Acute Distal Biceps Tendon Injury: Diagnosis and Treatment.

Acute distal biceps injuries clinically present with sudden pain and acute loss of flexion and supination strength. The main injury mechanism occurs during the eccentric load of the biceps. The hook test is the most significant examination test, presenting the highest sensibility and specificity for this lesion. Magnetic resonance imaging, the gold standard imaging test, can provide information regarding integrity and identify partial and/or complete tears. The surgical treatment uses an anterior or double approach and several reattachment techniques. Although there is no clinical evidence to recommend one fixation method over the other, biomechanical studies show that the cortical button resists better to failure. Although surgical treatment led to an 89% rate of return to work in 14 weeks, the recovery of high sports performance occurred in 1 year, with unsustainable outcomes.

Acute Distal Biceps Tendon Injury: Diagnosis and Treatment / Lesões agudas do tendão distal do bíceps: Diagnóstico e tratamento

Abstract Acute distal biceps injuries clinically present with sudden pain and acute loss of flexion and supination strength. The main injury mechanism occurs during the eccentric load of the biceps. The hook test is the most significant examination test, presenting the highest sensibility and specificity for this lesion. Magnetic resonance imaging, the gold standard imaging test, can provide information regarding integrity and identify partial and/or complete tears. The surgical treatment uses an anterior or double approach and several reattachment techniques. Although there is no clinical evidence to recommend one fixation method over the other, biomechanical studies show that the cortical button resists better to failure. Although surgical treatment led to an 89% rate of return to work in 14 weeks, the recovery of high sports performance occurred in 1 year, with unsustainable outcomes.

Resumo As lesões agudas do tendão distal do bíceps se apresentam, clinicamente, com uma dor súbita associada a perda aguda de força de flexão e supinação. Seu principal mecanismo de lesão ocorre durante contração excêntrica do bíceps. O "Hook Test" é o principal teste semiológico, sendo o mais sensível e específico. A ressonância magnética, exame padrão ouro para o diagnóstico, pode fornecer informações sobre a integridade, identificando as lesões parciais e/ou completas. O tratamento cirúrgico pode ser realizado por duas vias principais: anterior e por dupla via porém as técnicas de reinserção tendínea são diversas não havendo evidência clínica que recomende um método de fixação em detrimento ao outro; embora o botão cortical apresente maior resistência a falha nos estudos biomecânicos. Com o tratamento cirúrgico o retorno as atividades laborais foi de 89% em 14 semanas (média) porém ao esporte de alto rendimento o prazo foi longo, média de 1 ano, e não duradouro.

Return to Sport and Re-Injury Rate after Double-Bundle Anterior Cruciate Ligament Reconstruction with at least Five Years of Follow-Up.

BACKGROUND: This study retrospectively evaluated the medium- and long-term results of patients submitted to double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. METHODS: A retrospective study of case series at a single center. Cases submitted to isolated ACL reconstruction with at least five years of follow-up were included. The following data were collected: demographic data; practice of competitive sport before the injury; previous surgery; injury/surgery in the contralateral knee; return to the practices of sports and level; re-injury (postoperative time; mechanism; need for surgery); and symptoms at the last clinical follow-up visit. Descriptive and sub-group analyses were performed. RESULTS: Sixty-nine patients were included; 52 men (75%), 49 athletes (71%), 47 (68%) with primary injury, mean age of 30 years (SD 10). The patients were followed up for an average of 8.7 years (minimum 5, maximum 11.8) after surgery. After the reconstruction, 67 (97%) returned to the sport; 75% at the same level as before the injury. Ten patients (14%) suffered re-injury after an average of 32 months (between 9 and 50 months). Regarding the outcome of re-injury, no statistically significant differences were found between subgroups of athletes vs non-athletes or primary injury vs revision surgery, despite a significant tendency towards increased re-injury levels in athletes. However, this tendency was not statistically significant. CONCLUSION: In our series of patients operated on with the double-bundle technique and with a long follow-up time, 14% presented re-injury, with no differences between primary and revision cases, and with a trend towards higher re-injury levels among the athletes in relation to the non-athletes. The rate of return to sport was satisfactory, with 97%, of which 75% were playing at the same level as before the injury.

Arthroscopic Latarjet: Technique Description and Preliminary Results. Study of the First 30 Cases.

Objective Arthroscopic Latarjet has been performed with the aim to be an accurate technique with a low incidence of complications. The aim of the present study was to briefly describe the technique and to evaluate the shot-term complications following arthroscopic Latarjet procedure to correct anterior shoulder dislocation with glenoid bone loss. Methods Retrospective study with 30 subjects with anterior shoulder instability, submitted to arthroscopic Latarjet. Intraoperative and short-term postoperative complications were recorded, as well as the rate of revision surgery. Results Five cases had complication (16.7%), and in the last 10 cases no complication occurred. In 1 case (3.3%), it was required to reverse for open surgery due to a fracture of the coracoid process during fixation in the glenoid. No other intraoperative complication occurred. No infection was observed. Two cases (6.7%) evolved with temporary neuropraxia of the musculocutaneous nerve, totally reversed with physiotherapy. With a follow-up from 6 to 26 months, 2 patients (6.7%) required a new intervention for graft/screws removal and release of the joint due to excessive limitation in external rotation. There was no case of recurrence. Conclusion Even in an initial learning curve, arthroscopic Latarjet demonstrated a low rate of short-tem complications and was a safe procedure for treating anterior dislocation of the shoulder with glenoid bone loss.

Arthroscopic Latarjet: Technique Description and Preliminary Results. Study of the First 30 Cases / Latarjet artroscópico: Descrição de técnica cirúrgica e resultados preliminares. Estudo de 30 primeiros casos

Abstract Objective Arthroscopic Latarjet has been performed with the aim to be an accurate technique with a low incidence of complications. The aim of the present study was to briefly describe the technique and to evaluate the shot-term complications following arthroscopic Latarjet procedure to correct anterior shoulder dislocation with glenoid bone loss. Methods Retrospective study with 30 subjects with anterior shoulder instability, submitted to arthroscopic Latarjet. Intraoperative and short-term postoperative complications were recorded, as well as the rate of revision surgery. Results Five cases had complication (16.7%), and in the last 10 cases no complication occurred. In 1 case (3.3%), it was required to reverse for open surgery due to a fracture of the coracoid process during fixation in the glenoid. No other intraoperative complication occurred. No infection was observed. Two cases (6.7%) evolved with temporary neuropraxia of the musculocutaneous nerve, totally reversed with physiotherapy. With a follow-up from 6 to 26 months, 2 patients (6.7%) required a new intervention for graft/screws removal and release of the joint due to excessive limitation in external rotation. There was no case of recurrence. Conclusion Even in an initial learning curve, arthroscopic Latarjet demonstrated a low rate of short-tem complications and was a safe procedure for treating anterior dislocation of the shoulder with glenoid bone loss.

Resumo Objetivo A realização da cirurgia de Latarjet por via artroscópica tem sido possível pelo desenvolvimento de instrumentais adequados e um protocolo para cirurgia estabelecido e reprodutível, que promete uma técnica mais precisa e com menor incidência de complicações. O objetivo do presente estudo foi fazer uma breve descrição de técnica cirúrgica e avaliar as complicações de curto prazo após a cirurgia de Latarjet por via artroscópica para correção de luxação anterior do ombro com perda óssea glenoidal. Método Estudo retrospectivo com 30 pacientes com instabilidade anterior do ombro, operados com a técnica de Latarjet por via artroscópica. Foram feitas avaliação das complicações intraoperatórias e pós-operatório de curto prazo e documentação de necessidade de reintervenções. Resultados Cinco casos tiveram complicação (16,7%), sendo que nos últimos 10 casos nenhuma complicação foi observada. Em 1 caso (3,3%) foi necessária conversão para cirurgia aberta por fratura do processo coracoide no momento de fixação na glenoide. Nenhum outro caso apresentou complicação intraoperatória. Não houve infecção nos casos operados. Dois casos (6,7%) evoluíram com neuropraxia temporária do musculocutâneo, revertida com fisioterapia. Em tempo de seguimento de 6 a 26 meses, 2 pacientes (6,7%) necessitaram de nova intervenção para retirada do material de síntese e liberação articular por excessiva limitação da rotação externa. Não houve caso de recidiva. Conclusão O procedimento de Latarjet artroscópico se mostrou seguro e com baixa incidência de complicações de curto prazo para correção da luxação anterior no ombro com perda óssea na glenoide mesmo em curva inicial de aprendizagem.

Turco's injury: diagnosis and treatment.

The aim of this study was to alert doctors to the existence of Turco's injury and discus the existing treatments that have been described in the worldwide literature. A bibliographic survey of Lisfranc's injury and Turco's injury covering from 1985 to 2013 was conducted in the SciELO and PubMed databases. Among the 193 articles, those relating to bone-ligament injuries of the Lisfranc joint and high-energy trauma were excluded, as were the case reports. The patients selected were professional or amateur athletes who solely presented a ligament injury to the Lisfranc joint (Turco's injury), which was diagnosed from the history, physical examination, radiographs and magnetic resonance images. Non-athletic patients and those with associated bone injuries were excluded (10). According to the injury classification, the patients were treated by means of either an open or a closed procedure and then a standard rehabilitation protocol. Out of the 10 patients, five underwent conservative treatment and five underwent surgical treatment using different techniques and synthesis materials. We obtained two poor results, one satisfactory, five good and two excellent. We conclude that the correct diagnosis has a direct influence on the treatment and on the final result obtained, and that lack of knowledge of this injury is the main factor responsible for underdiagnosing Turco's injury. There is a need for randomized prospective studies comparing the types of synthesis and evolution of treated cases, in order to define the best treatment for this injury.

Este trabalho tem por objetivos alertar os médicos sobre a existência da lesão de Turco e discorrer sobre os tratamentos existentes descritos na literatura mundial. Foi feito levantamento bibliográfico da lesão de Lisfranc e da lesão de Turco de 1985 a 2013 nas bases de dados Scielo e Pubmed. Dos 193 artigos, foram excluídos os com lesão osteoligamentar da articulação de Lisfranc, os por traumas de alta energia, os relatos de caso. Foram selecionados pacientes atletas profissionais ou amadores, com lesão ligamentar exclusiva da articulação de Lisfranc (lesão de Turco), a qual foi diagnosticada pela história, pelo exame físico, pelas radiografias e pela ressonância magnética. Como fatores de exclusão, pacientes não atletas e com lesões ósseas associadas (10). De acordo com a classificação da lesão, os pacientes foram tratados cruenta ou incruentamente e submetidos a um protocolo-padrão de reabilitação. Dos 10 pacientes, cinco foram submetidos a tratamento conservador e cinco a tratamento cirúrgico, por diferentes técnicas e materiais de síntese. Obtiveram-se dois resultados ruins, um satisfatório, cinco bons e dois excelentes. Concluímos que o diagnóstico correto influencia diretamente no tratamento e no resultado final obtido e que o desconhecimento da lesão é o principal responsável pelo subdiagnóstico da lesão de Turco. Há necessidade de estudos prospectivos randomizados que comparem os tipos de síntese e a evolução dos casos tratados para uma definição do melhor tratamento para tal lesão.