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1.
Arthroscopy ; 36(6): 1647-1648, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32503775

RESUMEN

Graft choice for anterior cruciate ligament reconstruction has been a great controversy in the sports medicine literature for the last 25 years. It has been well studied in the orthopaedic literature, with numerous randomized control trials and large database studies. There remain advantages and disadvantages to each autograft choice, primarily bone-patellar tendon-bone, quadrupled hamstring, as well as allograft. More recently, quadriceps autograft has also been studied as a suitable alternative. Most studies show nearly equivalent functional outcomes for autograft anterior cruciate ligament using bone-patellar tendon-bone and hamstring autografts in athletes younger than the age of 25 years, whereas allograft may be preferred for older athletes.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Músculos Isquiosurales , Ligamento Rotuliano , Atletas , Autoinjertos , Plastía con Hueso-Tendón Rotuliano-Hueso , Humanos , Trasplante Autólogo
2.
Arthroscopy ; 36(6): 1702-1705, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32503779

RESUMEN

We are united as an orthopaedic community in trying to improve the outcomes of anterior cruciate ligament (ACL) reconstruction. Graft rupture rates of 10% to 28% are reported in high-risk populations, reoperation for non-graft rupture-related indications are reported in 18% to 26%, and only 50% to 65% of recreational athletes return to their preinjury level of sports. Numerous groups across the world have published studies providing evidence demonstrating significant clinical efficacy of lateral extra-articular tenodesis in improving the outcomes of ACL surgery. Finally, the reductions in ACL graft rupture rates augmented with anterolateral ligament or a modified Lemaire reconstruction appear to be broadly comparable. In our hands, anterolateral ligament may result in fewer adverse events.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Tenodesis , Humanos , Articulación de la Rodilla/cirugía , Rotura
3.
Arthroscopy ; 36(5): 1374-1375, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32370899

RESUMEN

There is a vast amount of conflicting literature evaluating the anatomic, biomechanical, and clinical outcomes of combined anterior cruciate ligament (ACL) and anterolateral complex injury. This has become-and remains-one of the most controversial topics in the ACL-deficient knee literature, thus requiring further inquiry with clear and systematic approaches to biomechanical analysis, indications, graft selection, surgical technique, and clinical outcome evaluation. The considerable variety of procedures to address anterolateral rotatory instability in the setting of ACL deficiency described in the literature strongly suggests the lack of a reliable and reproducible technique. Anterolateral complex reconstruction may provide protection to the ACL-reconstructed knee without detrimental overconstraint.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Inestabilidad de la Articulación/cirugía , Tenodesis , Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos , Cadáver , Humanos , Articulación de la Rodilla/cirugía , Rango del Movimiento Articular
4.
Arthroscopy ; 36(5): 1417-1418, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32370903

RESUMEN

An understanding of expected morbidity of various anterior cruciate ligament graft options is important to inform patient expectations and facilitate successful return to sport following anterior cruciate ligament reconstruction. Hamstring harvest results in decreased hamstring strength. Gracilis preservation may mitigate the degree of strength loss, particularly in deep knee flexion. The extent to which knee flexion strength at high flexion angles is important to return to play and functional outcomes remains unknown and is likely sport-dependent.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Tendones Isquiotibiales , Ligamento Cruzado Anterior/cirugía , Autoinjertos , Humanos , Tendones
5.
Medicine (Baltimore) ; 99(20): e20256, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32443364

RESUMEN

INTRODUCTION: Rehabilitation after anterior cruciate ligament (ACL) reconstruction is critical to patient outcome. Despite its importance; however, hospital-based rehabilitation is limited, with barriers, including distance and cost. With recent technological advancements, wearable devices have actively been used to address these barriers. In this study, we propose a randomized controlled trial protocol investigating the efficacy and feasibility of home-based rehabilitation after ACL reconstruction using a smart wearable device providing electrical stimulation that allows knee exercise. METHODS AND ANALYSIS: This is a protocol proposal for a prospective, single-center, randomized, controlled study. We plan to recruit adults discharged after ACL reconstruction; the recruited subjects will be randomly allocated to 1 of 2 groups, using a computer-generated randomization method: the intervention (n = 20) or control group (n = 20). The intervention group will receive a 6-week home-based rehabilitation program using smart wearable device. The control group will undergo a 6-week self-exercise program as normal. The following outcomes will be assessed at baseline, 2 weeks, and 6 weeks post the 6-week intervention program: quadriceps strength of the affect side as measured by a dynamometer (primary outcome); range of motion; root mean square of quadriceps muscle using surface electromyography; knee function using questionnaire; quality of life; subject's satisfaction score using questionnaire; frequency and duration of exercise; and knee pain. An intention-to-treat analysis will be conducted for the primary outcome. DISCUSSION: This study is a prospective, single-center, randomized, controlled study. This study aims to research the feasibility and efficacy of a 6-week, structured home-based rehabilitation program for patients after ACL reconstruction using a smart wearable device. The findings of this study will help to establish a home-based rehabilitation program to better recovery in patients with ACL reconstruction. TRIAL REGISTRATION NUMBER: This protocol was registered in ClinicalTrials.gov, under the number NCT04079205.


