RESUMO
PURPOSE: The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientific evidence and the clinical experience of knee experts. METHODS: Three groups of surgeons and scientists elaborated and ratified the so-called formal consensus process to define the recommendations for the management of traumatic meniscus tears. A traumatic meniscus tear was defined as a tear with an acute onset of symptoms caused by a sufficient trauma. The expert groups included a steering group of eight European surgeons and scientists, a rating group of another nineteen European surgeons, and a peer review group. The steering group prepared twenty-seven question and answer sets based on the scientific literature. The quality of the answers received grades of A (a high level of scientific support), B (scientific presumption), C (a low level of scientific support) or D (expert opinion). These question and answer sets were then submitted to and evaluated by the rating group. All answers were scored from 1 (= totally inappropriate) to 9 (= totally appropriate) points. Thereafter, the comments of the members of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the finalized question and answer sets were submitted for final review by the peer review group composed of representatives of the ESSKA-affiliated national societies. Eighteen representatives replied. RESULTS: The review of the literature revealed a rather low scientific quality of studies examining the treatment of traumatic meniscus tears. Of the 27 questions, only one question received a grade of A (a high level of scientific support), and another received a grade of B (scientific presumption). The remaining questions received grades of C and D. The mean rating of all questions by the rating group was 8.2 (95% confidence interval 8.1-8.4). A general agreement that MRI should be performed on a systematic basis was not achieved. However, MRI was recommended when arthroscopy would be considered to identify concomitant pathologies. In this case, the indication for MRI should be determined by a musculoskeletal specialist. Based on our data, stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears. When repair is required, surgery should be performed as early as possible. Evidence that biological enhancement such as needling or the application of platelet-rich plasma would improve healing was not identified. Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair. DISCUSSION: The consensus was generated to present the best possible recommendations for the treatment of traumatic meniscus tears and provides some groundwork for a clinical decision-making process regarding the treatment of meniscus tears. Preservation of the meniscus should be the first line of treatment when possible, because the clinical and radiological long-term outcomes are worse after partial meniscectomy than after meniscus preservation. The consensus clearly states that numerous meniscus tears that were considered irreparable should be repaired, e.g., older tears, tears in obese patients, long tears, etc. LEVEL OF EVIDENCE: II.
Assuntos
Artroscopia/métodos , Consenso , Imageamento por Ressonância Magnética/métodos , Meniscectomia/métodos , Meniscos Tibiais/cirurgia , Lesões do Menisco Tibial/cirurgia , Humanos , Meniscos Tibiais/diagnóstico por imagem , Ruptura , Lesões do Menisco Tibial/diagnósticoRESUMO
The Orthokine product used in the trial was donated by the manufacturer.
RESUMO
The aim of this prospective, randomised study was to measure and evaluate regional bone mineral changes and clinical results following the use of cemented and cementless hemiarthroplasty (HA) for treatment of femoral neck fracture in elderly patients. The study comprised 60 patients, 30 with cemented HA (group A) and 30 with cementless HA (group B). All patients underwent osteodensitometry of the contralateral hip, lumbar spine and bilateral distal femur. Dual-energy x-ray absorptiometry (DEXA) was scheduled at 1 month, 6 months and 1 year after surgery. Harris Hip Score (HHS) was used for functional assessment. Overall mortality rate was 20.3% within 1 year after surgery. There were no significant differences in morbidity, mortality and hospital stay between the two groups of patients. The implantation of cemented prosthesis took statistically significantly longer than that of cementless prosthesis (79.03±3.59 vs 68.02±5.97min; p=0.00). Functional score in patients treated with cemented HA was significantly higher compared with those with cementless HA. There was a trend of less intensive reduction of bone mineral density (BMD) in regions of interest of the lumbar spine and ipsilateral distal femur in patients with cemented HA (group A), whereas bone loss was less pronounced for the contralateral hip and distal femur in patients treated with cementless HA (group B). Management of displaced femoral neck fractures in elderly patients with cemented and cementless HA provides a comparable outcome with regard to morbidity and mortality; however, functional outcome of patients treated with cementless HA tends to be lower. There is less intensive BMD reduction in lumbar spine and ipsilateral distal femur in patients treated with cemented HA, whereas BMD reduction in patients treated with cementless HA is more likely to be less intensive in contralateral hip and distal femur.
