Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 41
Filtrar
Mais filtros

Base de dados
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Arthroscopy ; 38(6): 1933-1943.e1, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34920009

RESUMO

PURPOSE: To compare the clinical outcomes between conventional round tunnel and rectangular tunnel in anatomic anterior cruciate ligament (ACL) reconstruction. METHODS: This was a retrospective comparative cohort study between March 2015 and September 2018. The primary ACL reconstructions using anteromedial portal technique with minimum of 2 years follow-up were enrolled for this study. The exclusion criteria were patients with revision ACL reconstruction, high tibial osteotomy, multiligament injuries, and associated fractures around the knee. Outcome measures included the subjective International Knee Documentation Committee score, Tegner activity score, knee laxity testing, and measurement of the centers of the femoral and tibial tunnels on postoperative computed tomography (CT) images. RESULTS: Forty-seven patients with ACL reconstruction with rectangular tunnel (group 1) and 108 patients with ACL reconstructions with conventional rounded tunnel (group 2) were included consecutively. There were no significant differences between groups in terms of clinical scores or knee laxity, as well as femoral and tibial tunnel positions on CT. One patient in group 2 had ACL failure because of trauma and was treated with revision surgery. Two patients had incomplete tibial fracture, but they healed spontaneously and showed no residual laxity at final follow-up. The intraobserver and interobserver reliability for the radiological measurements ranged from 0.78 to 0.86. CONCLUSIONS: There were no differences in radiological and clinical results between rectangular tunnel group and conventional round tunnel group for arthroscopic ACL reconstruction. ACL reconstruction with a rectangular tunnel could be considered as a reliable technique, but care should be taken during tunnel establishment because of risk of fractures and malposition of rectangular tunnel.


Assuntos
Lesões do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos de Coortes , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Ligamentos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tíbia/cirurgia
2.
Knee Surg Sports Traumatol Arthrosc ; 29(11): 3724-3734, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33392699

RESUMO

PURPOSE: To compare clinical outcomes between the conventional round and rectangular tunnel techniques in single-bundle posterior cruciate ligament (PCL) reconstruction. METHODS: Twenty-seven and 108 patients who underwent PCL reconstructions using a rectangular dilator (Group 1) and rounded tunnel reamer (Group 2), respectively, were included. The exclusion criteria were having a concomitant fracture, osteotomy, subtotal or total meniscectomy, and no remnant PCL tissue. A 4:1 propensity score matching was performed. The knee laxity on stress radiography, International Knee Documentation Committee Subjective Knee Evaluation score, Tegner activity score and Orthopädische Arbeitsgruppe Knie score were evaluated. RESULTS: No significant differences were found between the groups in terms of clinical scores. (n.s.) The mean posterior translations were also not significantly different between the Group 1 and 2 (3.6 ± 2.8 and 3.8. ± 3.1 mm, respectively; n.s.). However, 3 patients (11.1%) in Group 1 and 15 patients (13.8%) in Group 2 showed posterior translation of > 5 mm. The combined posterolateral corner sling technique was performed for 27 patients (100%) in Group 1 and for 96 patients (88.9%) in Group 2. We found no significant difference in rotational stability at the final follow-up. One patient was found to have a femoral condyle fracture during rectangular femoral tunnel establishment, which was healed after screw fixation, without laxity, during follow-up. The intra- and inter-observer reliabilities of the radiological measurements ranged from 0.81 to 0.89. CONCLUSION: Arthroscopic anatomical remnant-preserving PCL reconstruction using a rectangular dilator showed satisfactory clinical results and stability as compared with PCL reconstruction using a conventional rounded reamer. Rectangular tunnel technique in PCL reconstruction could be a good treatment option with theoretical advantage to be anatomic. LEVEL OF EVIDENCE: Level IV.


Assuntos
Traumatismos do Joelho , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Seguimentos , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Resultado do Tratamento
3.
Knee Surg Sports Traumatol Arthrosc ; 23(10): 3062-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24962801

RESUMO

PURPOSE: The purpose of this study was to evaluate the usefulness of tibial reduction during dial test for clinical detection of underestimated posterolateral rotatory instability (PLRI) in combined posterior cruciate ligament (PCL)-posterolateral corner (PLC) deficient knee in terms of external rotation laxity and clinical outcomes. METHODS: Twenty-one patients who classified as grade I PLRI using dial test with subluxated tibia, but classified as grade II with tibial reduction evaluated retrospectively. The mean follow-up was 39.3 months (range 24-61 months). Each patient was evaluated by the following variables: posterior translation and varus laxity on radiograph, KT-1000 arthrometer, dial test (reduced and subluxated position), International Knee Documentation Committee, Orthopädische Arbeitsgruppe Knie scoring system and Tegner activity scale. RESULTS: There were significant improvements in posterior tibial translation (8.6 ± 2.0 to 2.1 ± 1.0 mm; P < 0.001), varus laxity (3.3 ± 1.3 to 1.4 ± 0.5 mm; P < 0.001) and external rotation (13.2° ± 0.8° to 3.6° ± 1.1° at 30°, 13.3° ± 0.9° to 3.6° ± 0.9° at 90°; P < 0.001). The clinical scores were improved significantly at the last follow-up (P < 0.001). The external tibial rotation during dial test with tibial reduction increased from 6.8° ± 0.9 to 13.2° ± 0.8° at 30° of knee flexion, from 7.0° ± 0.8° to 13.3° ± 0.9° at 90° (P < 0.001). CONCLUSIONS: The clinical application of reduction of posteriorly subluxated tibia during the dial test was essential for an appropriate treatment of underestimated PLRI in combined PCL-PLC deficient knee. LEVEL OF EVIDENCE: Retrospective case series, Level IV.


