Early or Delay? The Most Suitable Rehabilitation Protocol for "No Man's Land" Injury: Meta-Analysis with Trial Sequential Analysis - 20 Years Trends / Precoce ou tardio? O protocolo de reabilitação mais adequado para lesão na região 'terra de ninguém': Metanálise com análise sequencial de ensaios - Tendências de 20 anos

Abstract Objective The aim of this study is to analyze various rehabilitation protocol and determine which methods will yield a better outcome. Methods The database reports were searched within 1990 until 2020, using PubMed, Cochrane library database, Ovid, Medline, and the other several published trials. A statistical analysis was made from Review Manager and Trial Sequential Analysis (TSA). Result The mean of re-rupture rate is 3.3% (n= 8) in the combination protocol until 8% (n= 48) in CAM protocol. Meta-analyses found no significant difference between Kleinert vs CAM in re-rupture rate. Also no significant difference in Duran vs CAM in rerupture rate. In Trial Sequential Analysis (TSA), the z-curve does not cross both of the trial sequential boundaries, a further trial with larger sample will be required. The TSA of flexion contracture CAM vs Kleinert was indicated that CAM protocol may be superior than Kleinert to reduce the incidence of flexion contracture. For the range of mean flexion contracture 6.6% (n= 18) in CAM to 23.6% (n= 76) in Kleinert protocol. Conclusion Current meta-analysis proposed that the combination technique will result less re-rupture incidence and better functional outcome in flexor zone II injuries than other techniques. The CAM method also results less flexion contracture than others. However, a further meta-analyses with larger sample trials will be required to confirm this review's conclusion.

Resumo Objetivo O objetivo deste estudo é analisar vários protocolos de reabilitação e determinar quais métodos produzem um melhor resultado. Métodos Os relatórios dos bancos de dados foram pesquisados entre 1990 e 2020, usando PubMed, banco de dados da biblioteca Cochrane, Ovid, Medline e vários outros ensaios publicados. Uma análise estatística foi feita a partir do Review Manager e Trial Sequential Analysis (TSA). Resultado A taxa média de re-ruptura é de 3,3% (n = 8) no protocolo combinado, e até 8% (n = 48) no protocolo de Movimento Ativo Controlado (MAC). As metanálises não encontraram diferença significativa entre Kleinert vs MAC na taxa de re-ruptura. Também não há diferença significativa entre Duran e MAC na taxa de re-ruptura. Na Trial Sequential Analysis (TSA), a curva z não cruza ambos os limites sequenciais de ensaio, será necessário um ensaio adicional com amostra maior. A TSA de contratura em flexão MAC vs Kleinert indicou que o protocolo MAC pode ser superior ao Kleinert para reduzir a incidência de contratura em flexão. Para a faixa de contratura média em flexão de 6,6% (n = 18) no MAC a 23,6% (n = 76) no protocolo Kleinert. Conclusão A metanálise atual propôs que a técnica combinada resultará em menor incidência de re-ruptura e melhor resultado funcional em lesões da zona flexora II do que outras técnicas. O método MAC também resulta em menos contratura em flexão do que outros. No entanto, serão necessárias mais metanálises com estudos com amostras maiores para confirmar a conclusão desta revisão.

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.

Rotura traumática simultánea y bilateral del tendón del cuádriceps en un paciente fisicoculturista: informe de caso y revisión de la literatura / Simultaneous bilateral traumatic quadriceps tendon rupture in a bodybuilding patient: case report and literature review

La rotura traumática, simultánea y bilateral del tendón cuadricipital es una lesión infrecuente, generalmente asociada a otras enfermedades sistémicas tales como insuficiencia renal o trastornos endocrinos. Presentamos el caso de un varón sano y atleta de 38 años que sufrió esta lesión mientras realizaba una sentadilla en el gimnasio. (AU)

The traumatic bilateral and simultaneous quadriceps tendon rupture is a rare injury, usually associated with other systemic diseases such as renal insufficiency or endocrine disorders. We present the case of a 38-year-old healthy male athlete who sustained this injury while performing a squat at the gym. (AU)

Application of absorbable anchor combined with Kirschner wire in reconstruction of extension function of old mallet finger / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger.@*METHODS@#Between January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training.@*RESULTS@#The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%.@*CONCLUSION@#Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.

Progress in arthroscopic surgery for injury of superior labrum anterior posterior of shoulder joint / 中国骨伤

Superior labrum anterior posterior (SLAP) injury is a major challenge for orthopedic surgeons, due to the poor healing ability of the injured labrum. Although arthroscopic surgery is the gold standard for the treatment of SLAP injury, there are still disputes about the adaptation of different surgical techniques, the choice of anchors during operation, knotted or knotless anchors, and fixation methods. The authors believe that arthroscopic repair of SLAP lesions is effective for young patients with intact glenoid labrum(<35 years old) or with extensive activity, where single and knotless anchor is preferred. For the older patients(≥35 years old) with degeneration and wear of glenoid labrum, biceps tenodesis is more preferable, and interference screw fixation technique is recommended. As for patients with failed SLAP repair, biceps tenodesis can achieve a high success rate as a revision surgery. By review of the relevant literature in recent years, this paper summarizes the adaptation of different surgical methods of arthroscopic treatment of SLAP injury, intraoperative anchoring techniques, fixation methods and other improved surgical techniques.

