Outcomes of Anterior Cruciate Ligament Reconstruction in Patients with Associated Anterolateral Ligament Injury / Resultados da reconstrução do ligamento cruzado anterior em pacientes com lesão associada do ligamento anterolateral

Abstract Objective To evaluate if there is a significant difference in the outcomes of isolated anterior cruciate ligament (ACL) reconstruction in patients with or without associated anterolateral ligament (ALL) injury. Methods We conducted a retrospective cross-sectional study through the analysis of medical records and the application of the questionnaires of the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Form to patients undergoing isolated ACL reconstruction. Results The 52 participants included were divided into two groups: 19 with associated ALL injury and 33 with no associated ALL injury. None of the patients with associated ALL injury suffered an ACL rerupture, and 21.1% presented injuries to other knee structures after surgery. Among the patients with no associated injury, 6.1% suffered ACL rerupture, and 18.2% presented injuries to other structures after surgery (p = 0.544). Return to activities at the same level as that of the preoperative period occurred in 60% of the patients with associated ALL injury and in 72% of those with no associated injury (p = 0.309). The mean score on the Lysholm Knee Scoring Scale was of 81.6 points in patients with associated ALL injury, and of 90.1 in those with no associated injury (p = 0.032). The mean score on the IKDC Subjective Knee Form was of 70.3 points in patients with associated ALL injury and of 76.7 in those with no associated injury (p = 0.112). Conclusion There was no statistically significant difference regarding graft injuries or new injuries to other structures, satisfaction with the operated knee, or the score on the IKDC Subjective Knee Form. Return to activity was similar in the groups with and without associated ALL injuries. The scores on the Lysholm Knee Scoring Scale were better, with a statistically significant difference in the group with no associated ALL injuries.

Resumo Objetivo Avaliar se há diferença significativa nos resultados da reconstrução isolada do ligamento cruzado anterior (LCA) em pacientes com e sem lesão associada do ligamento anterolateral (LAL). Métodos Foi realizado um estudo transversal retrospectivo com análise de prontuários e aplicação dos questionários da Escala de Pontuação do Joelho de Lysholm e do Formulário Subjetivo de Joelho do International Knee Documentation Committee (IKDC) a pacientes com reconstrução isolada do LCA. Resultados Os 52 participantes incluídos foram separados em 2 grupos: 19 com lesão associada do LAL e 33 sem lesão associada. Nenhum paciente com lesão associada do LAL sofreu rerruptura do LCA, e 21,1% tiveram lesões em outras estruturas do joelho após a cirurgia. Entre os pacientes sem lesão associada, 6,1% sofreram rerruptura do LCA, e 18,2% tiveram lesões em outras estruturas após a cirurgia (p = 0,544). O retorno às atividades no mesmonível do quenopré-operatóriofoi observadoem60% dos pacientes com lesão associada do LAL e em 72% daqueles sem lesão associada (p = 0,309). Na Escala de Pontuação do Joelho de Lysholm, os pacientes com lesão associada do LAL obtiveram média de 81,6 pontos, e os sem lesão associada, média de 90,1 pontos (p = 0,032). No Formulário Subjetivo de Joelho do IKDC, os pacientes com lesão associada do LAL obtiveram média de 70,3 pontos, e os sem lesão associada, média de 76,7 pontos (p = 0,112). Conclusão Não foi observada diferença estatística significativa quanto a lesões do enxerto ou novas lesões de outras estruturas, satisfação com o joelho operado ou pontuação no Formulário Subjetivo de Joelho do IKDC. Oretorno às atividades foi semelhante nos grupos com e sem lesão associada do LAL, e os resultados na Escala de Pontuação do Joelho de Lysholm foram melhores, com diferença estatística significativa no gruposem lesãoassociada do LAL.

Outcomes of Anterior Cruciate Ligament Reconstruction in Patients with Associated Anterolateral Ligament Injury.

Objective To evaluate if there is a significant difference in the outcomes of isolated anterior cruciate ligament (ACL) reconstruction in patients with or without associated anterolateral ligament (ALL) injury. Methods We conducted a retrospective cross-sectional study through the analysis of medical records and the application of the questionnaires of the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Form to patients undergoing isolated ACL reconstruction. Results The 52 participants included were divided into two groups: 19 with associated ALL injury and 33 with no associated ALL injury. None of the patients with associated ALL injury suffered an ACL rerupture, and 21.1% presented injuries to other knee structures after surgery. Among the patients with no associated injury, 6.1% suffered ACL rerupture, and 18.2% presented injuries to other structures after surgery ( p = 0.544). Return to activities at the same level as that of the preoperative period occurred in 60% of the patients with associated ALL injury and in 72% of those with no associated injury ( p = 0.309). The mean score on the Lysholm Knee Scoring Scale was of 81.6 points in patients with associated ALL injury, and of 90.1 in those with no associated injury ( p = 0.032). The mean score on the IKDC Subjective Knee Form was of 70.3 points in patients with associated ALL injury and of 76.7 in those with no associated injury ( p = 0.112). Conclusion There was no statistically significant difference regarding graft injuries or new injuries to other structures, satisfaction with the operated knee, or the score on the IKDC Subjective Knee Form. Return to activity was similar in the groups with and without associated ALL injuries. The scores on the Lysholm Knee Scoring Scale were better, with a statistically significant difference in the group with no associated ALL injuries.

Can We Forgo the Use of Tourniquets in Total Knee Arthroplasty?