Assuntos
Instabilidade Articular/diagnóstico , Traumatismos do Joelho/diagnóstico , Procedimentos Ortopédicos/métodos , Ligamento Cruzado Posterior/cirurgia , Tíbia/cirurgia , Adulto , Feminino , Humanos , Instabilidade Articular/reabilitação , Instabilidade Articular/cirurgia , Traumatismos do Joelho/reabilitação , Traumatismos do Joelho/cirurgia , Escore de Lysholm para Joelho , Masculino , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/lesões , Período Pós-Operatório , Estudos Retrospectivos , Rotação
4.
Knee Surg Sports Traumatol Arthrosc ; 22(9): 2085-93, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23892438

RESUMO

PURPOSE: The purpose of this study was to evaluate the stability and functional outcomes of anterior cruciate ligament (ACL) reconstruction by tensioning of the ACL remnant using pull-out sutures compared with ACL double-bundle reconstruction. METHODS: Forty-four patients were included in single-bundle reconstruction with remnant tensioning group (Group 1), and 56 patients were included in the double-bundle reconstruction group (Group 2). The remnant tissue was tensioned to the direction of posterolateral bundle, which unrelated to the type of remnant bundle. Objective knee stability was evaluated by anterior stress radiography, KT-1000 and lateral pivot shift tests. The Tegner activity scale, International Knee Documentation Committee and OrthopädischeArbeitsgruppeKnie scoring systems were used for clinical evaluation. RESULTS: No statistically significant intergroup differences were observed in mechanical stability and clinical results (n.s). However, surgical time of remnant tensioning group is shorter than double-bundle reconstruction group (P = 0.005). CONCLUSION: Remnant tensioning suture with single-bundle reconstruction could be used with positive results as good as double-bundle technique if a good ACL remnant was found bridging the femur and tibia, rather than debride or damage to the remnant tissue during operation. LEVEL OF EVIDENCE: Retrospective, comparative cohort study, Level IV.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirurgia , Articulação do Joelho/cirurgia , Adulto , Lesões do Ligamento Cruzado Anterior , Feminino , Humanos , Masculino , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento , Adulto Jovem
5.
Knee Surg Sports Traumatol Arthrosc ; 21(5): 1029-35, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22763568

RESUMO

PURPOSE: It is reported that the length of the posterior cruciate ligament (PCL) fibres increases as the knee flexes, and the magnitude of the length change reaches up to 9.8 mm throughout the range of motion, which exceeds the range of failure strain. Therefore, we postulated that a compensatory mechanism must be recruited to overcome this large strain in order to maintain physiologic function as a key component of joint kinematics. Our main objective was to compare the length change pattern for the linear distance between the femoral and tibial tunnels with the length change patterns derived from a real isometer test of different curvatures. METHODS: We utilized ten intact cadaveric knees and created a vertical femoral tunnel (5 mm medial to the roof of the intercondylar notch and 5 mm proximal from the articular margin) and lateral tibial tunnels (5 mm proximal to the posterior bony ridge on the lateral side of the PCL fibre) and performed a 3D-CT scan at 0º, 30º, 60º, 90º, and 120º. The distances between the femoral and tibial tunnels were calculated from the 3D coordinates. Real isometry was checked both (1) over the PCL and (2) under the PCL using an isometer with an accuracy of 0.1 mm. RESULTS: The path over the PCL had the longest intra-articular length, followed by the path under the PCL, and the lengths measured by CT, respectively. The path over the PCL had a more curved path compared with the path under the PCL and the lengths measured by CT. The lengths measured by CT showed significantly larger excursion than the real isometer test. The path over the PCL showed the least excursion through the range of motion, followed by the path under the PCL, and the lengths measured by CT, respectively. CONCLUSION: Our findings suggested that a more curved PCL path has better isometry because the curvature of the PCL compensates for the length change between 0º and 60º flexion. In remnant preservation PCL reconstruction, the passage of graft over the PCL would have increased intra-articular length and better isometry compared with straight under the PCL path. LEVEL OF EVIDENCE: Basic science study.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Ligamento Cruzado Posterior/diagnóstico por imagem , Idoso , Fenômenos Biomecânicos , Cadáver , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Imageamento Tridimensional , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/fisiopatologia , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular , Procedimentos de Cirurgia Plástica , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Tomografia Computadorizada por Raios X
6.
Arthroscopy ; 28(6): 844-54, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22326904

