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OBJECTIVE: To assess the effectiveness of high-volume image-guided injection in the middle term in patients with recalcitrant patellar tendinopathy. DESIGN: Case series study; Level of evidence, 4. SETTING: All tertiary referrals, public, and private healthcare. PATIENTS: Forty-four patients (41 men and 3 women) with diagnosis of recalcitrant patellar tendinopathy were included. INTERVENTION: Tendon injection of a mixture of 10 mL of 0.5% bupivacaine hydrochloride, 62 500 international units of aprotinin, and 40 mL of normal saline solution. MAIN OUTCOME MEASURES: The Victorian Institute of Sport Assessment-patellar tendon (VISA-P), visual analogue scale, and Roles and Maudsley were assessed at baseline and at the last follow-up. RESULTS: The baseline VISA-P score of 46 ± 18.2 (range, 28-75) improved to 75.3 ± 19.2 (range, 68-100) by 15 months (P = 0.003). The mean pain visual analogue scale changed from 91 mm (range, 66-92 mm) before the injection to 28 mm (2-52 mm) (P = 0.01). Of 32 physically active patients, 23 (72%) had returned to sport at the same level practiced before the onset of symptoms. Thirty-five of the 44 patients (80%) rated their condition as good or excellent. CONCLUSIONS: High-volume injection at the interface between the deep surface of the patellar tendon and Hoffa body improves in the short-term symptoms and function of the knee. CLINICAL RELEVANCE: This procedure is minimally invasive, safe, and effective in the short term in athletes.
Assuntos
Anestésicos Locais/administração & dosagem , Traumatismos em Atletas/tratamento farmacológico , Bupivacaína/administração & dosagem , Dor Musculoesquelética/tratamento farmacológico , Neovascularização Patológica/tratamento farmacológico , Ligamento Patelar , Tendinopatia/tratamento farmacológico , Adulto , Idoso , Aprotinina/administração & dosagem , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Neovascularização Patológica/diagnóstico por imagem , Medição da Dor , Ligamento Patelar/irrigação sanguínea , Retratamento , Volta ao Esporte , Inibidores de Serina Proteinase/administração & dosagem , Cloreto de Sódio/administração & dosagem , Tendinopatia/complicações , Tendinopatia/diagnóstico por imagem , Ultrassonografia de Intervenção , Adulto JovemRESUMO
PURPOSE: To translate and adapt the English VISA-P questionnaire to Italian and to perform reliability and validity evaluations of the Italian VISA-P version in patients with patellar tendinopathy. METHODS: The VISA-P English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The original version was compared with the back translation. The VISA-P-I questionnaire was then administered to 25 male athletes (average age 27.9, range 18-32 years) with a diagnosis of patellar tendinopathy. For test-retest evaluation, the 25 patients were asked to complete the questionnaire at first examination, and 30 minutes following the end of this examination. RESULTS: The kappa statistics for 25 patients was 0.78. There were no significant differences between the scores immediately after the consultation and 30 minutes later. CONCLUSIONS: Italian and the English versions of the VISA-P questionnaire evaluate the same aspects of clinical severity in patients with patellar tendinopathy.
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Traumatismos em Atletas/fisiopatologia , Ligamento Patelar/fisiopatologia , Índice de Gravidade de Doença , Tendinopatia/fisiopatologia , Adolescente , Adulto , Humanos , Itália , Estudos de Linguagem , Masculino , Reprodutibilidade dos Testes , Adulto JovemRESUMO
Purpose. To translate and adapt the English VISA-A questionnaire to Italian, to perform reliability and validity evaluations of the Italian VISA-A version in patients with tendinopathy of the main body of the Achilles tendon. Methods. The VISA-A English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The original version was compared with the back translation. The VISA-A-I questionnaire was then administered to 50 male athletes (average age 26.4, range 18 - 49 years) with a diagnosis of tendinopathy of the main body of the AT. For test-retest evaluation, the 50 patients were asked to complete the questionnaire at first examination, and 30 minutes following the end of this examination. Results. The kappa statistics for 50 patients was 0.80 (range 0.7 - 0.86). There were no significant differences between the scores immediately after the consultation and 30 minutes later. Conclusions. Italian and the English versions of the VISA-A questionnaire evaluate the same aspects of clinical severity in patients with tendinopathy of the main body of the Achilles tendon.
