Posterior Knee Capsulotomy for the Relief of Patellofemoral Joint Pain: Long-Term Follow-up.

Lack of full extension of the knee is a disabling condition that sometimes needs to be treated by a posterior capsulotomy of the knee. However, it is not clear if the full extension acquired can be kept throughout long-time follow-up. We conducted a retrospective cohort study of 20 patients diagnosed with minimal flexion contracture of the knee who underwent open posterior capsulotomy between 1990 and 2010. All patients (100%) presented with a preoperative Lysholm's score classified as poor or fair (mean = 58.6 ± 13.8, 95% confidence interval [CI]: 52.3-64.9), but 14 patients (70%) experienced an improvement to good or excellent scores (mean = 87.6 ± 8.8, 95% CI: 83.6-91.6) after the follow-up. The mean preoperative angle of fixed flexion was 25.0 ± 9.1 degrees (95% CI: 20.8-29.2), and it decreased to 4.2 ± 4.1 degrees (95% CI: 2.3-6.1) after the follow-up. We conclude that posterior capsulotomy of the knee proved to be an effective procedure to treat properly patients with painful knees secondary to lack of full extension after 10.3 years of follow-up.

Fibular head-based posterolateral reconstruction of the knee combined with capsular shift procedure.

Posterolateral instability (PLI) is common with posterior cruciate ligament tears, is less common with anterior cruciate ligament tears, and isolated PLI is rare. There are varying degrees of PLI with respect to pathologic external tibial rotation and varus laxity. Surgical treatment of PLI must address all components of the PLI (popliteus tendon, popliteofibular ligament, lateral collateral ligament, and the lateral-posterolateral capsule), the abnormal planes of motion, as well as other structural injuries. Successful posterior cruciate ligament and anterior cruciate ligament surgery depends upon recognition and treatment of posterolateral corner injuries.

In vivo cervical facet joint capsule deformation during flexion-extension.

STUDY DESIGN: Nonrandomized controlled cohort. OBJECTIVE: To characterize subaxial cervical facet joint kinematics and facet joint capsule (FJC) deformation during in vivo, dynamic flexion-extension. To assess the effect of single-level anterior arthrodesis on adjacent segment FJC deformation. SUMMARY OF BACKGROUND DATA: The cervical facet joint has been identified as the most common source of neck pain, and it is thought to play a role in chronic neck pain related to whiplash injury. Our current knowledge of cervical facet joint kinematics is based on cadaveric mechanical testing. METHODS: Fourteen asymptomatic controls and 9 C5-C6 arthrodesis patients performed full range of motion flexion-extension while biplane radiographs were collected at 30 Hz. A volumetric model-based tracking process determined 3-dimensional vertebral position with submillimeter accuracy. FJC fibers were modeled and grouped into anterior, lateral, posterior-lateral, posterior, and posterior-medial regions. FJC fiber deformations (total, shear, and compression-distraction) relative to the static position were determined for each cervical motion segment (C2-C3 through C6-C7) during flexion-extension. RESULTS: No significant differences in the rate of fiber deformation in flexion were identified among motion segments (P = 0.159); however, significant differences were observed among fiber regions (P < 0.001). Significant differences in the rate of fiber deformation in extension were identified among motion segments (P < 0.001) and among fiber regions (P = 0.001). The rate of FJC deformation in extension adjacent to the arthrodesis was 45% less than that in corresponding motion segments in control subjects (P = 0.001). CONCLUSION: In control subjects, FJC deformations are significantly different among vertebral levels and capsule regions when vertebrae are in an extended orientation. In a flexed orientation, FJC deformations are different only among capsule regions. Single-level anterior arthrodesis is associated with significantly less FJC deformation adjacent to the arthrodesis when the spine is in an extended orientation. LEVEL OF EVIDENCE: 4.

Effect of surgical repair of the joint capsule in mandibular condyle fractures in adult rats.