Objective To analyze whether there is more bleeding in patients undergoing total knee arthroplasty (TKA) without using a tourniquet. The secondary objectives were to analyze the operative time, the length of hospital stay, the need for transfusion, and the complication rate. Methods The present is a retrospective study through the analysis of medical records. The patients were divided into two groups: TKA with and without the use of a tourniquet. Reductions in the levels of hemoglobin and packed cell volume 24 h and 48 h after surgery, the operative time, the length of hospital stay, the need for transfusion, and the rate of complications up to 6 months postoperatively were compared between the groups. Results During the period analyzed, 104 patients underwent TKA, and 94 were included in the study. There were no differences between the groups regarding the mean values of hemoglobin and packed cell volume before surgery ( p = 0.675 and p = 0.265), 24 h ( p = 0.099 and p = 0.563), and 48 h ( p = 0.569 and p = 0.810) after the procedure. Neither were there differences between the groups in terms of the operative time and the length of hospital stay ( p = 0.484 and p > 0.05). Moreover, there were no differences regarding the need for transfusion and the complication rate. Conclusion It is possible to forgo the use a tourniquet in TKA without a significant change in hemoglobin and packed cell volume levels 24 h and 48 h after surgery when compared with the group using a tourniquet. There were no significant differences in the total operative time, length of stay, need for transfusion, and complication rate.

Transtibial Femoral Tunnel Technique in ACL Reconstruction and Osteoarthritis Incidence.

Objective : Evaluate osteoarthritis incidence in patients that undergone ACL reconstruction using the transtibial technique, with a minimum of 5 years of follow up, with isolated ACL injury. Methods : Patients who underwent ACL reconstruction by the same surgeon using the transtibial technique with hamstrings graft and with a minimum of 5 years of follow-up, without other injuries during the surgical procedure, were selected to undergo imaging exams of the operated knee to assess the incidence of osteoarthritis. The obtained data were evaluated by descriptive statistics. Results : Forty-two patients (44 knees) were evaluated, with a mean age of 31 years old (SD: 8), being 23 right knees and 28 male patients. Mean time from surgery to imaging evaluation was 94.1 months (ranging from 60 to 154 months; SD: 28). Of the evaluated knees, 37 did not have osteoarthritis (83.3%) and 7 had (16.7%). Conclusion : ACL reconstruction with femoral tunnel performed through the transtibial technique in patients without other associated injuries in the operated knee, using hamstrings graft, with a minimum of 5 years of follow up, showed an osteoarthritis incidence of 16.7% in a mean follow-up of 94.1 months. Level Of Evidence V; Case Series.

Extraarticular infection 9 years after anterior cruciate ligament reconstruction. Case report.

Extraarticular infection after anterior cruciate ligament reconstruction (ACLr) is a rare condition with challenging diagnosis because the symptoms are milder and more insidious when compared to septic arthritis. When late (>2 months after surgery), it tends to be associated with osteomyelitis, requiring more extensive surgical debridement and hardware removal. We report a case of extraarticular infection after ACLr, in the acute phase affecting the tibial site and 9 years after index surgery affecting around the femur site. There was no progression to osteomyelitis at any of the sites. The infection developed a large posterolateral encapsulated abscess, with the endobutton plate loose inside it with its loop intact. In addition to the absence of osteomyelitis progression, there was no sinus tract formation, graft or joint involvement. With open debridement and antibiotic therapy, the patient returned to his activities without limitations. The reported case highlights that extraarticular infection after ACLr, while rare, can be challenging to diagnose and treat. However, with appropriate treatment, it can lead to good results with no functional limitations.

Transtibial Femoral Tunnel Technique in ACL Reconstruction and Osteoarthritis Incidence / Técnica do túnel femoral transtibial na reconstrução do LCA e incidência de osteoartrite

Abstract Objective: Evaluate osteoarthritis incidence in patients that undergone ACL reconstruction using the transtibial technique, with a minimum of 5 years of follow up, with isolated ACL injury. Methods: Patients who underwent ACL reconstruction by the same surgeon using the transtibial technique with hamstrings graft and with a minimum of 5 years of follow-up, without other injuries during the surgical procedure, were selected to undergo imaging exams of the operated knee to assess the incidence of osteoarthritis. The obtained data were evaluated by descriptive statistics. Results: Forty-two patients (44 knees) were evaluated, with a mean age of 31 years old (SD: 8), being 23 right knees and 28 male patients. Mean time from surgery to imaging evaluation was 94.1 months (ranging from 60 to 154 months; SD: 28). Of the evaluated knees, 37 did not have osteoarthritis (83.3%) and 7 had (16.7%). Conclusion: ACL reconstruction with femoral tunnel performed through the transtibial technique in patients without other associated injuries in the operated knee, using hamstrings graft, with a minimum of 5 years of follow up, showed an osteoarthritis incidence of 16.7% in a mean follow-up of 94.1 months. Level Of Evidence V; Case Series.

