Patients With More Than 6.5° of Knee Hyperextension are 14.6 Times More Likely to Have Anterior Cruciate Ligament Hamstring Graft Rupture and Worse Knee Stability and Functional Outcomes.

PURPOSE: To create a cut-off point for hyperextension that best discriminates retear and to verify whether this cut-off point can predict retear regardless of other characteristics after primary anterior cruciate ligament (ACL) reconstruction with hamstrings autograft. METHODS: A cohort of patients submitted to primary isolated ACL reconstruction with hamstrings autografts was retrospectively evaluated. Patients were stratified according to the degree of passive knee hyperextension measured in the normal contralateral knee. The following data were collected: patient age and sex, time from injury to surgery, knee hyperextension, KT-1000 and pivot-shift, associated meniscus injury, intra-articular graft size, follow-up time, graft failure, and postoperative Lysholm and subjective International Knee Documentation Committee scores. RESULTS: Data from 457 patients were evaluated. Median age was 31 years. Thirty-two (7.0%) presented with retear. There was a significant difference in hyperextension between patients with and without retear (P < .001), with the cut-off point established by the receiver operating characteristic curve from 6.5°. Patients with greater hyperextension had a statistically greater frequency of women, longer injury time, greater intra-articular graft diameter, greater postoperative KT-1000, and greater frequency of retear, whereas the subjective International Knee Documentation Committee and Lysholm scores were statistically lower in patients with greater hyperextension. Only hyperextension showed a statistically significant association with re-rupture (P < .001). The odds of retear in patients with hyperextension greater than 6.5 was 14.65 times the odds of patients with hyperextension less than 6.5. CONCLUSIONS: Patients with more than 6.5° of hyperextension are 14.6 times more likely to have a graft rupture than patients with lower hyperextension when submitted to ACL reconstruction with hamstring tendons. Also, they present worse knee stability by the KT-1000 test and worse functional outcomes. Therefore, patients with this degree of hyperextension should not have isolated reconstruction with hamstrings as their first choice. LEVEL OF EVIDENCE: Level III, retrospective comparative prognostic trial.

Small Hamstring Tendon Graft for Anterior Cruciate Ligament Reconstruction Combined With Anterolateral Ligament Reconstruction Results in the Same Failure Rate as Larger Hamstring Tendon Graft Reconstruction Alone.

PURPOSE: To compare patients undergoing anterior cruciate ligament (ACL) reconstruction with hamstring grafts 7 mm or less in diameter combined with anterolateral ligament (ALL) reconstruction versus isolated ACL reconstruction with grafts greater than 7 mm in diameter. METHODS: We retrospectively evaluated the descriptive data and clinical outcomes of patients who underwent primary ACL reconstruction with hamstring grafts from June 2013 to January 2020 and had a minimum follow-up period of 2 years. Patients with quadrupled or quintupled semitendinosus and gracilis autograft 7 mm or less in diameter combined with single-strand ALL reconstruction (ACL-ALL group) were matched in a 1:2 propensity ratio to patients who underwent isolated single-bundle ACL reconstruction with hamstring grafts greater than 7 mm (ACL group). RESULTS: We identified 30 patients in our database who met the criteria for the ACL-ALL group. The patients in this group were matched to 60 patients comprising the ACL group. Both groups were similar regarding all preoperative matched and unmatched variables. The mean ACL graft diameter was 6.8 ± 0.4 mm in the ACL-ALL group and 8.6 ± 0.6 mm in the ACL group (P < .001). The ACL-ALL group presented 1 failure (3.3%), and the ACL group presented 3 failures (5%) (P = .717). Postoperative KT-1000 measurements were similar between the groups (2.1 ± 1.1 mm vs 1.9 ± 1.2 mm, P = .114), as were postoperative pivot-shift grades (P = .652). Subjective International Knee Documentation Committee scores and Lysholm scores did not present any differences between the groups (P = .058 and P = .280, respectively). CONCLUSIONS: Patients who undergo combined ACL-ALL reconstruction with an ACL graft diameter of 7 mm or less can achieve similar results to patients who undergo isolated ACL reconstruction with a graft diameter greater than 7 mm. An associated ALL reconstruction can be performed to increase knee stability in patients with small-diameter hamstring grafts. LEVEL OF EVIDENCE: Level III, retrospective, comparative therapeutic trial.