Assuntos
Tendão do Calcâneo/fisiopatologia , Traumatismos em Atletas/fisiopatologia , Índice de Gravidade de Doença , Tendinopatia/fisiopatologia , Adolescente , Adulto , Humanos , Itália , Estudos de Linguagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
PURPOSE: To report the middle term outcome in male and female patients who underwent surgery for chronic recalcitrant Achilles tendinopathy. METHODS: We tried to match each of the 58 female patients with a diagnosis of tendinopathy of the main body of the Achilles tendon with a male patient with tendinopathy of the main body of the Achilles tendon who was within two years of age at the time of operation. A match accordingly was possible for 41 female subjects. RESULTS: Female patients were shorter and lighter than male patients. They had similar BMI, lower calf circumference, similar side-to-side calf circumference differences, and greater subcutaneous body fat than men. Of the 41 sedentary patients, only 25 reported an excellent or good result. Of these, three had undergone a further exploration of the Achilles tendon. The remaining patients could not return to their normal levels of activity despite prolonged supervised post-operative physiotherapy, with cryotherapy, massage, ultrasound, pulsed magnetic, and laser therapy. CONCLUSION: Females experience more prolonged recovery, more complications, and a greater risk of further surgery than males with recalcitrant Achilles tendinopathy.
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Tendão do Calcâneo/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Tendinopatia/cirurgia , Tendão do Calcâneo/fisiopatologia , Estatura , Peso Corporal , Doença Crônica , Feminino , Humanos , Estilo de Vida , Estudos Longitudinais , Masculino , Atividade Motora , Recuperação de Função Fisiológica/fisiologia , Reoperação , Fatores Sexuais , Tendinopatia/fisiopatologia , Fatores de TempoRESUMO
BACKGROUND: Recurrent peroneal tendon subluxation is uncommon. HYPOTHESIS: The authors tested the null hypothesis that there are no differences between preoperative and postoperative status after anatomical repair of the superior peroneal retinaculum. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: In the period 1996 to 2001, the authors operated on 14 patients (all men; mean age, 25.3 +/- 6.3 years; range, 18-37 years) with traumatic recurrent unilateral peroneal tendon subluxation, with a follow-up of 38 +/- 3 months (range, 22-47 months). RESULTS: No patient experienced a further episode of peroneal tendon subluxation, and all had returned to their normal activities. Maximum calf circumference, functional ability, peak torque, total work, and mean power of plantar flexion were always lower in the operated leg, but the differences did not reach statistical significance. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score increased significantly from 54.3 +/- 11.4 to 94.5 +/- 6.4 (P = .03), with 5 patients reporting a fully normal ankle. CONCLUSION: If an anatomical approach is used, reattachment of the superior retinaculum is a most appropriate technique. It returns patients to a high level of physical activity and gives a high rate of satisfactory results both objectively and subjectively. Randomized control trials may be the way forward in determining the best surgical management method. However, the relative rarity of the condition and the large number of techniques make such a study difficult.
Assuntos
Traumatismos da Perna/cirurgia , Procedimentos Ortopédicos/métodos , Traumatismos dos Tendões/cirurgia , Adolescente , Adulto , Humanos , Masculino , Recuperação de Função Fisiológica/fisiologiaRESUMO
Muscle injuries are frequent in athletes. Despite their high incidence, advances in clinical diagnostic criteria and imaging, their optimal management and rehabilitation strategies are still debated in literature. Furthermore, reinjury rate is high after a muscle lesion, and an improper treatment or an early return to sports can increase the rate of reinjury and complications. Most muscle injuries are managed conservatively with excellent results, and surgery is normally advocated only for larger tears. This article reviews the current literature to provide physicians and rehabilitation specialists with the necessary basic tools to diagnose, classify and to treat muscle injuries. Based on anatomy, biomechanics, and imaging features of muscle injury, the use of a recently reported new classification system is also advocated.
