The Dejour classification for trochlear dysplasia shows slight interobserver and substantial intraobserver reliability.

PURPOSE: Trochlear dysplasia is one of the main risk factors for recurrent patellar dislocation. The Dejour classification identifies four categories that can be used to classify trochlear dysplasia. The purpose of this study is to evaluate the inter- and intraobserver reliability of the Dejour classification for trochlear dysplasia. The hypothesis was that both intra- and interobserver reliability would be at least moderate. METHODS: This is a cross-sectional, reliability study. Twenty-eight examiners from the International Patellofemoral Study Group 2022 meeting evaluated lateral radiographs of the knee and axial magnetic resonance images from 15 cases of patellofemoral instability with trochlear dysplasia. They classified each case according to Dejour's classification for trochlear dysplasia (A-D). There were three rounds: one with only computed radiograph (CR), one with only magnetic resonance imaging (MRI) and one with both. Inter- and intraobserver reliability were calculated using κ coefficient (0-1). RESULTS: The mean age of patients was: 14.6 years; 60% were female and 53% had open physis. The interobserver reliability κ probabilities were 0.2 (CR), 0.13 (MRI) and 0.12 (CR and MRI). The intraobserver reliability κ probabilities were 0.45 (CR), 0.44 (MRI) and 0.65 (CR and MRI). CONCLUSION: The Dejour classification for trochlear dysplasia has slight interobserver reliability and substantial intraobserver reliability. LEVEL OF EVIDENCE: Level I.

Instrument-based anterolateral rotatory laxity assessment of the knee has a high intra-observer and inter-observer reliability: a systematic review.

IMPORTANCE: A reliable evaluation of anterolateral rotatory instability in the anterior cruciate ligament (ACL) deficient knee is important to help surgeons determine which patients might need concurrent anterolateral augmentation procedures. OBJECTIVE: The purpose of this study was to systematically review studies that assess the intra-observer and inter-observer reliability of instruments used to measure anterolateral rotatory laxity of the knee. EVIDENCE REVIEW: A comprehensive literature review was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, using PubMed, Embase, Scopus, and Google Scholar databases for original, English-language studies evaluating the reliability of objective or instrument-based anterolateral rotatory laxity of the knee until October 31, 2022. Reliability data were extracted from text, tables, and figures. FINDINGS: Twelve studies, with patients between the ages of 14-63 years, were included. The instruments used to measure anterolateral rotatory knee laxity included inertial sensors (n â€‹= â€‹9), magnetic resonance imaging (n â€‹= â€‹1), and navigation systems (n â€‹= â€‹2). The global intra-observer intraclass correlation coefficient for these devices was between 0.63 and 0.97, and the global inter-observer reliability was between 0.63 and 0.99. CONCLUSION AND RELEVANCE: Instrument-based anterolateral rotatory knee laxity assessment has moderate to good intra- and inter-observer reliability. Evaluating anterolateral instability in ACL-deficient knees with these devices could help in decision-making when considering anterolateral augmentation. LEVEL OF EVIDENCE: IV.

Review of Dohan Eherenfest et al. (2009) on "Classification of platelet concentrates: From pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)".

This classic discusses the original publication of Dohan Eherenfest et al. on "Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)", in which the authors propose four categories of platelet concentrates depending on their leucocyte and fibrin content (P-PRP, leucocyte- and platelet-rich plasma (L-PRP), pure platelet-rich fibrin (P-PRF), and L-PRF) to group a "jungle" of products in which the term platelet-rich plasma (PRP) was used indistinctly. They were able to identify common factors such as: (1) the use of anticoagulants and immediate centrifugation of the blood after its collection; (2) most preparation techniques allowed platelet concentrate preparation within an hour; (3) the centrifugation aimed to separate the blood in layers that would allow the extraction of specific fractions; and (4) the product was activated with thrombin or calcium chloride. The reviewed manuscript has been listed among the most cited PRP articles in regenerative medicine, with more than 800 citations, driving current scientific research and clinical practise by categorising L-PRP and P-PRP (now, leucocyte-poor PRP). The classification has also opened the door to understanding intrinsic biological mechanisms between platelets, leukocytes, fibrin, and growth factors, which will later be considered for studying the proliferation and differentiation of cells in different tissues affected by PRP. Since the initial classification of platelet concentrates, several other classification systems have been proposed and published in the current literature such as platelet, activation, white blood cell (PAW), Mishra, platelet, leucocyte, red blood cells, and activation (PLRA), dose of platelet, efficiency, purity, and activation (DEPA), method, activation, red blood cells, spin, platelets, image guidance, leukocytes, and light activation (MARSPILL), etc. These classifications have identified important aspects of PRP that affect the biological composition and, ultimately, the indications and outcomes. To date, there is still a lack of standardisation in sample preparation, cohort heterogeneity, and incomplete reporting of sample preparation utilised, leading to a lack of clarity and challenging researchers and clinicians.