Complications in repairing acute closed Achilles tendon rupture with micro-incision percutaneous Achilles tendon suture system / 中国骨伤

OBJECTIVE@#To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture.@*METHODS@#A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed.@*RESULTS@#No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores.@*CONCLUSION@#Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.

Tendones peroneos: una revisión contemporánea / Peroneal tendons. Contemporary update

La patología de peroneos es compleja y frecuentemente subdiagnosticada. El conocimiento detallado de la anatomía, biomecánica y fisiopatología es fundamental para realizar un correcto diagnóstico y tratamiento. El objetivo de este artículo es revisar la información más actualizada sobre la patología de los tendones peroneos (tendinopatía, inestabilidad y rotura).

Pathology of the peroneal tendons is complex and often underdiagnosed. Knowledge of anatomy, biomechanics, and physiopathology is necessary for diagnosing and treating this condition. The objective of this article is to review the most updated information regarding peroneal tendon pathology (tendinopathy, dislocation/subluxation, and tears), which may help managing patients with lateral pain of the foot and ankle.

Prevalence of Absence of Palmaris Longus Tendon in a Population Sample from a Multiethnic Brazilian City / Prevalência de ausência de tendão palmaris longus em uma amostra populacional de uma cidade brasileira multiétnica

Abstract Objective The objective of the study was to determine the prevalence of absence of palmaris longus tendon in a population sample from a multiethnic Brazilian city. Methods A cross-sectional observational study was carried out between October 2017 and April 2018. We included male and female volunteers aged 18 years or older. The absence of palmaris longus tendon was determined by asking the volunteers to perform the Schaeffer test bilaterally. Results We prospectively collected data on 1,008 volunteers, 531 male and 477 female, with age between 18 and 74 years (mean 38.4 years). The absence of palmaris longus tendon was observed in 264 (26.2%) volunteers. Bilateral absence was detected in 123 volunteers (12.2%), 60 female (48.8%) and 63 male (51.2%). Unilateral absence was found in 141 patients (14.0%), 54 female (38.2%) and 87 male (61.8%) (p < 0.05). Conclusion The prevalence of absence of palmaris longus tendon in our study was 26.2%. There was no statistically significant difference between gender and bilaterally. The absence of palmaris longus tendon was predominant on unilateral right side in males.

Resumo Objetivo O objetivo do presente estudo foi determinar a prevalência de ausência de tendão palmaris longus em uma amostra populacional de uma cidade multiétnica brasileira. Métodos Um estudo observacional transversal foi realizado entre outubro de 2017 e abril de 2018. Incluímos voluntários dos sexos masculino e feminino com 18 anos ou mais. A ausência do tendão palmaris longus foi determinada pedindo aos voluntários que realizassem o teste de Schaeffer bilateralmente. Resultados Foram coletados prospectivamente dados de 1.008 voluntários, 531 homens e 477 mulheres, com idade entre 18 e 74 anos (média de 38,4 anos). A ausência do tendão palmaris longus foi observada em 264 (26,2%) voluntários. A ausência bilateral foi detectada em 123 voluntários (12,2%), 60 mulheres (48,8%) e 63 homens (51,2%). A ausência unilateral foi encontrada em 141 pacientes (14,0%), 54 mulheres (38,2%) e 87 homens (61,8%) (p<0,05). Conclusão A prevalência de ausência do tendão palmaris longus em nosso estudo foi de 26,2%. Não houve diferença estatisticamente significativa bilateralmente e entre gêneros. A ausência do tendão palmaris longus foi predominante no lado direito unilateral no sexo masculino.

Estudio de las heridas por amoladora tratadas en el Hospital de Clínicas y Hospital Pasteur, Montevideo, Uruguay / Grinder injuries treated at the Clínicas and Pasteur Hospital of Montevideo, Uruguay / Estudo das lesões por esmerilhadeira tratadas no Hospital de Clínicas e Hospital Pasteur, Montevidéu, Uruguai

Resumen: Introducción: las heridas causadas por amoladora representan una consulta frecuente al cirujano plástico en nuestro país. Los objetivos del presente trabajo fueron conocer la epidemiología de los pacientes que consultaban con estas lesiones, conocer las circunstancias del accidente y estudiar si existía relación entre las condiciones de uso de la herramienta y la gravedad de las lesiones. Material y método: se realizó un estudio descriptivo, transversal, donde se recabaron los datos de los pacientes que consultaban por heridas por amoladora en las puertas de emergencia de Hospital Pasteur y Hospital de Clínicas en un período de 6 meses. Resultados: un total de 76 pacientes fueron incluidos en el estudio, la mayoría de sexo masculino, en edad laboral activa (39 a 58 años) dedicados a la realización de trabajos temporales o tareas de construcción, con bajo nivel de instrucción. El 84% de las heridas fueron graves. El 61% de los pacientes no utilizó los elementos de seguridad de la herramienta al momento del accidente. La mayoría de las lesiones se produjeron fuera del ambiente laboral. Conclusiones: en base a nuestro trabajo pudimos establecer el perfil epidemiológico de la población más susceptible de sufrir estas lesiones. Comprobamos que las heridas producidas por amoladora son en su mayoría graves y requieren procedimientos complejos para su resolución.

