RESUMEN
Irreparable rotator cuff tears can be treated in several ways. Superior capsular reconstruction has been reported as an excellent option, particularly for the young and active patients. We propose capsule reconstruction using the long head of the biceps tendon in a modified way. After its tenotomy at the musculotendinous junction, the long head is rerouted through a humeral bone tunnel and attached to a suture anchor in the posterior aspect of the superior glenoid rim. Further investigation is required, but this modified technique appears promising.
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Objective Coracoid osteolysis has been described as a possible complication after the Latarjet procedure. The aim of the present study was to investigate the incidence and risk factors associated to coracoid graft osteolysis and to correlate them with clinical results. Methods A retrospective review of 38 Latarjet procedures was conducted. Computed tomography (CT) scans were obtained from all of the patients before and at least 1 year after the surgery. Coracoid osteolysis was evaluated and correlated to preoperative factors, namely: age, smoking status, and preoperative glenoid bone loss. The patients were divided into 2 groups: A (no or minor bone resorption) and B (major or total bone resorption). The functional outcome was determined by the Rowe score. Results Coracoid graft osteolysis occurred in 22 cases (57.8%). The mean preoperative glenoid defect was 22.8% in group A, and 13.4% in group B ( p = 0.0075). The mean ages of the subjects in both groups were not significantly different. Smoking did not seem to affect the main outcome either, and no correlation was found between graft osteolysis and postoperative range of motion, pain, or Rowe score. There were no cases of recurrent dislocations in our sample, although four patients presented with a positive anterior apprehension sign. Conclusion Bone resorption of the coracoid graft is present in at least 50% of the patients submitted to the Latarjet procedure, and the absence of significant preoperative glenoid bone loss showed to be the only risk factor associated with severe graft osteolysis, even though this did not influence significantly the clinical outcome.
RESUMEN
Abstract Objective Coracoid osteolysis has been described as a possible complication after the Latarjet procedure. The aim of the present study was to investigate the incidence and risk factors associated to coracoid graft osteolysis and to correlate them with clinical results. Methods A retrospective review of 38 Latarjet procedures was conducted. Computed tomography (CT) scans were obtained from all of the patients before and at least 1 year after the surgery. Coracoid osteolysis was evaluated and correlated to preoperative factors, namely: age, smoking status, and preoperative glenoid bone loss. The patients were divided into 2 groups: A (no or minor bone resorption) and B (major or total bone resorption). The functional outcome was determined by the Rowe score. Results Coracoid graft osteolysis occurred in 22 cases (57.8%). The mean preoperative glenoid defect was 22.8% in group A, and 13.4% in group B (p= 0.0075). The mean ages of the subjects in both groups were not significantly different. Smoking did not seem to affect the main outcome either, and no correlation was found between graft osteolysis and postoperative range of motion, pain, or Rowe score. There were no cases of recurrent dislocations in our sample, although four patients presented with a positive anterior apprehension sign. Conclusion Bone resorption of the coracoid graft is present in at least 50% of the patients submitted to the Latarjet procedure, and the absence of significant preoperative glenoid bone loss showed to be the only risk factor associated with severe graft osteolysis, even though this did not influence significantly the clinical outcome.
