Surgical correction of juvenile idiopathic scoliosis. our patients' perception of their quality of life / Correção cirúrgica da escoliose idiopática juvenil - percepção de nossos pacientes sobre sua qualidade de vida / Corrección quirúrgica de escoliosis idiopática juvenil - percepción de nuestros pacientes sobre su calidad de vida

ABSTRACT Objective: To report the results of our patients who underwent scoliosis correction surgery in relation to their quality of life. Introduction: Juvenile idiopathic scoliosis affects between 1 and 3% of the population during puberty. Treatment will be conservative in most cases. The goal of surgical treatment is to improve coronal and sagittal alignment. The SRS 22 questionnaire is a useful tool for assessing quality of life in these patients. Methods: A retrospective study of 22 patients submitted to corrective surgery for juvenile idiopathic scoliosis between October 2017 and January 2020 was conducted. All of them had curves greater than 45 degrees managed through instrumentation and arthrodesis. Post-surgical quality of life was assessed using the SRS 22 questionnaire. Results: The average age of our patients at the time of the intervention was 15.5 years with a predominance of female patients. The application of the SRS 22 questionnaire generated the following mean scores: pain 4.6, function 4.3, self-image 4.41, mental health 4.89, and satisfaction 5.0. Conclusions: The development of surgical techniques has allowed good results to be achieved in the treatment of scoliosis. The evaluation of our patients using the SRS 22 questionnaire reflects a good quality of life in the 5 parameters evaluated. The main limitations of this study were the small sample size and its retrospective nature. Level of Evidence III; Retrospective, longitudinal, descriptive, observational study.

RESUMO Objetivo: Relatar os resultados de nossos pacientes operados para correção de escoliose com relação à sua qualidade de vida. Introdução: A escoliose idiopática juvenil afeta entre 1% e 3% da população durante a puberdade. O tratamento será conservador na maioria dos casos. O tratamento cirúrgico terá como objetivo melhorar o alinhamento coronal e sagital. O questionário SRS 22 é uma ferramenta útil para avaliar a qualidade de vida desses pacientes. Métodos: Foi realizado um estudo retrospectivo de 22 pacientes operados entre outubro de 2017 e janeiro de 2020 devido à escoliose idiopática juvenil. Todos tinham curvas superiores a 45 graus tratadas com instrumentação e artrodese. A qualidade de vida pós-operatória foi avaliada por meio do questionário SRS-22. Resultados: A média de idade dos nossos pacientes no momento da intervenção foi 15,5 anos, com predominância do sexo feminino. A aplicação do questionário SRS-22 gerou os seguintes escores médios: dor 4,6; função 4,3; autoimagem 4,41; saúde mental 4,89 e satisfação 5,0. Conclusões: O desenvolvimento das técnicas cirúrgicas permitiu obter bons resultados no tratamento da escoliose. A avaliação de nossos pacientes por intermédio do questionário SRS 22 reflete boa qualidade de vida nos cinco parâmetros avaliados. As principais limitações deste estudo foram o pequeno tamanho da amostra e seu caráter retrospectivo. Nível de Evidência III; Estudo retrospectivo, longitudinal, descritivo, observacional.