The Addition of Either an Anterolateral Ligament Reconstruction or an Iliotibial Band Tenodesis Is Associated With a Lower Failure Rate After Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Trial.

PURPOSE: To compare the failure rate in patients who underwent revision anterior cruciate ligament (ACL) reconstruction alone or associated with an extra-articular procedure. Secondary objectives were to compare ACL laxity, patient-reported outcome measures, and complication rates in these patients and, subsequently, to compare the outcomes of patients who underwent revision ACL reconstruction associated with anatomical anterolateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET). METHODS: This was a retrospective comparative study. Patients were classified into 2 groups, according to whether (group 2) or not (group 1) an extra-articular reconstruction was performed. Patients who underwent an extra-articular procedure were further divided into ALL reconstruction (group 2A) and LET (group 2B). Baseline demographic variables, operative data and postoperative data were evaluated. RESULTS: The groups with (86 patients) and without (88 patients) an associated extra-articular reconstruction had similar preoperative data. Group 2 had a lower failure rate (4.6% vs 14.7%; P = .038), better KT-1000, better pivot-shift, and better Lysholm. There was no difference regarding complications, except more lateral pain in group 2. Regarding the groups who underwent ALL reconstruction (41 patients) and LET (46 patients), group 2A showed better Lysholm scores. Both groups had similar failure rates and complications. CONCLUSIONS: Patients who underwent revision ACL reconstruction with a laterally based augmentation procedure had a lower failure rate than patients who underwent isolated revision ACL reconstruction. KT-1000 and pivot-shift examination were also significantly better when a lateral augmentation was performed. Complications were similar except for an increase in lateral pain in the augmented group. No clinically important differences were found when comparing the LET group to the ALL group other than a statistical improvement in the Lysholm functional scale, likely not clinically meaningful, favoring the ALL group and an increased duration of post-operative lateral pain in the LET group. LEVEL OF EVIDENCE: III, retrospective comparative therapeutic trial.

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction.

BACKGROUND: Revision anterior cruciate ligament (ACL) reconstructions are usually complex owing to previous tunnels. The objective of this study is to report the results of a revision ACL reconstruction technique with a tibial tunnel performed from the anterolateral plateau associated with an anterolateral ligament (ALL) reconstruction. METHODS: Patients with at least two ACL reconstructions that failed and who had significant enlargement and confluence of tunnels in the medial tibial plateau and underwent revision ACL reconstruction associated with ALL reconstruction with the tibial tunnel for the ACL performed from the lateral plateau between 2017 and 2019 were evaluated. All patients were evaluated by physical examination, International Knee Documentation Committee (IKDC), and Lysholm functional scales. RESULTS: Six patients who underwent this surgical procedure were evaluated. All patients were sports practitioners and presented a grade 3 pivot shift. The mean age was 28.5 ± 8.2 years, and the mean follow-up time was 34.1 ± 12.8 months. No patient had a new graft rupture, but three (50%) had grade 1 pivot shift. Four patients had minor complications with no clinical impact on the final result. All except one patient were able to return to pre-injury type of sports, at a mean time of 14.6 ± 2.3 months after surgery. CONCLUSION: The anterolateral tibial tunnel technique using an Achilles tendon allograft for revision ACL reconstruction after multiple failures associated with an ALL reconstruction showed good results and no major complications. The anterolateral tunnel can be considered a good alternative in cases of medial tibial confluence or significant enlargement of the medial tunnels in re-revision procedures.

Knee Hyperextension Greater Than 5° Is a Risk Factor for Failure in ACL Reconstruction Using Hamstring Graft.