Summary: Introduction: grinder injuries represent a large number of consultations for plastic surgeons in our country. This study aims to learn about the epidemiological characteristics of patients who consulted for these lesions and the circumstances of the accidents, and to analyze whether there is a relationship between the conditions for tool use and the severity of lesions. Methodology: we conducted a retrospective, descriptive, transversal study where we collected data from the patients who consulted for grinder injuries at the emergency departments of Pasteur and Clínicas Hospital during a 6-month period. Results: seventy-six patients were included in the study, most of which were male working adults (between 39 and 58 years-old) who had temporary jobs or were performing construction works and had low levels of education. 84% of lesions were severe. 61% of patients did not respect safety regulations at the time of the accident. Most lesions occurred out of working hours. Conclusions: based on our study, we could identify the epidemiological profile of the most vulnerable population for this kind of lesions. We proved that most grinder lesions are severe and their management requires complex procedures.

Resumo: Introdução: as lesões causadas por esmerilhadeira são causa frequente de consulta ao cirurgião plástico no Uruguai. Os objetivos do presente trabalho foram conhecer as características dos pacientes que consultaram com essas lesões, conhecer as circunstâncias do acidente e analisar a possível relação entre as condições de uso da ferramenta e a gravidade das lesões. Metodologia: foi realizado um estudo descritivo, transversal, onde foram coletados dados de pacientes que consultaram por lesões de esmerilhadeira no pronto-socorro do Hospital Pasteur e Hospital de Clínicas durante um período de 6 meses. Resultados: foram incluídos no estudo 76 pacientes, a maioria do sexo masculino, em idade ativa para trabalhar (39 a 58 anos) dedicados à realização de trabalhos temporários ou trabalhos na construção civil, com baixo nível de escolaridade. 84% dos ferimentos foram graves. 61% dos pacientes não utilizaram os elementos de segurança da ferramenta no momento do acidente. A maioria das lesões ocorreu fora do ambiente de trabalho. Conclusões: com base em nosso trabalho conseguimos estabelecer o perfil da população mais suscetível a esses agravos. Constatamos que a maioria das lesões causadas por esmerilhadeiras são graves, exigindo procedimentos complexos para sua resolução.

Tendinitis cálcica atraumática de tendón extensor común del dedo medio: un caso infrecuente de dolor metacarpofalángico / Atraumatic calcium tendonitis of common extensor tendon of the middle finger: a rare case of metacarpophalangeal pain

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

Efectividad de la terapia por ondas de choque en lesiones de tendones y ligamentos del sistema osteomioarticular / Effectiveness of Shock Wave Therapy in Tendon and Ligament Injuries of the Osteomioarticular System

Introducción: Por más de 20 años la litotricia extracorpórea se ha aplicado con éxito en el mundo. Objetivo: Evaluar la efectividad de la terapia por ondas de choque en el tratamiento a pacientes que presentan lesiones en los tendones y ligamentos del sistema osteomioarticular. Métodos: Se realizó un estudio descriptivo, de corte transversal, con 107 pacientes diagnosticados con lesiones en los tendones y ligamentos del sistema osteomioarticular, los cuales fueron tratados con el equipo Well Wave (ondas de choque extracorpóreas) en el Complejo Científico Ortopédico Internacional Frank País, en el período comprendido entre marzo de 2019 y abril de 2020. Se realizó el análisis de las variables edad, sexo, dolor y discapacidad. Se obtuvieron frecuencias absolutas y relativas, y con ellas se confeccionaron las tablas que resumen la información estadística de la investigación. Resultados: Predominó el sexo femenino (71,9 por ciento), de 51 - 60 años (28 por ciento). El 40,2 por ciento de los pacientes fueron atendidos por presentar una tendinitis del supraespinoso. Todos los pacientes presentaban dolor antes de la aplicación de la terapia. Luego del tratamiento el 78,5 por ciento de los enfermos dejaron de sentirlo y el 71 por ciento presentó ausencia de discapacidad según escala de DASH. Según los criterios de evaluación de la respuesta al tratamiento los resultados fueron satisfactorios en el 56 por ciento de los pacientes. Conclusiones: La terapia con las ondas de choque posibilitó una rápida recuperación de los pacientes atendidos y su incorporación a las actividades diarias(AU)