RESUMEN Objetivo: Reportar los resultados de nuestros pacientes operados para corrección de escoliosis en relación a su calidad de vida. Introducción: La escoliosis idiopática juvenil afecta entre el 1% y 3% de la población durante la pubertad. El tratamiento será, en la mayoría, de los casos conservador. El tratamiento quirúrgico tendrá como objetivo mejorar la alineación coronal y sagital. El cuestionario SRS 22 es una herramienta útil para la valoración de la calidad de vida en estos pacientes. Métodos: Se realizó un estudio retrospectivo de 22 pacientes intervenidos entre octubre de 2017 y enero de 2020 debido a la escoliosis idiopática juvenil. Todos tenían curvas mayores de 45 grados manejadas mediante instrumentación y artrodesis. Se realizó la evaluación de la calidad de vida posquirúrgica mediante el cuestionario SRS-22. Resultados: La edad promedio de nuestros pacientes en el momento de la intervención fue de 15,5 años con predominio de pacientes del sexo femenino. La aplicación del cuestionario SRS-22 generó las siguientes puntuaciones medias: dolor 4,6; función 4,3; autoimagen 4,41; salud mental 4,89 y satisfacción 5,0. Conclusiones: El desarrollo de las técnicas quirúrgicas ha permitido obtener buenos resultados en el tratamiento de la escoliosis. La evaluación de nuestros pacientes mediante el cuestionario SRS 22 refleja una buena calidad de vida en los 5 parámetros evaluados. Las limitaciones principales de este estudio han sido el pequeño tamaño de la muestra y su carácter retrospectivo. Nivel de Evidencia III; Estudio retrospectivo, longitudinal, descriptivo, observacional.

Prevalence and characteristics of upper lumbar disc herniations in our practice: a retrospective analysis / Prevalência e características das hérnias lombares superiores em nosso meio: análise retrospectiva / Prevalencia y características de las hernias lumbares altas en nuestro medio: analisis retrospectivo

ABSTRACT Introduction: Upper lumbar disc herniations (ULDH) are considered infrequent injuries (1-11%). They present, most often in older adults, with special clinical features that make diagnosis and therapeutic decision-making difficult. The prevalence, location, and management of these herniations and the medical history of our patients were analyzed. Methods: Sex, age, injury level, previous surgery, and patient treatment data from July 2018 to May 2021 were collected retrospectively. During this period, 179 patients underwent surgery, 33 of whom patients presented ULDH. Results: Thirty-three patients were included in the study (18 male and 15 female). Ages ranged from 39 to 85 years, with a predominance of elderly patients. The levels operated were L1-L2 in seven patients, L2-L3 in ten patients, L3-L4 in fourteen patients, and surgery in two levels (L2-L3, L3-L4) in two patients. In our practice, microdiscectomy is the preferred approach and was performed in all cases, with the addition of fusion in four of the 33 patients. Finally, a history of low lumbar disc herniation (LLDH) surgery was found in 16 patients. Conclusions: In our population, ULDHs are a rare entity with lower prevalence at the higher lumbar levels. They occur more frequently in elderly patients and clinical presentation can vary, which is a challenge for surgeons. In older adults, the development of lumbar kyphosis due to vertebral wedging is considered a risk factor for the development of ULDH. Surgical management by microdiscectomy is considered a technique with good results for this pathology. Level of Evidence III; Retrospective, longitudinal, descriptive, observational study.

RESUMO Introdução: As hérnias de disco lombares altas (ULDH) são consideradas lesões infrequentes (1% a 11%). Ocorrem principalmente em idosos com características clínicas especiais que dificultam o diagnóstico e a decisão terapêutica. A prevalência, localização, o tratamento e a história de nossos pacientes foram analisados. Métodos: Dados sobre sexo, idade, nível das lesões, história cirúrgica e tratamento de nossos pacientes foram coletados retrospectivamente de julho de 2018 a maio de 2021. Nesse período, 179 pacientes foram operados, dos quais 33 apresentavam ULDH. Resultados: Trinta e três pacientes foram incluídos neste estudo, sendo 18 homens e 15 mulheres. A faixa etária variou de 39 a 85 anos, predominando os pacientes idosos. Os níveis operados foram L1-L2 em sete pacientes, L2-L3 em dez pacientes, L3-L4 em catorze pacientes e cirurgia em 2 níveis (L2-L3, L3-L4) em dois pacientes. Em nosso meio, a microdiscectomia é o tratamento de escolha, que foi realizado em todos os casos, adicionando fusão em 4 dos 33 pacientes. Finalmente, encontrou-se o antecedente de cirurgia de hérnia de disco lombar baixa (LLDH) em 16 pacientes. Conclusões: Em nosso meio, a ULDH é uma entidade rara e com menor prevalência em níveis lombares mais altos. Ocorrem com maior frequência em idosos e seu quadro clínico pode ser variado, o que representa um desafio para o cirurgião. Em idosos, o desenvolvimento de cifose lombar devido ao acunhamento vertebral é considerado um fator de risco para o desenvolvimento de ULDH. A cirurgia de microdiscectomia é considerada uma técnica com bons resultados nessa patologia. Nível de Evidência III; Estudo retrospectivo, transversal, descritivo, observacional.

