , Perissodáctilos , Análise de Elementos Finitos , Fenômenos Biomecânicos
15.
Am J Case Rep ; 25: e941248, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38486378

RESUMO

BACKGROUND Adamantinoma is a rare low-grade malignant bone tumor, usually found in the tibial diaphysis and metaphysis, with histological similarities to mandibular ameloblastoma. The most effective treatment of recurrent adamantinoma is not yet clear. This report is of a 22-year-old woman with recurrent tibial adamantinoma treated with the tyrosine kinase inhibitor pazopanib. CASE REPORT We report the case of a 22-year-old woman who was referred to our center for a suspicious bone lesion in the right tibia. Bone biopsy findings were consistent with an adamantinoma. En bloc resection was completed successfully, with no postoperative complications. Five years later, a positive emission tomography scan revealed mildly increased tracer uptake near the area of the previous lesion and in the right inguinal lymph node. Biopsies of the lesion and inguinal lymph node confirmed recurrence of the adamantinoma. Due to abdominal and pelvic metastasis, the patient underwent surgical debulking, along with an appendectomy, right salpingo-oophorectomy, intraoperative radiation therapy, and hyperthermic intraperitoneal chemotherapy. Subsequently, the patient was placed on pazopanib for 4 months; however, her tumor continued to worsen after 4 months of chemotherapy. Currently, the patient is receiving gemcitabine and docetaxel as second-line medical therapy. CONCLUSIONS This report showed that pazopanib as standalone treatment does not appear to have promising role on patient outcomes. To the best of our knowledge, this is the second report of pazopanib in the treatment of adamantinoma.


Assuntos
Adamantinoma , Ameloblastoma , Neoplasias Ósseas , Indazóis , Pirimidinas , Sulfonamidas , Feminino , Humanos , Adulto Jovem , Adulto , Adamantinoma/patologia , Adamantinoma/secundário , Adamantinoma/cirurgia , Tíbia/cirurgia , Neoplasias Ósseas/patologia , Ameloblastoma/complicações , Ameloblastoma/patologia , Ameloblastoma/cirurgia
16.
J Orthop Surg Res ; 19(1): 189, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500214

RESUMO

PURPOSE: The aim of this study is to find a new method for femoral side preservation positioning in anterior cruciate ligament (ACL) reconstruction and test the accuracy and precision of this method. METHOD: Fifty patients with isolated ACL rupture (42 males and 8 females) who underwent single-bundle ACL reconstruction in our hospital between July 2022 and July 2023 were included. The lowest point of the cartilage margin of the lateral wall of the intercontinental fossa and the tibial plateau plumb line at 120° of knee flexion were used as the anatomical landmarks for positioning of the femoral tunnel for ACL reconstruction surgery. Femoral side remnant preservation was performed in all cases. Three-dimensional CT was performed 3 days postoperatively to collect the data, which were analyzed using Mimics 21.0 software. We measured the posterior cortical distance of the femoral condyle at 90° of knee flexion and the vertical distance from the center of the bone tunnel to the cortical extension line behind the femur. All femoral tunnel positions were marked on a 4 × 4 grid and visualized using the quadrant method. RESULTS: Using the new positioning method in 50 knees, the average distance of x was 25.26 ± 2.76% of t and the average distance of y was 23.69 ± 6.19% of h. This is close to the results of previous studies, where x was 24.2 ± 4.0% of t and the average distance of y was 21.6 ± 5.2% of h. Most femoral tunnel positions were located in the same area. The D values were distributed as follows: 60% in the range of 0 to 2 mm, 24% in the range of 2 to 4 mm, and 16% more than 4 mm. The E values were distributed as follows: 80% in the range of 0 to 4 mm and 20% more than 4 mm. CONCLUSION: In arthroscopic ACL reconstruction, the knee was flexed at 120° and the lowest point of the cartilage edge of the lateral wall of the intercondylar fossa and the tibial plateau plumb line were used as anatomical landmarks for the positioning of the femoral bone tunnel, which resulted in more accurate femoral bone tunnel positioning, better reproducibility, and better preservation of the femoral stump compared to traditional positioning methods.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Masculino , Feminino , Humanos , Reprodutibilidade dos Testes , Articulação do Joelho/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Tíbia/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos
17.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38484087

RESUMO

CASE: We will present the case of a 6-year-old girl who presented with a 3-cm limb length discrepancy after intraosseous line placement at age 14 months without other known history of trauma or infection to account for the growth arrest. Imaging revealed a left proximal tibial physeal bar amenable to surgical resection with autologous lipotransfer. At 10 months postoperatively, physical examination and imaging demonstrated a stable 3-cm leg length discrepancy with an interval increase in the length of the left tibia in proportion to the growth of the right side with an increase in valgus alignment that will continue to be monitored and addressed as indicated. CONCLUSION: Pediatric intraosseous line placement presents unique challenges and can ultimately lead to physeal injury and growth arrest in the case of malpositioning.