RESUMO
PURPOSE: To report the middle to long-term results of ultrasound-guided percutaneous longitudinal tenotomy of the Achilles tendon METHOD: Seventy-five athletes with unilateral Achilles tendinopathy underwent ultrasound-guided percutaneous longitudinal tenotomy under local anesthetic infiltration after failure of conservative management. Sixty-three patients were reviewed at least 36 months after the operation (51 +/- 18.2 months). RESULTS: Thirty-five patients were rated excellent, 12 good, 9 fair, and 7 poor. Nine of the 16 patients with a fair or poor result underwent a formal exploration of the Achilles tendon 7-12 months after the index procedure. The operated tendons remained thickened and the ultrasonographic appearance of operated tendons remained abnormal even 8 yr after the operation, without interfering with physical training. Isometric maximal muscle strength and isometric endurance gradually returned to values similar to their contralateral unoperated tendon. CONCLUSIONS: Percutaneous longitudinal ultrasound-guided internal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, does not hinder further surgery should it be unsuccessful, and, in our experience, has produced no significant complications. It should be considered in the management of chronic Achilles tendinopathy after failure of conservative management. However, patients should be advised that, if they suffer from diffuse or multinodular tendinopathy or from pantendinopathy, a formal surgical exploration with stripping of the paratenon and multiple longitudinal tenotomies may be preferable.
Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/cirurgia , Tendão do Calcâneo/diagnóstico por imagem , Adolescente , Adulto , Procedimentos Cirúrgicos Ambulatórios , Feminino , Seguimentos , Humanos , Contração Isométrica , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tendinopatia/diagnóstico por imagem , Tendinopatia/etiologia , Tendinopatia/cirurgia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
PURPOSE: To ascertain whether there are differences in the histopathological appearance of tendinopathic Achilles and patellar tendons. METHODS: In males, we studied biopsies from tendinopathic Achilles (N = 28; average age 34.1 yr) and patellar tendons (N = 28; average age 32.1), Achilles tendons (N = 21; average age 61.8 yr) from deceased patients with no known tendon pathology, and patellar tendons (N = 15; average age 28.3) from patients undergoing anterior cruciate ligament reconstruction. Hematoxylineosin stained slides were interpreted using a semiquantitative grading scale (0: normal to 3: maximally abnormal) for fiber structure, fiber arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinization. All slides were assessed blindly twice, the agreement between two readings ranging from 0.170 to 0.750 (kappa statistics). RESULTS: The highest mean score of tendinopathic Achilles tendons was not significantly different from that of tendinopathic patellar tendons (11.6 +/- 5 and 10.4 +/- 3, respectively). The ability to differentiate between an Achilles tendon and a patellar tendon was low. CONCLUSIONS: Tendinopathic Achilles and patellar tendons show a similar histological picture. It was not possible to identify whether a specimen had been harvested from an Achilles or a patellar tendon on the basis of histological examination. The general pattern of degeneration was common to both tendinopathic Achilles and patellar tendons. A common, as yet unidentified, etiopathological mechanism may have acted on both these tendon populations.
Assuntos
Tendão do Calcâneo/patologia , Patela/patologia , Traumatismos dos Tendões/patologia , Tendões/patologia , Adolescente , Adulto , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Recalcitrant calcific insertional Achilles tendinopathy is difficult to treat. HYPOTHESIS: Bursectomy, excision of the distal paratenon, disinsertion of the tendon, removal of the calcific deposit, and reinsertion of the Achilles tendon with bone anchors is safe and effective. STUDY DESIGN: Longitudinal study. METHODS: Twenty-one patients (six women) (21 feet) (average age 46.9 +/- 6.4 years) with recalcitrant calcific insertional Achilles tendinopathy were treated surgically with removal of the calcific deposit; the Achilles tendon was reinserted with bone anchors. RESULTS: At an average follow-up of 48.4 months, one patient necessitated a further operation. Eleven patients reported an excellent result, and five a good result. The remaining five patients could not return to their normal levels of sporting activity and kept fit by alternative means. The results of the VISA-A questionnaire were markedly improved in all patients, from an average of 62.4% to 88.1%. CONCLUSIONS: We recommend disinsertion of the Achilles tendon to excise the calcific deposit fully and reinsertion of the Achilles tendon in the calcaneus with suture anchors. No patient experienced a traumatic disinsertion of the reattached tendon. However, five patients were not able to return to their original level of physical activity.