RESUMEN Introducción: Las hernias discales lumbares altas (ULDH) son consideradas lesiones infrecuentes (1-11%). Se presentan principalmente en adultos mayores con características clínicas especiales que dificultan su diagnóstico y decisión terapéutica. La prevalencia, localización, manejo y antecedentes de nuestros pacientes fueron analizados. Métodos: Los datos con respecto a sexo, edad, nivel de lesión, antecedentes quirúrgicos y manejo de nuestros pacientes fueron recolectados retrospectivamente desde julio del 2018 hasta mayo del 2021. Durante este periodo 179 pacientes fueron operados, de los cuales 33 presentaron ULDH. Resultados: Treinta y tres pacientes fueron incluidos en éste estudio, de los cuales 18 eran hombres y 15 mujeres. Los rangos de edad variaron entre 39 y 85 años, predominando pacientes de la tercera edad. Los niveles intervenidos fueron L1-L2 en siete pacientes, L2-L3 en diez pacientes, L3-L4 en catorce pacientes y cirugía en 2 niveles (L2-L3, L3-L4) en dos pacientes. En nuestro medio, la microdiscectomía es el manejo preferido, el cual se realizó en todos los casos, agregando fusión en 4 de los 33 pacientes. Finalmente se encontró antecedente de cirugía por hernias discales lumbares bajas (LLDH) en 16 pacientes. Conclusiones: En nuestro medio, las ULDH son una entidad rara con menor prevalencia en niveles lumbares más altos. Se presentan con mayor frecuencia en personas de edad avanzada y su cuadro clínico puede ser variado, lo cual representa un reto para cirujano. En adultos mayores el desarrollo de cifosis lumbar por acuñamientos vertebrales se considera un factor de riesgo para el desarrollo de ULDH. El manejo quirúrgico mediante microdiscectomía se considera una técnica con buenos resultados en ésta patología. Nivel de Evidencia III; Estudio retrospectivo, transversal, descriptivo, observacional.

Evolución clínica y análisis del estado del cartílago articular por mapeo-T2 y segunda vista artroscópica a veinticuatro meses del trasplante de menisco medial / Meniscal transplantation. Clinical evolution of articular cartilage for T2-mapping and second-look arthroscopic at twenty-four months

Introducción: El objetivo de nuestro trabajo es evaluar la evolución clínica, la condroprotección y la reacción inmunológica del trasplante de menisco (TM) con aloinjerto gama irradiado (GI) versus fresco congelado (FC) a veinticuatro meses. Materiales y métodos: veinte TM mediales en veinte pacientes, se evaluaron escalas de rodilla, Mapeo-T2 y segunda vista artroscópica, así como identificación de reacciones inmunológicas con la medición de citocinas inflamatorias por PCR en sangre y líquido sinovial. Trece trasplantes con injerto FC y siete GI, edad promedio de treinta y dos años. Resultados: mejoría significativa en escalas a veinticuatro meses: KOOS (dolor 67.80/79.30; síntomas 60.80/82.10; AVD 8.05/92.40; deportes 37/63.35; CV 28.90/71.30), Lysholm (62.20/85.80), IKDCs (50.17/72.12), EVA (3.35/0.4). El cartílago del compartimento trasplantado se mantuvo dentro de valores normales, sin diferencia a los veinticuatro meses (fémur: 33.43 versus 33.50 ms, p = 0.16) (tibia: 33.57 versus 34.35 ms, p = 0.21). Todos los pacientes mostraron integridad del injerto a los doce meses en la segunda vista artroscópica. Solo se observó aumento en las citoquinas plasmáticas IL-6 e IL-17 en un paciente del grupo GI, sin repercusión clínica. Conclusiones: mejoría clínica, adecuada integración y condroprotección significativa a veinticuatro meses en ambos tipos de injertos