A Review of the Lateral Patellofemoral Joint: Anatomy, Biomechanics, and Surgical Procedures.

The lateral patellofemoral joint soft tissues contain key structures that surround and balance the joint. These structures can affect joint tracking, stability, and force distribution. It is important to understand the lateral patellofemoral anatomy and biomechanics, and their relationship with patellofemoral instability, anterior knee pain, and osteoarthritis. Lateral-sided surgical procedures such as lateral release, lateral retinacular lengthening, and partial lateral patellar facetectomy can be useful in the treatment of such patellofemoral problems.

Magnetic resonance imaging overestimates patellar height compared with radiographs.

PURPOSE: To evaluate the inter-observer and inter-method reliability for patellar height measurements between conventional radiographs (CR) and magnetic resonance imaging (MRI) using one or two slices. METHODS: This was a reliability study, with 60 patients divided in two groups: 30 patients with patellar instability (patella group) and 30 patients with anterior cruciate ligament or meniscus injury (control group). CR and MRI were evaluated by two independent observers. Insall-Salvati index (IS) and Caton-Deschamps index (CD) were measured using three different methods: CR, one-slice MRI or two-slice MRI. Intra-class correlation coefficients (ICC) were calculated for inter-observer reliability and inter-method reliability. Bland-Altman agreement was also calculated. RESULTS: The inter-observer reliability was very good for the IS with ICCs of 0.93, 0.84 and 0.82, for the CR, one-slice MRI and two-slice MRI, respectively. Similarly, for the CD the ICCs were good, 0.76, 0.80 and 0.75 for the CR, one-slice MRI and two-slice MRI, respectively. No differences were found between the patella and the control group. The inter-method analysis results were: ICCs for IS (0.83, 0.86, 0.93) and CD (0.72, 0.82, 0.83), for the comparisons of CR/one-slice MR, CR/two-slice MRI and one-slice MRI/two-slice MRI, respectively. The Bland-Altman mean differences showed an 8% and a 7% increase on IS values with one-slice MRI and two-slice MRI compared to CR results, while the increase was of 9% and 1% in CD for the respective comparisons with CR. CONCLUSION: MRI can overestimate patellar height compared to CR, as much as an 8% increase in Insall-Salvati values when using one- or two-slice MRI measurements, and up to a 9% increase in Caton-Deschamps value when using the one-slice MRI method. It is recommended to use the CR as the preferred method when measuring patellar height. LEVEL OF EVIDENCE: III.

Current Concepts in the Management of Patellofemoral Pain Syndrome / Conceptos Actuales en el Manejo del Síndrome de Dolor Patelofemoral

Introduction Patellofemoral pain syndrome (PFPS) is one of the leading causes of knee pain, manifesting itself during daily life activities. This study presents a review on PFPS treatment modalities. Materials and methods State of the art review on the treatment of PFPS with grades of recommendation. Active and passive conservative interventions are reviewed, as well as surgical alternatives. Results Hip and lower-limb muscle strengthening and stretching are active interventions that provide long-lasting benefits. Passive interventions include patellofemoral joint bracing, kinesiotaping and foot orthoses, and are considered useful coadjuvants to active interventions, with quick relief for patients but usually in the short term. Surgical treatment is only recommended in a small subset of patients with specific anatomic abnormalities in the patellofemoral joint. Discussion Conservative treatment remains as the mainstream in the management of patellofemoral pain syndrome.

Introducción El síndrome de dolor patelofemoral (SDPF) es una de las principales causas de dolor de rodilla y se presenta con actividades diarias de la vida cotidiana. Este estudio presenta una revisión de la literatura acerca de las modalidades de tratamiento actual para el SDPF. Materiales y métodos Revisión estado del arte acerca del tratamiento del SDPF con grados de recomendación según la evidencia. Se revisan las intervenciones conservadoras activas y pasivas, así mismo las alternativas quirúrgicas. Resultados El fortalecimiento de los músculos de la cadera y del miembro inferior, así como el estiramiento, son intervenciones activas que ofrecen beneficios en el largo plazo para el SDPF. Las intervenciones pasivas como las rodilleras, el kinesiotaping y las ortesis para los pies, ofrecen alivio rápido pero de corta duración. El tratamiento quirúrgico solamente se recomienda en un subgrupo de pacientes que no han respondido a otros tratamientos y que tienen ciertas anormalidades anatómicas específicas que alteran la articulación patelofemoral. Discusión El tratamiento conservador continúa siendo la piedra angular en el tratamiento del síndrome de dolor patelofemoral