PURPOSE: The aim of the present study was to assess histologic changes in the temporomandibular joint (TMJ) of adult rats subjected to unilateral fracture of the mandibular condyle and soft tissue injury. MATERIALS AND METHODS: The animals were divided into 2 groups: one had surgical treatment for soft tissue repair and the other had no soft tissue treatment. All histologic evaluations were performed according to the presence or absence of synovitis, vascularity, presence or absence of joint inflammation, and presence or absence of the articular disc. The contralateral TMJs also were evaluated. RESULTS: The results showed few histologic changes in the synovial membrane and joint disc for the 2 groups and in the synovial membrane and disc of the contralateral side, where indirect trauma occurred in the unoperated joint. CONCLUSION: This study showed that treating or not treating soft tissues does not change the treatment results of condyle fracture or interfere with TMJ pathosis.

Treatment of chronic mandibular dislocations using a new miniplate.

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. The aim of this study was to describe a modified miniplate designed for treating chronic mandibular dislocations and evaluate the results of its placement in one patient, who was followed for 18 months. The treatment of chronic mandibular dislocation using this modified miniplate was shown to be efficient in relation to the postoperative maximal mouth opening, recurrence and articular function.

Temporomandibular joint meniscopexy with Mitek mini anchors.

PURPOSE: The purpose of this study is to show long-term results with the use of Mitek mini anchors (DePuy Mitek, Raynham, MA) in the surgical treatment (meniscopexy or discoplasty) of internal derangements that lead to a dysfunctional temporomandibular joint (TMJ). PATIENTS AND METHODS: We evaluated 50 patients, 32 women and 18 men, ranging in age from 19 to 53 years, with a mean age of 33.5 years. All patients included in the study were diagnosed with anterior disc displacement without reduction. Each patient underwent surgical meniscopexy and placement of Mitek mini anchors with No. 2-0 nylon monofilament sutures. The variables taken into account in this study include range of mouth opening, painful symptoms (evaluated with the visual analog verbal scale), and the presence of any clicks in the TMJ. RESULTS: Preoperative analysis showed painful symptoms in 100% of evaluated patients, the presence of clicks of the TMJ in 76%, and a mean mouth opening range of 23.5 mm. Postoperative analysis showed that 92% of the patients had no painful symptoms, 90% did not have any associated clicks in the TMJ, and the mean mouth opening range on postoperative evaluation was 38.3 mm, with a mean increase of 14.8 mm. CONCLUSIONS: We conclude that surgical placement of Mitek mini anchors represents an alternative that can be considered a tool of great utility for discoplasty procedures, showing evident clinical improvement.

Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome.

PURPOSE: To evaluate the short-term results of 2 different techniques of endoscopic iliopsoas tendon release for the treatment of internal snapping hip syndrome. METHODS: Between January 2005 and January 2007, a consecutive series of patients with the diagnosis of internal snapping hip syndrome was treated with endoscopic release of the iliopsoas tendon. The patients were randomized into 2 different groups. Patients in group 1 were treated with endoscopic iliopsoas tendon release at the lesser trochanter, and patients in group 2 were treated with endoscopic transcapsular psoas release from the peripheral compartment. Hip arthroscopy of both the central and peripheral compartments was performed in both groups using the lateral approach. Associated injuries were identified and treated arthroscopically. Postoperative physical therapy was the same for both series, and each patient received 400 mg of celecoxib daily for 21 days after surgery. Preoperative and postoperative Western Ontario MacMaster (WOMAC) scores and imaging studies were evaluated. RESULTS: Nineteen patients were included in the study: 10 in group 1 (5 male and 5 female; average age, 29.5 years) and 9 in group 2 (8 female and 1 male; average age, 32.6 years). No statistical difference was found in group composition. Associated injuries were found and treated in 8 patients in group 1 and 7 patients in group 2. No statistical difference was found between groups in preoperative WOMAC scores, and every patient in both groups had an improvement in the WOMAC score. Improvements in WOMAC scores were statistically significant in both groups, and no difference was found in postoperative WOMAC results between groups. No complications were seen. CONCLUSIONS: Iliopsoas tendon release at the level of the lesser trochanter or at the level of the hip joint using a transcapsular technique is effective and reproducible. We found no clinical difference in the results of both techniques.

Trapeziectomy and intermetacarpal ligament reconstruction with the extensor carpi radialis longus for osteoarthritis of the trapeziometacarpal joint: surgical technique and long-term results.