RESUMO

PURPOSE: To evaluate the isometry of different tunnel positions in posterolateral corner (PLC) reconstruction using 3-dimensional computed tomography. METHODS: In 10 fresh-frozen cadaveric knees, fibular tunnels were made from the anterodistal surface of the fibular neck to the posteroproximal fibular tip. Tibial tunnels were made from just medial to the Gerdy tubercle to a point 1 to 1.5 cm medial to the proximal tibiofibular joint. Femoral condyles were marked at 3 different locations: (1) epicondyle, (2) 5 mm distal-anterior to the epicondyle, and (3) 18 mm distal-anterior to the epicondyle. All specimens were scanned by computed tomography at different ranges of motion. Relative length changes between the tunnels were calculated by use of medical imaging software, and the center of rotation (COR) of each distal tunnel was obtained by use of a least-squares circle-fitting algorithm. RESULTS: The anterior fibular tunnel to lateral epicondyle and the posterior fibular or posterior tibial tunnel to 5 mm distal-anterior to the lateral epicondyle showed the best results in terms of isometry. The COR of the posterior fibular tunnel is distal and anterior to the epicondyle, whereas the COR of the posterior tibial tunnel is distal and slightly posterior to the epicondyle (8.4 mm away from the epicondyle, with a -8.4° angle along the longitudinal axis of the femur). The COR of the anterior fibular tunnel is located posterior and distal to the epicondyle. CONCLUSIONS: Contrary to our hypothesis, the distal tunnels for PLC reconstruction each have different isometric points. The isometric point of the posterior fibular tunnel is distal and anterior to the epicondyle, whereas the isometric points of the posterior tibial and anterior fibular tunnels are distal and posterior to the epicondyle. CLINICAL RELEVANCE: The isometric pattern of each tunnel combination should be considered in PLC reconstruction; currently, popliteus tendon reconstruction is non-isometric.


Assuntos
Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Articulação do Joelho , Ligamentos Articulares/anatomia & histologia , Ligamentos Articulares/diagnóstico por imagem , Idoso , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
7.
Arthroscopy ; 28(10): 1504-12, 1512.e1-2, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22739002

RESUMO

PURPOSE: The purpose of this study was to evaluate the isometry of an anatomic femoral tunnel and anterior tibial tunnel positions. METHODS: Tibial tunnels were made at 2 different locations in 10 cadaveric knees: the conventional tunnel and a more anterior position. Three-dimensional computed tomography (CT) scanning was then performed at 0°, 30°, 60°, 90°, and 120°. After removal of the anterior cruciate ligament from its femoral attachment, the 2 different femoral tunnels were marked at (1) the vertical femoral tunnel point and (2) the anatomic femoral tunnel point. After scans were repeated for coordinate transformation, the change in length between the tunnels was calculated with imaging software (OsiriX, version 3.2; Apple, Cupertino, CA) and the center of rotation for the femoral tunnels was calculated with a least squares fitting algorithm. RESULTS: The conventional tibial tunnel-vertical femoral tunnel combination showed the least excursion as knee flexion angle changed. The vertical femoral tunnel combination groups showed a trend toward increasing length as the knee flexion angle increased. In contrast, the anatomic femoral tunnel combination groups displayed a trend toward decreased length with increasing knee flexion. At less than 30° of flexion, the tibial anterior-anatomic femoral tunnel showed the least excursion. CONCLUSIONS: The anatomic femoral tunnel was nonisometric, and the differences in isometry for each tunnel type were explained primarily by differences in relations between the centers of rotation of tunnels and tunnel position. When a femoral anatomic tunnel is chosen for anterior cruciate ligament reconstruction, the anterior tibial tunnel offers greater isometric benefits than the conventional tibial tunnel, especially in near full extension. CLINICAL RELEVANCE: The distance between anatomic femoral and tibial tunnels is greatest in full extension and decreases with flexion. This would result in graft laxity. The surgeon should give consideration to a more anterior tibial tunnel position, which shows less excursion in early flexion.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Idoso , Algoritmos , Fenômenos Biomecânicos , Cadáver , Fêmur/fisiopatologia , Humanos , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Rotação , Tíbia/fisiopatologia , Tomografia Computadorizada Espiral
8.
Arthroscopy ; 27(9): 1252-8, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21839607

RESUMO

PURPOSE: To evaluate the stability and functional outcomes of anterior cruciate ligament (ACL) reconstruction by tensioning of the ACL remnant using pullout sutures compared with a remnant preservation technique only. METHODS: The data of 33 patients who underwent ACL reconstruction by a remnant tensioning technique (tensioning group) were reviewed retrospectively and compared with the data of 43 patients who underwent ACL reconstruction with remnant preservation without tensioning (preservation-only group) from September 2004 to April 2008 with a minimum follow-up of 2 years. The stability and function were assessed from the side-to-side difference with a KT-1000 arthrometer (MEDmetric, San Diego, CA) and Telos device (Austin & Associates, Fallston, MD), as well as International Knee Documentation Committee and Orthopadische Arbeitsgruppe Knie scores. RESULTS: There were no significant differences between the groups with respect to the subjective and objective International Knee Documentation Committee scores (P = .808 and P = .152, respectively) and Orthopadische Arbeitsgruppe Knie score (P = .702) at the last follow-up. No significant differences in mechanical stability were observed with the KT-1000 arthrometer and stress radiographs between the groups (P = .650 and P = .791, respectively). The remnant tensioning group took a longer surgical time than the preservation-only group (156.4 minutes v 134.5 minutes, P = .117). CONCLUSIONS: The ACL remnant tensioning procedure did not improve the final results of an ACL reconstruction in terms of the clinical function and stability compared with an ACL reconstruction using the preservation-only technique. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/métodos , Adulto , Idoso , Ligamento Cruzado Anterior/patologia , Ligamento Cruzado Anterior/cirurgia , Artrometria Articular , Fenômenos Biomecânicos , Pinos Ortopédicos , Parafusos Ósseos , Feminino , Seguimentos , Humanos , Instabilidade Articular/epidemiologia , Instabilidade Articular/prevenção & controle , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Lesões do Menisco Tibial , Resultado do Tratamento , Adulto Jovem
9.
Arthroscopy ; 27(4): 507-15, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21444010