Validación de la versión en español para Colombia de la escala ASES / Validation of the Spanish version for Colombia of the ASES (American Shoulder and Elbow Surgeons) score

Introducción: La escala de ASES (American Shoulder and Elbow Surgeons) es una herramienta de medición funcional para evaluar problemas alrededor del hombro. Desarrollada en inglés, se utiliza desde 1993 en su idioma original. Está conformada por datos demográficos, una sección de evaluación médica y otra sección autodiligenciada por el paciente. El objetivo de este estudio es la traducción al español de Colombia de la escala ASES y su validación. Materiales y métodos: Estudio de traducción al español y validación de la escala de ASES. Se incluyeron pacientes con patología en el hombro entre diciembre de 2015 y marzo de 2016. Los pacientes respondieron la escala en dos ocasiones, con diferencia de 7-14 días entre una y otra. Se calculó el alfa de Cronbach (AC) y el coeficiente de correlación intraclase (CCI) para determinar la consistencia interna y la confiabilidad test-retest. Se utilizó el gráfico de Bland-Altman para determinar el error de medición. Resultados: Sesenta y cinco pacientes con patología de hombro fueron incluidos en el estudio, la lesión del manguito rotador (27%) fue la patología más frecuente. El alfa de Cronbach fue de 0.76 y el coeficiente de correlación intraclase fue de 0.74. El gráfico de Bland-Altman determinó la ausencia de error sistemático. Conclusiones: La versión en español para Colombia de la escala de ASES es una herramienta válida y confiable para evaluar calidad de vida en pacientes con patología en el hombro y puede ser aplicada en pacientes de habla hispana en Colombia.

Introduction: The ASES (American Shoulder and Elbow Surgeons) score, is a measurement tool developed in English for evaluating function around the shoulder. It has been used since 1993 in its original language. It is made up of demographic data, a medical evaluation section and another section self-completed by the patient. The aim if the study was to translate the ASES score to Colombian Spanish and validate it. Materials and methods: This is a translation and validation study of Spanish of the ASES score. Patients with shoulder problems were included between December 2015 and March 2016. Patients answered the score twice, during the first consultation and again 7-14 days after. Statistical analysis was performed with Stata 13.0. Cronbach's alpha (AC) and intraclass correlation coefficient (ICC) were calculated to determine internal consistency and test-retest reliability. The Bland-Altman plot was used to determine the measurement error. Results: Sixty-five patients were included in the study. The first cause of consultation was rotator cuff tear (27%). Cronbach's alpha was 0.76 and the intraclass correlation coefficient was 0.74. The Bland-Altman showed absence of systematic error. Conclusion: The Colombian Spanish version of the ASES score is a valid and reliable tool to assess the quality of life in patients with shoulder pathology and can be used in Colombia on Spanish speaking patients.

Incidencia de luxación primaria de patela en Colombia / IncidenceofprimarypatellardislocationinColombia

Introducciónyobjetivos:Laluxaciónagudaprimariadepatelarepresentael3%delaslesionestraumáticasdelarodilla.Diferentesestudioshanestimadolaincidenciadeluxacióndepatelaentre2y77.4por100,000personasa ̃no.HaypocosestudiosenLatinoamérica.ElobjetivodeesteestudioescalcularlaincidenciadeluxaciónpatelofemoralenuncentrodereferenciaenelsuroccidentedeColombia,evaluarlatendenciaenlosúltimosa ̃nosydescribirlatasademanejoquirúrgico.Materialesymétodos:Estudioobservacionalanalíticotipocortetransversalqueincluyótodoslospacientesmayoresde9a ̃nosconluxaciónprimarialateraldepatelaentreenerode2011yjuniode2018,enunhospitaldeatenciónavanzadaenColombia.Resultados:Enestapoblación,laincidenciadeluxaciónlateralpatelofemoralfuede32.38por100,000personas-a ̃no.Elgrupodeedadentre14-18a ̃nostuvolamayorincidencia(187.74por100.000).Soloenelgrupoentre10-13a ̃nos,elsexofemeninotuvounaincidenciasignificati-vamentemayorqueloshombres(179.05vs59.85por100,000,p<0.001).Conclusiones:Conincidenciade32.38por100,000personas-a ̃no,laluxaciónpatelofemoralesunapatologíaortopédicafrecuenteennuestrapoblación.Elpicodeincidenciaesentre14-18a ̃nos