PURPOSE: To report the long-term results of excision of the trapezium and intermetacarpal ligament reconstruction with the extensor carpi radialis longus for thumb trapeziometacarpal osteoarthritis. METHODS: Fourteen women and 5 men were retrospectively reviewed after an average of 9 years of follow-up evaluation. Trapeziectomy was performed and the extensor carpi radialis longus was harvested by a dorsoradial approach to reconstruct the intermetacarpal ligament. All patients wore a below-elbow cast for 6 weeks. Each patient had objective and subjective assessments. Thumb shortening was measured in follow-up radiographs. RESULTS: At the final follow-up evaluation, 16 (84%) patients were free of pain and 17 patients (89%) were satisfied with the results. Grip, key strength, and pinch strength improved compared with preoperative values. The trapezium space lost 14% of its height compared with preoperative values. Thumb motion improved, and there were no cases of instability. CONCLUSIONS: Resection-arthroplasty of the trapezium with intermetacarpal ligament reconstruction with the extensor carpi radialis longus is an effective procedure that permits motion restoration and pain relief in the trapeziometacarpal joint in the long term without affecting thumb stability. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Treatment of developmental dysplasia of the hip after walking age with open reduction, femoral shortening, and acetabular osteotomy.

The one-stage surgical treatment for developmental dysplasia of the hip-consisting of open reduction, femoral shortening, and pelvic osteotomy-is a demanding procedure, one that is more challenging, technically, than a staged procedure. It can, however, be done safely and effectively, providing good conditions for proper development of the hip joint in the older child who has untreated developmental dysplasia of the hip.

Como mejorar la capacidad del ancla para llevar suturas en inestabilidad de hombro / Improving anchors capabilities to hold sutures on shoulder instability

El fracaso de la cirugia de inestabilidad de hombro ocurre frecuentemente por abrasion de la sutura en el ancla o por desprendimiento de la sutura de la capsula articular. Para mejorar la capacidad de las anclas de llevar multiples suturas a fin de aumentar la superficie capsular con suturas por numero de anclas, diseñamos una tecnica que utiliza el nudo de la sutura del ancla para albergar suturas libres capsulares mejorando el numero de suturas por ancla, sin riesgo de abrasion en el ojo del arpon.

Como mejorar la capacidad del ancla para llevar suturas en inestabilidad de hombro / Improving anchors capabilities to hold sutures on shoulder instability

El fracaso de la cirugia de inestabilidad de hombro ocurre frecuentemente por abrasion de la sutura en el ancla o por desprendimiento de la sutura de la capsula articular. Para mejorar la capacidad de las anclas de llevar multiples suturas a fin de aumentar la superficie capsular con suturas por numero de anclas, diseñamos una tecnica que utiliza el nudo de la sutura del ancla para albergar suturas libres capsulares mejorando el numero de suturas por ancla, sin riesgo de abrasion en el ojo del arpon. (AU)

A new modified endaural approach for access to the temporomandibular joint.

We present a new modification of an endaural incision for access to the temporomandibular joint. This gives excellent posterior, anterior, lateral and inferior exposure, avoids important anatomical structures and provides an almost invisible scar.

Tratamiento quirúrgico de la inestabilidad glenohumeral multidireccional / Surgical treatment for multidirectional instability of the shoulder

Ensayo clínico realizado entre 1987 y 1992; la muestra estuvo conformada por 22 pacientes que reunieron los criterios de inclusión (inestabilidad glenohumeral multidireccional), las variables de estudios fueron: signos de hiperelasticidad, de inestabilidad glenohumeral, y de alamiento escapular. En todos se realizó tratamiento quirúrgico, y posteriormente llevaron a cabo tratamiento de rehabilitación. Se estudiaron 22 pacientes, 14 de sexo masculino y 8 de sexo femenino; rango de edad de 16 a 35 años; todos mostraron signos de alamiento escapular y en 20 se identificaron signos de alamiento escapular y en 20 se identificaron signos positivos de hiperelasticidad e inestabilidad anterior e inferior. Se mostró negativización de los signos clínicos a las 12 semanas del postoperatorio y hubo reintegración a las actividades deportivas al 5º mes de la cirugía. La técnica quirúrgica utilizada es un procedimiento sencillo, que no limita la movilidad articular y permite una rápida reintegración a las actividades ocupacionales y deportivas. No se registraron complicaciones