Assuntos
Lâmina de Crescimento , Tíbia , Feminino , Humanos , Criança , Lactente , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Lâmina de Crescimento/cirurgia , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/cirurgia
18.
Sci Rep ; 14(1): 6192, 2024 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-38486115

RESUMO

Posterior tibial translation (PTT) after double-bundle posterior cruciate ligament (PCL) reconstruction has sometimes occurred. Purpose of this study is to identify the risk factors for postoperative PTT after double-bundle PCL reconstruction with a hamstring autograft. Comparing the results of bilateral gravity sag view (GSV) at 12 months after surgery, over 5-mm PTT was defined as 'failure' in this study. Of 26 isolated PCL reconstruction cases, over 5-mm PTT was seen in 7 cases (group F: 9.57 ± 1.28 mm), and 19 cases had less than 5 mm (group G: 2.84 ± 1.29 mm). Age, sex, body mass index (BMI), preoperative GSV, posterior slope angle of the tibia, anterolateral bundle (ALB) and posteromedial bundle (PMB) graft diameters, and tibial tunnel diameter were evaluated. The two groups were compared with the 2 × 2 chi-squared test, the Mann Whitney U-test, and Spearman's rank correlation coefficient. Multivariate logistic regression analysis was also performed to determine the risk factor. Statistical significance was indicated as p < 0.01 for correlation with postoperative PTT, and as p < 0.05 for all other comparisons. Mean age (group G 31.8 ± 12.5 vs group F 34.9 ± 15.9 years), sex (male/female: 15/4 vs 3/4), BMI (25.6 ± 4.6 vs 24.9 ± 3.9 kg/m2), preoperative GSV (11.3 ± 2.2 vs 11.6 ± 2.9 mm), PMB diameter (5.37 ± 0.33 vs 5.36 ± 0.48 mm), and tibial tunnel diameter (9.32 ± 0.58 vs 9.29 ± 0.49 mm) showed no significant differences. ALB diameter was significantly greater in group G (7.0 ± 0.5 mm) than in group F (6.5 ± 0.29 mm; p = 0.022). There was also a significant difference in posterior tibial slope angle (group G 9.19 ± 1.94 vs group F 6.54 ± 1.45, p = 0.004). On Spearman rank correlation coefficient analysis, ALB diameter GSV (correlation coefficient: - 0.561, p = 0.003) and posterior tibial slope angle (correlation coefficient: - 0.533, p = 0.005) showed a significant correlation with postoperative PTT. Multivariate logistic regression analysis showed that ALB diameter (OR 19.028; 95% CI 1.082-334.6; p = 0.044) and posterior slope angle of tibia (OR 3.081; 95% CI 1.109-8.556; p = 0.031) were independently associated with postoperative PTT, respectively. In double-bundle PCL reconstruction with hamstring, smaller ALB graft diameter and lower (flatted) tibial slope angle were considered risk factors for postoperative PTT.


Assuntos
Instabilidade Articular , Traumatismos do Joelho , Ligamento Cruzado Posterior , Entorses e Distensões , Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/cirurgia , Articulação do Joelho/cirurgia , Autoenxertos , Tíbia/cirurgia , Traumatismos do Joelho/cirurgia , Instabilidade Articular/cirurgia , Fatores de Risco
19.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38517987

RESUMO

CASE: A 19-year-old man underwent arthroscopic posterior glenoid reconstruction with a distal tibia allograft (DTA) after failing 2 posterior, soft-tissue instability surgeries. Although he experienced near-complete resolution of symptoms and return to sport, graft resorption was noted 7 months postoperatively. The patient underwent revision surgery for screw removal. CONCLUSION: Graft resorption has not previously been reported in the setting of arthroscopic DTA use for posterior instability. It is believed that stress shielding contributed to resorption. In such situations, screw removal may be warranted. Consideration of alternative fixation techniques and additional investigation into the causes, clinical significance, and optimal management of posterior DTA resorption are warranted.


Assuntos
Instabilidade Articular , Articulação do Ombro , Masculino , Humanos , Adulto Jovem , Adulto , Ombro , Articulação do Ombro/cirurgia , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Tíbia/transplante , Aloenxertos
20.
Sci Rep ; 14(1): 6652, 2024 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509137

RESUMO

Osteochondral damage (OD) is a significant outcome following acute patellar dislocation (APD), yet the factors contributing to its susceptibility remain unclear. The primary objective of this study was to assess the association between demographic characteristics, patellofemoral (PF) joint morphology, and the occurrence of OD. A retrospective analysis identified 74 patients with APD who underwent treatment in our unit between 2019 and 2022. All patients received MRI within a week of injury to assess OD, subsequently categorized according to the injury pattern. The Caton-Deschamps index (CDI), tibial tuberosity-trochlear groove distance (TT-TG), lateral trochlear inclination (LTI), sulcus angle (SA), patellar width (PW), patellar thickness (PT), and femoral condyle geometry were calculated from the MRI scans and compared between groups. The findings revealed that OD predominantly manifested in the lateral femoral condyle (LFC) region and the medial patella (MP) region. In our patient cohort, this study identified a significant association between sulcus angle and the incidence of OD in both MP and LFC regions. Additionally, a significant correlation was discerned between skeletal maturity and the incidence of OD in the LFC region within demographic characteristics.


Assuntos
Fraturas Intra-Articulares , Luxação Patelar , Articulação Patelofemoral , Humanos , Patela/diagnóstico por imagem , Estudos Retrospectivos , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/epidemiologia , Articulação Patelofemoral/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Fatores de Risco
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