RESUMO

PURPOSE: To evaluate functional results and knee stability after tensioning of remnant posterior cruciate ligament (PCL) with anterolateral (AL) bundle reconstruction and posterolateral corner (PLC) reconstruction in chronic PCL and PLC injuries. METHODS: Between March 2001 and March 2007, 95 patients with chronic PCL injuries combined with PLC injuries underwent tensioning of the remnant PCL with AL bundle reconstruction and PLC reconstruction. Among these 95 patients, 70 who were satisfied with our inclusion were reviewed. The mean follow-up period was 40.1 months (range, 24 to 96 months). Tensioning of remnant PCL fibers was performed by distal transfer of the posterior tibial attachment. The AL bundle of the PCL was reconstructed by use of the modified inlay technique. The PLC reconstructive procedure was performed with a single sling through fibular tunnel. Stability was measured on posterior stress radiographs and by use of a maximal manual displacement test performed with a KT-1000 arthrometer (MEDmetric, San Diego, CA). The International Knee Documentation Committee and Orthopädishe Arbeitsgruppe Knie scoring systems were used for clinical evaluation. RESULTS: Stress radiographs showed that the mean side-to-side difference (posterior tibial translation compared with that of the contralateral knee) was reduced from 10.3 ± 2.4 mm preoperatively to 2.2 ± 1.5 mm at the last follow-up (P < .001), whereas the KT-1000 tests showed that this difference was reduced from 8.4 ± 2.2 mm preoperatively to 2.0 ± 1.4 mm (P < .001). The final International Knee Documentation Committee objective score was A in 30 patients (42.8%), B in 34 (48.6%), and C in 6 (8.6%). The mean Orthopädishe Arbeitsgruppe Knie score improved from 63.5 ± 10.4 to 88.9 ± 7.6 (P < .001). CONCLUSIONS: Excellent posterior stability and relatively good clinical results were achieved with tensioning of the remnant PCL and AL bundle and PLC reconstruction by use of fibular tunnel for patients with chronic combined PCL-PLC injuries. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Tendão do Calcâneo/transplante , Artroscopia/métodos , Ligamento Cruzado Posterior/cirurgia , Tendões/transplante , Adolescente , Adulto , Parafusos Ósseos , Doença Crônica , Feminino , Fêmur/cirurgia , Fíbula/cirurgia , Seguimentos , Humanos , Traumatismos do Joelho/reabilitação , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Satisfação do Paciente , Seleção de Pacientes , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/lesões , Radiografia , Amplitude de Movimento Articular , Técnicas de Sutura , Tíbia/cirurgia , Lesões do Menisco Tibial , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
10.
Arthroscopy ; 27(7): 965-77, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21620633

RESUMO

PURPOSE: The purpose was to identify the effect of intra-articular autogenous bone marrow injection on the healing of an acute posterior cruciate ligament (PCL) rupture in a rabbit model. The effect of autogenous bone marrow on the healing process was assessed serially by gross inspection, histologic examination, and immunohistochemical study of growth factors. METHODS: In both knee joints, the PCL was completely transected surgically near the femoral attachment site in 24 rabbits. Autogenous bone marrow was obtained from both tibias and delivered only to the right knee joint by direct intra-articular injection. Gross inspection, histologic examination, and immunohistochemical study of growth factors were performed at 8, 12, and 16 weeks after severing of the posterior cruciate ligament (PCL) among 8 randomly chosen specimens. The degree of healing in both marrow-stimulated and untreated control ligaments was evaluated by gross inspection using an ordinal scale consisting of 5 grades. The degree of fibroblast and vessel proliferation and alignment of collagen fibers were evaluated by histologic examination. The degree of expression of transforming growth factor ß1, epidermal growth factor receptor, and vascular endothelial growth factor was evaluated by immunohistochemical study. Statistical analysis was performed with the Mann-Whitney U test. RESULTS: In the group with marrow-stimulated ligaments, the degree of healing was higher at 8 and 12 weeks by gross examination, whereas there was no significant difference at 16 weeks between the 2 groups. According to histologic examination, the healing process was faster in the bone marrow injection group than in the control group at 8 and 12 weeks because the degree of fibroblast and vessel proliferation significantly declined and collagen fibers were arranged more regularly compared with the control group. Similar to the results of histologic examination, the results of immunohistochemical studies showed that the healing process was faster in the bone marrow injection group. However, the recovery of the PCL was completed at 16 weeks after PCL resection in both the bone marrow injection group and the control group. CONCLUSIONS: Intra-articular autogenous bone marrow injection appeared to promote the initiation of healing response in acutely injured PCLs in rabbits. CLINICAL RELEVANCE: Intra-articular autogenous bone marrow injection can be a viable option for treating acutely injured PCLs.