Introduction: Our objective is to evaluate the clinical course, chondroprotection and immunological reaction of meniscus transplantation (TM) with gamma irradiated (GI) versus fresh frozen (FC) allograft at twenty-four months. Materials and methods: twenty medial TMs in twenty patients, knee scales, T2-mapping and second arthroscopic view were evaluated, as well as identification of immunological reactions with the measurement of inflammatory cytokines by PCR in blood and synovial fluid. Thirteen transplants with FC graft and seven GI grafts, average age of thirty-two years. Results: significant improvement on scales at twenty-four months: KOOS (pain 67.80 / 79.30; symptoms 60.80 / 82.10; AVD 8.05 / 92.40; sports 37 / 63.35; CV 28.90 / 71.30), Lysholm (62.20 / 85.80), IKDCs (50.17 / 72.12), EVA (3.35 / 0.4). The cartilage of the transplanted compartment remained within normal values, with no difference at twenty-four months (femur: 33.43 versus 33.50 ms, p = 0.16) (tibia: 33.57 versus 34.35 ms, p = 0.21). Conclusions: all patients showed integrity of the graft at twelve months in the second arthroscopic view. An increase in plasma cytokines IL-6 and IL-17 was only observed in one patient in the GI group, without clinical repercussion. Clinical improvement, adequate integration and significant chondroprotection at twenty-four months in both types of grafts

Radiographic displacement of acute acromioclavicular joint dislocations fixed with AC TightRope.

BACKGROUND: The arthroscopic approach to acromioclavicular (AC) dislocation with methods such as AC TightRope fixation has reported radiographic failure rates between 18% and 50% with functional results graded as good or excellent. Our objective was to review the outcomes after arthroscopic fixation for acute AC joint dislocation using the TightRope device. METHODS: We reviewed the records of 52 patients, with a mean age of 31 years, who underwent arthroscopic fixation with the TightRope device for acute AC joint dislocation. Outcomes were evaluated using the Constant and University of California, Los Angeles scores. The coracoclavicular (CC) distance before and after surgery was compared by radiography. RESULTS: The mean follow-up period was 36.7 months (range, 6-65 months). Postoperatively, the mean Constant score was 97.13 and the mean University of California, Los Angeles score was 33.2. The CC distance was maintained in 73% of the patients, whereas partial loss of reduction occurred in 19.2% and failure of reduction occurred in 7.7%. CONCLUSION: Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory clinical outcomes. However, CC reconstruction appears to result in subluxation in cases with AC dislocation for a period of more than 10 days.

Reparación meniscal con técnica dentro-fuera / Inside-out meniscal repair technique

Sabemos que la meniscectomía lleva al desarrollo temprano de osteoartritis, es por ello que en la actualidad se tiende a reparar más que a resecar meniscos. La reparación meniscal Dentro-Fuera es una técnica que ha probado ser efectiva tanto así que sigue siendo el estándar de oro. Aunque la técnica todo dentro ha sido mejorada, la técnica Dentro-Fuera ofrece ventajas como el poder reparar diferentes tipos de patrones de lesiones así como utilizar diferentes tipos de puntos y suturas. La desventaja es que requiere de una incisión extra y una adecuada disección de los tejidos blandos para evitar complicaciones iatrogénicas y anudar los puntos directamente sobre la cápsula. En el artículo describimos la técnica que utilizamos

It is well known that meniscectomy leads to the early development of knee arthritis, that is the reason that nowadays we favour meniscal repair rather than meniscectomy. The Inside-out meniscal repair technique has proven to be effective, has passed the test of time and has withstanded as the gold standard of meniscal repair techniques. Even when the All-inside technique has improved the inside-out offers advantages like the possibility of repairing all tear patterns and the chance of using several stitch configurations and different kinds of sutures. The main disadvantage is that it requires an extra incision and some deep dissection to tie the knots against the capsule. We describe the technique we currently use

Meniscal repair using the inside-out technique with cross stitch.