ABSTRACT Introduction: Over more than 20 years, extracorporeal lithotripsy has been successfully used worldwide. Objective: To evaluate the effectiveness of shock wave therapy in the treatment of patients with injuries to the tendons and ligaments of the osteomioarticular system. Methods: A descriptive, cross-sectional study was carried out with 107 patients diagnosed with injuries to the tendons and ligaments of the osteomioarticular system. These subjects were treated with the Well Wave equipment (extracorporeal shock waves) at Frank País International Orthopedic Scientific Center, from March 2019 to April 2020. The variables age, sex, pain and disability were analyzed. Absolute and relative frequencies were obtained, and the results of statistical information of the investigation was shown in summarizing tables. Results: The female sex prevailed (71.9percent), 51 - 60 years old (28 percent). 40.2 percent of the patients were treated for supraspinatus tendinitis. All patients had pain before the use of therapy. After treatment, 78.5 percent of the patients stopped feeling pain and 71 percent showed no disability according to DASH scale. According to the treatment response evaluation criteria, the results were satisfactory in 56percent of the patients. Conclusions: This therapy enabled rapid recovery of the patients treated and their integration into daily activities(AU)

Biceps tenotomy or tenodesis in association with rotator cuff repair: is there an influence on functional results? A retrospective cohort study

ABSTRACT BACKGROUND: Instability or tears of the long head of the biceps tendon (LHBT) may be present in more than 35% of rotator cuff repairs (RCR). OBJECTIVE: To compare clinical results from patients undergoing arthroscopic RCR, according to the procedure performed at the LHBT. DESIGN AND SETTING: Retrospective cohort study designed at the shoulder and elbow clinic of Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. METHODS: Functional results among patients were compared using the American Shoulder and Elbow Surgeons (ASES) and University of California Los Angeles (UCLA) scales, according to the LHBT approach adopted: no procedure, tenotomy or tenodesis. RESULTS: We evaluated 306 shoulders (289 patients): 133 underwent no procedure at the LHBT, 77 tenotomy and 96 tenodesis. The ASES scale at 24 months showed no difference (P = 0.566) between the groups without LHBT procedure (median 90.0; interquartile range, IQR 29), tenotomy (median 90.0; IQR 32.1) or tenodesis (median 94.4; IQR 22.7); nor did the UCLA scale (median 33; IQR 7 versus median 31; IQR 8 versus median 33; IQR 5, respectively, P = 0.054). The groups differed in the preoperative functional assessment according to the ASES and UCLA scale, such that the tenodesis group started from higher values. However, there was no difference in pre and postoperative scores between the groups. CONCLUSION: Tenodesis or tenotomy of the LHBT, in the sample analyzed, did not influence the clinical results from RCR, as assessed using the ASES and UCLA scales.

Progress on arthroscopic surgery for massive rotator cuff tears / 中国骨伤

The surgical treatment of massive rotator cuff tears is a clinical challenge for orthopaedic surgeons. Moreover, tendon retraction, adhesions and fatty infiltration after rotator cuff tear will further increase the difficulty of surgical repair. Therefore, it has become a hotspot and difficulty to repair massive rotator cuff tears with a better way in current research. In recent years, with the continuous development of arthroscopic techniques, shoulder arthroscopic surgery has become the gold standard for the treatment of massive rotator cuff tears, but the adaptations, effects and combined application of different surgical methods are still controversial. The author believes that arthroscopic debridement of shoulder joint and acromioplasty or tuberoplasty could relieve shoulder pain in the short-term for elderly patients with lower functional requirements;long biceps tenotomy or tenodesis is effective for patients with biceps long head tendon injury; complete repair is still the first line treatment for massive rotator cuff tears, but partial repair is possible for massive rotator cuff tears that could not be completely repaired;patch augmentation technology could bring good results for young patients with high functional requirements;for patients with limited internal and external rotation of the shoulder joint and high functional requirements, tendon transfers surgery is recommended;superior capsular reconstruction is more advantageous for young patients with no obvious glenohumeral arthritis, better deltoid muscle strength and higher functional requirements. In addition, subacromial spacer implantation has become a current research hotspot due to its advantages of small trauma, low cost and relative safety, and its long-term effect still needs to be further confirmed.

Tenodesis suprapectoral del bíceps. Resultados clínicos / Suprapectoral biceps tenodesis. Clinical outcomes

Objetivo: Evaluar los resultados de la tenodesis suprapectoral mediante un miniabordaje en una serie de pacientes con lesión SLAP y desgarros completos de la porción larga del bíceps, y compararlos con los valores prequirúrgicos. Materiales y Métodos: Se incluyeron pacientes adultos tratados con dicha técnica entre 2019 y 2020, y un seguimiento mínimo de un año. Se registraron las características demográficas, la indicación de cirugía, el retorno a las actividades consideradas habituales por el paciente y las complicaciones. Se utilizó el puntaje ASES para hombro, y se midió la movilidad activa del hombro afectado. Además, se le preguntó al paciente si retomó la actividad que consideraba habitual, con opciones "sí" o "no". Se consignó si los pacientes reconocían un evento traumático con el inicio de los síntomas y se registró el diagnóstico con el que se llegó a la cirugía. Resultados: Se evaluó a 8 pacientes (7 hombres), con una mediana de la edad de 42.5 años. El seguimiento fue de 17 meses (RIC 13.5-21.5). Seis (75%) tenían diagnóstico de lesión SLAP tipo II y dos (25%), de desgarro completo. Seis pacientes (75%) asociaron los síntomas con un evento traumático. Las medianas de los rangos de movilidad finales fueron: flexión 180° (RIC 170°-180°), rotación interna 65° (RIC 60°-75°) y rotación externa 70° (RIC 5°-87,5°). Conclusión: La tenodesis suprapectoral tras una tenotomía artroscópica para casos de lesión SLAP tipo II o de desgarros completos de la porción larga del bíceps resultó una técnica segura y con resultados funcionales. Nivel de Evidencia: IV

Objective: To evaluate and compare outcomes in a case series of SLAP injuries and complete tears of the long head of the biceps treated with suprapectoral tenodesis using a mini-open approach. materials and methods: Patients aged over 18, treated between 2019 and 2020, with a minimum 1-year follow-up were included. The demographic characteristics, indication for surgery, return to activities considered usual by the patient, and complications were recorded. The American Shoulder and Elbow Surgeons (ASES) score for the shoulder was used, and the active range of motion of the affected shoulder was measured. In addition, the patients were asked if they were able to return to their daily activities. We recorded the diagnosis that led the patients to surgery and whether they had undergone a traumatic event coinciding with the onset of symptoms. Results: 8 patients were evaluated, the median age was 42.5, and the follow-up was 17 months (IQR 13.5-21.5). Six patients (75.0%) had a type II SLAP injury, and two (25.0%) had a complete LHB tear. Six patients (75.0%) associated the symptoms with a traumatic event. The final range of motion of the shoulder (median) was: flexion 180° (IQR 170°-180°), internal rotation 65° (IQR 60°-75°), and external rotation 70° (IQR 65°-87.5°). Conclusion: Suprapectoral tenodesis with a prior arthroscopic tenotomy for SLAP II cases or in cases of complete tears of the long head of the biceps is a safe technique for achieving functional outcomes. Level of Evidence: IV

Lesiones traumáticas en la mano por el uso de amoladora. Un problema en nuestro medio / Traumatic injuries to the hand from the use of an angle grinder. A problem in our field

Introducción: Las lesiones en las manos causadas por amoladora son comunes y generalmente ocurren en adultos jóvenes. En países en desarrollo, el ámbito doméstico y el trabajo informal son los escenarios más frecuentes. El objetivo de este estudio fue describir factores asociados a las lesiones por amoladora, y cuantificar y clasificar las heridas, según la gravedad y la región anatómica de la mano involucrada. Materiales y Métodos: Se realizó un estudio epidemiológico, retrospectivo. Entre 2016 y 2020, estudiamos a los pacientes con heridas de mano causadas por amoladora. Se analizaron el nivel educativo, la experiencia con la herramienta, el material cortado, el uso de equipo de protección personal, la edad y el sexo. Para determinar el patrón de las lesiones se realizó un análisis clínico-anatómico y radiológico detallado e individualizado. La gravedad fue evaluada con el Hand Injury Severity Score. Resultados: Se evaluó a928 pacientes (920 hombres y 8 mujeres, edad promedio 42 años). Solo el 22,4% usaba equipo de protección personal en el momento del accidente. El 84,5% (776 casos) realizaba tareas inusuales para la que esta herramienta no fue diseñada. La mano más afectada fue la izquierda (62,06%). En 784 pacientes, las heridas involucraban los dedos, el patrón de asociación predominante fue entre el 2do y 3er dedo (54,44%). Las lesiones fueron leves (24,1%), moderadas (41,3%), graves (26%) y mayores (8,6%). Conclusiones: Las lesiones por amoladora pueden resultar devastadoras. Una actualización epidemiológica reforzaría la necesidad de desarrollar métodos preventivos con el fin de disminuir su alta incidencia. Nivel de Evidencia: IV

Introduction: Hand injuries caused by angle grinders are frequent and generally take place among young adults. In developing countries, the domestic and informal work environments are the most frequent places where this could happen. The present study is aimed at describing associated factors to these types of injuries. Lesions were quantified and classified according to the sever-ity and anatomic region of the hand involved. Methods: An epidemiologic, retrospective study was performed between 2016 and 2020. The patients' level of education, previous experience using the machine, use of personal protective equipment (PPE), sex, and age were analyzed. To determine the pattern of the injuries, a clinical-anatomical and a detailed and individualized radiological analysis were performed on each patient. The severity was measured using the "Hand Injury Severity Score" (HISS). Results: 928 patients were studied (920 men, 8 women, average age of 42 years [range 18-67]). Only 22.4% were wearing PPE at the time of the accident. 776 participants were performing tasks for which the tool was not intended (84.5%). The left hand was the most af-fected (60%). In 784 patients, the injuries involved their fingers (84.48%); the predominant pattern was the index and middle finger (55%). According to the HISS, 24.1% were minor injuries, 41.3% were moderate, 26% were serious, and 8.6% were severe. Con-clusions: Injuries caused by an angle grinder can be devastating. We believe that an epidemiological update is likely to increase the need to develop preventive methods to decrease its high incidence. Level of Evidence: IV

Fractura de fémur distal asociada con una lesión del tendón cuadricipital: reporte de dos casos / Fractures of the distal femur associated with a complete quadricipital tendon injury: report of two cases

Las fracturas de fémur distal, especialmente las abiertas, se asocian con traumas de alta energía. Las lesiones asociadas al-rededor de la rodilla son frecuentes; sin embargo, la asociación con una lesión completa del tendón cuadricipital ha sido poco documentada. El diagnóstico temprano y un adecuado tratamiento de ambas lesiones son fundamentales para conseguir buenos resultados posoperatorios. Presentamos dos casos de fracturas intrarticulares de fémur distal expuestas asociadas con lesiones completas del tendón cuadricipital. La reparación de la lesión tendinosa asociada mediante túneles transóseos luego de la fijación de la fractura permite comenzar un protocolo de rehabilitación temprano, esencial para obtener buenos resultados funcionales.Palabras clave: Fractura; fémur distal; lesión; tendón cuadricipital; aparato extensor. Nivel de Evidencia: V

Fractures of the distal femur, especially open fractures, occur in association with high-energy trauma. The presence of associated injuries around the knee is common; however, the association with a complete quadricipital tendon injury has been poorly documented. Early diagnosis and adequate treatment of both injuries is essential to achieve good postoperative outcomes. We present two cases of exposed intra-articular distal femoral fractures associated with complete quadricipital tendon injuries. The repair of the associated tendon injury with transosseous tunnels after fracture fixation allows an early rehabilitation protocol, essential to obtain good functional outcomes.Key words:Fracture; distal femur; injury; quadricipital tendon; extensor mechanism. Level of Evidence: V

Comparative analysis of pathological structure between acute closed and open Achilles tendon rupture / 中国骨伤

OBJECTIVE@#To investigate the morphological, histological and ultrastructural changes of acute closed rupture of Achilles tendon, in order to clarify the pathological basis of the injury and to explore the significance.@*METHODS@#From January 2015 to January 2019, 35 patients with acute Achilles tendon rupture who underwent the minimally invasive Achilles tendon suture technique were retrospectively analyzed. Among these patients, 12 cases in acute open Achilles tendon rupture group included 10 males and 2 females, with an average age of (35.1±9.7) years old ranging from 19 to 50, and the time from injury to operation was 2 to 8 hours with an average of(5.6±1.8);23 cases in acute closed Achilles tendon rupture group included 21 males and 2 females, with an average age of (35.5±6.6) years old ranging from 18 to 50, and the time from injury to operation was 3 to 15 hours with an average of (7.5±3.1). The gross appearance and imaging findings of the broken end of Achilles tendon tissue in the two groups were compared by naked eye observation and foot and ankle MRI at 4 to 6 hours before operation. HE staining, scanning and fluoroscopic electron microscopy, immunohistochemistry(Sirius red staining) were performed on the intraoperative Achilles tendon tissue specimens at 1 to 2 days after operation, the collagen fiber degeneration and local fat infiltration, collagen fiber shape, cell morphology and function, and the distribution of typeⅠand type Ⅲ collagen fibers in Achilles tendon were compared between the two groups.@*RESULTS@#Compared with the acute open Achilles tendon rupture group, the acute closed Achilles tendon rupture group had poor elasticity, hard texture, moderate edema, irregular shape of Achilles tendon broken end, horsetail shape, and more calcification around the broken end. HE staining results:the collagen fibers in the Achilles tendon of the acute open Achilles tendon rupture group were arranged irregularly, with hyaline degeneration and fat infiltration;The results of electron microscopy showed that collagen arranged disorderly and fibroblasts atrophied in the acute closed Achilles tendon rupture group. Immunohistochemical(Sirius staining) results:the proportion of collagenⅠin the acute open Achilles tendon rupture group and the acute closed Achilles tendon rupture group was(91.12±4.34)% and(54.71±17.78)% respectively, and the proportion of collagen Ⅲ was (8.88±4.34)% and (45.29±17.78)% respectively. The content of collagenⅠin the acute closed Achilles tendon rupture group was lower than that in the acute open Achilles tendon rupture group, and the content of collagen Ⅲ in the acute closed Achilles tendon rupture group was higher than that in the acute open Achilles tendon rupture group(P<0.05).@*CONCLUSION@#The morphology, histology and ultrastructure of the acute closed ruptured Achilles tendon are significantly altered compared with the normal Achilles tendon. The original fine and orderly spatial structure cannot be maintained, part of collagen Ⅰ is replaced by collagen Ⅲ, and the toughness and strength of the tendon tissue decreased, which may be the feature of degeneration of the Achilles tendon and an important pathological basis for closed Achilles tendon rupture.

Presión y área de contacto en reparación de manguito rotador: una revisión sistemática / Pressure and contact area in rotator cuff repair: a systematic review

OBJETIVO Proporcionar una sinopsis exhaustiva y un análisis de los estudios biomecánicos sobre la magnitud y distribución de la presión en la interfase tendón-huella de las roturas del manguito rotador, informadas en la literatura en los últimos cinco años. MÉTODOS La investigación se realizó de acuerdo con los métodos descritos en el Manual Cochrane. Los resultados se informan de acuerdo con el consenso de Ítems Preferidos de Reporte en Revisiones Sistemáticas y Metaanálisis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA, en inglés). La búsqueda se realizó el 1er de junio de 2020. Se identificaron e incluyeron estudios ex vivo de ciencia básica y estudios biomecánicos publicados, que evaluaran la magnitud y distribución de la presión en la interfase tendón-huella de las roturas del manguito rotador reparadas entre enero de 2015 y junio de 2020. Se realizaron búsquedas sistemáticas en las bases de datos MEDLINE, Embase, Scopus y Google Scholar utilizando los términos y operadores booleanos: (Rotator Cuff OR Supraspinatus OR Infraspinatus OR Subscapularis OR Teres Minor) AND Pressure AND Footprint. En la base de datos Embase, respetando su sintaxis, se utilizó: Rotator Cuff AND Pressure AND Footprint. RESULTADOS Un total de 15 de los 87 artículos encontrados cumplieron con todos los criterios de elegibilidad y se incluyeron en el análisis. CONCLUSIÓN La presión y área de contacto sería optimizada biomecánicamente con una reparación transósea de doble fila equivalente, sin nudos en la hilera medial, y con el uso de cintas para su ejecución, conceptos de reparación específica para roturas delaminadas, y limitación de la abducción en el postoperatorio inmediato.

OBJETIVE To provide a comprehensive synopsis and analysis of biomechanical studies on the magnitude and distribution of pressure at the tendon-footprint interface of rotator cuff tears reported in the literature in the last five years. METHODS The research was performed according to the methods described in the Cochrane Manual. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consensus. The search was performed on June 1st, 2020. We identified and included ex vivo basic science studies and published biomechanical studies that evaluated the magnitude and distribution of pressure at the tendon-footprint interface of rotator cuff tears repaired between January 2015 and June 2020. Systematic searches on the MEDLINE, Embase, Scopus and Google Scholar databases were performed using the terms and Boolean operators: (Rotator Cuff OR Supraspinatus OR Infraspinatus OR Subscapularis OR Teres Minor) AND Pressure AND Footprint. In the Embase database, respecting its syntax, the following was used: Rotator Cuff AND Pressure AND Footprint. RESULTS In total, 15 of the 87 articles found fulfilled all the eligibility criteria and were included in the analysis. CONCLUSION The pressure and contact area would be biomechanically optimized with an equivalent transosseous double-row repair, without knots in the medial row, and with the use of tapes for its execution, specific repair concepts for delaminated tears, and a limitation of abduction in the immediate postoperative period.

Mayor presión y área de contacto en reparación transósea cruzada de manguito rotador versus reparación simple / Increased pressure and contact area in rotator cuff crossed versus simple transosseous repair

OBJETIVO: Comparar la presión y el área de contacto en la interfase tendón-huella de una reparación realizada con suturas transóseas simples y cruzadas. MÉTODOS: Se utilizaron doce hombros de cordero para simular una rotura de manguito rotador. Se midió el área de contacto en la interfase tendón-huella con láminas sensibles a presión; luego, se midió la presión con un sensor digital. Se registró la presión basal durante la aplicación de carga cíclica y al final de la intervención. Se compararon 2 reparaciones: 2 túneles transóseos con nudos simples (TOS; n = 6) y 2 túneles transóseos con nudos cruzados (TOC; n = 6), utilizando FiberWire #2. Se realizaron 1.400 ciclos, con una frecuencia 2,5 Hz y una carga de 5 N. Se utilizó la prueba de Mann-Whitney, y ae consideraron significativos valores de p < 0,05. RESULTADOS: La reparación TOS presentó un 50,9 ± 12,7% distribución de presiones en comparación con 72,2 ± 5,3% en la reparación TOC (p < 0,009). La presión promedio en la reparación TOS fue 0,7 ± 0,1 MPa en comparación con 1,1 ± 0,2 MPa en la reparación TOC (p < 0,007). La reparación TOS registró una presión basal de 5,3 ± 5,3 N, presión final de 3,8 ± 4,6 N, y una variación de 51,7 ± 38%. La reparación TOC registró una presión basal de 10,7 ± 1,8 N, presión final de 12,9 ± 8,7 N, y una variación de 114,9 ± 65,9% (p < 0,044; p < 0,022; y p < 0,017, respectivamente). CONCLUSIÓN: La reparación TOC presenta mayor presión a nivel de la interfase tendón-hueso, menor pérdida de fuerza de contacto ante cargas cíclicas, y una mejor distribución de fuerza en la huella al comparar con la reparación TOS, lo que se podría traducir en mejor cicatrización tendínea.