BACKGROUND: The degree of knee hyperextension in isolation has not been studied in detail as a risk factor that could lead to increased looseness or graft failure after anterior cruciate ligament (ACL) reconstruction. PURPOSE: To analyze whether more than 5° of passive knee hyperextension is associated with worse functional outcomes and greater risk of graft failure after primary ACL reconstruction with hamstring tendon autograft. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A cohort of patients who had primary ACL reconstruction with hamstring tendon autografts was divided into 2 groups based on passive contralateral knee hyperextension greater than 5° (hyperextension group) and less than 5° (control group) of hyperextension. Groups were matched by age, sex, and associated meniscal tears. The following data were collected and compared between the groups: patient data (age and sex), time from injury to surgery, passive knee hyperextension, KT-1000 arthrometer laxity, pivot shift, associated meniscal injury and treatment (meniscectomy or repair), contralateral knee ligament injury, intra-articular graft size, follow-up time, occurrence of graft failure, and postoperative Lysholm knee scale and International Knee Documentation Committee subjective form scores. RESULTS: Data from 358 patients initially included in the study were analyzed; 22 were excluded because the time from injury to surgery was greater than 24 months, and 22 were lost to follow-up. From the cohort of 314 patients, 102 had more than 5° of knee hyperextension. A control group of the same size (n = 102) was selected by matching among the other 212 patients. Significant differences in the incidence of graft failure (14.7% vs 2.9%; P = .005) and Lysholm knee scale score (86.4 ± 9.8 vs 89.6 ± 6.1; P = .018) were found between the 2 groups. CONCLUSION: Patients with more than 5° of contralateral knee hyperextension submitted to single-bundle ACL reconstruction with hamstring tendons have a higher failure rate than patients with less than 5° of knee hyperextension.

Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta-analysis.

OBJECTIVES: To compare the clinical outcomes of isolated anterior cruciate ligament (ACL) reconstruction with combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. METHODS: A search was conducted on the PubMed, Medline, Google Scholar, EMBASE, and Cochrane library databases, in line with the PRISMA protocol. The indexation terms used were "anterior cruciate ligament" OR "acl" AND "anterolateral ligament" AND "reconstruction." Articles that compared patients submitted to combined ACL and ALL reconstruction with those submitted to isolated reconstruction of the ACL, with levels of evidence I, II, and III, were included. Studies with follow-up of less than 2 years and articles that did not use "anatomical" techniques for ALL reconstruction, such as extraarticular tenodesis, were excluded. A meta-analysis with R software was conducted, with a random effects model, presented as risk ratio (RR) or mean difference (MD), with a 95% confidence level (CI) and statistically significant at p < 0.05. RESULTS: Ten articles were selected, with a total of 1495 patients, most of whom were men, of whom 674 submitted to ACL and ALL reconstruction and 821 to isolated ACL reconstruction. Combined ACL and ALL reconstruction exhibited a statistically significant advantage in residual pivot shift (RR 0.34, 95% CI 0.24-0.47, I2 = 0%, p < 0.01), rerupture rate (RR 0.34, 95% CI 0.19-0.62, I2 = 0%, p < 0.01), Lachman test (RR 0.59, 95% CI 0.40-0.86, I2 = 21%, p < 0.01), and postoperative Lysholm score (MD 2.28, CI 95% 0.75-3.81, I2 = 73%, p < 0.01). CONCLUSIONS: Combined ACL and ALL reconstruction obtained better postoperative clinical outcomes when compared with isolated ACL reconstruction, especially in reducing residual pivot shift and rerupture rate.

Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment.