Assuntos
Transplante de Medula Óssea/métodos , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/cirurgia , Cicatrização , Doença Aguda , Animais , Vasos Sanguíneos/patologia , Colágeno/metabolismo , Imuno-Histoquímica , Injeções Intra-Articulares , Ligamento Cruzado Posterior/irrigação sanguínea , Ligamento Cruzado Posterior/fisiopatologia , Coelhos , Ruptura/patologia , Ruptura/fisiopatologia , Ruptura/cirurgia , Fatores de Tempo , Transplante Autólogo/métodos
11.
Arthroscopy ; 26(2): 223-9, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20141985

RESUMO

PURPOSE: To evaluate the results of a remnant posterior cruciate ligament (PCL)-augmenting stent procedure for acute- or subacute-stage PCL injuries in terms of stability and clinical results. METHODS: Between September 2003 and March 2006, 32 patients with a PCL tear underwent a reconstructive stent procedure with an autogenous hamstring tendon graft to augment the remains of the injured PCL. Of these patients, 20 who satisfied our inclusion criteria and could be followed up for a minimum duration of 24 months were enrolled in our study. The remnant PCL and synovium were preserved, and augmentation was performed by use of the transtibial technique. A femoral tunnel was created near the footprint of the anterolateral bundle. Stability was measured on posterior stress radiographs and by use of a maximum manual displacement test performed with a KT-1000 arthrometer (MEDmetric, San Diego, CA). The International Knee Documentation Committee (IKDC) and Orthopädische Arbeitsgruppe Knie scoring systems were used for clinical evaluation. RESULTS: Stress radiographs showed that the mean side-to-side differences in displacement were reduced from 9.9 +/- 4.0 mm preoperatively to 3.0 +/- 2.6 mm at the last follow-up, whereas KT-1000 tests showed that these differences were reduced from 6.9 +/- 2.1 mm preoperatively to 2.7 +/- 1.5 mm. The final IKDC score was A in 7 patients (35%), B in 10 (50%), C in 2 (10%), and D in 1 (5%). The mean Orthopädische Arbeitsgruppe Knie score improved from 61.6 +/- 13.1 to 88.2 +/- 9.5. CONCLUSIONS: Of the patients, 90% showed satisfactory posterior stability and 85% had a normal or nearly normal rating based on the IKDC score at a mean of 3 years after the remnant PCL-augmenting stent procedure in the acute or subacute stage of PCL injuries.


Assuntos
Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/cirurgia , Adolescente , Adulto , Feminino , Fêmur/anatomia & histologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Atividade Motora , Ligamento Cruzado Posterior/transplante , Postura , Amplitude de Movimento Articular , Procedimentos de Cirurgia Plástica/métodos , Estresse Mecânico , Tíbia/anatomia & histologia , Tíbia/cirurgia , Adulto Jovem
12.
Arthroscopy ; 26(5): 630-6, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20434660

RESUMO

PURPOSE: The purpose of this study was to compare the clinical results of arthroscopic single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: We designed a prospective study that included patients with an isolated ACL injury. From April 2004 to February 2007, of 147 patients who underwent ACL reconstruction, 113 were included in this study. We serially obtained clinical and radiologic data preoperatively and postoperatively. We compared preoperative data and data at 2 years postoperatively in patients who had undergone single-bundle ACL reconstruction versus patients who had undergone double-bundle ACL reconstruction. There were 50 single-bundle reconstructions and 63 double-bundle reconstructions. Anteroposterior stability was assessed objectively by anterior stress radiographs with the telos device (telos, Marburg, Germany) and the maximal manual test with the KT-2000 arthrometer (MEDmetric, San Diego, CA). Rotational stability was determined by lateral pivot-shift test. The clinical results were assessed by International Knee Documentation Committee and Orthopadische Arbeitsgruppe Knie scores and Tegner activity scale. In addition, we evaluated postoperative thigh circumference and range of motion. RESULTS: Residual anteroposterior laxity determined at 2 years postoperatively by telos and KT-2000 was 1.74mm +/- 1.67mm and 1.79mm +/- 1.56mm, respectively, in the single-bundle reconstruction group and 1.63mm +/- 1.50mm and 1.61mm +/- 1.22mm, respectively, in the double-bundle reconstruction group. There were no statistically significant differences. For the lateral pivot-shift test done at 2 years postoperatively, there was no statistically significant difference. In addition, clinical results such as International Knee Documentation Committee score, Orthopadische Arbeitsgruppe Knie score, Tegner activity scale, thigh circumference, and range of motion showed no significant differences between the 2 groups. CONCLUSIONS: Double-bundle reconstruction of the ACL by a method using 2 femoral tunnel and 2 tibial tunnels showed no differences in stability results or any other clinical aspects or in terms of patient satisfaction. LEVEL OF EVIDENCE: Level II, prospective comparative study.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Artroscopia/métodos , Traumatismos do Joelho/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Acta Med Okayama ; 64(5): 331-8, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20975767