Resumo Objetivo: Avaliar a incidência de osteoartrite em pacientes submetidos à reconstrução do LCA pela técnica transtibial, com seguimento mínimo de 5 anos, com lesão isolada do LCA. Métodos: Pacientes que passaram por reconstrução LCA pelo mesmo cirurgião usando a técnica transtibial com enxerto de tendão dos músculos isquiotibiais e que foram acompanhados por no mínimo 5 anos, sem outras lesões durante o procedimento cirúrgico, foram selecionados para realizar exames de imagem do joelho operado a fim de avaliar a incidência de osteoartrite. Os dados obtidos foram avaliados por meio de estatísticas descritivas.. Resultados: Foram avaliados 42 pacientes (44 joelhos), com idade média de 31 anos (DP: 8), sendo 23 joelhos direitos e 28 pacientes do sexo masculino. O tempo médio entre a cirurgia e a avaliação por imagem foi de 94,1 meses (variando de 60 a 154 meses; DP: 28). Dos joelhos avaliados, 37 não apresentavam osteoartrite (83,3%) e 7 apresentavam (16,7%). Conclusão: A reconstrução do LCA com túnel femoral realizado por meio da técnica transtibial em pacientes sem outras lesões associadas no joelho operado, utilizando enxerto dos tendões isquiotibiais, com um acompanhamento mínimo de 5 anos, apresentou uma incidência de osteoartrite de 16,7% em um acompanhamento médio de 94,1 meses. Level of Evidence V; Case Series. Nível de Evidência V; Série de casos

Can We Forgo the Use of Tourniquets in Total Knee Arthroplasty? / Podemos dispensar o uso do torniquete nas artroplastias totais do joelho?

Abstract Objective To analyze whether there is more bleeding in patients undergoing total knee arthroplasty (TKA) without using a tourniquet. The secondary objectives were to analyze the operative time, the length of hospital stay, the need for transfusion, and the complication rate. Methods The present is a retrospective study through the analysis of medical records. The patients were divided into two groups: TKA with and without the use of a tourniquet. Reductions in the levels of hemoglobin and packed cell volume 24 h and 48 h after surgery, the operative time, the length of hospital stay, the need for transfusion, and the rate of complications up to 6 months postoperatively were compared between the groups. Results During the period analyzed, 104 patients underwent TKA, and 94 were included in the study. There were no differences between the groups regarding the mean values of hemoglobin and packed cell volume before surgery (p = 0.675 and p = 0.265), 24 h (p = 0.099 and p = 0.563), and 48 h (p = 0.569 and p = 0.810) after the procedure. Neither were there differences between the groups in terms of the operative time and the length of hospital stay (p = 0.484 and p > 0.05). Moreover, there were no differences regarding the need for transfusion and the complication rate. Conclusion It is possible to forgo the use a tourniquet in TKA without a significant change in hemoglobin and packed cell volume levels 24 h and 48 h after surgery when compared with the group using a tourniquet. There were no significant differences in the total operative time, length of stay, need for transfusion, and complication rate.

Resumo Objetivo Analisar se há mais sangramento em pacientes submetidos a artroplastia total do joelho (ATJ) sem a utilização do torniquete. Os objetivos secundários foram analisar os tempos cirúrgico e de internação, a necessidade de transfusão e a taxa de complicações. Métodos Estudo retrospectivo por meio da análise de prontuários. Os pacientes foram divididos em dois grupos: ATJ com e sem a utilização de torniquete. Foram comparados os valores das quedas da hemoglobina e do hematócrito 24 h e 48 h após a cirurgia, os tempos cirúrgico e de internação, a necessidade de transfusão e a taxa de complicações até 5 meses de pós-operatório. Resultados No período, foram operados 104 pacientes, sendo 94 incluídos no estudo. Não houve diferença entre as médias dos valores da hemoglobina e do hematócrito entre os grupos no pré-operatório (p = 0,675 e p = 0,265, respectivamente), 24 h (p = 0,099 e p = 0,563, respectivamente) e 48 h (p = 0,569 e p = 0,810, respectivamente) após a cirurgia. O tempo cirúrgico e o tempo de internação também não foram diferentes entre os grupos (p = 0,484 e p > 0,05, respectivamente). Não houve diferença com relação à necessidade de transfusões, nem com relação à taxa de complicações analisadas. Conclusão Podemos dispensar o uso do torniquete nas cirurgias de ATJ sem alteração significativa no valor dos níveis de hemoglobina e de hematócrito 24 h e 48 h após a cirurgia quando comparado ao grupo com uso de torniquete. Não houve diferenças significativas no tempo total das cirurgias, no tempo de internação, na necessidade de transfusões e nas taxas de complicações analisadas.

DOES PARTIAL MEDIAL KNEE ARTHROPLATIES HAVE BETTER RESULTS THAN TOTAL ONES?

Objective: Compare the results of medial unicompartmental knee arthroplasty (UKA) using a mobile platform and total knee arthroplasty (TKA) in patients with isolated medial osteoarthritis. Methods: Retrospectivecross-sectional study. Preoperative radiographs of 602 patientswho underwent knee arthroplastybetween February 2017 and February 2020 were evaluated. Isolated medial osteoarthritis was found in 125 patients. Of these, 57 underwent UKA and 68 TKA. With chart analysis and telephone interviews, we compared patients' clinical outcomes and degree of satisfaction. The statistical analysis used a confidence level of 5%. Results: The group of UKA patients obtained 65.8% of favorable results against 79.1% of those undergoing TKA in the function questionnaire (p<0.0001). The complication rate was statistically similar between the groups(p>0.5). Most patients were satisfied or very satisfied in both groups (88.6% of UKA and 91.2% of TKA) (p>0.999). Conclusion: Patients submitted to UKA or TKA have presented the same degree of satisfaction and rate of postoperative complications when comparing patients with isolated medial osteoarthritis. UKA patients had less favorable results onthe clinical functional questionnaire than patients undergoing total arthroplasty. Level Of Evidence III;Retrospective Study.