Assuntos
Absorciometria de Fóton , Cimentos Ósseos/uso terapêutico , Cimentação/estatística & dados numéricos , Fraturas do Colo Femoral/diagnóstico por imagem , Hemiartroplastia , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Croácia/epidemiologia , Feminino , Fraturas do Colo Femoral/patologia , Fraturas do Colo Femoral/cirurgia , Seguimentos , Hemiartroplastia/efeitos adversos , Hemiartroplastia/métodos , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Complex tibial plateau fractures are most commonly caused by high-energy trauma and they are often associated with severe soft tissue injuries that can frequently result in severe complications. Ilizarov external circular fixation is an ideal method of treatment for high- energy fractures of the tibial plateau when extensive soft tissue dissection and internal fixation are contraindicated. Our research included 50 consecutive patients and clinical features of the patients were evaluated during the follow up period using the following instruments: Gustillo-Anderson, Sc- hatzker and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/ OTA) classification methods. Bony results were evaluated using the Association of the Study and Application of the Method ofIlizarov (ASAMI) protocol. The mean functional recovery scores were obtained by the modified functional evaluation system of Karlstrom-Olerud. All fractures healed successfully. Circular fixators could be removed without anesthesia for type IV fractures at 16 weeks (range 12-21) and for type V-VI at 18 weeks (range 15-26) after the operation. According to ASA- MI bone results, there were 39 (78%) excellent, 7 (14%) good, 3 (6%) fair results and 1 (2%) poor result. Analysis of data obtained by the Karlstrom-Olerud functional evaluation system in this study yielded a mean value of 24.7 after six months, which implies recovery. Functional recovery at 12 months after surgery revealed satisfactory recovery with a mean value of 27.7, whereas the mean sco- re of 29.8 recorded at the last evaluation suggested good functional status. The treatment of patients with open and closed multiple intra-articular fractures of proximal tibia applying Ilizarov apparatus showed good functional outcome, which had positive impact on our patients' quality of life.
Assuntos
Técnica de Ilizarov , Satisfação do Paciente , Fraturas da Tíbia/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Gravidez , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento , Cicatrização/fisiologia , Adulto JovemRESUMO
PURPOSE: Anterior knee pain (AKP) is a common complication following intramedullary nailing of tibial shaft fractures. Our aim was, by analysing the postoperative lateral knee X-rays and clinical status (VAS score), to find the best intramedullary tip position of a non protruded nail that will provide the best postoperative outcome avoiding AKP. METHODS: We evaluated the postoperative outcome of 221 patients, from the last four years, with healed fractures initially treated with intramedullary reamed nails with two or three interlocking screws proximally and distally through a medial paratendinous incision for nail entry portal. Our aim was to analyse a possible relationship between AKP according to the VAS scale, and nail position marked as a distance from tip of nail to tibial plateau (NP) and to tibial tuberosity (NT), measured postoperatively on lateral knee X-rays. RESULTS: Two groups of patients were formed on the basis of presence of pain related to AKP (the level of pain was neglected): group A were patients with pain and group B without pain. The difference between the two groups concerning NP and NT measurements appeared to be statistically significant concerning NT measurement (p < 0.05), with high accuracy according to the classification tree. CONCLUSIONS: We presume that the position of the proximal tip of the nail and its negative influence on the innervation pattern of the area dorsal to patellar tendon could be the key factor of AKP. We conclude that the symptoms of AKP will not appear if the tip of the nail position is more than 5.5 mm from the tibial plateau (NP) and more than 2.5 mm from the tibial tuberosity (NT).
Assuntos
Artralgia/prevenção & controle , Pinos Ortopédicos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Articulação do Joelho , Dor Pós-Operatória/prevenção & controle , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Artralgia/epidemiologia , Artralgia/etiologia , Parafusos Ósseos , Feminino , Seguimentos , Consolidação da Fratura , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Ligamento Patelar/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
The most frequent indication for surgical treatment of the knee is lesion of the meniscus. The "all inside" arthroscopic technique with bioresorptive material for meniscus lesion is becoming the most popular treatment. This prospective study included 10 patients with posterior meniscal horn lesion operatively treated at Sports Traumatology Department. The "all inside" technique was performed by intra-articular application of bioresorptive pins-Darts sticks or Meniscus Viper and bioresorptive string. Patients were followed up for 2-6 months postoperatively and graded according to the IKDC 2000 scale. All surgical treatments showed satisfactory results. Young patients with acute longitudinal peripheral lesion-posterior horn lesions, in the red-red or red-white meniscal zone, 1-2 centimeters long are most appropriate for this type of treatment. In these patients, this technique proved to be superior and free from the risk of neurovascular damage. For better authentication of this conclusion, additional prospective randomized studies should be performed.