Introductionandobjectives:Primaryacutepatellardislocations(PAPD)accountfor3%ofalltraumatickneelesions,andseveralstudieshaveestimatedthegeneralincidenceofpatellardislocationtobebetween2and77.4per100,000person-years.FewstudieshaveevaluatedtheincidenceofprimarylateralpatellardislocationinLatinAmerica.TheaimofthestudywastoevaluatetheincidenceofpatellardislocationinpatientsfromareferencecenterintheColombiansouthwest,reporttrendsintheincidenceofdislocation,anddescribetherateofsurgicaltreatment.Materialsandmethods:Weperformedanobservational,analytical,cross-sectionalstudyincludingallpatientsolderthan9yearsoldwithprimarylateralpatellardislocation(PLPD),betweenJanuary2011andJune2018,inatertiarycarecenterinLatinAmerica.Results:Inourpopulation,theincidenceofprimarylateralpatellardislocation(PLPD)was32.38per100,000person-years.Theagegroupbetween14and18yearsoldhadthehighestincidence(187.74per100.000).Inthe10to13-year-oldgroup,femaleshadasignificantlyhigherincidence(179.05vs59.85/100,000,p-value<0.001).Conclusions:Withanincidenceof32.38per100,000person-years,primarypatellardislocationisafrequentorthopaedicinjuryinourpopulation.Thepeakincidencebyagegroupwasinadolescentsbetween14to18yearsold

El ligamento anterolateral de la rodilla, reflexiones más allá de su existencia / The anterolateral ligament of the knee, reflections beyond its existence

Todosrecordamoslostitulareshaceunosa ̃nosderevistasnomédicas,noticierosyperiódicos,anunciandoeldescu-brimientodeunligamento;yesquenotodoslosdíassedescubreunnuevoligamentoenlarodilla.Sinembargo,asífuecomosepopularizóelligamentoanterolateralini-cialmenteysedesencadenótambiénunaexplosióndeinvestigaciónypublicacionesacercadesuanatomía,apa-rienciaenresonanciamagnética,biomecánicaytécnicasparasureconstrucción.Dostemashansidodeinterésparticular.Elprimero,esacercadelaexistenciadedicholigamento.Conpublica-cionesenunoyotrosentido,sehaconformadoungrupoquedefiendesuexistencia,yasímismo,quienesconside-ranquemásqueunligamentoloquehayesunconjuntodeestructurasanterolateralesqueseencargandedichafunción1,2.Enmiconceptoesunadiscusiónfútil.Enreali-dad,lofundamentalesentenderelroldelasestructurasanterolaterales,cuándohayquereconstruirlasyporquérazonessedeberíahacer

We all remember the headlines a few years ago in non-medical magazines, newscasts and newspapers, announcing the discovery of a ligament; and that it is not every day that a new ligament is discovered in the knee. However, this is how the anterolateral ligament initially became popular and also triggered an explosion of research and publications about its anatomy, appearance in magnetic resonance, biomechanics and techniques for its construction. Two topics have been of particular interest. The first, is about the existence of said ligament. With publications in both directions, a group has been formed that defends its existence, and likewise, who considers that more than a ligament what there is is a set of anterolateral structures that are responsible for said function1,2. In my concept is a futile discussion. In reality, the fundamental thing is to understand the role of the anterolateral structures When should they be rebuilt and why should they be done?

Eventos tromboembólicos sintomáticos después de artroscopia de rodilla / Symptomatic thromboembolic events after knee arthroscopy

Introducción: La artroscopia de rodilla es usualmente un procedimiento seguro con pocas complicaciones. El objetivo de este estudio es calcular la incidencia de eventos tromboembólicos sintomáticos: trombosis venosa profunda y tromboembolismo pulmonar, asociados a artroscopia de rodilla y los posibles factores de riesgo relacionados. Materiales and Métodos: Cohorte retrospectiva que incluyó todos los pacientes llevados a artroscopia de rodilla entre Enero 2011 y Diciembre 2015 en un hospital universitario. El seguimiento fue de 30 días después de la cirugía. Se registraron datos demográficos, los eventos de interés, el tipo de cirugía y los posibles factores de riesgo. Resultados: 1,097 artroscopias de rodilla se hicieron en los 5 años. El 100% tuvieron seguimiento de 10 días mínimo, 90.5% alcanzaron el seguimiento de 30 días. El tiempo promedio de seguimiento fue 15.1 meses. El porcentaje de eventos tromboembólicos fue de 1.4% (n = 14). Se encontraron dos factores de riesgo asociados: eventos tromboembólicos previos (p = 0.013) y uso de anticoagulantes previo a la cirugía (p=0.001). La edad promedio fue mayor en los pacientes con eventos tromboembólicos comparado con los que no tuvieron eventos (58 vs 46 años), p = 0.009. Discusión: La incidencia de eventos tromboembólicos sintomáticos tras artroscopia de rodilla es bajo. El uso rutinaio de profilaxis tromboembólica no se recomienda. En los pacientes con historia de eventos tromboembólicos previos o que estpan anticoagulados en el momento de la cirugía, si se recomienda. Además, en los pacientes mayores de 50 años, debería considerarse su uso. Nivel de Evidencia: III, Estudio de Cohorte Restrospectiva.