Objetivo: Comparar os resultados da artroplastia unicompartimental do joelho (UKA) medial com plataforma móvel e artroplastia total do joelho (TKA) em pacientes com osteoartrose medial isolada. Métodos: Estudo transversal retrospectivo. Foram avaliadas radiografias pré-operatórias de 602 pacientes submetidos à artroplastia de joelho entre fevereiro de 2017 e fevereiro de 2020. A osteoartrose medial isolada foi encontrada em 125 pacientes, destes em 57 haviam sido submetidos a UKA e 68 TKA. Com análise de prontuários e entrevistas telefônicas comparamos os resultados clínicos e o grau de satisfação dos pacientes. A análise estatística utilizou nível de confiança de 5%. Resultados: O grupo de pacientes com UKA obteve 65,8% de resultados favoráveis contra 79,1% daqueles submetidos à TKA no questionário de função (p<0,0001). A taxa de complicações foi estatisticamente semelhante entre os grupos (p>0,5). A maioria dos pacientes estava satisfeita ou muito satisfeita em ambos os grupos (88,6% de UKA e 91,2% de TKA) (p>0,999). Conclusão: Pacientes submetidos a UKA ou TKA apresentaram o mesmo grau de satisfação e taxa de complicações pós-operatórias quando comparados pacientes com osteoartrite medial isolada. Os pacientes da UKA apresentaram resultados menos favoráveis ao questionário clínico funcional do que os pacientes submetidos à artroplastia total. Nível de Evidência III; Estudo Retrospectivo.

EVALUATION OF THE ANTEROLATERAL LIGAMENT OF THE KNEE IN MAGNETIC RESONANCE MRI: CASE SERIES.

Objective: To evaluate the citation of the ligament in the magnetic resonance imaging (MRI) reports and confirm its presence and injury in the images of exams performed in the acute phase retrospectively. Methods: In total, 103 patients who underwent anterior cruciate ligament (ACL) reconstruction in 2019 were included. The images were reanalyzed by two radiologists. Results: In the first analysis, only one report mentioned the anterolateral ligament (ALL) and its injury (0.97%). On reanalysis, ALL was visualized in almost all cases (95% and 97%). An injury was found in 53 (51.5%) cases by radiologist A and in 56 (54.4%) cases by radiologist B. The injury was diagnosed by both in 39 (37.9%) cases (p < 0.0001). Radiologists disagreed regarding the injury (Kappa = 0.411). Conclusion: The reports failed to describe the ligament and diagnose a significant number of injuries. The analysis of conventional resonance images still presents divergences in the diagnosis of ALL injury associated with the ACL among radiologists. Level of Evidence IV, Case Series.

Objetivo: Avaliar, de forma retrospectiva, a citação do ligamento anterolateral (LAL) em laudos de ressonância magnética (RM) e confirmar sua presença e lesão nas imagens de exames feitos na fase aguda. Métodos: Foram incluídos 103 pacientes submetidos à reconstrução do ligamento cruzado anterior (LCA) em 2019, cujas imagens foram reanalisadas por dois radiologistas. Resultados: Em primeira análise, apenas um laudo citava o LAL e sua lesão (0,97%); enquanto na reanálise, o LAL foi visualizado em quase todos os casos (95% pelo radiologista A e 97% pelo radiologista B). Foi encontrada lesão em 53 (51,5%) casos pelo radiologista A e 56 (54,4%) pelo radiologista B. Lesão foi diagnosticada por ambos em 39 (37,9%) casos (p < 0,0001). Houve divergência entre os radiologistas com relação à lesão (KappaL = 0,411). Conclusão: Os laudos deixaram de descrever o ligamento e diagnosticar um número significativo de lesões. A análise das imagens convencionais de ressonância ainda gera divergências no diagnóstico da lesão do LAL associada ao LCA entre os radiologistas. Nível de Evidência IV, Série de Casos.

Evaluation of the anterolateral ligament of the knee in magnetic resonance mri: case series / Avaliação do ligamento anterolateral do joelho em exames de ressonância magnética: série de casos

ABSTRACT Objective: To evaluate the citation of the ligament in the magnetic resonance imaging (MRI) reports and confirm its presence and injury in the images of exams performed in the acute phase retrospectively. Methods: In total, 103 patients who underwent anterior cruciate ligament (ACL) reconstruction in 2019 were included. The images were reanalyzed by two radiologists. Results: In the first analysis, only one report mentioned the anterolateral ligament (ALL) and its injury (0.97%). On reanalysis, ALL was visualized in almost all cases (95% and 97%). An injury was found in 53 (51.5%) cases by radiologist A and in 56 (54.4%) cases by radiologist B. The injury was diagnosed by both in 39 (37.9%) cases (p < 0.0001). Radiologists disagreed regarding the injury (Kappa = 0.411). Conclusion: The reports failed to describe the ligament and diagnose a significant number of injuries. The analysis of conventional resonance images still presents divergences in the diagnosis of ALL injury associated with the ACL among radiologists. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar, de forma retrospectiva, a citação do ligamento anterolateral (LAL) em laudos de ressonância magnética (RM) e confirmar sua presença e lesão nas imagens de exames feitos na fase aguda. Métodos: Foram incluídos 103 pacientes submetidos à reconstrução do ligamento cruzado anterior (LCA) em 2019, cujas imagens foram reanalisadas por dois radiologistas. Resultados: Em primeira análise, apenas um laudo citava o LAL e sua lesão (0,97%); enquanto na reanálise, o LAL foi visualizado em quase todos os casos (95% pelo radiologista A e 97% pelo radiologista B). Foi encontrada lesão em 53 (51,5%) casos pelo radiologista A e 56 (54,4%) pelo radiologista B. Lesão foi diagnosticada por ambos em 39 (37,9%) casos (p < 0,0001). Houve divergência entre os radiologistas com relação à lesão (KappaL = 0,411). Conclusão: Os laudos deixaram de descrever o ligamento e diagnosticar um número significativo de lesões. A análise das imagens convencionais de ressonância ainda gera divergências no diagnóstico da lesão do LAL associada ao LCA entre os radiologistas. Nível de Evidência IV, Série de Casos.