Resumo Objetivo Osteólise do processo coracoide é descrita como uma possível complicação da cirurgia de Latarjet. O objetivo do presente estudo foi avaliar a incidência e fatores de risco associados à osteólise do enxerto do coracoide e correlacioná-los com resultados clínicos. Métodos Foi realizada uma revisão retrospectiva incluindo 38 casos submetidos ao procedimento de Latarjet. Em todos os casos, foi realizada uma tomografia computadorizada antes e pelo menos 1 ano após a cirurgia. A presença de osteólise do coracoide foi avaliada e correlacionada com os seguintes fatores de risco: idade, tabagismo, e perda óssea pré-operatória da glenóide. Os pacientes foram divididos em dois grupos: A (ausência ou menor reabsorção óssea) e B (maior reabsorção óssea ou total). A avaliação funcional foi determinada através do escore de Rowe. Resultado Osteólise do processo coracoide ocorreu em 22 casos (57,8%). O defeito ósseo médio pré-operatório da glenóide foi de 22,8% no grupo A e de 13,4% no grupo B (p= 0.0075). A média de idade dos casos em ambos os grupos não apresentou diferença estatística. Tabagismo também não esteve relacionado com diferenças no resultado. Não houve correlação entre a presença de osteólise e o arco de movimento, dor ou ao escore de Rowe. Não houve casos de reluxação; entretanto, quatro pacientes apresentaram apreensão anterior no exame físico. Conclusão A reabsorção do processo coracoide ocorreu em pelo menos 50% dos pacientes submetidos à cirurgia de Latarjet, e a ausência pré-operatória de perda óssea significativa da glenóide foi o único fator de risco associado a osteólise mais severa do enxerto, porém sem influência no resultado clínico.
Asunto(s)
Humanos , Masculino , Adulto , Osteólisis , Dolor , Luxación del Hombro , Articulación del Hombro , Tabaquismo , Huesos , Resorción Ósea , Fumar , Tomografía Computarizada por Rayos X , Rango del Movimiento Articular , Apófisis Coracoides , Inestabilidad de la ArticulaciónRESUMEN
Objectives To evaluate the factors that influence the outcome of osteosynthesis after closed reduction of the fracture of the femoral neck in young adult patients. Methods A retrospective study was conducted, reviewing the data of patients operated in a large orthopedic hospital from 2003 to 2011; a total of 81 patients met the inclusion criteria. The time interval between the fracture and the surgery, the initial fracture deviation, the quality of the reduction, and the placement of the implant were evaluated. Results The present study observed a strong relationship between the quality of the reduction and therapeutic success. The degree of the initial deviation and the time elapsed between the initial trauma and the osteosynthesis did not influence the surgical outcome regarding bone consolidation. The correct positioning of the implants was associated with a satisfactory evolution in the postoperative period. Conclusion The quality of the reduction and the positioning of the implants are factors that influence the results of osteosynthesis in fractures of the femoral neck in young adult patients.
RESUMEN
Abstract Objectives To evaluate the factors that influence the outcome of osteosynthesis after closed reduction of the fracture of the femoral neck in young adult patients. Methods A retrospective study was conducted, reviewing the data of patients operated in a large orthopedic hospital from 2003 to 2011; a total of 81 patients met the inclusion criteria. The time interval between the fracture and the surgery, the initial fracture deviation, the quality of the reduction, and the placement of the implant were evaluated. Results The present study observed a strong relationship between the quality of the reduction and therapeutic success. The degree of the initial deviation and the time elapsed between the initial trauma and the osteosynthesis did not influence the surgical outcome regarding bone consolidation. The correct positioning of the implants was associated with a satisfactory evolution in the postoperative period. Conclusion The quality of the reduction and the positioning of the implants are factors that influence the results of osteosynthesis in fractures of the femoral neck in young adult patients.
Resumo Objetivos Avaliar os fatores que influenciam o resultado da osteossíntese pela redução fechada da fratura do colo femoral nos pacientes jovens. Métodos Foi feito um estudo retrospectivo com revisão dos dados dos pacientes operados em um hospital ortopédico de grande porte, de 2003 a 2011, com um total de 81 pacientes que atenderam aos critérios de inclusão. O intervalo de tempo entre a fratura e a cirurgia, o desvio inicial da fratura, a qualidade da redução e o posicionamento dos implantes foram os fatores avaliados. Resultados O estudo encontrou forte relação entre a qualidade da redução e o sucesso terapêutico. O grau de desvio inicial e o tempo entre o trauma inicial e a osteossíntese não influenciaramo desfecho cirúrgico emrelação à consolidação óssea. O correto posicionamento dos implantes mostrou relação com a evolução satisfatória no pós-operatório dos pacientes. Conclusão A qualidade da redução e o posicionamento dos implantes são fatores que influenciamoresultadodaosteossíntesenafraturadocolodofêmurnopacienteadultojovem.