RESUMO

Among patients that underwent total knee arthroplasty from June, 1990 to January, 1999, 61 cases (44 patients) that could be followed for more than 10 years were included in this study. The patients were divided into a patellar retention group and a patellar resurfacing group, and were compared with regard to their clinical and radiological outcomes. In patients undergoing primary TKA, a selective patellar resurfacing protocol was used. The indications for patellar retention were a small patella, nearly normal articular cartilage, minimal preoperative patellofemoral pain, poor patellar bone quality, and young patient age. When patellar retention was performed, osteophytes of the patella were removed and marginal electrocauterization was carried out. There were 25 cases (20 patients) in the patellar retention group and 36 cases (29 patients) in the patellar resurfacing group. The mean follow-up period was 140.7 months in the patellar retention group and 149.0 months in the patellar resurfacing group. The selective patellar resurfacing with total knee arthroplasty had a favorable outcome;there were a significant difference noted between the 2 groups in the functional scores, which showed better outcomes in the patellar resurfacing group than in the patellar retention group.


Assuntos
Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Patela/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Prótese do Joelho , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do Tratamento
14.
Knee Surg Sports Traumatol Arthrosc ; 18(9): 1219-25, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20182869

RESUMO

If posterolateral rotatory instability (PLRI) injury in patients with a torn anterior cruciate ligament (ACL) is not diagnosed and treated, ACL reconstruction can fail. We retrospectively evaluated the clinical outcome after reconstructions between 2002 and 2007 of both the ACL and the posterolateral corner (PLC) in 44 knees with combined ACL and PLC injuries. The median follow-up duration was 49 months (range, 24-68 months). ACL reconstruction employed autogenous hamstring grafts from the ipsilateral knee. For grade II PLRI, a posterolateral corner sling through the fibular head was placed obliquely from the anteroinferior aspect to the posterosuperior aspect using autogenous hamstring grafts of the contralateral knee. Clinical outcomes were evaluated using the OAK (Orthopadishe Arbeitsgruppe Knie) and IKDC (International Knee Documentation Committee) knee scoring systems. Anterior stability was measured on pull stress radiographs using a Telos stress device and the manual maximum displacement test using a KT-1000 arthrometer with the knee flexed 30 degrees. PLRI was classified according to varus and rotational instability preoperatively and at final follow-up. Median OAK scores improved from 71 points (range, 48-86) to 93 points (range, 75-100). Satisfactory IKDC results were achieved in 39 knees (89%). As for anterior stability, as measured by anterior stress radiography, mean side-to-side displacement difference dropped significantly from 6.9 +/- 1.9 preoperatively to 1.4 +/- 1.1 mm at final follow-up. Forty patients (91%) had the same or better rotational stability compared to the normal side. Varus stress radiographs showed mean side-to-side displacement differences dropped from 1.8 +/- 1.7 preoperatively to 0.4 +/- 0.8 mm at final follow-up. Thus, chronic ACL deficiency is often accompanied by grade II PLRI and can be treated successfully by arthroscopic ACL reconstruction paired with posterolateral reconstruction employing a single sling through the fibular tunnel and a hamstring tendon autograft.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Artroplastia/métodos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Tendões/transplante , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Traumatismos dos Tendões/cirurgia , Transplante Autólogo , Adulto Jovem
15.
Arthroscopy ; 25(3): 257-61, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19245987

RESUMO

PURPOSE: This study examined the effect of the anteroposterior (AP) direction force on the tibial external rotation of a posterior cruciate ligament (PCL)/posterolateral corner (PLC)-deficient knee in a clinical setting. METHODS: Between December 2006 and December 2007, 21 patients with a PCL-PLC injury were assessed using a dial test. The thigh-foot angle (TFA) and patella-tubercle angle (PTA) were measured with an external rotation stress applied to the tibia at both 30 degrees and 90 degrees of knee flexion in 2 different positions (reduced and posterior subluxed). The test was performed with the patient in the supine position and with an AP force applied to the tibia by an assistant. To reduce intra- and interobserver bias, the measurements were taken twice by 2 orthopaedic surgeons for all patients. RESULTS: In the subluxed position, the mean side-to-side differences in the TFA at 30 degrees and 90 degrees knee flexion were 12.6 degrees +/- 2.0 degrees and 12.3 degrees +/- 1.4 degrees , respectively. In the reduced position, the mean side-to-side differences in the TFA at 30 degrees and 90 degrees knee flexion were 18.4 degrees +/- 1.4 degrees and 18.5 degrees +/- 1.5 degrees , respectively. In the subluxed position, the mean side-to-side differences in the PTA at 30 degrees and 90 degrees knee flexion were 9.1 degrees +/- 0.8 degrees and 9.0 degrees +/- 0.7 degrees , respectively. In the reduced position, the mean side-to-side differences in the PTA at 30 degrees and 90 degrees knee flexion were 13.3 degrees +/- 0.6 degrees and 13.2 degrees +/- 0.6 degrees , respectively. CONCLUSIONS: The reduction of a posteriorly subluxed knee increased the tibial external rotation (TFA and PTA) during the dial test of combined PCL-PLC injuries in a clinical setting. The accuracy of the dial test may help present surgeons from missing a combined PLC injury that should be corrected in a PCL deficient knee. LEVEL OF EVIDENCE: Level I, testing of previously developed diagnostic criteria in series of consecutive patients.