OBJETIVE: To compare the pressure and contact area at the tendon-footprint interface of a repair performed with simple and crossed transosseous sutures. METHODS: Twelve lamb shoulders were used to simulate a rotator cuff tear. The contact area at the tendon-footprint interface was measured with pressure-sensitive films; then, the pressure was measured with a digital sensor. The baseline pressure was recorded during the application of a cyclic load and at the end of the intervention. A total of 2 repairs were compared: 2 transosseous sutures with single knots (STO; n = 6) and 2 transosseous sutures with crossed knots (TOC; n = 6) using FiberWire #2. In total, 1,400 cycles were performed, with a frequency of 2.5 Hz and a load of 5 N. The Mann-Whitney test was used. Values of p < 0.05 were considered significant.RESULTS: The TOS repair presented 50.9 ± 12.7% of pressure distribution compared to 72.2 ± 5.3% in the TOC repair (p < 0.009). The mean pressure in the TOS repair was of 0.7 ± 0.1 MPa compared to 1.1 ± 0.2 MPa in the TOC repair (p < 0.007). The TOS repair registered a basal pressure of 5.3 ± 5.3 N, a final pressure of 3.8 ± 4.6 N, and a variation of 51.7 ± 38%. The TOC repair registered a basal pressure of 10.7 ± 1.8 N, a final pressure of 12.9 ± 8.7 N, and a variation of 114.9 ± 65.9% (p < 0.044; p < 0.022; and p < 0.017 respectively).CONCLUSION: The TOC repair presents higher pressure at the tendon-bone interface, less loss of contact force under cyclic loads, and a better distribution of force on the footprint when compared with the TOS repair, which could translate into better tendon healing.

Abrasión intraósea por sutura según el ángulo del túnel transóseo en huella del manguito rotador / Intraosseous suture abrasion according to the angle of the transosseous tunnel in rotator cuff footprint

OBJETIVO: Comparar el desgaste óseo generado por la abrasión de una carga cíclica entre túneles clásicos oblicuos y perpendiculares. Nuestra hipótesis es la de que el túnel oblicuo presenta un menor desgaste óseo por abrasión cíclica comparado con el túnel perpendicular. MÉTODOS: Ocho hombros congelados de cordero fueron usados para el estudio biomecánico. En cada húmero proximal, dos túneles (oblicuo y perpendicular) fueron generados en la tuberosidad mayor. Se utilizó un sistema de tracción cíclica para traccionar hacia atrás y adelante una sutura trenzada en tensión a través del túnel, midiendo la distancia entre la entrada y la salida de la sutura en el túnel antes y después del proceso de ciclado como medida de perdida de tensión de la sutura. El resultado principal es el cambio de la distancia entre la entrada y la salida de la sutura en el túnel después del ciclado para estimar el desgaste óseo dentro del túnel. Para el análisis estadístico, se utilizó la prueba U de Mann-Whitney. Se consideraron significativos valores de p < 0,05. RESULTADOS: Los túneles perpendiculares tuvieron un 23,24 7,44% de pérdida de longitud, y los túneles oblicuos, 7,76 4,32%. La diferencia de pérdida de longitud fue significativa (p » 0,0003). CONCLUSIÓN: La abrasión ósea generada por el movimiento cíclico de la sutura en el túnel transóseo está influenciada por la geometría del túnel. El desgaste óseo es menor en un túnel oblicuo comparado con un túnel perpendicular. NIVEL DE EVIDENCIA: Estudio de ciencia básica

OBJETIVE: To compare the bone wear generated by the abrasion of a cyclic load between classic oblique and perpendicular tunnels. Our hypothesis is that the oblique tunnel is submitted to less cyclic abrasion bone wear compared with the perpendicular tunnel. METHODS: Eight fresh-frozen lamb shoulders were used for biomechanical testing. In each proximal humerus, two tunnels (one oblique and one perpendicular) were drilled at the greater tuberosity. We used a cyclic traction system to pull back and forth a braided suture under tension through the tunnel, measuring the distance between the entry and exit points of the suture within the tunnel before and after the cyclic process to release the tension in the suture. The main outcome was the percentage of change in the distance between the entry and exit points of the suture within the tunnel before and after cyclic abrasion to estimate the degree of bone wear inside the tunnel. For the statistical analysis, the Mann-Whitney U test was used. Values of p < 0.05 were considered significant. RESULTS: The perpendicular bone tunnels had 23.24 7.44% decrease in length, and the oblique bone tunnels, 7.76 4.32%. The difference in the decrease in length was significant (p » 0.0003). CONCLUSION: The bone abrasion caused by the cyclical movement of the suture in the bone tunnel was influenced by the shape of the tunnel. Bone wear was lower with an oblique tunnel compared with a perpendicular tunnel. LEVEL OF EVIDENCE: Basic Science Study