Assuntos
Tendão do Calcâneo/cirurgia , Calcinose/cirurgia , Dispositivos de Fixação Ortopédica , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/fisiopatologia , Adulto , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Radiografia , Estatísticas não Paramétricas , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/fisiopatologiaRESUMO
BACKGROUND: Multiple percutaneous longitudinal tenotomies have been successfully undertaken in runners with isolated midportion Achilles tendinopathy (nodular lesions <2.5 cm) without any sign of paratendinopathy. HYPOTHESIS: In the long term, minimally invasive multiple tenotomies allow the patient to remain involved in middle- and long-distance running. Clinical and ultrasound (US) evidence of paratendinopathy is a negative prognostic factor. STUDY DESIGN: Case series study; Level of evidence, 4. METHODS: A total of 39 patients were reviewed at an average follow-up of 17 years (range, 15-22 years) after US-guided multiple percutaneous longitudinal tenotomies for chronic Achilles tendinopathy. The Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire was completed by each patient, maximum calf circumference and isometric plantarflexion strength of the gastrocsoleus complex were measured in both the affected and contralateral legs, and functional assessment was scored by the 4-point Boyden scale. Achilles tendon changes were also assessed according to the grayscale US grading system. RESULTS: At the final follow-up, the maximum calf circumference and the strength in the operated leg were not significantly different than those measured preoperatively, but they were significantly lower than those on the contralateral side. This did not affect patients' daily or sports activities. All patients had returned to their preinjury working occupation; 20 patients were still active in middle- and long-distance running, with an average current level of sport and function that was 60% ± 13% compared with baseline status (before onset of symptoms). Thirty of 39 patients (77%) reported good or excellent outcomes according to the Boyden assessment. On US assessment, the tendon was generally thicker than the contralateral asymptomatic tendon (average, 7.0 vs 8.7 mm, respectively; P = .003). There was no significant difference (P > .05) when comparing patients with good or excellent Boyden results versus those with fair or poor outcomes. The mean VISA-A score was 78.5, with no significant difference between patients with and without paratendinopathy on US assessment (P > .05). All of the patients who did not return to running or who gave up sports activities had signs of paratendinopathy. CONCLUSION: This approach to the management of midportion Achilles tendinopathy is safe, has a low cost, and is effective in the long term.
Assuntos
Tendão do Calcâneo/cirurgia , Tendinopatia/cirurgia , Adulto , Antropometria , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Força Muscular , Recuperação de Função Fisiológica , Corrida/fisiologiaRESUMO
BACKGROUND: Lateral ankle sprains may result in pain and disability in the short term, decreased sport activity and early retirement from sports in the mid term, and secondary injuries and development of early osteoarthritis to the ankle in the long term. HYPOTHESIS: This combined approach to chronic lateral instability and intra-articular lesions of the ankle is safe and in the long term maintains mechanical stability, functional ability, and a good level of sport activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We present the long-term outcomes of 42 athletes who underwent ankle arthroscopy and anterior talofibular Broström repair for management of chronic lateral ankle instability. We assessed in all patients preoperative and postoperative anterior drawer test and side-to-side differences, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Kaikkonen grading scales. Patients were asked about return to sport and level of activity. Patients were also assessed for development of degenerative changes to the ankle, and preoperative versus postoperative findings were compared. RESULTS: Thirty-eight patients were reviewed at an average of 8.7 years (range, 5-13 years) after surgery; 4 patients were lost to follow-up. At the last follow-up, patients were significantly improved for ankle laxity, AOFAS scores, and Kaikkonen scales. The mean AOFAS score improved from 51 (range, 32-71) to 90 (range, 67-100), and the mean Kaikkonen score improved from 45 (range, 30-70) to 90 (range, 65-100). According to outcome criteria set preoperatively, there were 8 failures by the AOFAS score and 9 by the Kaikkonen score. Twenty-two (58%) patients practiced sport at the preinjury level, 6 (16%) had changed to lower levels but were still active in less demanding sports (cycling and tennis), and 10 (26%) had abandoned active sport participation although they still were physically active. Six of these patients did not feel safe with their ankle because of the occurrence of new episodes of ankle instability. Of the 27 patients who had no evidence of degenerative changes preoperatively, 8 patients (30%) had radiographic signs of degenerative changes (5 grade I and 3 grade II) of the ankle; 4 of the 11 patients (11%) with preexisting grade I changes remained unchanged, and 7 patients (18%) had progressed to grade II. No correlation was found between osteoarthritis and status of sport activity (P = .72). CONCLUSION: Combined Broström repair and ankle arthroscopy are safe and allow most patients to return to preinjury daily and sport activities.
Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Adolescente , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Artroscopia/métodos , Feminino , Seguimentos , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico por imagem , Masculino , Radiografia , Estudos Retrospectivos , Adulto JovemRESUMO
Muscle injuries are frequent in high demand sports. No guidelines are available in the scientific literature. ISMuLT, the "Italian Society of Muscles, Ligaments and Tendons", in line with its multidisciplinary mission, is proud to cover this gap.
RESUMO
BACKGROUND: Chronic tears of the Achilles tendon with a tendon gap exceeding 6 cm are a surgical challenge. The purpose of this study is to report the long-term results of reconstruction of such chronic Achilles tendon ruptures with use of a free autologous gracilis tendon graft. METHODS: Twenty-one patients underwent reconstruction of a chronic rupture of the Achilles tendon. Fifteen patients were available for clinical and functional assessment on the basis of anthropometric measurements, isometric strength testing, and the Achilles Tendon Total Rupture Score after a mean duration of follow-up of 10.9 years (range, eight to twelve years). RESULTS: All fifteen patients were able to walk on the tiptoes, and no patient used a heel lift or walked with a visible limp. At an average of 10.9 years of follow-up, the maximum calf circumference of the operatively treated leg remained substantially decreased and the operatively treated limb was significantly weaker than the contralateral, normal limb. Two patients had developed tendinopathy of the contralateral Achilles tendon, one had developed tendinopathy of the reconstructed tendon, and one had ruptured the contralateral Achilles tendon eight years after the index tear. CONCLUSIONS: The long-term results of treatment of chronic tears of the Achilles tendon with free gracilis tendon grafting showed that patients retained good functional results despite permanently impaired ankle plantar flexion strength and decreased calf circumference.
Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Transferência Tendinosa/métodos , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Medição da Dor , RupturaRESUMO
BACKGROUND: Chronic tears of the Achilles tendon can result in substantial loss of function. Those tears with a tendon gap of up to 6.5 cm can be treated surgically with use of an autologous peroneus brevis tendon graft. METHODS: At an average follow-up period of 15.5 years after the surgery, we examined sixteen of twenty-two patients who had undergone peroneus brevis tendon graft reconstruction for a chronic Achilles tendon tear. Clinical and functional assessment was performed. RESULTS: All sixteen patients were able to walk on tiptoe, and no patient used a heel lift or walked with a visible limp. The maximum calf circumference of the involved limb remained significantly decreased. The involved limb was significantly less strong than the contralateral one. One patient had developed a tendinopathy of the opposite Achilles tendon, one had developed a tendinopathy of the reconstructed tendon, and one had ruptured the contralateral Achilles tendon five years after the original injury. CONCLUSIONS: The long-term results of treatment of chronic tears of the Achilles tendon by means of autologous peroneus brevis tendon grafting are encouraging. Patients retain good functional results despite permanently impaired ankle plantar flexion strength and decreased calf circumference.
Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Satisfação do Paciente , Complicações Pós-Operatórias , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
BACKGROUND: Several reconstruction procedures have been proposed to manage recurrent dislocation of the superior tibiofibular joint. HYPOTHESIS: Reconstruction of the superior tibiofibular joint using a gracilis tendon autograft is effective in recurrent dislocation of the superior tibiofibular joint. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eight patients with recurrent dislocation of the superior tibiofibular joint without anatomical predisposing factors and who practiced sports were included in the study. Evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry. RESULTS: The average follow-up was 44 ± 13 months. The mean modified Cincinnati score increased from 54 preoperatively to 92 (P = .01). The mean Kujala scores increased from 48 preoperatively to 85 (P = .05). The muscle volume of the thigh of the operated limb remained less well developed than the muscle volume of the nonoperated limb (P = .05). Significant isokinetic strength differences were found between the operated and the contralateral limb (P = .02) even at the latest follow-up. CONCLUSION: Gracilis autograft for posttraumatic instability of the superior tibiofibular joint is a safe, reliable management option for recurrent dislocation of the superior tibiofibular joint in patients without any predisposing factors.
