RESUMO
Long-term results of anatomic reconstruction for chronic ankle instability are good, but no study has shown the results of fibular periosteum ligamentoplasty associated with extensor retinaculum flap at long-term follow-up. To demonstrate the efficacy of fibular periosteum ligamentoplasty and extensor retinaculum flap in chronic lateral instability, 40 patients underwent surgery for ankle instability. Thirty-three (82.5%) patients were reviewed, with a median follow-up duration of 8.2 (range 4 to 13) years. Functional results were assessed using the Karlsson score. Static and dynamic x-ray images were realized to measure varus tilt and anterior drawer, and osteoarthritis was evaluated with the van Dijk classification. The median Karlsson score was 95 (range 80 to 100). The mean decrease in varus laxity was 11° (range 0 to 18) and in anterior drawer was 1 (range -8 to 4) mm. At the last follow-up visit, 3 (7.5%) patients showed an evidence of osteoarthritis according to the preoperative criteria of the van Dijk classification (grade 2) and 6 (15%) patients had radiologic changes, without narrowing of the joint space (grade 1). Studies that have a follow-up time >5 years are rare. This study shows that despite the excellent control of ankle laxity, severe radiographic changes (grade 2) continue to evolve in the long term. This study indicates a good long-term outcome but suggests the need to monitor the occurrence of osteoarthritis over the long term.
Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adulto , Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/diagnóstico por imagem , Atletas , Feminino , Seguimentos , Humanos , Instabilidade Articular/etiologia , Masculino , Satisfação do Paciente , Periósteo/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Estudos RetrospectivosRESUMO
Indications for hip and knee replacement will continue to grow over the next few years. Robotic systems have been developed since the early 1990s in order to optimize implant positioning, to potentially improve clinical results, and to reduce perioperative morbidity. Currently, the different available systems certainly improve the accuracy and reproducibility of prosthetic components placement. However, the cost of robotic surgery remains very high. Early results in terms of implant survival, postoperative pain, mobility, and length of stay are encouraging. Long-term studies are needed to validate the clinical efficacy and to perform a medico-economic evaluation of robots in orthopedic surgery.
Les indications de mise en place des prothèses de hanche et de genou ne cesseront de croître au cours des prochaines années. Afin de parfaire la technique d'implantation, d'améliorer les résultats cliniques et de réduire la morbidité périopératoire, l'emploi de systèmes robotiques fait l'objet d'un intérêt grandissant depuis le début des années 90. Actuellement, les différents systèmes disponibles permettent assurément d'améliorer la reproductibilité et la précision de l'implantation des prothèses aux dépens de coûts encore élevés. Les résultats précoces en termes de survie des implants, de douleur et de mobilité post-opératoires sont encourageants. Des études au long terme seront nécessaires afin de confirmer ces derniers et valider l'efficacité clinique ainsi que l'intérêt médico-économique des robots en chirurgie orthopédique.
Assuntos
Artroplastia do Joelho , Procedimentos Ortopédicos , Procedimentos Cirúrgicos Robóticos , Previsões , Humanos , Reprodutibilidade dos TestesRESUMO
Cartilaginous tumours are rare and often incidentally discovered on imaging. They can also be responsible for osteoarticular symptoms (pain, joint stiffness, deformity or fracture) and will require a clinical, radiological and a histopathological assessment. Depending on the lesion, the management may consist of observation or a complex surgical procedure that will take place after a multidisciplinary discussion including the radiologist, the pathologist and the orthopaedic surgeon. The discovery of such cartilage tumours often induces a significant dose of anxiety in the affected patients. A better knowledge of these lesions by the family practitioner and the orthopaedic surgeon therefore seems very useful to provide optimal care before referring the patient to a specialized centre.
Les tumeurs cartilagineuses sont des pathologies rares, dont la découverte est souvent fortuite sur une imagerie réalisée pour une autre raison. Parfois symptomatiques (douleur, raideur articulaire, déformation, fracture), elles doivent motiver une exploration clinique, radiologique, et histopathologique. La prise en charge dépend des lésions identifiées et peut comporter un simple suivi clinique ou un geste chirurgical complexe, fruit d'une discussion menée par une équipe multidisciplinaire composée de radiologues, pathologues et chirurgiens. La découverte d'une lésion cartilagineuse induit souvent une dose d'inquiétude non négligeable chez les patients atteints. Leur connaissance, par le médecin traitant et le chirurgien orthopédiste, nous semble indispensable afin de proposer une prise en charge optimale qui devra se faire dans un centre spécialisé.