Introduction: Knee arthroscopy is usually a safe procedure with few complications. The objective of this study is to calculate the incidence of symptomatic thromboembolic events: deep vein thrombosis and pulmonary thromboembolism, associated with knee arthroscopy and the possible related risk factors. Materials and Methods: Retrospective cohort that included all patients undergoing knee arthroscopy between January 2011 and December 2015 at a university hospital. Follow-up was 30 days after surgery. Demographic data, events of interest, type of surgery and possible risk factors were recorded. Results: 1,097 knee arthroscopies were performed in the 5 years. 100% had follow-up of at least 10 days, 90.5% reached follow-up of 30 days. The average follow-up time was 15.1 months. The percentage of thromboembolic events was 1.4% (n = 14). Two associated risk factors were found: previous thromboembolic events (p = 0.013) and use of anticoagulants prior to surgery (p = 0.001). The average age was higher in patients with thromboembolic events compared to those without events (58 vs 46 years), p = 0.009. Discussion: The incidence of symptomatic thromboembolic events after knee arthroscopy is low. The routine use of thromboembolic prophylaxis is not recommended. In patients with a history of previous thromboembolic events or who are on anticoagulation at the time of surgery, if recommended. Furthermore, its use should be considered in patients over 50 years of age. Level of Evidence: III, Retrospective Cohort Study.

Anterior knee pain in runners after a half-marathon race.

BACKGROUND: Anterior knee pain has been associated with sports activity, especially long-distance running and endurance sports. It is important to determine the incidence of anterior knee pain (AKP) in runners after a half-marathon race and identify possible risk factors associated. METHODS: Cross-sectional study where runners from a half marathon race were randomly invited to participate. Participants were recruited at the race kit pickup site the day before the race. Eligible participants completed a survey regarding demographic information, running experience and training details. An orthopedic surgeon performed a physical examination and recorded the medical history. At the finish line, the participants were evaluated again for possible new injuries. RESULTS: A total of 205 runners were included in the study, with a 98.5% follow-up rate (n = 203). 24% of runners had an injury at the end of the race (n = 49). Anterior knee pain was the most frequent injury (n = 12), followed by iliotibial band syndrome (n = 10), muscle cramps (n = 7) and hamstring tears (n = 4). Anterior knee pain had a statistically significant association with insufficient stretching of the hamstrings (p = 0.048) and finishing the race in more than 2 h (p = 0.014). CONCLUSIONS: Anterior knee pain was the most frequent new injury in the half-marathon runners after the competition. Spending more than 2 h to finish the race and stretching the hamstrings by less than 70° in the supine position were risk factors for anterior knee pain.

Cross-cultural translation and validation of the Spanish version of the patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF).

OBJECTIVE: The aim of this study was to translate to Spanish the patellofemoral pain and osteoarthritis subscale of the knee injury and osteoarthritis outcome score (KOOS-PF) and validate this Spanish version of a disease-specific patient-reported outcome measure (PROM) for patellofemoral pain. RESULTS: The KOOS-PF was translated to Spanish and sixty patients with patellofemoral pain and/or osteoarthritis accepted to complete the questionnaire. 1-week later 58 patients answered the questions again for the test-retest reliability validation and finally 55 patients completed 1-month later for the responsiveness assessment. The Spanish version showed very good internal consistency (Cronbach's alpha: 0.93) and test-retest reliability (intraclass correlation coefficient: 0.82). Responsiveness was confirmed, showing a strong correlation with the global rating of change (GROC) score (r 0.64). The minimal detectable change was 11.1 points, the minimal important change was 17.2 points, and there were no floor or ceiling effects for the score.

Editorial Commentary: Anterolateral Hinge Position Decreases the Slope in Opening-Wedge High Tibial Osteotomy: A Key Point in Treating an Anterior Cruciate Ligament-Deficient, Varus Knee.

The orthopaedic surgeon who performs opening-wedge high tibial osteotomy (HTO) has to be aware of the behavior of the tibial slope depending on variations in the location of the hinge and in the inclination of the osteotomy. The most important point is that changing both the inclination and the rotation axis of the osteotomy cut affects the tibial slope. There is a natural trend to unintentionally increase the tibial slope when performing an opening-wedge HTO. However, an increased tibial slope has been established as a risk factor for both primary and recurrent anterior cruciate ligament (ACL) injuries, whereas slope-reducing osteotomies decrease anterior tibial translation and protect the ACL graft. To reduce tibial slope in opening-wedge HTO, it seems more practical to internally rotate the osteotomy, establishing an anterolateral hinge, than to change the inclination of the cut, given that it seems more predictable and technically easier to perform internal rotation during surgery. Trying to achieve both internal rotation and extension increases the complexity of the osteotomy. Not every osteotomy needs to have an anterolateral hinge; in fact, decreasing the tibial slope would be a disadvantage in the posterior cruciate ligament-deficient knee. However, for the ACL-deficient knee with varus malalignment, aiming to decrease the tibial slope using an anterolateral hinge could be considered during preoperative planning.