Assuntos
Instabilidade Articular/cirurgia , Luxação do Joelho/cirurgia , Articulação do Joelho , Procedimentos Ortopédicos/métodos , Tendões/transplante , Transplante Autólogo/instrumentação , Adulto , Traumatismos em Atletas/cirurgia , Feminino , Fíbula/lesões , Indicadores Básicos de Saúde , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/prevenção & controle , Luxação do Joelho/etiologia , Luxação do Joelho/prevenção & controle , Masculino , Contração Muscular , Força Muscular , Músculo Esquelético/fisiologia , Procedimentos Ortopédicos/instrumentação , Procedimentos de Cirurgia Plástica/instrumentação , Procedimentos de Cirurgia Plástica/métodos , Recidiva , Estudos Retrospectivos , Estatísticas não Paramétricas , Tíbia/lesões , Fatores de Tempo , Transplante Autólogo/métodos , Ferimentos e Lesões/complicações , Adulto JovemRESUMO
BACKGROUND: Recurrent patellar dislocations are common injuries in children and adolescents. The subjective and functional results of soft tissue surgical management in a population that was skeletally immature at the time of surgery have not been reported. HYPOTHESIS: The 3-in-1 procedure is an effective treatment for recurrent patellar dislocation in skeletally immature patients. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty-five skeletally immature patients (age at operation, 13.5 +/- 3.8 years) who were practicing sports and suffering from recurrent unilateral patellar dislocation were included in the study and followed until skeletal maturation. Clinical evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry. RESULTS: The average follow-up was 3.8 years (range, 2.5-6 years). The mean modified Cincinnati score increased from 51.7 +/- 12.6 preoperatively to 94.3 +/- 10.8 (P < .02), while the mean Kujala scores increased from 52.4 +/- 12.7 preoperatively to 93.8 +/- 14.2 (P < .02). The Insall-Salvati index remained essentially unchanged, being 1.04 +/- 0.2 preoperatively and 1.02 +/- 0.3 at latest follow-up. Significant differences were found between the operated and the contralateral limb in the various isokinetic strength variables at all angular velocities measured at the latest follow-up (.05 < P < .0042). CONCLUSION: The 3-in-1 procedure is a safe, reliable management option for recurrent patellar dislocation in skeletally immature patients. Side-to-side differences in isokinetic strength and in anthropometric indices persist despite subjective success of the procedure.
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Luxação do Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Patela/fisiopatologia , Adolescente , Criança , Feminino , Humanos , Luxação do Joelho/fisiopatologia , Luxação do Joelho/prevenção & controle , Masculino , Prevenção Secundária , EsportesRESUMO
BACKGROUND: Several medial patellofemoral ligament reconstruction procedures have been proposed to manage recurrent patellar dislocation. HYPOTHESIS: Reconstruction of the medial patellofemoral ligament using a hamstring graft with a 2 transverse patellar tunnels technique is an effective treatment for recurrent patellar dislocation in patients without any evident predisposing factors. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty-eight patients with chronic patellar instability without any anatomic predisposing factors, experiencing recurrent unilateral patellar dislocation, were included in the study. Evaluation included the modified Cincinnati and the Kujala scores, anthropometry, plain radiography, and isokinetic dynamometry. RESULTS: The average follow-up was 3.1 years (range, 2.5-4 years). The mean modified Cincinnati score increased from 52 preoperatively to 89 (P = .001). The mean Kujala scores increased from 45 preoperatively to 83 (P = .03). The muscle volume of the thigh of the operated limb increased with time, but remained less well developed than the nonoperated limb (P = .04). The mean Insall-Salvati index was 1.1 (range, 0.9-1.2) preoperatively and remained within normal range (1.1 [range, 0.9 to 1.2]) (P = .07), at latest follow-up. Significant isokinetic strength differences were found between the operated and the contralateral limbs (.05 < P < .006), even at the latest follow-up. Three patients experienced a new patellar dislocation. CONCLUSION: Medial patellofemoral ligament reconstruction using hamstring tendon passed through a double patellar transverse bony tunnel technique is a safe, reliable management option for recurrent patellar dislocation in patients without any predisposing anatomic factors.
