RESUMO
Operative procedures are considered the gold standard when treating delayed union or non-union of the scaphoid despite their considerable complexity and the risk of intraoperative complications. Although extracorporeal shockwave therapy has been reported as a non-invasive treatment option for non-union cases, only a few papers on delayed union or non-union of the scaphoid have been published. A 57-year-old man with delayed union of a scaphoid fracture was treated with extracorporeal shockwave therapy and showed complete bone healing with promising results two months after the start of treatment without undergoing surgery. This result indicated that extracorporeal shockwave therapy could be an option for treating delayed union of scaphoid fractures.
RESUMO
PURPOSE: To compare the postoperative rotatory knee laxity between ACL-reconstructed knees with different meniscus treatments using an electromagnetic pivot-shift measurement. METHODS: Forty-six patients with unilateral ACL reconstructions were enrolled (21 males/25 females, 25 ± 12 y.o.). Concomitant meniscus tears, if any, were repaired whenever possible during primary ACL reconstruction. At 1 year postoperatively, pivot-shift test was performed under anaesthesia during screw removal surgery and quantitatively evaluated by tibial acceleration using an electromagnetic system. The acceleration was compared between ACL-reconstructed knees with different meniscal treatments: intact, repaired and unrepaired. RESULTS: A concomitant meniscus tear was found in 28 knees preoperatively: lateral tears in 11 knees, medial tears in 11 knees and both medial and lateral tears in 6 knees. Postoperatively, 19 ACL-reconstructed knees had a repaired meniscus for either medial, lateral or bilateral menisci tears, and 18 knees had intact menisci pre- and post-operatively. Meanwhile, nine lateral meniscus tears were irreparable and treated by partial meniscectomy or left in situ. ACL-reconstructed knees with unrepaired lateral menisci had significantly larger pivot-shift acceleration (0.9 ± 0.7 m/s2) than those with intact menisci (0.5 ± 0.2 m/s2, p < 0.05), whereas rotatory knee laxity was similar between the knees with fully repaired menisci (0.6 ± 0.3 m/s2) and intact menisci (n.s.). CONCLUSION: An unrepaired lateral meniscus tear in an ACL-reconstructed knee could lead to remaining pivot-shift postoperatively. A concomitant meniscus tear should be repaired during ACL reconstruction to restore normal rotational laxity. LEVEL OF EVIDENCE: Therapeutic Study, Level III.
Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiopatologia , Meniscos Tibiais/cirurgia , Aceleração , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Parafusos Ósseos , Feminino , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Masculino , Meniscectomia/métodos , Exame Físico , Período Pós-Operatório , Lesões do Menisco Tibial/cirurgia , Adulto JovemRESUMO
PURPOSE: To compare rotational laxity in anterior cruciate ligament (ACL)-reconstructed knees retrospectively with and without concomitant anterolateral capsule (ALC) injury confirmed by magnetic resonance imaging (MRI) prior to ACL reconstruction. METHODS: Sixty-two ACL-reconstructed knees (26 men, 36 women; median age 20 (range 13-59)) were included. Pivot-shift test was performed before ACL reconstruction and 1 year postoperatively under anesthesia with both clinical grading and quantitative measurement simultaneously. Clinical grading was determined according to the International Knee Documentation Committee (IKDC) criteria (none, glide, clunk, or gross), and an electromagnetic measurement system was used to provide tibial acceleration as a quantitative parameter. The resence of concomitant ALC injury was confirmed retrospectively by MRI. The pivot-shift test was compared between ACL-reconstructed knees with and without ALC injury test for clinical grading and the independent t test for quantitative evaluation. RESULTS: ALC injury was identified in 26 of 62 (42%) knees. Before ACL reconstruction, there was no difference in the pivot-shift test results between the ACL-deficient knees with and without ALC injury in IKDC grading (n.s.) or tibial acceleration (1.1 ± 0.7 m/s2 and 1.4 ± 1.1 m/s2, respectively, n.s.). At 1 year postoperatively, no difference was observed between groups (IKDC, p = 0.90; tibial acceleration, 0.6 ± 0.3 m/s2 and 0.8 ± 0.6 m/s2, n.s.). CONCLUSIONS: Concomitant ALC injury at the time of ACL injury had no effect on the rotational laxity of the knee in the postoperative course after ACL reconstruction. Therefore, additional treatment for ALC injury may not be warranted. LEVEL OF EVIDENCE: IV.
Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Cápsula Articular/lesões , Instabilidade Articular/diagnóstico , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Seguimentos , Humanos , Cápsula Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Físico , Estudos Retrospectivos , Rotação , Adulto JovemRESUMO
PURPOSE: In clinical practice, people with better femorotibial rotation in the flexed position often achieve a favourable postoperative maximum flexion angle (MFA). However, no objective data have been reported to support this clinical observation. In the present study, we aimed to investigate the correlation between the amount of intraoperative rotation and the pre- and postoperative flexion angles. METHODS: Fifty-five patients with varus osteoarthritis undergoing computer-assisted posterior-stabilized total knee arthroplasty (TKA) were enrolled. After registration, rotational stress was applied towards the knee joint, and the rotational angles were recorded by using a navigation system at maximum extension and 90° of flexion. After implantation, rotational stress was applied for a second time, and the angles were recorded once more. The MFA was measured before surgery and 1 month after surgery, and the correlation between the amount of femorotibial rotation during surgery and the MFA was statistically evaluated. RESULTS: Although the amount of tibial rotation at maximum extension was not correlated with the MFA, the amount of tibial rotation at 90° of flexion after registration was positively correlated with the pre- and postoperative MFA (both p < 0.005). However, no significant relationship was observed between the amount of tibial rotation after implantation and the postoperative MFA (n.s.). CONCLUSION: The results showed that better femorotibial rotation at 90° of flexion is associated with a favourable postoperative MFA, suggesting that the flexibility of the surrounding soft tissues is an important factor for obtaining a better MFA, which has important clinical relevance. Hence, further evaluation of navigation-based kinematics during TKA may provide useful information on MFA. LEVEL OF EVIDENCE: Diagnostic studies, development of diagnostic criteria in a consecutive series of patients, and a universally applied "gold" standard, Level II.