The treatment of meniscal tears continues to evolve. A few years ago most tears were treated with total meniscectomy, which evolved to partial meniscectomy and then to meniscal repair. The purpose is to preserve as much of the menisci as possible, to maintain their potential biomechanical properties, and to preserve normal knee function. Different repair techniques have been used many of them involving both vertical and horizontal sutures. We are proposing an inside-out meniscal repair technique with cross-shaped stitches that provides a 4-point fixation construct.

Técnica para realizar el tunel femoral a través del portal anteromedial en la reconstrucción del ligamento cruzado anterior / Using the anteromedial portal for anterior cruciate ligament reconstruction

La perforación del túnel femoral a través del portal anteromedial permite la colocación anatómica del túnel femoral, es indispensable en la reconstrucción con doble banda y en la técnica todo adentro. Existen varios retos y complicaciones cuando se toma la decisión de realizar esta técnica, los cuales deben ser conocidos por el cirujano antes de llevar a cabo este procedimiento. El propósito de esta revisión es describir los pasos a seguir para los cirujanos que contemplan realizar el túnel femoral a través del portal anteromedial para la reconstrucción del ligamento cruzado anterior.

[Clinical-ultrasonographic assessment in arthroscopic rotator cuff repair after 1-year follow-up]. / Evaluación clínico-ultrasonográfica en la reparación artroscópica del mango rotador a 1 año de seguimiento postoperatorio.

INTRODUCTION: Arthroscopic repair of the rotator cuff have shown have shown encouraging clinical results. However, few authors have assessed integrity of repair with ultrasound. The presence of re-rupture by ultrasonography in a rotator cuff repair may not relate to the patient's functional status. OBJECTIVE: We used ultrasonography to assess the prevalence of re-rupture in rotator cuff repairs and its clinical relevance with minimum 1 year postoperatively. MATERIALS AND METHODS: Evidence level IV (Case series). We evaluated 27 shoulders that underwent arthroscopic rotator cuff repair. Clinical evaluation was performed using UCLA functional scale, visual analogue scale (UCLA, VAS). Post-operative ultrasound was performed at least 1 year postoperatively. Statistical analysis was done with the SPSS 11.0 software. RESULTS: We examined 27 shoulders, mean age 56.4 (41-78), mean postoperative follow-up 19.6 (12 m-88 m). Clinical assessment with UCLA functional scale results were: good-excellent (77.4%); fair (22.2%). VAS results showed that 44.4% reported VAS of 0; in the range of 1-3 VAS was 55.5% of the patients. Ultrasound evaluation showed no injury in 37%; partial lesion 51.9%, and a total lesion 11.1%. Thirty-three % of the patients with VAS of 0 showed no injury when evaluated by ultrasonography, injury by ultrasound 33.3% with VAS (1-3) 22.2%. UCLA (good-excellent) without injury by ultrasound 33.3% with a 44.4% degree of injury, UCLA (Fair) without injury 3.7%, with some degree of lesion 18.5%. Results no statistically significant difference (p > 0.05). CONCLUSIONS: In our series, we find that integrity of rotator cuff postoperative ultrasound, it has no effect on the functional status of patients with postoperative follow-up of at least 1 year, with UCLA and VAS.

[Results of arthroscopic debridement and lavage in patients with knee osteoarthritis]. / Resultados obtenidos con la limpieza articular artroscópica de rodilla en pacientes con osteoartritis.