Tratamento da luxaçäo recidivante anterior de ombro: uso de enxerto ósseo na deficiência da glenóide / Treatment of anterior recurrent shoulder dislocation: bone graft in glenoid deficiency

Alguns pacientes com luxaçäo recidivante anterior de ombro apresentam um defeito ósseo na borda ântero-inferior da cavidade glenóide associado à lesäo cápsulo-labial, defeito este que, dependendo de seu tamanho, deve ser corrigido durante o ato cirúrgico. Entre junho de 1987 e abril de 1997 foram operados 413 ombros, pelo Grupo de Ombro do Departamento de Ortopedia e Traumatologia da Santa Casa de Säo Paulo, para o tratamento de instabilidade. Destes, 23 (5,6 por cento) foram submetidos, além da capsuloplastia e reparaçäo da lesäo de Bankart, à colocaçäo de um enxerto ósseo na borda ântero-inferior da cavidade glenóide, porque esta se apresentava insuficiente. Foram reavaliados 13 pacientes com seguimento mínimo de 12 meses, média de 22,6 meses, obtendo-se resultados satisfatórios em todos os casos (11 excelentes e 2 bons), com limitaçäo média de rotaçäo externa de 15§. Os autores discutem a indicaçäo para a reconstruçäo óssea da cavidade glenóide, pois näo existe consenso na literatura quanto ao tamanho do defeito a partir do qual o enxerto se torna necessório. Concluem que esse procedimento leva a altos índices de bons resultados, já que nenhum dos pacientes evoluiu com instabilidade residual.

Desenvolvimento de um aparelho portátil de movimentaçäo contínua passiva para a mäo / Development of the portatil equipment of continuous passive motions for hand

A movimentação contínua passiva (MCP) visa uma movimentação lenta. Ela é realizada através de aparelhos adaptados para cada articulação. Empregado precocemente, previne sequelas e deformidades, diminuindo o tempo de tratamento, com consequente diminuição dos custos e com melhores resultados funcionais. O objetivo deste trabalho é desenvolver, com tecnologia nacional, um dispositivo de MCP para a mão, baseado em modelos de aparelhos estrangeiros. O aparelho deve ser portátil e de simples manuseio

Abstract - Continuous Passive Motion (CPM) units promote gentle passive motion to the joints. Different models are used for different joints. CPM helps mantain the potential for motion by moving tissues while healing occurs, preventing adhesion and deformities. The goal ofthis research is to develop national technology in this field creating a CPM unit for the hand

Técnica artroscópica para o tratamento da instabilidade anterior do ombro: resultados / Arthroscopic technique for the treatment of anterior instability of the shoulder: results

Os autores comentam as indicaçoes e os resultados obtidos no tratamento de 30 ombros com instabilidade anterior, operados pela técnica artroscópica que utiliza um ponto para reparar a lesao da cápsula articular na regiao anterior do ombro(4). O seguimento variou de nove a 73 meses (média = 29,4 + 19,8 meses). Foram operados 28 (93 por cento) ombros classificados como instabilidade traumática e dois (7 por cento), como atraumática. Os resultados obtidos foram satisfatórios em 24 (80 por cento) casos e insatisfatórios em seis (20 por cento). Os dois casos com instabilidade atraumática foram insatisfatórios. A instabilidade anterior traumática demonstrou tendência a resultados satisfatórios, sendo mais favorável do que aquela atraumática.

Técnica artroscópica para correçäo da lesäo de Bankart / Arthroscopic approach for correction of Bankart lesion

Os autores descrevem técnica cirúrgica por via artroscópica para a reconstruçäo da lesäo da cápsula articular e do lábio glenoidal na regiäo anterior do ombro (lesäo de Bankart). A técnica consiste em dar um ponto em formato de "U", com auxílio de uma agulha reta, envolvendo toda a regiäo lesada da cápsula articular e do lábio glenoidal, atravessando o colo da glenóide, da regiäo anterior para a posterior do ombro. A cápsula articular e o lábio glenoidal säo reinseridos sob tensäo na borda anterior da glenóide, com fio inabsorvível. Foram operados 28 ombros, com seguimento que variou de nove meses a seis anos (média = 29,4 meses)