Does partial medial knee arthroplaties have better results than total ones? / Artroplastias parciais mediais do joelho têm resultados melhores do que as totais?

ABSTRACT Objective Compare the results of medial unicompartmental knee arthroplasty (UKA) using a mobile platform and total knee arthroplasty (TKA) in patients with isolated medial osteoarthritis. Methods Retrospectivecross-sectional study. Preoperative radiographs of 602 patientswho underwent knee arthroplastybetween February 2017 and February 2020 were evaluated. Isolated medial osteoarthritis was found in 125 patients. Of these, 57 underwent UKA and 68 TKA. With chart analysis and telephone interviews, we compared patients' clinical outcomes and degree of satisfaction. The statistical analysis used a confidence level of 5%. Results The group of UKA patients obtained 65.8% of favorable results against 79.1% of those undergoing TKA in the function questionnaire (p<0.0001). The complication rate was statistically similar between the groups(p>0.5). Most patients were satisfied or very satisfied in both groups (88.6% of UKA and 91.2% of TKA) (p>0.999). Conclusion Patients submitted to UKA or TKA have presented the same degree of satisfaction and rate of postoperative complications when comparing patients with isolated medial osteoarthritis. UKA patients had less favorable results onthe clinical functional questionnaire than patients undergoing total arthroplasty. Level Of Evidence III;Retrospective Study.

RESUMO Objetivo Comparar os resultados da artroplastia unicompartimental do joelho (UKA) medial com plataforma móvel e artroplastia total do joelho (TKA) em pacientes com osteoartrose medial isolada. Métodos Estudo transversal retrospectivo. Foram avaliadas radiografias pré-operatórias de 602 pacientes submetidos à artroplastia de joelho entre fevereiro de 2017 e fevereiro de 2020. A osteoartrose medial isolada foi encontrada em 125 pacientes, destes em 57 haviam sido submetidos a UKA e 68 TKA. Com análise de prontuários e entrevistas telefônicas comparamos os resultados clínicos e o grau de satisfação dos pacientes. A análise estatística utilizou nível de confiança de 5%. Resultados O grupo de pacientes com UKA obteve 65,8% de resultados favoráveis contra 79,1% daqueles submetidos à TKA no questionário de função (p<0,0001). A taxa de complicações foi estatisticamente semelhante entre os grupos (p>0,5). A maioria dos pacientes estava satisfeita ou muito satisfeita em ambos os grupos (88,6% de UKA e 91,2% de TKA) (p>0,999). Conclusão Pacientes submetidos a UKA ou TKA apresentaram o mesmo grau de satisfação e taxa de complicações pós-operatórias quando comparados pacientes com osteoartrite medial isolada. Os pacientes da UKA apresentaram resultados menos favoráveis ao questionário clínico funcional do que os pacientes submetidos à artroplastia total. Nível de Evidência III; Estudo Retrospectivo.

CLINICAL RESULTS OF MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION.

Objective: To assess clinical results of patients who underwent medial patellofemoral ligament (MPFL) reconstruction after a minimum of two years of follow-up. Methods: Patients' medical records were assessed for residual instability, patient satisfaction, and post-operative functional outcomes. Results: Fifty-one patients were analyzed, out of which 56.87% were women. Patients' mean age was 30.8 years (16 to 57 years). The mean follow-up time was 68.7 months (37 to 120 months). Length between first dislocation and surgery was less than 1 year for 58.82% of patients, between 1 and 5 years for 37.25%, and over 5 years for 3.93%. Patients showed a high degree of satisfaction (96.08% would undergo surgery again), with recurrence rate of 11.76%. Twenty-two patients reported knee symptoms, including pain from movements (72.72%), weakness (18.18%), constant pain (13.63%), and crepitus (4.54%). Considering dissatisfied patients, patients with dislocation recurrence, and patients with symptoms, five cannot practice physical activity, out of which only three blame their knee. Conclusion: MPFL reconstruction showed a recurrence rate of 11.7%, with high patient satisfaction, good functional results, and high rate of return to sports, after a minimum of two years of follow-up. Level of Evidence IV, Case Series.

Objetivo: Avaliar o resultado clínico de pacientes submetidos à reconstrução do ligamento patelofemoral medial (LPFM), acompanhados por mínimo de dois anos. Métodos: Avaliação de prontuários para informações sobre instabilidade residual, satisfação do paciente e resultado funcional pós-operatório. Resultados: Foram analisados 51 pacientes. 56,87% do sexo feminino e média etária 30,8 anos (16 a 57). Tempo médio de acompanhamento de 68,7 meses (37 a 120). Intervalo entre primeira luxação e cirurgia foi menos de 1 ano em 58,82%, entre 1 e 5 anos em 37,25% e mais de 5 anos para 3,93%. Os pacientes apresentaram alto grau de satisfação (96,08% fariam a cirurgia novamente), com 11,76% de recidiva. Houve persistência de sintomas em 22 pacientes, sendo dor ao movimento o principal (72,72%), seguido de fraqueza (18,18%), dor constante (13,63%) e crepitações (4,54%). Somando os pacientes insatisfeitos aos que tiveram recidiva da instabilidade e os sintomáticos, 5 não conseguem praticar atividade física, mas apenas 3 por causa do joelho. Conclusão: A reconstrução isolada do LPFM demonstrou índice de recidiva de 11,7%, com alto nível de satisfação dos pacientes, ótimos resultados funcionais e alta taxa de retorno ao esporte, em acompanhamento mínimo de 2 anos. Nível de Evidência IV, Série de Casos.

THE RESULTS OF A COMPARISON OF A BRAZILIAN AND AN IMPORTED KNEE PROSTHESIS - 5 YEARS OF FOLLOW-UP.

Introduction: To compare the functional results, satisfaction rates, and revisions of total knee arthroplasties performed by the same surgical team using either Brazilian or imported implants, with a minimum follow-up of 5 years after surgery. Materials and Methods: A retrospective cohort study analyzing the medical records and interviews of patients who underwent total knee arthroplasty with Brazilian or imported implants with a minimum of 5 years after surgery. Results: One hundred and fifty patients were evaluated (164 knees). In the functional questionnaire, 71% of patients had favorable answers in the group of patients who underwent surgery using the Brazilian prosthesis and 74.8% in the group with imported implants (p=0.634). There was no statistical difference in satisfaction between the groups, with 78.4% of patients satisfied or very satisfied in the Brazilian implant group and 90.7% in the imported implant group (p=0.053). Loosening of the implants was reported in 5.3% versus 4.7% (p>0.999). Conclusion: The total knee arthroplasties performed by the same surgical team with a minimum follow-up period of 5 years showed similar levels of satisfaction, function, and complications with both the Brazilian and imported implants. Level of Evidence III, cohort study.

Introdução: Comparar resultados funcionais, índices de satisfação e revisões de artroplastias totais de joelho realizadas pela mesma equipe cirúrgica usando implantes brasileiros ou importados, com acompanhamento mínimo de cinco anos após a cirurgia. Material e Método: Estudo de coorte retrospectivo com análise de prontuários e entrevistas de pacientes submetidos à artroplastia total do joelho com implantes brasileiros e importados com no mínimo cinco anos de pós-operatório. Resultados: Foram avaliados 150 pacientes (164 joelhos). No questionário funcional, encontramos 71% dos pacientes com respostas favoráveis no grupo de pacientes submetidos à cirurgia com uso de próteses brasileiras e 74,8% no grupo com implantes importados (p = 0,634). Em relação à satisfação, não houve diferença estatística entre os grupos com 78,4% dos pacientes satisfeitos ou muito satisfeitos no grupo com implante brasileiro e 90,7% no grupo com implante importado (p = 0,053). A ocorrência de soltura dos implantes foi relatada em 5,3% versus 4,7% (p > 0,999). Conclusões: As artroplastias totais de joelho realizadas pela mesma equipe cirúrgica com acompanhamento mínimo de cinco anos apresentaram níveis semelhantes de satisfação, função e complicações com os implantes brasileiros e importados. Nível de evidência III, estudo de coorte.

The results of a comparison of a brazilian and an imported knee prosthesis - 5 years of follow-up / Os resultados de uma comparação de uma prótese de joelho brasileira e uma importada - cinco anos de acompanhamento

ABSTRACT Introduction To compare the functional results, satisfaction rates, and revisions of total knee arthroplasties performed by the same surgical team using either Brazilian or imported implants, with a minimum follow-up of 5 years after surgery. Materials and Methods A retrospective cohort study analyzing the medical records and interviews of patients who underwent total knee arthroplasty with Brazilian or imported implants with a minimum of 5 years after surgery. Results One hundred and fifty patients were evaluated (164 knees). In the functional questionnaire, 71% of patients had favorable answers in the group of patients who underwent surgery using the Brazilian prosthesis and 74.8% in the group with imported implants (p=0.634). There was no statistical difference in satisfaction between the groups, with 78.4% of patients satisfied or very satisfied in the Brazilian implant group and 90.7% in the imported implant group (p=0.053). Loosening of the implants was reported in 5.3% versus 4.7% (p>0.999). Conclusion The total knee arthroplasties performed by the same surgical team with a minimum follow-up period of 5 years showed similar levels of satisfaction, function, and complications with both the Brazilian and imported implants. Level of Evidence III, cohort study.

RESUMO Introdução Comparar resultados funcionais, índices de satisfação e revisões de artroplastias totais de joelho realizadas pela mesma equipe cirúrgica usando implantes brasileiros ou importados, com acompanhamento mínimo de cinco anos após a cirurgia. Material e Método Estudo de coorte retrospectivo com análise de prontuários e entrevistas de pacientes submetidos à artroplastia total do joelho com implantes brasileiros e importados com no mínimo cinco anos de pós-operatório. Resultados Foram avaliados 150 pacientes (164 joelhos). No questionário funcional, encontramos 71% dos pacientes com respostas favoráveis no grupo de pacientes submetidos à cirurgia com uso de próteses brasileiras e 74,8% no grupo com implantes importados (p = 0,634). Em relação à satisfação, não houve diferença estatística entre os grupos com 78,4% dos pacientes satisfeitos ou muito satisfeitos no grupo com implante brasileiro e 90,7% no grupo com implante importado (p = 0,053). A ocorrência de soltura dos implantes foi relatada em 5,3% versus 4,7% (p > 0,999). Conclusões As artroplastias totais de joelho realizadas pela mesma equipe cirúrgica com acompanhamento mínimo de cinco anos apresentaram níveis semelhantes de satisfação, função e complicações com os implantes brasileiros e importados. Nível de evidência III, estudo de coorte.

Clinical results of medial patellofemoral ligament reconstruction / Resultados clínicos da reconstrução do ligamento patelofemoral medial

ABSTRACT Objective: To assess clinical results of patients who underwent medial patellofemoral ligament (MPFL) reconstruction after a minimum of two years of follow-up. Methods: Patients' medical records were assessed for residual instability, patient satisfaction, and post-operative functional outcomes. Results: Fifty-one patients were analyzed, out of which 56.87% were women. Patients' mean age was 30.8 years (16 to 57 years). The mean follow-up time was 68.7 months (37 to 120 months). Length between first dislocation and surgery was less than 1 year for 58.82% of patients, between 1 and 5 years for 37.25%, and over 5 years for 3.93%. Patients showed a high degree of satisfaction (96.08% would undergo surgery again), with recurrence rate of 11.76%. Twenty-two patients reported knee symptoms, including pain from movements (72.72%), weakness (18.18%), constant pain (13.63%), and crepitus (4.54%). Considering dissatisfied patients, patients with dislocation recurrence, and patients with symptoms, five cannot practice physical activity, out of which only three blame their knee. Conclusion: MPFL reconstruction showed a recurrence rate of 11.7%, with high patient satisfaction, good functional results, and high rate of return to sports, after a minimum of two years of follow-up. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar o resultado clínico de pacientes submetidos à reconstrução do ligamento patelofemoral medial (LPFM), acompanhados por mínimo de dois anos. Métodos: Avaliação de prontuários para informações sobre instabilidade residual, satisfação do paciente e resultado funcional pós-operatório. Resultados: Foram analisados 51 pacientes. 56,87% do sexo feminino e média etária 30,8 anos (16 a 57). Tempo médio de acompanhamento de 68,7 meses (37 a 120). Intervalo entre primeira luxação e cirurgia foi menos de 1 ano em 58,82%, entre 1 e 5 anos em 37,25% e mais de 5 anos para 3,93%. Os pacientes apresentaram alto grau de satisfação (96,08% fariam a cirurgia novamente), com 11,76% de recidiva. Houve persistência de sintomas em 22 pacientes, sendo dor ao movimento o principal (72,72%), seguido de fraqueza (18,18%), dor constante (13,63%) e crepitações (4,54%). Somando os pacientes insatisfeitos aos que tiveram recidiva da instabilidade e os sintomáticos, 5 não conseguem praticar atividade física, mas apenas 3 por causa do joelho. Conclusão: A reconstrução isolada do LPFM demonstrou índice de recidiva de 11,7%, com alto nível de satisfação dos pacientes, ótimos resultados funcionais e alta taxa de retorno ao esporte, em acompanhamento mínimo de 2 anos. Nível de Evidência IV, Série de Casos.

INTRAARTICULAR EPSILON AMINOCAPROIC ACID VERSUS TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY.

OBJECTIVE: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). METHODS: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. RESULTS: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. CONCLUSIONS: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

OBJETIVO: Avaliar e comparar a eficácia clinica do uso intra-articular do ácido épsilon aminocaproico (AEAC) versus o ácido tranexâmico (ATX) na prótese total do joelho. MÉTODOS: Estudo clínico prospectivo, centro-único, duplo-cego e randomizado. Sessenta pacientes com osteoartrose de joelho foram incluídos. Os participantes foram divididos em dois grupos de 30 pacientes. No grupo ATX, foi aplicado 1 g de ATX (0.05 g/ml) intra-articular e, no grupo AEAC, foram aplicados 4 g de AEAC (0.2 g/ml) intra-articular. Valores séricos da hemoglobina (Hb) e hemtatócrito (Ht) foram dosados no pré-operatório e com 24 e 48 horas após a cirurgia. A amplitude de movimento e a dor também foram avaliadas no exame clínico. O índice WOMAC foi utilizado para avaliar a função do joelho antes e após dois meses da cirurgia. RESULTADOS: Foram avaliados 56 (93.3%) pacientes até o segundo mês pós-operatório. Depois da cirurgia, não houve diferenças entre os grupos (p > 0.05) na queda do valor de Hb e Ht com 24 ou 48 horas. Com relação à avaliação da dor, WOMAC e ganho de flexão do joelho, não houve vantagem significativa para nenhum dos grupos até os 60 dias depois da cirurgia(p > 0.05). CONCLUSÃO: A queda do valor da Hb e do Ht durante as primeiras 48 horas pós-operatórias e o risco de transfusão foram similares com o uso intra-articular de 1 g de ATX e 4 g de AEAC na artroplastia total do joelho. Os possíveis benefícios com relação ao controle da dor, ganho de flexão e função foram similares entre as duas drogas. Nível de Evidência II, Ensaio-Clínico Prospectivo, Randomizado, Duplo Cego, Centro-Único.

Intraarticular epsilon aminocaproic acid versus tranexamic acid in total knee arthroplasty / Acido épsilon aminocaproico intra-articular versus acido tranexâmico na prótese total do joelho

ABSTRACT Objective: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). Methods: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. Results: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. Conclusions: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

RESUMO Objetivo: Avaliar e comparar a eficácia clinica do uso intra-articular do ácido épsilon aminocaproico (AEAC) versus o ácido tranexâmico (ATX) na prótese total do joelho. Métodos: Estudo clínico prospectivo, centro-único, duplo-cego e randomizado. Sessenta pacientes com osteoartrose de joelho foram incluídos. Os participantes foram divididos em dois grupos de 30 pacientes. No grupo ATX, foi aplicado 1 g de ATX (0.05 g/ml) intra-articular e, no grupo AEAC, foram aplicados 4 g de AEAC (0.2 g/ml) intra-articular. Valores séricos da hemoglobina (Hb) e hemtatócrito (Ht) foram dosados no pré-operatório e com 24 e 48 horas após a cirurgia. A amplitude de movimento e a dor também foram avaliadas no exame clínico. O índice WOMAC foi utilizado para avaliar a função do joelho antes e após dois meses da cirurgia. Resultados: Foram avaliados 56 (93.3%) pacientes até o segundo mês pós-operatório. Depois da cirurgia, não houve diferenças entre os grupos (p > 0.05) na queda do valor de Hb e Ht com 24 ou 48 horas. Com relação à avaliação da dor, WOMAC e ganho de flexão do joelho, não houve vantagem significativa para nenhum dos grupos até os 60 dias depois da cirurgia(p > 0.05). Conclusão: A queda do valor da Hb e do Ht durante as primeiras 48 horas pós-operatórias e o risco de transfusão foram similares com o uso intra-articular de 1 g de ATX e 4 g de AEAC na artroplastia total do joelho. Os possíveis benefícios com relação ao controle da dor, ganho de flexão e função foram similares entre as duas drogas. Nível de Evidência II, Ensaio-Clínico Prospectivo, Randomizado, Duplo Cego, Centro-Único.

Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Chondral Injuries In Young Patients.

Objective The present study aimed to compare the clinical and functional outcomes of hyaluronic acid (HA) or platelet-rich plasma (PRP) applications to treat young patients with knee chondral lesions with no arthrosis. Methods Prospective clinical and functional evaluation of 30 young adult patients with knee chondral lesions submitted to conservative treatment with HA or PRP for a minimum follow-up time of 12 months. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and visual analog scale (VAS) were used for the evaluation. Results According to the WOMAC score, the PRP group showed significant improvement in all evaluated points, whereas the HA group presented no score improvement. In the VAS, the PRP group showed improvement in all evaluated points, and the HA group presented improvement at 6 and 12 months. Compared to the HA group, the PRP group presented better WOMAC scores at all evaluated points and better VAS scores up to 6 months after treatment. Conclusion Platelet-rich plasma application resulted in better clinical and functional outcomes at both the WOMAC and VAS scores when applied to knees from young patients with chondral lesions, but no arthrosis. These outcomes were sustained for up to 12 months. Level of evidence Randomized clinical trial (Type 2B).

Early tibial component loosening of medial UKA after severe medial plateau SONK-report of three cases.

Spontaneous osteonecrosis or subchondral bone insufficiency fracture of the knee is a frequent injury in elderly female patients. The medial femoral condyle followed by the medial plateau is the most prevalent sites. When its evolution after conservative treatment is not favorable, medial unicompartimental arthroplasty is a surgical option with good results. We report three cases of early tibial component loosening of medial unicompartimental arthroplasty that could be related to a severe subchondral bone insufficiency fracture of the tibial plateau. In these cases of severe involvement of the tibial plateau, a more careful evaluation would be recommended to choose between unicompartimental and total knee replacement to avoid this early loosening.

Leucocyte-poor-platelet-rich plasma intra-operative injection in chondral knee injuries improve patients outcomes. A prospective randomized trial.

PURPOSE: Evaluate the effects of intra-operative leucocyte-poor-platelet-rich plasma (PRP) (type P3-Bß with endogenous activation) injection in International Cartilage Repair Society (ICRS) grade III knee chondral injuries treated by chondroplasties, to increase and ameliorate the repair tissue. METHODS: Patients were divided into two groups. Group A (control) consisted of 31 patients and Group B (PRP) 33 patients, totaling 64 patients analyzed. Patients also could had associated injuries (meniscal and/or ACL) being equally divided between both groups to avoid bias. PRP was injected at the end of surgery in group B. The patient outcomes were assessed using subjective International Knee Documentation Committee (IKDC) form, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity forms, prior to the surgery and three, six, 12, and 24 months after surgery (medium-term follow up). RESULTS: IKDC and KOOS scores showed increase at each evaluation time points after surgery in both groups, but the treated Group (B) showed a higher increase with statistically significant difference. The Tegner activity scores were higher for the treated group only at six and 12 months. CONCLUSION: Based on the subjective IKDC, KOOS, and Tegner scores, those patients affected by ICRS grade III chondral injuries undergoing arthroscopic chondroplasty who were also treated with PRP showed better and faster outcomes than the control group. Independently from the associated injury (meniscal or ACL). This difference could be measured for up to two years.