Assuntos
Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Articulação do Joelho/fisiopatologia , Procedimentos de Cirurgia Plástica/métodos , Ligamento Cruzado Posterior/cirurgia , Ligamento Cruzado Posterior/transplante , Tíbia/cirurgia , Fenômenos Biomecânicos , Transplante Ósseo , Humanos , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Patela/cirurgia , Patela/transplante , Postura , Amplitude de Movimento Articular , Rotação , Estresse Mecânico
16.
Knee Surg Sports Traumatol Arthrosc ; 17(3): 286-92, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19104773

RESUMO

The efficacy and accuracy of computer navigation have been proved during recent years. But most of recent studies focused on the coronal alignment in total knee arthroplasty and less on sagittal alignment. We retrospectively compared the results of the radiographs of 35 primary TKAs using a non-image based navigation system and 36 primary TKAs using fluoroscopy-assisted conventional technique. To compare the radiographic results, the following parameters were measured: mean mechanical femorotibial angle, mean femorotibial anatomical angle, mean coronal femoral component angle, mean coronal tibial component angle, mean sagittal femoral component angle, and mean sagittal tibial component angle. The navigation TKA showed better accuracy and consistency in mechanical axis deviation, coronal femoral component angle, and sagittal tibial component angle. The coronal tibial component position was acceptable in both groups. The navigation TKA markedly improved the restoration of mechanical axis, but not so much in sagittal femoral component position. The fluoroscopy-assisted conventional TKA had a tendency that femoral component was inserted in flexed position than in navigation TKA. Unlike the fluoroscopy-assisted conventional TKA, the femoral component was inserted in slightly extended position in the navigation TKA than expected. In conclusion, even though the use of navigation in TKAs help the surgeon to achieve good results, the surgeon should know the tendency of extension of the femoral component in sagittal plane to avoid anterior notching.


Assuntos
Artroplastia do Joelho/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Fenômenos Biomecânicos , Feminino , Fêmur/anatomia & histologia , Fêmur/diagnóstico por imagem , Fluoroscopia/métodos , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Instabilidade Articular/prevenção & controle , Prótese do Joelho , Masculino , Ajuste de Prótese/métodos , Estudos Retrospectivos , Tíbia/anatomia & histologia , Tíbia/diagnóstico por imagem , Resultado do Tratamento
17.
Int Orthop ; 33(2): 419-23, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18196241

RESUMO

In this paper, we evaluated the difference between the modified subvastus approach and the medial parapatellar approach in total knee arthroplasty(TKA). We assessed the time of active straight-leg raise (SLR) post-operatively and the range of flexion of the operated knee at the tenth post-operative day, 6 weeks and 6 months, 12 months and 3 years. We investigated the degree of the patellar tilt and subluxation 24 months post-operatively. The patients who underwent the modified subvastus approach performed active SLR earlier (mean 0.5 days) than the medial parapatellar approach patients (mean 2.2 days). Knee flexion was better at the tenth post-operative day in the modified subvastus approach group compared to the medial parapatellar approach group. There was no statistical difference between the two groups with regard to the patellar tilt and subluxation. We conclude that the modified subvastus approach is recommendable in primary TKA.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Patela/cirurgia , Músculo Quadríceps/cirurgia , Amplitude de Movimento Articular/fisiologia , Idoso , Artroscopia/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Medição da Dor , Cuidados Pós-Operatórios/métodos , Probabilidade , Recuperação de Função Fisiológica , Sensibilidade e Especificidade , Fatores de Tempo , Resultado do Tratamento
18.
Arthroscopy ; 22(3): 329-38, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16517318

RESUMO

PURPOSE: Posterior cruciate ligament (PCL) injuries have potential for intrinsic healing and several magnetic resonance imaging studies have reported that the PCL healed with continuity but also with residual laxity. The goal of our study was to introduce a new method and investigate the outcome of tensioning of the remnant PCL and reconstruction of the anterolateral (AL) bundle of the PCL using modified inlay technique. TYPE OF STUDY: Therapeutic study. METHODS: Forty-nine patients who underwent tensioning of the remnant PCL and reconstruction of the AL bundle of the PCL were evaluated 45.7 months (range, 24 to 78 months) on average after surgery. Tensioning was performed by distal transfer of the tibial attachment. The AL bundle of the PCL was reconstructed with 4 bundles of hamstring tendon (34 cases), bone-patellar tendon-bone graft (7 cases), or Achilles tendon allograft (8 cases), arthroscopically at the femoral tunnel and by the modified inlay technique through a posteromedial approach in the supine position. In 35 patients who had a combined posterolateral rotatory instability, the posterolateral corner reconstruction was performed. Stability was assessed by stress radiographs with the Telos device and maximal manual testing with KT-1000 arthrometer. The clinical results were assessed by IKDC and OAK scores. Physical examination was performed using the posterior drawer test, varus stress test, posterolateral drawer test, and dial test in 30 degrees and 90 degrees flexion. RESULTS: The average side-to-side difference of posterior tibial translation on posterior stress radiographs decreased from 10.4 +/- 2.1 mm to 2.2 +/- 1.0 mm. The average side-to-side difference in maximal manual test with the KT-1000 arthrometer also decreased from 8.2 +/- 1.5 mm to 1.9 +/- 1.0 mm. The final IKDC score was A in 10 (20.4%), B in 33 (67.3%), and C in 6 (12.2%) patients. The average OAK score improved from 63.3 +/- 8.3 to 91 +/- 7.3. CONCLUSIONS: Good clinical results and very good posterior stability were achieved with tensioning of the remnant PCL and reconstruction of the AL bundle using the modified inlay technique in chronic PCL injuries. With this technique, the surgeon can operate without changing the patient's position during surgery. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Artroscopia/métodos , Ligamento Cruzado Posterior/cirurgia , Tendões/transplante , Tíbia/cirurgia , Tendão do Calcâneo/transplante , Adolescente , Adulto , Doença Crônica , Feminino , Fêmur/transplante , Fíbula/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ligamento Patelar/transplante , Satisfação do Paciente , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/lesões , Postura , Radiografia , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Estresse Mecânico , Tíbia/transplante , Transplante Autólogo , Transplante Heterotópico , Transplante Homólogo , Resultado do Tratamento
19.
J Bone Joint Surg Am ; 87 Suppl 1(Pt 2): 247-63, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16140798

