Effect of the calcaneal medializing osteotomy on soft tissues supporting the plantar arch: A computational study. / Efecto de la osteotomía medializante de calcáneo sobre tejidos blandos de soporte del arco plantar: un estudio computacional.

Medializing calcaneal osteotomy forms part of the treatment options for adult acquired flat foot. The structural correction that is achieved is widely known. However, the effect of this procedure on the soft tissues that support the plantar arch has been little studied, since it is not possible to quantify experimentally the tension and deformation variations generated. Therefore, the objective of this study was to evaluate the effect of medializing calcaneal osteotomy on the soft tissue that supports the plantar arch, using a computational model of the human foot designed with a clinical approach. The proposed finite element model was reconstructed from computerized tomography images of a healthy patient. All the bones of the foot, the plantar fascia, cartilages, plantar ligaments and the calcaneus-navicular ligament were included, respecting their anatomical distribution and biomechanical properties. Simulations were performed emulating the monopodal support phase of the human walk of an adult. The effect on each tissue was evaluated according to clinical and biomechanical criteria. The results show that calcaneal osteotomy reduces the tension normally generated on the evaluated tissues, with the effect on the calcaneus-navicular ligament and the plantar fascia being the most notable. The deformation results obtained are consistent with experimental tests and clinical knowledge. The versatility of this model allows the objective assessment of different conditions and supports decision making for the treatment of adult acquired flat foot in middle and advanced stages.

[Medium-term results of arthroscopic repair of relapsing anteroinferior glenohumeral instability]. / Resultados a mediano plazo de la reparación artroscópica en la inestabilidad recidivante glenohumeral anteroinferior.

OBJECTIVES: Arthroscopic repair of Bankart lesion has become the treatment of choice of anterior shoulder instability. Our objective is to analyze the medium-term results of arthroscopic Bankart repair. MATERIAL AND METHODS: Between January 1999 and November 2007, 86 shoulders of 85 patients with diagnosis of relapsing shoulder dislocation were treated arthroscopically. After a mean 62-month follow-up (minimum 24 months) the results obtained were retrospectively assessed according the Rowe and Constant functional scales. A statistical analysis was done of the relation between functional results and age, sex, the side operated, capsulorrhaphy, rehabilitation and postoperative immobilization in our series. Moreover, the validity of MRI for diagnosing Bankart lesion was assessed. RESULTS: Eighty-five percent of patients had good or excellent results according to the Rowe scale. The mean Constant scale score was 90.6. There-dislocation rate in our series was 9%. The statistical analysis showed that female sex and immobilization time were related with worse results according to the Constant scale. CONCLUSIONS: In our hands, arthroscopic Bankart repair provides results similar to those in other published series. MRI is a useful diagnostic test in our setting, albeit its important implications for the diagnosis of Bankart lesion. Female sex and prolonged immobilization were related with worse functional results.