Assuntos
Artroscopia/métodos , Traumatismos em Atletas/cirurgia , Técnicas de Sutura , Lesões do Menisco Tibial , Implantes Absorvíveis , Adolescente , Adulto , Feminino , Humanos , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Ruptura , Adulto JovemRESUMO
Intra-articular distal humeral fractures (DHF) present great challenge to an orthopedic-trauma surgeon. We analyzed the relationship between functional results of DHF surgical treatment and elements that can affect patient recovery. During the 5-year follow-up study, 32 patients were treated for DHF at our Trauma Department, 30 of them by surgical procedure. Functional results of surgical treatment were scored according to the Jupiter criteria. According to the A-O classification of DHF, there were 11 type A fractures, 5 type B fractures and 14 type C fractures. Postoperative complications were infections, neural lesions, inadequate healing, and instability of osteosynthesis. Analysis of functional results in patients with operated C type fractures according to different elements influencing postoperative result revealed correct healing in 74% of patients, which was statistically significantly higher than the percentage of unsatisfactory results (p < 0.05). Study results provided evidence for patient age, sex, infection, neural function preservation, successful and rigid fixation, anatomical reconstruction of articular surface, and early rehabilitation to be significant elements for successful functional recovery.
Assuntos
Lesões no Cotovelo , Fixação Interna de Fraturas , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-OperatóriasRESUMO
Our aim was to determine the possible relationship between anterior knee pain (AKP) and nail position marked as a distance from tip of nail to tibial plateau (NP) and to the tuberositas tibiae (NT). Nail position has an influence on anterior knee pain after tibial intramedullary nailing. We evaluated postoperative outcome results of 50 patients in the last 3 years with healed fractures initially treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws on both parts of the nail and with the use of medial paratendinous incision for nail entry portal. Patients marked a point on the visual analog scale (VAS) that corresponded to the level of postoperative AKP felt. Two groups of patients were formed on the basis of AKP (pain level was neglected): groups A and B, with and without pain, respectively. The difference between the two groups concerning NP measurements was statistically significant (p < 0.05), but not concerning NT measurements at the p < 0.05 level. Patients were classified by pain with high accuracy (98%) according to a classification tree. Symptoms of AKP did not appear if the tip of the nail position was more than 6.0 mm from the NP and more than 2.6 mm from the NT. However, for better evaluation of these results it will be necessary to examine a larger number of postoperative patients with AKP.
Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/efeitos adversos , Articulação do Joelho/fisiopatologia , Dor Pós-Operatória/etiologia , Fraturas da Tíbia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
PURPOSE: Pro-inflammatory cytokines play a pivotal role in osteoarthritis, as well as in bone tunnel widening after ACL reconstructive surgery. A new treatment option is to administer autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors (IGF-1, PDGF, and TGF-ß1, among others) in the liquid blood phase. The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS. METHODS: In a prospective, randomized, double-blinded, placebo-controlled trial with two parallel groups, 62 patients were treated. Bone tunnel width was measured by CT scans, while clinical efficacy was assessed by patient-administered outcome instruments (WOMAC, IKDC 2000) up to 1 year following the ACL reconstruction in patients receiving either ACS (Group A) or placebo (Group B). We compared the levels and dynamics of IL-1ß concentrations in the synovial liquid and examined the correlation between the levels of IL-1ß at three different postoperative points. RESULTS: Bone tunnel enlargement was significantly less (6 months: 8%, 12 months: 13%) in Group A than in Group B (6 months: 31%, 12 months: 38%). Clinical outcomes (WOMAC, IKDC 2000) were consistently better in patients treated with ACS at all data points and for all outcome parameters, and there were statistically significant differences in the WOMAC stiffness subscale after 1 year. The decrease in IL-1ß synovial fluid concentration was more pronounced in the ACS group, and values were lower, to a statistically significant degree, in the ACS group at day 10. CONCLUSION: The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Transfusão de Sangue Autóloga , Interleucina-1beta/metabolismo , Soro/química , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Humanos , Masculino , Placebos , Estudos Prospectivos , Amplitude de Movimento Articular , Líquido Sinovial/química , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The incidence of fifth metatarsal fracture is somewhat common in sports and can be complicated in nature. Fractures of the fifth metatarsal can occur at a number of locations. Although some of these fractures respond well to conservative treatment, others have been notoriously hard to heal, with high rates of nonunions and other complications. Foot orthotic devices are commonly used as aids in the treatment of foot problems. In our case, we considered the combined effect of the surgical treatment and application of the custom-made foot orthoses. Special attention was taken with adjustments to the orthotic devices along and beneath the affected regions of the foot for adequate pain management and quick recovery to return to normal sports activities. Requirements for computer aided design/computer aided manufacturing orthotic design and manufacturing in this case were specific and considerably different from the usual procedure.