PURPOSE: To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema, and focal knee medial pain. As a secondary objective, we propose to identify possible factors associated with a good or poor prognosis of the surgical treatment of this lesion. METHODS: From 2012 to 2018, patients who had this specific meniscus pathology and underwent arthroscopic surgical treatment were retrospectively evaluated. Patients with Kellgren-Lawrence (KL) classification greater than 2 were excluded. KL classification, the presence of an Outerbridge grade III/V chondral lesion of the medial compartment, limb alignment, body mass index, and smoking were evaluated. The subjective outcomes included the International Knee Documentation Committee score, improvement in the pain reported by patients, and the Global Perceived Effect (GPE) scale score. RESULTS: A total of 69 patients were evaluated. The mean age was 58.6 ± 7.1 years. The follow-up time was 48.7 ± 20.8 months. Fifty-five (79.7%) patients reported pain improvement. The postoperative International Knee Documentation Committee was 62.6 ± 15.4, and the mean GPE was 2.3 ± 2.6. Fourteen patients (20.3%) showed no improvement in pain, and 7 patients (10.2%) presented complications. Groups that improved (GPE > 0) and did not improve (GPE < 0) did not present differences regarding age, sex, follow-up time, chondral lesions, or body mass index. Patients without improvement had a greater incidence of smoking (P = .001), varus alignment (P = .008), and more advanced KL classification (P < .001). In the multivariate analysis based on the GPE score, KL classification (P = .038) and smoking (P = .003) were significant. CONCLUSIONS: Arthroscopic surgical treatment of degenerative medial meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were factors associated with poor prognosis of surgical treatment. LEVEL OF EVIDENCE: Level IV (case series).

Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury.

BACKGROUND: Isolated reconstruction of the anterior cruciate ligament (ACL) does not reestablish the normal knee biomechanics in cases of associated injuries to the anterolateral structures. Studies evaluating the potential clinical effect of anterolateral ligament (ALL) injury on the treatment of ACL injuries are necessary to validate the findings of biomechanical studies. PURPOSE: To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed using magnetic resonance imaging. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL group) or absence (no-ALL group) of ALL injury on preoperative magnetic resonance imaging scans. Both groups underwent anatomic reconstruction of the ACL with autologous hamstring tendon grafts. The Lysholm and subjective IKDC scores (International Knee Documentation Committee), KT-1000 arthrometer and pivot-shift test results, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. RESULTS: A total of 182 patients were evaluated. Postoperative mean ± SD follow-up was 33.6 ± 7.1 and 36.1 ± 8.1 months for the ALL and no-ALL groups, respectively. No significant differences were found between the groups in terms of age, sex, knee hyperextension, duration of injury before reconstruction, follow-up time, or associated meniscal injuries. In the preoperative evaluation, the pivot-shift grade was similar, and the ALL group had worse KT-1000 arthrometer values (7.9 ± 1.2 mm vs 7.2 ± 1.1 mm; P < .001). In the postoperative evaluation, patients in the no-ALL group had a lower reconstruction failure rate (10.2% vs 1.4%; P = .029) and better clinical outcomes according to the IKDC subjective (85.5 ± 10.7 vs 89.1 ± 6.6; P = .035) and Lysholm scores (85.9 ± 10.1 vs 92.0 ± 6.3; P < .001). There was no postoperative difference in the KT-1000 or pivot-shift results. CONCLUSION: Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 2 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores.

Alternative Techniques for Lateral and Medial Posterior Root Meniscus Repair Without Special Instruments.

Improved understanding and treatment of posterior medial and lateral meniscus root tears have attracted increasing interest. These lesions significantly compromise meniscal function, which can result in an outcome resembling total meniscectomy, and are also a potential cause of knee instability. Despite facilitating repair procedures and reducing the operative time for these lesions, all-inside meniscal repair devices are not available in all circumstances or registered for use in all countries worldwide. Furthermore, all-inside arthroscopic devices can be expensive. Therefore, low-cost alternatives for the treatment of these lesions must be identified. We present 2 efficient and safe techniques: an outside-in technique for repairing medial meniscus root tears and a technique using a simple needle inserted through the transtibial tunnel for lateral meniscal root repairs, neither of which requires the use of specific instruments, thus enabling appropriate treatment of posterior medial and lateral meniscus root tears.

KNEE ARTHROPLASTY REVISION WITH A CONSTRAINED IMPLANT USING HINGE AND ROTATING TIBIAL BASIS.