Patellofemoral Dislocation Recurrence After a First Episode: A Case-Control Study.

BACKGROUND: Lateral patellar dislocation can become a recurrent problem after the first episode. Identifying those patients who are at increased risk of redislocation is important for the treatment decision-making process. PURPOSE: To identify clinical and radiologic risk factors for recurrence of patellar dislocation after a first episode. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The study included patients with lateral patellar dislocation and a 1-year minimum follow-up who were seen between 2011 and 2018. Patients aged 10 to 65 years were included. Patient characteristics, physical examination (patellar apprehension, J sign), and radiographs were reviewed. The Caton-Deschamps and Insall-Salvati ratios were used to evaluate patella alta. High-grade trochlear dysplasia was defined as Dejour types B, C, and D. RESULTS: A total of 130 patients (139 knees) with primary lateral patellar dislocation were included. Recurrent dislocation was seen in 83 knees (59.71%). Stepwise logistic regression analysis demonstrated that Caton-Deschamps ratio ≥1.15 (OR, 2.39; 95% CI, 1.09-5.22; P = .029), age <21 years (OR, 2.53; 95% CI, 1.11-5.77; P = .027), and high-grade trochlear dysplasia (OR, 4.17; 95% CI, 1.90-9.17; P < .001) were significantly associated with patellar redislocation. Based on the presence of these factors, the probability of dislocation after a first lateral patellar dislocation was 31.2% with no factors present, 36.6% with any 1 factor present, 71.7% with any 2 factors present, and 86.2% if all 3 conditions were present. CONCLUSION: The results of this study indicated that patella alta, high-grade trochlear dysplasia, and age <21 years were independent risk factors for patellar redislocation after a first episode, with an additive effect when they were present together. This may help to guide the type of treatment for these patients.

Body mass index and knee arthroplasty.

OBJECTIVE: this study aims to evaluate the relationship between body mass index (BMI), age at which knee joint arthroplasty is performed and complications. The hypothesis is that the higher the BMI, the greater likelihood that the patient will require surgery at an earlier age.Methods: this is a cohort study with all patients who underwent a primary knee arthroplasty, between August 2013 and February 2019, in a tertiary level university hospital. Association between BMI, age and complications were analyzed. Quality of life of patients was also evaluated with the Oxford Knee Score (OKS). RESULTS: 565 primary total knee replacements (TKR) were performed. A cut-off point was found in BMI of 30; 348 patients had a BMI ≤30 and 173 patients had a BMI >30. When comparing the two groups, a statistically significant difference (p = 0.0186) was found in the age at which the TKR was performed. There was a significant improvement for both groups in functional score (Oxford knee score). Additionally, intra and post-operative complications showed no statistically significant difference. CONCLUSION: patients with BMI greater than 30 required primary knee arthroplasty at a younger age (average: 3.5 years), compared to patients with a lower BMI. Obesity does not appear to confer and independent risk for surgery in the short and mid-term. Knee arthroplasty improves significantly quality of life in the short and mid-term, regardless of their BMI, as measured with the OKS.

Quadrupled Semitendinosus ACL Reconstruction Combining Cortical Button in Femur and Interference Screw in Tibia.

Anterior cruciate ligament (ACL) reconstruction with hamstring tendons has gained popularity in the past and is the most used type of graft in several national registries. It usually involves the harvest of both gracilis and semitendinosus tendons from the ipsilateral knee. More recently, the use of only 1 of the tendons (semitendinosus) in a tripled or quadrupled arrangement has been described, especially in an all-inside type of reconstruction. Having a thicker tendon with a quadrupled semitendinosus (ST), instead of double gracilis and ST enables to a have a graft with enough diameter to resemble more closely the native ACL and decreases the risk of graft rerupture. This Technical Note aims to present a way of reconstructing the ACL using a quadrupled ST graft, with suspensory cortical button in femur and interference screw in tibia, as an alternative to the all-inside technique.