Assuntos
Fixação Intramedular de Fraturas/métodos , Fraturas de Estresse/terapia , Ossos do Metatarso/lesões , Aparelhos Ortopédicos , Terapia Assistida por Computador/métodos , Adolescente , Basquetebol/lesões , Fraturas de Estresse/diagnóstico por imagem , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/terapia , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , RadiografiaRESUMO
Calcaneal fracture (CF) treatment results are not always satisfied. Our aim was to compare medium-term results between standardized and unstandardized protocol in treatment of displaced intra-articular CF. We evaluate experience of our Department where 50 patients with CF in last 5 years--Group X have been treated with standardized protocol, and compare their postoperative results with unstandardized treatment's effects in 50 patients with CF cured 5 years before--Group Y As based on Sanders classification, radiographic evaluation and Maryland Foot Score, postoperative results were satisfying in 100% X and 90% Y patients with intra-articular type I, in 86% X and 70% Y patients with type II, and sufficient in 75% X and 52% Y patients with type III, in 50% X and 33% Y patients with type IV. We suggest standardized protocol with operative treatment for types II, III and even for type IV of intra-articular CF.
Assuntos
Calcâneo/lesões , Fraturas Ósseas/cirurgia , Fixadores Internos/normas , Procedimentos Ortopédicos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Guias de Prática Clínica como Assunto , Radiografia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The possibility of controlling the harmful intra-articular influence of elevated interleukin (IL)-1beta synovial fluid concentration after anterior cruciate ligament (ACL) surgery could be useful. We investigated the correlation between serum and synovial fluid IL-1beta levels following ACL reconstruction. We measured IL-1beta concentration periodically in three synovial fluid and four serum samples in each of 20 patients receiving either autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and several growth factors (group A) or placebo (group B). A decrease in IL-1beta synovial fluid concentration appeared to be more pronounced in absolute terms in group A. In eight patients serum IL-1beta was detected on the 6th postoperative day. In four of them whose synovial fluid levels were over 10 pg/ml on the 6th postoperative day, serum IL-1beta was detected on the 10th postoperative day. The results were different in group B. Correlation between serum and synovial fluid IL-1beta appearance persists in patients after ACL surgery and ACS application. This study is an example of ACS influence on the ACL healing process controlling the IL-1beta levels on the basis of the serum IL-1beta detection.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Citocinas/uso terapêutico , Mediadores da Inflamação/metabolismo , Interleucina-1beta/sangue , Procedimentos de Cirurgia Plástica/métodos , Líquido Sinovial/metabolismo , Adulto , Lesões do Ligamento Cruzado Anterior , Artroscopia/métodos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Mediadores da Inflamação/análise , Injeções Intra-Articulares , Interleucina-1beta/metabolismo , Traumatismos do Joelho/tratamento farmacológico , Traumatismos do Joelho/cirurgia , Masculino , Cuidados Pós-Operatórios/métodos , Probabilidade , Estudos Prospectivos , Valores de Referência , Líquido Sinovial/química , Resultado do Tratamento , Adulto JovemRESUMO
Fractura radii loco typico (FRLT) is the fracture of the distal radius. That is the one of the most frequent fractures of locomotor system with the widest range of treatment in traumatology. Therapy depends on the stability of the fracture: nonoperative or operative. We analysed the five-year experience of our Department of Traumatology where more than 1500 patients with FRLT have been treated in the urgent surgery clinic and 126 of them were hospitalized. In our study we evaluated the results of the operative treatment and postoperative functional status of a treated wrist. According to the A-O classification, we hospitalized 36 patients with A type, 28 patients with B type, and 62 patients with C type of FRLT. We operated 80 patients. The postoperative functional status of a treated wrist was excellent or good in 64 patients and good in 16 patients. The treatment of FRLT depends on the type and the complications of the fracture and the age of the patients. Operative therapy is indicated in the unstable FRLT or after an inadequate nonoperative treatment.
Assuntos
Fratura de Colles/cirurgia , Fratura de Colles/classificação , Fratura de Colles/diagnóstico , Feminino , Fixação de Fratura , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report a case of orthotopic liver retransplantation (OLRT) in a patient who was suffering from rejection and graft failure after orthotopic liver transplantation (OLT). The patient was a 32-year old female who had diagnosed liver lesion--hepatic cirrhosis. Within two months, with presented condition as a terminal stage of her disease, she underwent the OLT and immunosuppressive postoperative management. Two months after the OLT, in the one-week period, the patient underwent two new operations because of obstructive icterus due to fulminant cholangitis and subhepatic abscess. In spite of this operative and conservative treatment the patient's condition did not improve. Because of graft failure due to bile duct necrosis, she underwent an ORLT operation and her condition is satisfactory, till now. We confirmed that the overall impact of retransplatation persists because patients undergoing elective retransplatation have significantly better prognosis than those requiring an emergency operation.