RESUMO

BACKGROUND: The tibial inlay method for reconstruction of the posterior cruciate ligament has been performed with the patient in the prone or lateral decubitus position. The purpose of this report is to present a modification of this method wherein the patient is positioned supine throughout the procedure. METHODS: Between May 1995 and September 1998, twelve patients who had an isolated tear of the posterior cruciate ligament underwent reconstruction with use of the modified tibial inlay technique. Eleven patients were evaluated after a minimum duration of follow-up of two years. Stability was measured on posterior stress radiographs and with a maximum manual displacement test performed with a KT-1000 arthrometer. Clinical evaluation was carried out with use of the scoring systems of the Orthopädische Arbeitsgruppe Knie and the International Knee Documentation Committee. Second-look arthroscopy was performed in five patients at the time of follow-up. RESULTS: The mean side-to-side difference in displacement (and standard deviation) was reduced from 10.8 +/- 1.9 mm preoperatively to 3.4 +/- 2.4 mm at the time of follow-up as measured on the stress radiographs, and it was reduced from 9.0 +/- 2.1 mm preoperatively to 1.8 +/- 1.2 mm at the time of follow-up as measured with the KT-1000 arthrometer. The average Orthopädische Arbeitsgruppe Knie score was improved from 71.6 +/- 6.8 to 92.5 +/- 4.8 points. All eleven patients had a satisfactory clinical outcome at the time of the final clinical evaluation. The second-look arthroscopic examination in the five patients showed no evidence of partial tearing or abrasion of the graft. CONCLUSIONS: Use of our modified tibial inlay technique for reconstruction of the posterior cruciate ligament achieved a good clinical result in eleven of twelve patients. The advantages of the technique are (1) minimal tendon abrasion at the posterior opening of the tibial tunnel, and (2) elimination of the need to change the patient's position during surgery.


Assuntos
Artroscopia/métodos , Traumatismos do Joelho/cirurgia , Ligamento Patelar/transplante , Ligamento Cruzado Posterior/lesões , Humanos , Procedimentos de Cirurgia Plástica/métodos , Tíbia/cirurgia
20.
J Bone Joint Surg Am ; 86(9): 1878-83, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15342748

RESUMO

BACKGROUND: The tibial inlay method for reconstruction of the posterior cruciate ligament has been performed with the patient in the prone or lateral decubitus position. The purpose of this report is to present a modification of this method wherein the patient is positioned supine throughout the procedure. METHODS: Between May 1995 and September 1998, twelve patients who had an isolated tear of the posterior cruciate ligament underwent reconstruction with use of the modified tibial inlay technique. Eleven patients were evaluated after a minimum duration of follow-up of two years. Stability was measured on posterior stress radiographs and with a maximum manual displacement test performed with a KT-1000 arthrometer. Clinical evaluation was carried out with use of the scoring systems of the Orthopädische Arbeitsgruppe Knie and the International Knee Documentation Committee. Second-look arthroscopy was performed in five patients at the time of follow-up. RESULTS: The mean side-to-side difference in displacement (and standard deviation) was reduced from 10.8 +/- 1.9 mm preoperatively to 3.4 +/- 2.4 mm at the time of follow-up as measured on the stress radiographs, and it was reduced from 9.0 +/- 2.1 mm preoperatively to 1.8 +/- 1.2 mm at the time of follow-up as measured with the KT-1000 arthrometer. The average Orthopädische Arbeitsgruppe Knie score was improved from 71.6 +/- 6.8 to 92.5 +/- 4.8 points. All eleven patients had a satisfactory clinical outcome at the time of the final clinical evaluation. The second-look arthroscopic examination in the five patients showed no evidence of partial tearing or abrasion of the graft. CONCLUSIONS: Use of our modified tibial inlay technique for reconstruction of the posterior cruciate ligament achieved a good clinical result in eleven of twelve patients. The advantages of the technique are (1) minimal tendon abrasion at the posterior opening of the tibial tunnel, and (2) elimination of the need to change the patient's position during surgery.


Assuntos
Procedimentos Ortopédicos/métodos , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/cirurgia , Tendões/transplante , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Patela , Decúbito Dorsal
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA