RESUMO
BACKGROUND: During medial opening wedge high tibial osteotomy (MOWHTO), sometimes the plate tends to be positioned anteromedially. The plate position can affect the length of the proximal screw, which significantly affects stability after osteotomy. Therefore, research on the correlation among plate position, screw length, and clinical outcomes is needed. METHODS: This retrospective review examines 196 knees in 175 patients who underwent MOWHTO from May 2012 to December 2018, for symptomatic medial compartment osteoarthritis with a varus alignment of > 5°. We evaluated the anteroposterior plate position, length of proximal screw, and postoperative computed tomography (CT). We reviewed patients' clinical outcome scores, presence of lateral hinge fracture, neurovascular complications, and infection. The correlation among proximal plate position, proximal screw length, and clinical outcomes was evaluated using Pearson's correlation analysis. A subgroup analysis by screw angle (> 48 ° or < 48 °) was also performed using chi-square test and Student t-test. RESULTS: The mean proximal plate position was 16.28% (range, 5.17-44.74) of the proximal tibia's anterior-to-posterior distance ratio, and the proximal screw length averaged 63.8 mm (range, 44-80 mm). Proximal posteromedial plate position and proximal screw length were significantly correlated (r2 = 0.667, P < .001), as were screw angle and length (r2 = 0.746, P < .001). Medial plating (< 48°) can use a longer proximal screw; nevertheless, no significant difference occurred in clinical outcomes between the two groups. Also, no differences occurred in complication rate, including hinge fracture. CONCLUSION: With more medially positioned plating during MOWHTO, we can use longer proximal screws. However, there was no significant difference in clinical outcomes and the incidence of lateral hinge fractures regardless of plate position and screw length.
Assuntos
Fraturas Ósseas , Osteoartrite do Joelho , Humanos , Placas Ósseas , Parafusos Ósseos/efeitos adversos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Tíbia/diagnóstico por imagem , Tíbia/cirurgiaRESUMO
PURPOSE: To compare the clinical, radiographic, and second-look arthroscopic outcomes between double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (DB group) and combined single-bundle (SB) ACL and anterolateral ligament (ALL) reconstruction (SB + ALL group) by a prospective randomized controlled trial. METHODS: From May 2019 to June 2020, 84 patients were enrolled in this study. Among them, 10 were lost to follow-up. Thirty-six and 38 patients were successfully allocated to the DB (mean follow up 27.3 ± 4.2 months) and SB + ALL groups (27.2 ± 4.5 months), respectively. The preoperative and postoperative Lachman test, pivot shift test, anterior translation on stress radiographs, KT-2000 arthrometer, Lysholm score, International Knee Documentation Committee score, and Tegner activity score were evaluated and compared. Graft continuity was evaluated using postoperative magnetic resonance imaging (MRI) (32 and 36 patients underwent MRI in the DB and SB + ALL groups at 7.4 ± 3.2 and 7.5 ± 2.9 months after surgery, respectively), and second-look examinations (second-look examination and tibial screw removal were performed concomitantly when patients (1) had tibial screw-related irritation or (2) needed the screws removed, 28 and 23 patients underwent examinations in the DB and SB + ALL groups at 24.0 ± 6.8 and 24.9 ± 8.1 months after surgery, respectively). All measurements were compared between the groups. RESULTS: Postoperative clinical outcomes significantly improved in both groups. (All variables showed P < .001) No statistically different outcomes were found between the 2 groups. Additionally, postoperative graft continuity on MRI and second-look examinations were not different between the 2 groups. CONCLUSIONS: The DB and SB + ALL groups showed similar postoperative clinical, radiographic, and second-look arthroscopic outcomes. Both groups showed excellent postoperative stability and clinical outcomes compared with the preoperative measurements. LEVEL OF EVIDENCE: Level II, randomized controlled trial.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Humanos , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Seguimentos , Estudos Prospectivos , Resultado do Tratamento , Articulação do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodosRESUMO
PURPOSE: This study aimed to evaluate the infection control rate of palliative arthroscopic debridement, antibiotics, and implant retention (DAIR) for the high mortality risk or terminal cancer stage patients. METHODS: From March 2018 to August 2021, 21 patients met the following inclusion criteria: old age of more than 80, diagnosed as a terminal stage of cancer, high risk of mortality and morbidity representing as Charlson comorbidity index (CCI) ≥ 5, low daily activity with disabled extremity, and re-infection after two-stage revision. Each patient underwent arthroscopic DAIR and additional continuous irrigation for 48 hours. The need for subsequent re-arthroscopic DAIR or two-stage revision was determined by the post-operative trends of C-reactive protein (CRP) levels. Infection control was defined as continuing controlled status of infection based on clinical and laboratory results by one or two times of arthroscopic DAIR within initial two months. Treatment failure was defined as more than three times arthroscopic debridement, two-stage revision surgery, or expired due to uncontrolled infection. RESULTS: Arthroscopic DAIR controlled the infection in 19 (90.5%) of the 21 cases. The other knee underwent a total of three times of re-arthroscopic DAIR and the other one underwent two-stage revision. Although five patients expired during the follow-up period due to worsening medical problems or terminal cancer, there were no deaths from uncontrolled infection, sepsis, or surgery-related complications. CONCLUSIONS: Arthroscopic debridement with continuous irrigation for the infection TKA with high mortality risk or terminal cancer patients showed a 90.5% infection control rate. For high-risk patients, arthroscopic debridement with continuous irrigation can be an alternative treatment to improve the quality of life during survival.
Assuntos
Artroplastia do Joelho , Infecções Relacionadas à Prótese , Humanos , Artroplastia do Joelho/efeitos adversos , Desbridamento/efeitos adversos , Desbridamento/métodos , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Antibacterianos/uso terapêutico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia , Infecções Relacionadas à Prótese/diagnósticoRESUMO
Osteoarthritis (OA) has generally been introduced as a degenerative disease; however, it has recently been understood as a low-grade chronic inflammatory process that could promote symptoms and accelerate the progression of OA. Current treatment strategies, including corticosteroid injections, have no impact on the OA disease progression. Mesenchymal stem cells (MSCs) based therapy seem to be in the spotlight as a disease-modifying treatment because this strategy provides enlarged anti-inflammatory and chondroprotective effects. Currently, bone marrow, adipose derived, synovium-derived, and Wharton's jelly-derived MSCs are the most widely used types of MSCs in the cartilage engineering. MSCs exert immunomodulatory, immunosuppressive, antiapoptotic, and chondrogenic effects mainly by paracrine effect. Because MSCs disappear from the tissue quickly after administration, recently, MSCs-derived exosomes received the focus for the next-generation treatment strategy for OA. MSCs-derived exosomes contain a variety of miRNAs. Exosomal miRNAs have a critical role in cartilage regeneration by immunomodulatory function such as promoting chondrocyte proliferation, matrix secretion, and subsiding inflammation. In the future, a personalized exosome can be packaged with ideal miRNA and proteins for chondrogenesis by enriching techniques. In addition, the target specific exosomes could be a gamechanger for OA. However, we should consider the off-target side effects due to multiple gene targets of miRNA.
Assuntos
Exossomos/transplante , Células-Tronco Mesenquimais/citologia , MicroRNAs/genética , Osteoartrite/terapia , Animais , Diferenciação Celular , Condrogênese , Progressão da Doença , Exossomos/genética , Humanos , Células-Tronco Mesenquimais/metabolismo , Osteoartrite/imunologia , Comunicação Parácrina , RegeneraçãoRESUMO
Background and Objectives: Intraarticular injection of tranexamic acid (IA-TXA) plus drain-clamping is a preferred method of reducing bleeding after total knee arthroplasty (TKA). However, no consensus has been reached regarding the timing of the clamping. The purpose of this study was to determine the optimum duration of drain-clamping after TKA with IA-TXA. Materials and Methods: We retrospectively reviewed 151 patients that underwent unilateral TKA with IA-TXA plus drain-clamping for 30 min, 2 h, or 3 h. The total drained volume was reviewed as the primary outcome, and hematocrit (Hct) reductions, estimated blood loss (EBL), transfusion rates, and wound complications were reviewed as secondary outcomes. Results: The mean total drained volume, Hct reduction, and EBL were significantly less in the 3 h group than in the 30 min group. Between the 2 h and 3 h groups, there was no statistical difference in the mean total drained volume, Hct reduction, or EBL. The proportion of patients who drained lesser than 300 mL was high in the 3 h group. No significant intergroup difference was observed for transfusion volume, transfusion rate, and wound related complications. Conclusions: In comparison of the IA-TXA plus drain-clamping after TKA, there was no difference in EBL between the 2 h group and the 3 h group, but the amount of drainage volume was small in the 3 h group.
Assuntos
Antifibrinolíticos , Artroplastia do Joelho , Ácido Tranexâmico , Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica , Constrição , Drenagem/métodos , Humanos , Injeções Intra-Articulares , Hemorragia Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Ácido Tranexâmico/uso terapêuticoRESUMO
BACKGROUND: With the developments in the arthroscopic technique, anterior cruciate ligament (ACL) remnant-preserving reconstruction is gradually gaining attention with respect to improving proprioception and enhancing early revascularization of the graft. To evaluate the mechanical pull-out strength of three different methods for remnant-preserving and re-tensioning reconstruction during ACL reconstruction. METHODS: Twenty-seven fresh knees from mature pigs were used in this study. Each knee was dissected to isolate the femoral attachment of ACL and cut the attachment. An MTS tensile testing machine with dual-screw fixation clamp with 30° flexion angle was used. The 27 specimens were tested after applying re-tensioning sutures with No. 0 polydioxanone (PDS), using the single stitch (n = 9), loop stitch (n = 9), and triple stitch (n = 9) methods. We measured the mode of failure, defined as (1) ligament failure (longitudinal splitting of the remnant ACL) or (2) suture failure (tearing of the PDS stitch); load-to-failure strength; and stiffness for the three methods. Kruskal-Wallis test and Mann-Whitney U-test were used to compare the variance of load-to-failure strength and stiffness among the three groups. RESULTS: Ligament failure occurred in all cases in the single stitch group and in all but one case in the triple stitch group. Suture failure occurred in all cases in the loop stitch group and in one case in the triple stitch group. The load-to-failure strength was significantly higher with loop stich (91.52 ± 8.19 N) and triple stitch (111.1 ± 18.15 N) than with single stitch (43.79 ± 11.54 N) (p = 0.002). With respect to stiffness, triple stitch (2.50 ± 0.37 N/mm) yielded significantly higher stiffness than the other methods (p = 0.001). CONCLUSIONS: The results suggested that loop stitch or triple stitch would be a better option for increasing the mechanical strength when applying remnant-preserving and re-tensioning reconstruction during ACL reconstruction.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Animais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/cirurgia , SuínosRESUMO
BACKGROUND: With the development of health care-related mobile apps, attempts have been made to implement remote patient-reported outcome measures (PROMs). In order for remote PROMs to be widely used by mobile apps, the results should not be different depending on the location; that is, remote PROM results performed in locations other than hospitals should be able to obtain reliable results equivalent to those performed in hospitals, and this is very important. However, to our knowledge, there are no studies that have assessed the reliability of PROMs using mobile apps according to the location by comparing the results performed remotely from the hospital and performed at the outpatient visits. OBJECTIVE: The purpose of this study was to evaluate the reliability of remote PROMs using mobile apps compared to PROMs performed during outpatient follow-up visits after arthroscopic shoulder surgery. METHODS: A total of 174 patients who underwent arthroscopic rotator cuff repair completed questionnaires 2 days before visiting the clinic for the 1-, 2-, 3-, 6-, and 12-month follow-ups (test A). The patients completed the questionnaires at the clinic (test B) using the same mobile app and device for the 1-, 2-, 3-, 6-, and 12-month follow-ups. Test-retest comparisons were performed to analyze the differences and reliability of the PROMs according to the period. RESULTS: Comparisons of tests A and B showed statistically significant differences at 1, 2, and 3 months (all Ps<.05 except for the ASES function scale at 3-months) but not 6 or 12 months after surgery (all Ps>.05). The intraclass correlation values between the two groups were relatively low at the 1-, 2-, and 3-month follow-ups but were within the reliable range at 6 and 12 months after surgery. The rate of completion of tests A and B using the mobile app was significantly lower in the group older than 70 years than in the other groups for all postoperative periods (P<.001). CONCLUSIONS: PROMs using mobile apps with different locations differed soon after surgery but were reliably similar after 6 months. The remote PROMs using mobile apps could be used reliably for the patient more than 6 months after surgery. However, it is to be expected that the use of mobile app-based questionnaires is not as useful in the group older than 70 years as in other age groups.
Assuntos
Aplicativos Móveis , Seguimentos , Humanos , Pacientes Ambulatoriais , Medidas de Resultados Relatados pelo Paciente , Reprodutibilidade dos Testes , Manguito Rotador , Resultado do TratamentoRESUMO
Medial open-wedge high tibial osteotomy is an established treatment option for relatively young patients with medial-compartment osteoarthritis and varus deformity. This procedure is mainly focused on correcting coronal malalignment; however, it inevitably affects the posterior tibial slope (PTS) in the sagittal plane. The alteration of the PTS significantly affects knee stability and kinematics. When medial open-wedge high tibial osteotomy is performed, incomplete osteotomy of the posterior cortex could lead to a cortical hinge shift from the lateral side to the posterolateral side, which indicates the alteration of the axial hinge axis. In this case, there is a risk of an increasing PTS. In addition, incomplete posterior cortex osteotomy can lead to a lateral hinge fracture.
Assuntos
Osteoartrite , Tíbia , Humanos , Articulação do Joelho/cirurgia , Osteotomia , Próteses e Implantes , Tíbia/cirurgiaRESUMO
BACKGROUND: Actinomycosis is a rare, chronic granulomatous disease caused by Gram-positive anaerobic bacteria that colonize the oral cavity. Cervicofacial actinomycosis is the most frequent clinical presentation of actinomycosis, but hematogenous osteomyelitis at distant sites can occur in rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Here we described a new case of distal femur osteomyelitis caused by Actinomyces in an adult patient who was immunocompetent and had no predisposing factors. CASE PRESENTATION: A woman aged 52 years with no history of trauma presented with severe pain, swelling, and increased local heat in the proximal area of the right knee 3 weeks after she first noticed discomfort. Magnetic resonance imaging showed persistent osteomyelitis of the distal metaphysis and diaphysis of the femur with a multifocal intraosseous abscess pocket. An incision and drainage of the abscess were conducted. The tissue culture, fungus culture, acid fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was successfully treated with intravenous penicillin G for 8 weeks followed by oral amoxicillin-clavulanate for 6 weeks with repeated surgical debridement and drainage. After a 5-year follow up, the patient had no signs of recurring infection or complications and she had full range of movement in the affected knee. CONCLUSIONS: Although rare, actinomycotic osteomyelitis can occur in healthy people. Furthermore, actinomycotic osteomyelitis is easily misdiagnosed as tuberculosis in areas with a high prevalence of tuberculosis. To detect and identify the bacteria accurately, pathologic examination should be performed as well as culture tests, because the probability for culture confirmation of actinomycosis is quite low. The initial treatment is vital to a successful outcome without ostectomy or amputation.
Assuntos
Actinomyces/isolamento & purificação , Actinomicose/complicações , Antibacterianos/administração & dosagem , Drenagem , Osteomielite/microbiologia , Actinomyces/imunologia , Actinomicose/imunologia , Actinomicose/microbiologia , Actinomicose/terapia , Biópsia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/microbiologia , Fêmur/patologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/imunologia , Osteomielite/terapia , Resultado do TratamentoRESUMO
Injury of the medial head of the gastrocnemius, also called "tennis leg," is known to heal uneventfully in most cases with compression and immobilization therapy. Failure to heal or long-term complications, including ongoing pain and pes equinus, have been documented in only a limited number of case reports. To the best of our knowledge, a severe concomitant contracture of the knee and ankle joint as a consequence of a maltreated gastrocnemius muscle rupture has not been previously reported in English-language reports. The purpose of the present study was to report a serious complication of neglected tennis leg with a review of the published data.
Assuntos
Articulação do Tornozelo , Contratura/etiologia , Articulação do Joelho , Músculo Esquelético/lesões , Procedimentos de Cirurgia Plástica/métodos , Ruptura/complicações , Adulto , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Biópsia por Agulha , Contratura/diagnóstico por imagem , Contratura/cirurgia , Progressão da Doença , Pé Equino/diagnóstico por imagem , Pé Equino/etiologia , Pé Equino/cirurgia , Seguimentos , Futebol Americano/lesões , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética/métodos , Masculino , Músculo Esquelético/cirurgia , Recuperação de Função Fisiológica , Ruptura/diagnóstico por imagem , Ruptura/reabilitação , Contenções , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: This study aimed to investigate the correlation between serum creatinine levels and the presence and severity of radiographic knee osteoarthritis (OA) in individuals aged ≥50 years while adjusting for potential confounders. MATERIALS AND METHODS: Cross-sectional data from the 2009-2011 Korea National Health and Nutrition Examination Survey comprising 3428 individuals aged ≥50 years were utilized. The Kellgren-Lawrence (K-L) grading scale was used to assess the radiographic presence and severity of knee OA. Logistic regression and receiver operating characteristic analyses were used to investigate the association between serum creatinine levels and the presence of knee OA, whereas ordinal regression was used to assess the impact of creatinine levels on knee OA severity. RESULTS: The presence of radiographic knee OA conferred by low serum creatinine levels was found to be significant in both sexes [odds ratio (OR), 0.118; 95% confidence interval (CI), 0.045-0.314, p<0.001 for men; OR, 0.148; 95% CI, 0.040-0.549, p=0.004 for women]. Low serum creatinine was significantly associated with knee OA-graded K-L severity in each sex-based group [ß, -1.923; standard error, 0.478; p<0.001 for men and ß, -1.532; SE, 0.575; p=0.008 for women]. CONCLUSION: Low serum creatinine level was associated with a higher presence of knee OA in both men and women, and was also linked to the severity of the disease. These findings suggest that the serum creatinine level may be a potential biomarker for assessing the presence and severity of knee OA.
Assuntos
Creatinina , Osteoartrite do Joelho , Humanos , Masculino , Feminino , Osteoartrite do Joelho/sangue , Osteoartrite do Joelho/diagnóstico por imagem , Creatinina/sangue , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Transversais , Idoso , Insuficiência Renal/sangue , Modelos Logísticos , Índice de Gravidade de Doença , Inquéritos Nutricionais , Curva ROC , População do Leste AsiáticoRESUMO
For many years, sustained-release drug delivery systems (SRDDS) have emerged as a featured topic in the pharmaceutical field. Particularly for chronic diseases, such as osteoarthritis, there is a lot of demand for SRDDS because of the long treatment period and repetitive medication administration. Thus, we developed an injectable PLGA-F127 microsphere (MS) that is capable of the in situ conversion to an implant. The microprecipitation method for PLGA-F127 MS was established, and the physicochemical stability of the products was confirmed. The microspheres were assembled into a single mass in 37 °C aqueous conditions and showed a remarkably delayed drug release profile. First, the release started with no significant initial burst and lagged for 60 days. After that, in the next 40 days, the remaining 75% of the drugs were constantly released until day 105. We expect that our PLGA-F127 MS could be employed to extend the release period of 2 months of medication to 4 months. This could be a valuable solution for developing novel SRDDS for local injections.
RESUMO
BACKGROUND: This study aimed to evaluate the femoral tunnel position and fiber length of the anterolateral ligament (ALL) reconstruction compared with the natural anatomy of the ALL. We also evaluated whether the femoral tunnel position would affect residual pivot shift. METHODS: This study was a retrospective review of 55 knees that underwent ALL reconstruction considering the anatomical and functional aspects, during primary anterior cruciate ligament (ACL) reconstruction in the presence of a high-grade pivot shift or revisional ACL reconstruction. We determined the position of the femoral tunnel and the length of graft using a three-dimensional (3D)-computed tomography (CT) model after ALL reconstruction. We also measured graft excursion during surgery and examined pivot shift 2 years after surgery. We conducted a subgroup analysis of femoral tunnel position, fiber length, isometricity, and residual pivot shift depending on whether the tunnel was anterior or posterior to the lateral epicondyle (LE). We also performed a subgroup analysis depending on whether the ACL reconstruction was primary or revisional. RESULTS: The mean femoral tunnel position was 2.04 mm posterior and 14.5 mm proximal from the center of the LE. The mean lengths of the anterior and posterior fibers were 66.6 and 63.4 mm, respectively. The femoral tunnel was positioned more proximally than the anatomical position, and both anterior and posterior ALL fibers were longer than the natural anatomy. The anteroposterior femoral tunnel position was significantly correlated with anterior (p = 0.045) and posterior (p = 0.037) fiber excursion. In the subgroup analysis, there was no significant difference in the residual pivot shift between the posterior and anterior tunnel positions. However, there were significant differences for proximal position (p < 0.001) and fiber length (p = 0.006). There was no significant difference between primary and revisional ACL regarding femoral tunnel position and fiber lengths. CONCLUSION: It is challenging to reproduce both anatomical and functional aspects of ALL reconstruction in both primary and revision ACL reconstruction. Especially for functional reconstruction, the femoral tunnel tended to be positioned more proximally than the anatomical position. However, the femoral tunnel position did not affect functional clinical outcomes at the 2-year follow-up. LEVEL OF EVIDENCE: Level IV Case series.
RESUMO
Background: Various arthroscopic rotator cuff repair techniques are being used for the treatment of rotator cuff tears with the development of surgical instruments. However, retears after repair are not completely avoidable, and efforts to reduce retears remain a challenge. Purpose/Hypothesis: To introduce a new repair technique, the double-row modified Mason-Allen technique with a single knot, and to compare clinical outcomes and retear rates with the single-row modified Mason-Allen technique. It was hypothesized that this new technique would have a better clinical outcome and significantly lower retear rate than the single-row modified Mason-Allen technique. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 110 patients with small- to medium-sized (<1.5 cm) full-thickness supraspinatus tears were enrolled into 2 groups, with 65 patients receiving the single-row modified Mason-Allen technique (group A) and 45 patients receiving the double-row modified Mason-Allen technique with a single knot (group B). The clinical and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score; Disabilities of the Arm, Shoulder and Hand (DASH) score; and visual analog scale (VAS) for pain and satisfaction scores. All patients enrolled in this study were monitored for a minimum of 24 months. Magnetic resonance imaging was performed to analyze the integrity of tendons and retear at 6 months after surgery. Results: No statistically significant differences between the 2 groups were found regarding the VAS for pain, ASES, and DASH scores. However, retear was found in 9 patients (13.8%) in group A and 1 patient (2.2%) in group B. The difference in the retear rate was statistically significant between the 2 groups (P = .037). Conclusion: A significantly lower retear rate and comparable clinical outcomes were seen after the double-row modified Mason-Allen repair technique with a single knot when compared with the single-row modified Mason-Allen technique. Based on these findings, the double-row modified Mason-Allen repair technique with a single knot can be considered a surgical treatment option that can provide sufficient stability in small- to medium-sized supraspinatus tears.
RESUMO
Background: Disruption of the rotator cuff muscles compromises concavity compression force, which leads to superior migration of the humeral head and loss of stability. A novel idea of using the magnetic force to achieve shoulder stabilization in massive rotator cuff tears (MRCTs) was considered because the magnets can stabilize two separate entities with an attraction force. This study aimed to investigate the biomechanical effect of the magnetic force on shoulder stabilization in MRCTs. Methods: Seven fresh frozen cadaveric specimens were used with a customized shoulder testing system. Three testing conditions were set up: condition 1, intact rotator cuff without magnets; condition 2, an MRCT without magnets; condition 3, an MRCT with magnets. For each condition, anterior-posterior translation, superior translation, superior migration, and subacromial contact pressure were measured at 0°, 30°, and 60° of abduction. The abduction capability of condition 2 was compared with that of condition 3. Results: The anterior-posterior and superior translations increased in condition 2; however, they decreased compared to condition 2 when the magnets were applied (condition 3) in multiple test positions and loadings (p < 0.05). Abduction capability improved significantly in condition 3 compared with that in condition 2, even for less deltoid loading (p < 0.05). Conclusions: The magnet biomechanically played a positive role in stabilizing the shoulder joint and enabled abduction with less deltoid force in MRCTs. However, to ensure that the magnet is clinically applicable as a stabilizer for the shoulder joint, it is necessary to thoroughly verify its safety in the human body and to conduct further research on technical challenges.
Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Lesões do Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiologia , Imãs , Fenômenos Biomecânicos , Cadáver , Amplitude de Movimento Articular/fisiologiaRESUMO
Purpose: We report on the 10-year clinical hip function and radiologic outcomes of patients who underwent hip arthroplasty using a COREN stem. Materials and Methods: A consecutive series of 224 primary cementless hip arthroplasty implantations were performed using a COREN stem between 2009 and 2011; among these, evaluation of 128 hips was performed during a minimum follow-up period of 10 years. The mean age of patients was 65.4 years (range, 40-82 years) and the mean duration of follow-up was 10.8 years (range, 10-12 years). Evaluation of clinical hip function and radiologic implant outcomes was performed according to clinical score, thigh pain, and radiologic analysis. Results: Dramatic improvement of the mean Harris hip score (HHS) from 59.4 preoperatively to 93.5 was observed at the final follow-up (P≤0.01). Stable fixation was demonstrated for all implants with no change in position except for one case of Vancouver type B2 periprosthetic femur fracture. A radiolucent line (RLL) was observed in 16 hips (12.5%). Thigh pain was observed in only two hips (1.6%) at the final follow-up. There were no cases of osteolysis around the stem. The survival rate for the COREN stem was 97.7%. Conclusion: Good long-term survival with excellent clinical and radiological outcomes can be achieved using the COREN femoral stem regardless of Dorr type.
RESUMO
Background: Time-dependent changes in lower extremity alignment after an opening-wedge high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few studies have investigated risk factors of postoperative alignment change. Purposes: To investigate time-dependent alignment changes and identify predictive factors for postoperative alignment change after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent OWHTO between March 2010 and September 2018. A total of 142 knees with a mean follow-up of 42 months were included and classified as the change group when the amount of hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the no-change group. HKA angle was obtained at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively. Multiple regression analysis was performed to identify the factors that were correlated with the changes in the HKA angle from 3 months to the final follow-up. Results: Among the 142 knees, 59 (42%) were included in the change group. The overall postoperative HKA angles progressed serially toward varus after OWHTO. The mean angles of the 6 time points were 8.5°, -3.7°, -3.6°, -3.3°, -3.1°, and -2.7°, respectively. The mean HKA angles of the change and no-change groups were 9.1°, -4.3°, -3.4°, -2.8°, -2.0°, and -1.4° and 8.1°, -3.3°, -3.8°, -3.6°, -3.8°, and -3.7°, respectively. Greater change in the HKA angle was predicted by preoperatively greater valgus stress joint line convergence angles and less medial joint space width. Conclusion: Of the cases of OWHTO, 42% showed correction loss of >1° at a mean follow-up of 42 months. The overall postoperative HKA angles progressed serially to varus angles after OWHTO. Preoperative greater valgus stress joint line convergence angles and less medial joint space width were predictive factors for greater change in alignment toward varus after OWHTO.
RESUMO
OBJECTIVE: To compare the clinical outcomes among three analgesic techniques, continuous femoral nerve block (CFNB), epidural patient-controlled analgesia (EPCA) and periarticular injection (PAI), in patients undergoing total knee arthroplasty (TKA). METHODS: This retrospective case-control study enrolled patients that underwent TKA. Visual analogue scale (VAS) pain scores, sleep disturbance, additional opioid consumption and incidence of opioid-related side-effects were assessed. RESULTS: A total of 120 patients were categorized into three groups: EPCA (group A, n = 40), PAI (group B, n = 40) and CFNB (group C, n = 40). Group C had significantly lower VAS pain scores than groups A and B at 8, 12 and 24 h after TKA. There were no significant differences in VAS pain scores among the three groups from 48 h after TKA. Sleep quality on the first day after surgery was significantly better in group C than in groups A and B. Additional opioid consumption was significantly lower in the group C than in the groups A and B. Group C showed a lower rate of opioid-related side-effects than groups A and B. CONCLUSION: CFNB was a more effective additional analgesic technique than EPCA or PAI for acute postoperative pain control within 24 h of TKA.
Assuntos
Artroplastia do Joelho , Bloqueio Nervoso , Analgesia Controlada pelo Paciente , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Estudos de Casos e Controles , Nervo Femoral , Humanos , Injeções Intra-Articulares/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Achieving the postoperative mechanical axis passing through 62.5% of the tibial plateau is considered successful osteotomy surgery. Despite precise preoperative planning and surgical techniques, some procedures result in under- or overcorrection. Few studies have investigated the relationship between clinical outcomes and unintentional under- or overcorrection after open wedge high tibial osteotomy (OWHTO) using whole-leg standing radiographs. PURPOSE: To investigate the relationship between postoperative alignment using whole-leg standing radiographs and clinical outcomes after OWHTO. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 89 knees (72 patients) that underwent OWHTO between October 2013 and September 2018 were included. Patients with postoperative weightbearing line (WBL) ratios within 57% to 67% were classified as appropriate correction (group A; 45 cases), whereas ratios <57% and >67% were classified as undercorrection (group U; 20 cases) and overcorrection (group O; 24 cases), respectively. The following patient-reported outcomes (PROs) were investigated: International Knee Documentation Committee (IKDC) subjective score, Kujala score, and Knee injury and Osteoarthritis Outcome Score (KOOS). The correlation between postoperative WBL and PROs was analyzed. PROs were compared among the 3 groups. RESULTS: Regarding the correlation between postoperative WBL ratio and PROs, a larger postoperative WBL ratio was significantly correlated with a poor IKDC subjective score (P = .002), Kujala score (P = .009), and KOOS. Group O showed inferior postoperative PRO scores when compared with group A or U, whereas group U showed a similar result to group A (mean IKDC subjective scores: group U, 62.0; group A, 61.2; group O, 47.6; P = .004). CONCLUSION: Overcorrection after OWHTO surgery correlated with inferior PROs; therefore, overcorrected alignment should be avoided for patient satisfaction. Knees with an undercorrected alignment showed clinical results similar to those with appropriate correction.
Assuntos
Osteoartrite do Joelho , Estudos de Coortes , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Satisfação do Paciente , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgiaRESUMO
BACKGROUND: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon's preference. However, it is still unclear whether transection of sMCL increases valgus laxity. PURPOSE: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. RESULTS: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment (P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, -3.5°± 2.0°; 6 months, -3.2°± 2.3°; 1 year, -3.1°± 2.3°; 2 years, -2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, -0.1°± 2.1°; 3 months, -0.2°± 2.4°; 6 months, -0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). CONCLUSION: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.