OBJECTIVE: To evaluate the results of total knee arthoplasty revisions performed in high complexity cases, with large bone defects or serious ligament deficiencies using a constrained implant hinge associated to a rotating tibial basis. METHODS: We evaluated 11 patients in which we used the constrained implant hinge associated to rotating tibial basis, with minimum follow-up of two years. The indications for the procedure included instability, septic loosening, late postoperative infection without loosening and periprosthetic fracture. We evaluated the knee range of movement and functional outcomes by the Knee Society Score (KSS) e Knee Injury and Osteoarthritis Outcome Score (KOOS), besides the presence of complications. RESULTS: All patients achieved 5(o) to 85(o) minimum range of motion at 1 year postoperatively and, in the present evaluation, KSS ranged from 67 to 95. Three patients had no complications until the last evaluation and two patients required implant revision. CONCLUSION: Despite the complications rate observed, the functional result were acceptable for most patients, and it proved being a viable alternative, especially for patients with low functional demand. Level of Evidence IV, Case Series.

KNEE ARTHROPLASTY REVISION WITH A CONSTRAINED IMPLANT USING HINGE AND ROTATING TIBIAL BASIS

ABSTRACT Objective: To evaluate the results of total knee arthoplasty revisions performed in high complexity cases, with large bone defects or serious ligament deficiencies using a constrained implant hinge associated to a rotating tibial basis. Methods: We evaluated 11 patients in which we used the constrained implant hinge associated to rotating tibial basis, with minimum follow-up of two years. The indications for the procedure included instability, septic loosening, late postoperative infection without loosening and periprosthetic fracture. We evaluated the knee range of movement and functional outcomes by the Knee Society Score (KSS) e Knee Injury and Osteoarthritis Outcome Score (KOOS), besides the presence of complications. Results: All patients achieved 5o to 85o minimum range of motion at 1 year postoperatively and, in the present evaluation, KSS ranged from 67 to 95. Three patients had no complications until the last evaluation and two patients required implant revision. Conclusion: Despite the complications rate observed, the functional result were acceptable for most patients, and it proved being a viable alternative, especially for patients with low functional demand. Level of Evidence IV, Case Series.

Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws.

BACKGROUND: Osteosynthesis of femoral neck fractures is particularly indicated in patients aged under 60 years. A prolonged interval between the fracture and surgical fixation has been associated with avascular necrosis (AVN) of the femoral head. The primary objective of this study was to evaluate the association between the time to surgery and the development of complications in patients with femoral neck fractures. METHODS: Patients with displaced fractures of the femoral neck (Garden III or IV) who underwent fixation with three cannulated screws in the inverted triangle configuration from January 2009 to December 2010 were evaluated retrospectively for the development of orthopaedic complications. Patients were divided into two groups according to the time to surgery (within 7 days or more than 7 days). Complication rates were compared between the two groups. Regression analyses were performed to assess the risk factors for complications. RESULTS: Thirty-one patients were included in the study; the duration of follow-up ranged from 24 to 50 months. The time from fracture to surgery ranged from 3 to 18 days. Fifteen patients underwent surgery within 7 days, and 16 patients underwent surgery after 7 days. There were four cases of femoral head necrosis. One patient had an associated infection; one patient experienced non-union, and another demonstrated osteosynthesis failure. There were no statistically significant differences in the overall rate of complications between the groups (p = 0.999). None of the preoperative parameters or fracture characteristics were predictive factors for complications. The only factor associated with the development of complications was inadequate fracture reduction in the anteroposterior (AP) view (odds ratio [OR] = 35.50, 95% confidence interval [CI] = 2.56 to 548.36, p = 0.008). CONCLUSIONS: The interval between the occurrence of the injury and surgical fixation is not associated with the development of complications in fractures of the femoral neck. Inadequate fracture reduction in the AP view is a predictive factor for complications in these fractures.