INTRODUCTION: Knee osteoarthritis (OA) is a degenerative process that affects people over 50 years old and is an important cause of disability. Treatment options include non-operative and operative modalities. Arthroscopic lavage and debridement may be the first choice to consider in patients between 45 and 65 years with early OA. MATERIAL AND METHODS: We conducted a self-controlled clinical trial with deliberate maneuver assignment. Thirty nine patients between 38 and 68 year of age with clinical and radiographic knee OA were included. Patients underwent arthroscopic lavage and debridement between January of 2001 and December 2003. Preoperative and postoperative evaluation was performed using the HSS knee score as well as questions that evaluated patient satisfaction and subjective function. Statistical analysis using one tailed Student's t-test was performed. Significance was considered with ap value of < 0.0001. RESULTS: Thirty-three patients completed the evaluation. Six patients were lost to follow-up. Mean age of patients was 53 (38 to 68). Mean preoperative HSS score was 54.9 and average postoperative score was 74.8. Thirty-one out of 33 patients (93%) were satisfied and reported good subjective function after the operation. Twenty five of these patients presented Outerbridge grade II-III cartilage defects and 6 patients presented grade IV lesions. Twenty nine of the 33 patients (87.8%) referred improvement to perform their daily-living activities and 4 patients did not improve. Thirty two out of 33 patients would recommend the operation. DISCUSSION: Arthroscopic debridement and lavage improves function and satisfaction in patients with grade II and III of OA. Patients with severe chondral lesions (grade IV) also improved to a lesser extent. Thus, arthroscopic debridement and lavage is a good treatment alternative in young patients with early OA.

[Cost analysis and economic impact of anterior cruciate ligament reconstruction]. / Análisis de costo e impacto económico de la reconstrucción de ligamento cruzado anterior (LCA).

INTRODUCTION: Health economics studies play an important role in all healthcare systems. The purpose of the latter is to offer effective and low-cost treatments. OBJECTIVE: Analyze the costs and the economic impact of the comprehensive ACL treatment. MATERIAL AND METHODS: An average cost study was done of primary ACL reconstruction. We studied 104 patients during 2005, 79 males and 25 females, with mean age 31.5 years. The assessment of the preoperative, operative and postoperative costs was related to each patient's socioeconomic stratum (SES). RESULTS: The hamstrings were the most frequently used graft (71%) versus the bone-patellar tendon-bone graft (BTB) (29%). Socioeconomic strata 2 and 3 were predominant. The following were the most frequent hamstrings implants used: Rigidfix/Intrafix and Endobutton/Xtralok, while the most frequent BTB grafts used were the metallic interference screws. No difference was found between the types of grafts and the SES in the preoperative and postoperative costs, including imaging studies, hospital say and rehabilitation. However, differences were found among the different groups in the cost of surgery, resulting from the type of implant used. The mean cost for SES 1 and 2 was $6475.20, for SES 3 and 4, $8057.51, and for SES 5 and 6, $16,242.5. The vulnerable population (SES 1) needs 7.34-fold its monthly income to pay for the comprehensive treatment, while the middle stratum (SES 3) needs 3.27-fold its monthly income. CONCLUSIONS: The comprehensive cost of treatment is proportionally higher than the patients' income. It is important to point out that the systems using state-of-the-art technology, which in another setting would be inaccessible, have significant advantages when compared with the less expensive systems. Thus the economically vulnerable SES benefit from the subsidy granted by the National Institutes of Health.

[Meniscal repair in patients with chronic lesions]. / Reparación meniscal en pacientes con lesiones crónicas.