Assuntos
Enxerto Osso-Tendão Patelar-Osso/métodos , Ligamento Colateral Médio do Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Luxação Patelar/cirurgia , Adulto , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Adulto JovemRESUMO
OBJECTIVE: To report the outcome of surgery for chronic recalcitrant Achilles tendinopathy in nonathletic and athletic subjects. DESIGN: Case-control study. SETTING: University teaching hospitals. PATIENTS: We matched each of the 61 nonathletic patients with a diagnosis of tendinopathy of the Achilles tendon with an athletic patient with tendinopathy of the main body of the Achilles tendon of the same sex and age (+/-2 years). A match was possible for 56 patients (23 males and 33 females). Forty-eight nonathletic subjects and 45 athletic subjects agreed to participate. INTERVENTIONS: Open surgery for Achilles tendinopathy. MAIN OUTCOME MEASURE: Outcome of surgery, return to sport, complication rate. RESULTS: Nonathletic patients were shorter and heavier than athletic patients. They had greater body mass index, calf circumference, side-to-side calf circumference differences, and subcutaneous body fat than athletic patients. Of the 48 nonathletic patients, 9 underwent further surgery during the study period, and only 25 reported an excellent or good result. Of the 45 athletic subjects, 4 underwent further surgery during the study period, and 36 reported an excellent or good result. The remaining patients could not return to their normal levels of activity. In all of them, pain significantly interfered with daily activities. CONCLUSIONS: Nonathletic subjects experience more prolonged recovery, more complications, and a greater risk of further surgery than athletic subjects with recalcitrant Achilles tendinopathy.
Assuntos
Tendão do Calcâneo/cirurgia , Aptidão Física/fisiologia , Recuperação de Função Fisiológica/fisiologia , Tendinopatia/reabilitação , Tendinopatia/cirurgia , Tendão do Calcâneo/patologia , Tendão do Calcâneo/fisiologia , Antropometria , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Inquéritos e Questionários , Tendinopatia/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate sensitivity, specificity, reproducibility, and predictive value of palpation of the painful arc sign and of the Royal London Hospital test in 10 patients with Achilles tendinopathy and in 14 asymptomatic subjects. DESIGN: Test-retest study. SETTING: University teaching hospital. PARTICIPANTS: Ten male athletes on the waiting list for exploration of one of their Achilles tendons for tendinopathy of the main body of the tendon attended a special clinic. Each was invited to bring at least one athlete of the same sex in the same discipline aged within 2 years of themselves with no history and no symptoms of Achilles tendinopathy. A total of 14 controls were thus recruited. MAIN OUTCOME MEASURES: Pain and tenderness following performance of palpation, the painful arc sign, and the Royal London Hospital test. RESULTS: There were no statistically significant differences at the 5% level among the effects of investigator or between morning and afternoon measurements for any of the three measurement methods. There was no evidence of a difference of the three assessment methods (p > 0.05). When the three methods were combined, the overall sensitivity was 0.586 (confidence interval [CI], 0.469-0.741), and the overall specificity was 0.833 (CI, 0.758-0.889). CONCLUSIONS: In patients with tendinopathy of the Achilles tendon with a tender area of intratendinous swelling that moves with the tendon and whose tenderness significantly decreases or disappears when the tendon is put under tension, a clinical diagnosis of tendinopathy can be formulated, with a high positive predictive chance that the tendon will show ultrasonographic and histologic features of tendinopathy.
Assuntos
Tendão do Calcâneo , Tendinopatia/diagnóstico , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Tendinopatia/diagnóstico por imagem , Tendinopatia/patologia , UltrassonografiaRESUMO
We compared the efficacy of conservative management of de Quervain's disease in 30 women postpartum (group 1) and 30 nonpregnant women (group 2). All patients underwent conservative management consisting of 2 weeks of splinting of the affected wrist, followed by physiotherapy and antiinflammatory drugs (NSAIDs). Clinical evaluation was performed using a functional score and the visual analogue scale (VAS) of Scott-Huskinson at entry to the study, 1 month later, and at a follow-up of 6 months. Conservative management gave good results in patients in group 1. At the 6-month follow-up a significant difference between the two groups on pain and function was evident. Only one patient in group 1 versus 25 patients in group 2 underwent surgery because of failure of conservative management.