Retalhos de rotação para cobertura após artroplastia total de joelho / Rotation flaps for coverage after total knee arthroplasty

Objetivo: Avaliar os resultados obtidos com o uso de retalhos miocutâneos de rotação local nos casos de deiscência da ferida operatória após artroplastia total de joelho. Métodos: Os pacientes submetidos a esse procedimentos cirúrgicos foram selecionados no período de 2000 a 2012. Os nove casos selecionados neste período foram submetido a retalhos de cobertura devido a deiscência de pele associada a infecção. Em oito casos utilizamos retalhos de rotação local do gastrocnêmio medial e um caso de avanço de pele. Resultados: em 89% destes casos houve sucesso quanto à cobertura da prótese e viabilidade dos retalhos. Em quatro casos foi possível manter ou revisar a prótese. Outros quatro casos evoluíram com necessidade de amputação por falha no tratamento infeccioso e um caso permaneceu sem a prótese. A avaliação funcional mostrou um resultado insatisfatório em 89% desses casos. Conclusão: Os retalhos de cobertura são uma boa opção para o tratamento dos casos de deiscência com exposição da prótese e que o insucesso funcional esteve associado à falha no controle do quadro infeccioso e aos danos causados por este. Nível de Evidência IV, Série de Casos.

Objective: To evaluate the results obtained using local rotation myocutaneous flaps in cases of wound dehiscence after total knee arthroplasty. Methods: Patients undergoing these surgical procedures were selected in the period 2000-2012. The nine selected cases in this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius and in one case, we used advancing skin. Results: 89% of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation for infectious treatment failure and a case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. Conclusion: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage caused by this. Level of Evidence IV, Case Series.

Rotation flaps for coverage after total knee arthroplasty.

OBJECTIVE: To evaluate the results obtained using local myocutaneous rotation flaps in cases of wound dehiscence after total knee arthroplasty. METHODS: Patients undergoing these surgical procedures were selected in the 2000-2012 period. The nine selected cases during this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius, and in one case we used advancing skin. RESULTS: Eighty nine percent of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation due to failure on treatment of infections, and one case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. CONCLUSION: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage it caused. Level of Evidence IV, Case Series.

Análise fluoroscópica da movimentação in vivo do insert na ATJ de plataforma rotatória / Fluoroscopic analysis of in vivo movement of the insert in rotating platform TKA

OBJETIVO: Confirmar por análise fluoroscópica a movimentação rotacional do insert de polietileno em artroplastias totais de joelho (ATJ) de plataforma rotatória, após um tempo pós operatório mínimo de seis meses, foram estudados 15 joelhos, submetidos a ATJ de plataforma rotatória, com a prótese NEW WAVE, da LEPINE. MÉTODOS: Foi utilizado para a avaliação da rotação do insert de polietileno através de um aparelho de fluoroscopia numa visão anteroposterior do joelho com 90º de flexão. Caso a imagem do marcador radiopaco do polietileno permanecesse inalterada, ou seja, acompanhasse o fêmur, era considerado então que a rotação estaria ocorrendo entre o insert e o componente tibial. RESULTADOS: Dos 15 joelhos analisados, 14 apresentaram movimentação demonstrável do insert de polietileno, totalizando 93,3 por cento. Para que a ATJ de plataforma rotatória mantenha seu potencial é necessário que a movimentação rotacional do insert de polietileno se mantenha com o tempo. CONCLUSÃO: Com estudo dessa amostra concluiu-se que a rotação se mantém de forma consistente (93 por cento). Sugerindo que a ATJ de plataforma rotatória tem efetivamente o potencial de apresentar menor desgaste do polietileno pela maior congruência articular, em relação à ATJ de apoio fixo, além da vantagem de auto-alinhamento do mecanismo extensor.