OBJECTIVE: To analyze the subjective and objective outcome of arthroscopic meniscal repair in patients with chronic meniscal lesions. METHODS: A group of patients that underwent arthroscopic meniscal repair of chronic tears with a minimum follow-up of six months was retrospectively evaluated. Physical examination oriented at finding persistent meniscal lesions was performed. IKDC, Lysholm and Tegner scores were applied, and a control magnetic resonance imaging (MRI) was performed. RESULTS: Twenty seven menisci in 25 patients were repaired. There were 21 male and 4 female patients with a mean age of 29.6 +/- 8.2 years (20-45). Mean time from lesion to surgery was 25.24 +/- 26 months (6-120). 27. There was significant improvement in all parameters evaluated in 21 patients. Four patients were found to have signs and symptoms of persistent meniscal tears. Abnormal increased signal intensity in the repaired menisci was observed by MRI in all patients, not correlating with clinical findings. CONCLUSIONS: Short-term success rate of 85% was obtained with arthroscopic repair of chronic meniscal lesions in this study, which supports the fact that a long period of time before surgery does not necessarily lead to failure. It is valid to perform a meniscal repair in patients with chronic tears as long as the proper surgical technique and an adequate rehabilitation protocol are used.

Minimally invasive quadriceps tendon harvest.

Quadriceps tendon (QT) is becoming a popular graft for primary and revision ligament surgery. A subcutaneous technique for graft harvesting a QT is presented. Special closed tendon strippers were designed; these devices have 10- and 11-mm inner diameters and are stronger and sharper than regular hamstrings strippers. In the mid-line of the patellar upper pole, a 2-cm longitudinal incision is made, a 20- x 10-mm bone plug is created with an oscillating saw, and the tendon stripper is positioned and advanced into the thigh, dissecting the QT until the desired length, usually 10 cm, is obtained. The graft can be released by making a stab incision at the device's tip or by ventrally pointing and turning the tendon stripper to amputate the graft's end. The QT graft can be prepared in several fashions for 1- or 2-bundle ligament reconstructions. The technique was tested and refined in 3 cadaver specimens and has been used at our institution since 2003 in 18 primary posterior cruciate ligament reconstructions with no problems. This minimally invasive technique is safe, provides a consistently good-quality graft with excellent cosmetic results, and is simple and easily reproducible.

Resultados en la reconstrucción del ligamento cruzado anterior con el injerto rotuliano hueso-tendon-hueso. Seguimiento a dos años / Results of reconstruction of anterior cruciate ligament by bone tendon bone patellar grafting. A two year follow up

Se desarrolló el presente trabajo con el objetivo de evaluar los resultados, a dos años de la reconstrucción del ligamento cruzado anterior (LCA) con el injerto rotuliano hueso-tendón-hueso. El presente estudio incluyó a 37 pacientes con lesión del LCA que se sometieron a reconstrucción con técnica artroscópica utilizando injerto autólogo del tendón patelar, hueso-tendón-hueso. Se les realizó una evaluación pre y postoperatoria clínica, radiográfica y funcional de acuerdo a las escalas de valoración de Lysholm y del IKDC. Se observó mejoría funcional en 36 de los pacientes estudiados retornando a sus actividades previas a la lesión, la inestabilidad disminuyó en todos los pacientes al menos 1 grado y en algunos ésta desapareció. Como complicaciones 3 pacientes refirieron dolor en la zona donadora del injerto y 2 más presentaron intolerancia al material por lo que se retiraron los tornillos sin afectar el resultado final. Se concluye que se obtuvo un 94.5 por ciento de resultados excelentes y buenos, proporcionando adecuada estabilidad, excelente función de la rodilla y con mínimos o nulos cambios radiográficos postoperatorios.

Artroscopía y osteotomía proximal de tibia tipo Maquet en el tratamiento del genu varo / Arthroscopy and Maquet proximal tibial osteotomy for treatment of genu varus