Criterio apropiado para el tratamiento quirúrgico de las fracturas de platillos tibiales / Use of Benchmarking for Surgical Treatment of Tibial Plateau Fractures

Introducción Este trabajo propone el concepto de criterio apropiado en el tratamiento quirúrgico de las fracturas de platillos tibiales compuesto por 10 elementos. Dentro de estos se incluye el abordaje, la calidad de la reducción, la estabilidad de la fijación y el tiempo para la fijación, entre otros. El estudio busca correlacionar el puntaje de esta escala propuesta con la escala funcional descrita por Rasmussen. Materiales y métodos Estudio tipo cohorte retrospectiva que incluye los pacientes con fracturas de platillos tibiales tratadas quirúrgicamente entre enero de 2013 y junio de 2017. Se registraron variables demográficas, las variables de interés para establecer el criterio apropiado y el resultado funcional con la escala de Rasmussen. Resultados 75 pacientes fueron incluidos, logrando seguimiento mínimo de 6 meses en 89% (n=67). La mediana para edad fue 39 años y el predominio masculino (56.7%). La etiología principal fue accidente de tránsito en moto (67%). En 78% se presentó compromiso de alguna columna posterior. El tratamiento fue apropiado en 61% de los casos, mientras 89% tuvieron resultado bueno o excelente en la escala de Rasmussen. La correlación fue lineal y estadísticamente significativa entre el criterio apropiado y la escala funcional de Rasmussen, correlación Pearson: 0.6279 (p<0.001). Discusión El concepto de criterio apropiado puede ser aplicado en la toma de decisiones y planeamiento quirúrgico de las fracturas de platillos tibiales. Sus buenos resultados se asocian con mejores resultados en la escala de Rasmussen y mayor satisfacción para el paciente.

Background This study presents the use of benchmark criteria for the surgical treatment of tibial plateau fractures. It has 10 elements, including: quality of fracture reduction, fixation stability, time elapsed to fixation, among others. The purpose of the study is to correlate the benchmark criteria used with Rasmussen's functional score system. Materials and methods A retrospective cohort study that included patients with a tibial plateau fracture that required surgical treatment between January 2013 and June 2017. Baseline characteristics, outcomes related with the benchmark criteria, and Rasmussen's score variables, were registered. Results A total of 75 patients were included, with a 6-months minimum follow-up for 89% (n=67). The median age was 39 years old, and the majority (56.7%) were men. The first cause of fracture was motorcycle accident (67%). There was compromise of a posterior column in 78% of the cases. Treatment was considered appropriate in 61%, and 89% had a good/excellent result in Rasmussen's functional score. There was a significant linear correlation between the benchmark criteria and Rasmussen's score, with a Pearson correlation coefficient of 0.6279 (P<.001). Discussion Benchmarking criteria may be useful in the evaluation and planning of surgical treatment of tibial plateau fractures. They are associated with better functional results and satisfaction in the Rasmussen's score.

Fracturas en niños: experiencia en un centro de alta complejidad del suroccidente Colombiano / Fractures in children: experience in a tertiary referral hospital in South west Colombia

Resumen Introducción: Es importante conocer las características demográficas y clínicas de las fracturas en niños para mejorar las estrategias de prevención y tratamiento en estos pacientes. Objetivos: Describir las fracturas en niños y sus características epidemiológicas. Metodología: Estudio tipo corte transversal desde enero 2014 hasta diciembre 2017. Pacientes menores de 18 años que consultaron por fracturas a una clínica en Colombia fueron incluidos. Se incluyeron datos demográficos, lugar donde ocurrió el trauma, huesos fracturados y tipo de tratamiento. Se evaluó la distribución por género y grupo etario. La fuente de información fue la historia clínica. Se utilizaron medidas de tendencia central y dispersión para agrupar los datos. Se calculó la incidencia de fracturas por cada 1000 niños/ año. Este estudio recibió aval del comité de ética de la institución. Resultados: Hubo 2436 niños fracturados, 65.6% (n=1597) ocurrieron en hombres. La mayoría fueron entre 6-11 años (40.7%, n=991), luego entre 12-17 años (36.4%, n=887) y finalmente, menores de 6 años (22.9%, n=558). La localización de la fractura más frecuente entre 0-5 años fue el húmero (30.6%, n=171), seguido por el radio (29%, n=162) y la clavícula (15.9%, n=89); entre 6-11 años fue el radio (45.2%, n=448), seguido por el húmero (18%, n=178) y el cúbito (16.6%, n=165); y entre 12-17 años fue el radio (34.6%, n=307), seguido por los huesos de la mano (22.7%, n=201) y los huesos del pie (10.8%, n=96). Requirieron manejo quirúrgico 30.9% de los niños fracturados (n=752). La incidencia de fracturas fue de 29.7/1000 niños por año. Conclusión: Las fracturas en niños se presentan con mayor frecuencia en el género masculino. Los huesos fracturados varían dependiendo del grupo etario, con un porcentaje importante del radio en todos los grupos. La mayoría se manejan de forma conservadora.

Abstract Introduction: It is important to know the demographic and clinical characteristics of fractures in children to improve prevention and treatment strategies in these patients. Objectives: To describe fractures in children and their epidemiological characteristics. Methodology: Cross-sectional study performed between January 2014 and December 2017. Patients under 18 years old with fractures who consulted to a hospital in Colombia were included. Demographic data, the location where the trauma occurred, fractured bones and type of treatment were included. Age and gender distribution were analyzed. Medical records were the source of information. Central tendency and dispersion measures were used to group the data. Incidence of fractures per 1000 children / year was calculated. This study received approval from the institution's ethics committee. Results: There were 2436 children with fractures, 65.6% (n=1597) occurred in males. Most fractures were in children between 6-11 years old (40.7%, n=991), followed by 12-17 years old (36.4%, n=887) and finally by children under 6 years old (22.9%, n=558). For the group under 6 years, most fractures occurred in humerus (30.6%, n=171), followed by radius (29%, n=162) and clavicle (15.9%, n=89); between 6-11 years old it was in radius (45.2%, n=448), followed by humerus (18%, n=178) and ulna (16.6%, n=165); and between 12-17 years it was in radio (34.6%, n=307), followed by bones of the hand (22.7%, n=201) and bones of the foot (10.8%, n=96). Surgical treatment was required in 30.9% (n=752) of the patients. The incidence of fractures was 29.7/1000 children per year. Conclusions: Fractures in children occur more frequently in males. The fractured bones differ depending on the age group; however, radius fractures represent an important proportion in all groups. Most fractures in children are treated in a conservative manner.

Actualización en las inserciones anatómicas del ligamento anterolateral: revisión sistemática de la literatura / Update in the Anatomical Insertions of the Anterolateral Ligament: Systematic Review of Literature

Introducción Aunque las indicaciones para su reconstrucción aún son motivo de debate, desde su descripción, la anatomía del ligamento anterolateral ha sido estudiada extensivamente. Sus puntos de inserción se han modificado en los estudios más recientes y esto es importante en el momento de hacer una reconstrucción anatómica. Este estudio busca hacer una revisión sistemática de la literatura para establecer sus puntos de inserción en fémur y tibia. Materiales y métodos Revisión sistemática desde enero de 2012 hasta junio de 2017. Se buscaron publicaciones en Pubmed, Embase, Google Scholar y Cochrane. Se incluyeron estudios cadavéricos que evaluaran la anatomía del ligamento anterolateral y describieran sus puntos de inserción. Resultados Se encontraron 334 estudios con los términos de interés, que tras su evaluación llevó a incluir 13 artículos. El ligamento no estaba presente en el 100% de los especímenes evaluados en los diferentes artículos. Su inserción tibial se ha mantenido sin cambios desde la descripción inicial, en un punto intermedio entre la cabeza del peroné y el tubérculo de Gerdy, mientras que la femoral ha cambiado. Esta se ha modificado a un punto posterior y proximal al epicóndilo lateral del fémur y al origen del colateral externo, contrario a la ubicación inicial anterior y distal a estos. Discusión Actualmente se considera que la inserción del ligamento anterolateral es posterior y proximal al origen del ligamento colateral externo. Esto tiene importancia para su reconstrucción quirúrgica: el ligamento debería ser fijado cuando tiene su máxima longitud, entre 20-30° de flexión de la rodilla.

Introduction Although its anatomy has been extensively studied, there is still controversy in the medical literature as regards when the anterolateral ligament should be reconstructed. Its insertion points have been modified in the most recent studies and this might play an important role in its anatomical reconstruction. This study aims to conduct a systematic review of literature in order to establish insertion points of the anterolateral ligament in the femur and tibia. Materials and methods A systematic review of literature was conducted between January 2012 and June 2017. It included post-mortem studies of dissection of the anterolateral ligament in adult knees that reported its anatomical insertions. The following databases were searched: PubMed, Embase, Google Scholar and Cochrane. Results A total of 334 studies were found in the systematic review using the key words. After evaluating them, 13 papers fulfilled the eligibility criteria and were included in the study. The anterolateral ligament was not found in the 100% of the post-mortem knees. Its tibial insertion continued to be similar to the original description: between the fibula head and Gerdy's tubercle. The femoral insertion has changed, now being posterior and proximal to the lateral epicondyle and the insertion of the lateral collateral ligament, as opposed to its initial location of anterior and distal to these structures. Discussion The femoral insertion of the anterolateral ligament is currently considered to be proximal and posterior to the origin of the lateral collateral ligament. This is important for an anatomical surgical reconstruction, when the ligament should be fixed in its maximal length, between 20-30° of knee flexion.