OBJECTIVE: To confirm by fluoroscopic analysis the rotational movement of the polyethylene insert in rotating platform total knee arthroplasty (TKA) after a minimum postoperative time of six months. Fifteen knees submitted to rotating platform TKA with the LEPINE NEW WAVE prosthesis were studied. METHODS: A fluoroscopic appliance in an anterior-posterior view of the proximal tibia was used to evaluate the rotation of the polyethylene insert, with the knee at a 90º flexion. If the image of the polyethylene radiopaque marker remained unchanged, i.e. if it accompanied the femur, then it was considered that rotation was occurring between the insert and the tibial component. RESULTS: Of the fifteen knees analyzed, fourteen displayed demonstrable movements of the polyethylene insert, totaling 93.3 percent. For the rotating platform TKA to maintain its potential, the rotating movements of the polyethylene insert must be maintained over time. CONCLUSION: The study of this sample demonstrated that the rotation is consistently maintained (93 percent). This confirmation suggests that rotating platform TKA effectively has the potential to present lower polyethylene wear due to the higher articulation congruence, compared with fixed support TKA, besides having the additional advantage of self-alignment of the extensor mechanism.

[Stroke in a neurology ward: etiologies, complications and length of stay]. / Acidente vascular cerebral isquêmico em uma enfermaria de neurologia: complicações e tempo de internação.

INTRODUCTION: Purposes of this study were: evaluate complications and length of stay of patients admitted with diagnosis of ischemic stroke (IS) in the acute or subacute phase, in a general Neurology ward in São paulo, Brazil; investigate the influence of age, risk factors for vascular disease, arterial territory and etiology. METHODS: Data from 191 IS patients were collected prospectively. RESULTS: Fifty-one patients (26.7%) presented at least one clinical complication during stay. pneumonia was the most frequent complication. Mean length of stay was 16.8+-13.8 days. Multivariate analysis revealed a correlation between younger age and lower complication rates (OR=0.92-0.97, p < 0.001). presence of complications was the only factor that independently influenced length of stay (OR=4.20; CI=1.928.84; p<0.0001). CONCLUSION: These results should be considered in the planning and organization of IS care in Brazil.

Acidente vascular cerebral isquêmico em uma enfermaria de neurologia: complicações e tempo de internação / Stroke in a neurology ward: etiologies, complications and length of stay

OBJETIVOS: Os objetivos deste trabalho foram: avaliar as complicações e o tempo de internação de doentes com acidente vascular cerebral isquêmico (AVCI) na fase aguda ou subaguda em uma enfermaria de Neurologia geral em São Paulo; investigar a influência de idade, fatores de risco para doença vascular, território arterial acometido e etiologia sobre as complicações e o tempo de internação. MÉTODOS: Foram coletados prospectivamente dados de 191 doentes com AVCI e posteriormente analisados. RESULTADOS: Cinquenta e um doentes (26,7 por cento) apresentaram alguma complicação clínica durante a internação. A pneumonia foi a complicação mais frequente. O tempo médio de internação na enfermaria foi de 16,8±13,8 dias. Na análise multivariável, o único fator que se correlacionou significativamente com menor taxa de complicações foi idade mais jovem (OR=0,92-0,97, p < 0,001). O único fator que influenciou independentemente o tempo de internação foi a presença de complicações (OR=4,20; IC=1,92-8,84; p<0,0001). CONCLUSÃO: Estes resultados devem ser considerados no planejamento e organização do atendimento do AVCI no Brasil.

INTRODUCTION: Purposes of this study were: evaluate complications and length of stay of patients admitted with diagnosis of ischemic stroke (IS) in the acute or subacute phase, in a general Neurology ward in São paulo, Brazil; investigate the influence of age, risk factors for vascular disease, arterial territory and etiology. METHODS: Data from 191 IS patients were collected prospectively. RESULTS: Fifty-one patients (26.7 percent) presented at least one clinical complication during stay. pneumonia was the most frequent complication. Mean length of stay was 16.8+-13.8 days. Multivariate analysis revealed a correlation between younger age and lower complication rates (OR=0.92-0.97, p < 0.001). presence of complications was the only factor that independently influenced length of stay (OR=4.20; CI=1.928.84; p<0.0001). CONCLUSION: These results should be considered in the planning and organization of IS care in Brazil.