La osteotomía correctora de varo en la rodilla es un tratamiento extraarticular que cuando se asocia a la artroscopía, es posible mejorar el pronóstico funcional de la rodilla. Se incluyen 48 pacientes (53 rodillas) con diagnóstico de genu varo, con una edad promedio de 55 años 5 meses y con un seguimiento de 25 meses. A todos se les efectuó una artroscopía en el mismo tiempo quirúrgico de la realización de la osteotomía proximal de tibia tipo Maquet para el diagnóstico y tratamiento de las lesiones asociadas de la rodilla. De los 48 pacientes, a 11 de ellos se les contraindicó la osteotomía debido a los cambios degenerativos del compartimento lateral, programándose en fechas posteriores para un reemplazo articular total. De los restantes pacientes se obtuvieron 23 resultados excelentes, 16 buenos, 2 regulares y 1 malo. La artroscopía asociada a la osteotomía proximal de tibia tipo Maquet en el tratamiento del genu varo es un método objetivo de evaluación, que permite detectar y tratar las lesiones articulares asociadas mejorando los resultados funcionales a mediano plazo.

Procedimiento, técnicas y comunicacion en traumatología y patología quirúrgica del la rodilla: abordajes quirurgicos en la artroplastía total de rodilla / Proccedings, techniques and communications in orthopaedics: surgical approaches for total knee arthroplasty

Se presenta una revisión de los diversos abordajes quirúrgicos más usuales para la artroplastía total de la rodilla, entre los que destacan: el trivectorial, recomendado para el varo mayor de 10 grados o valgo menor de 15 grados no estructurados; el antero-lateral, recomendado para valgo mayor de 15 grados y valgo fijo o estructurado; el trans-vasto medial indicado en gonartrosis sin deformidad angular importante en varo o valgo menor de 10 grados y el trans-cuadricipital extenso en "V" o en "Y", que está indicado para las rodillas contracturadas en extensión rígida por adherencias del cuadríceps.

Osteotomía pélvica de Chiari con injerto en repisa para el tratamiento de caderas displásicas y/o subluxadas / Chiari pelvic osteotomy and shelf bone grafting for treatment of displastic or dislocated hips

Se presentan 25 caderas intervenidas quirúrgicamente de osteotomía pélvica de Chiari con colocación de injerto óseo en repisa. La indicación en estos casos de la aplicación del injerto óseo en repisa se debió a que no se alcanzaba una cobertura anterior y lateral satisfactoria con la técnica clásica de Chiari. Se registran las causas por las que en estos pacientes hubo necesidad de agregar el injerto óseo en repisa, encontrando la más frecuente a la displasia congénita de la cadera en 14 casos. Las mediciones radiográficas con y sin el injerto óseo muestran la ventaja de haberlos utilizado. Se demuestra que esta modificación a la técnica no altera el curso postoperatorio de los pacientes

Abordaje lateral para la deformidad en valgo en la artroplastía total de la rodilla / Lateral approach for correction of the valgus deformity of the knee in total prosthetic replacement

Se presenta un análisis de nuestros resultados usando el abordaje lateral descrito por Keblisch en 1985, para la deformidad en valgo en la artroplastía total de rodilla y que se ha iniciado su aplicación en algunos de nuestros casos. La rodilla valga representa el 21 por ciento de los casos operados por gonartrosis en el servicio de cirugía articular del Instituto Nacional de Ortopedia y a los que se les ha colocado una prótesis total de rodilla. Se describe la técnica quirúrgica detalladamente y los resultados de 7 pacientes operados de enero de 1995 a marzo de 1996. Todos los casos fueron del sexo femenino, entre 64 y 84 años de edad, con un valgo promedio de 20.28 grados y un ángulo ®Q¼ mayor de 10 grados. Se reporta la valoración de los casos pre y postoperatoriamente de acuerdo con el puntaje del Hospital de Cirugía Especial de Nueva York, obteniendo 6 casos excelentes con 95 puntos y un caso bueno con 85 puntos, este último disminuyó su puntaje por haber cursado, dentro de las primeras 6 semanas postoperatorias con una luxación posterolateral. Se concluye que el abordaje lateral es mejor para la artroplastía total de rodilla(ATR), con deformidad angular, ya que permite realizar una buena liberación de partes blandas dando un balance significativo y permitiendo la corrección de la deformidad en valgo