Asunto(s)
Ligamento Cruzado Anterior/cirugía , Estimulación Eléctrica/instrumentación , Terapia por Ejercicio/instrumentación , Servicios de Atención de Salud a Domicilio/normas , Rehabilitación/normas , Adulto , Ligamento Cruzado Anterior/anomalías , Ligamento Cruzado Anterior/fisiopatología , Lesiones del Ligamento Cruzado Anterior/rehabilitación , Lesiones del Ligamento Cruzado Anterior/cirugía , Protocolos Clínicos , Estimulación Eléctrica/métodos , Terapia por Ejercicio/métodos , Servicios de Atención de Salud a Domicilio/tendencias , Humanos , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Rehabilitación/instrumentación , Rehabilitación/métodos , Encuestas y Cuestionarios , Resultado del Tratamiento
6.
Arthroscopy ; 36(4): 1083-1085, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32247405

RESUMEN

When considering repair of the meniscal cartilages of the knee, the indications for repair must be carefully considered. The morphology of the tear, the zone of injury, and likely vascularity have an impact on patient selection. Patient factors, chronicity of tear, medial or lateral tear, and tear complexity all have a bearing on whether to repair or resect and how best to achieve stable repair. The consequences of meniscectomy are well established, and meniscal tissue resection comes at a cost. The success rates of meniscal cartilage repair are greater when performed in conjunction with anterior cruciate ligament reconstruction. Patient outcomes are better for anterior cruciate ligament reconstruction when performed with meniscal repair than when partial meniscectomy is performed. The optimal configuration of sutures, the suture material used, and the type of suture technique are all important considerations. The focus of this commentary is on the use of absorbable versus nonabsorbable suture material.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Menisco , Lesiones de Menisco Tibial/cirugía , Ligamento Cruzado Anterior/cirugía , Humanos , Meniscos Tibiales/cirugía , Suturas
7.
Arthroscopy ; 36(4): 1103-1104, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32247407

RESUMEN

Debate remains on which technique(s) of femoral tunnel drilling is most able to recreate an anatomic femoral footprint in anterior cruciate ligament reconstruction. The most commonly used techniques are the transtibial, anteromedial rigid reamer (AM-RR), anteromedial flexible reamer (AM-FR), and outside-in. Technique is based solely on surgeon preference. Each technique carries its own risks, benefits, advantages, and disadvantages, and there remains no single "gold standard." The AM-RR, AM-FR, and outside-in methods are considered independent or "unconstrained" methods that allow more variability in recreating anatomic angles compared with the transtibial technique, which is "constrained" by the tibial tunnel. Historically, the AM-RR and AM-FR techniques have not been subdivided in the orthopaedic literature. Further study is needed to determine whether there is a significant difference between the 2 techniques with respect to anatomical, biomechanical, and clinical results.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Fémur/cirugía , Humanos , Tibia/cirugía
8.
Arthroscopy ; 36(4): 1202-1203, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32247414

RESUMEN

Use of allograft/autograft hybrid hamstring anterior cruciate ligament grafts has gained popularity as a method to ensure appropriate graft diameter when autograft alone is insufficient. Several institutional series have been published with conflicting results. When there is any concern for autograft hamstring diameter, it is potentially better to consider other graft options. Patellar tendon autograft remains an excellent graft option for many patients. In patients where a soft-tissue graft is desired, including adolescents, quadriceps tendon has emerged as a promising option with excellent clinical outcomes. Even in patients in which hamstrings are used as a graft, when insufficient diameter is encountered, newer techniques, including the use of retrograde reamers, allows for creation of a bulleted graft of sufficient diameter without the need for allograft augmentation. We have completely abandoned the use of hybrid grafts in this younger population at our institution for these reasons. Because there are numerous other options available for anterior cruciate ligament reconstruction in patients where hamstring size may be a concern, this may become less of a debate over the next decade.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Adolescente , Ligamento Cruzado Anterior/cirugía , Autoinjertos , Automóviles , Humanos , Trasplante Autólogo
9.
Arthroscopy ; 36(4): 1211-1212, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32247415

RESUMEN

The advantages of using platelet-rich plasma application in anterior cruciate ligament reconstruction remains controversial. However, I think further long-term and better design studies are needed to identify whether the administration of platelet-rich plasma could truly play a beneficial role during anterior cruciate ligament reconstruction.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Plasma Rico en Plaquetas , Ligamento Cruzado Anterior/cirugía , Humanos
10.
PLoS One ; 15(3): e0230497, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32203530

RESUMEN

PURPOSE: Theoretical considerations suggest that femoral tunnel length might cause graft mismatch, and femoral tunnel obliquity could be related to the longevity of graft in anterior cruciate ligament (ACL) reconstruction. However, controversy still exists regarding these issues in the context of the comparison of anatomic and nonanatomic ACL reconstructions. The purpose of this meta-analysis was to compare the length and obliquity of the femoral tunnel created by drilling through either anatomic or nonanatomic ACL reconstructions. MATERIALS AND METHOD: In this meta-analysis, we reviewed studies that compared femoral tunnel length and femoral tunnel obliquity in the coronal plane with the use of anatomic or nonanatomic ACL reconstruction. The major databases were reviewed for appropriate studies from the earliest available date of indexing through December 31, 2018. No restrictions were placed on the language of publication. RESULTS: Twenty-seven studies met the criteria for inclusion in this meta-analysis. The femur tunnel length of anatomic ACL reconstruction was significantly shorter compared with that of nonanatomic ACL reconstruction by 8.66 mm (95% CI: 7.10-10.22 mm; P<0.001), while the femur tunnel obliquity in the coronal plane of anatomic ACL reconstruction was significantly more oblique versus that of nonanatomic ACL reconstruction by 15.29° (95% CI: 8.07°-22.52°; P<0.001). Similar results in terms of femoral tunnel length were found for the subgroup with cadaveric (7.15 mm; 95% CI: 2.69-11.61 mm; P = 0.002) and noncadaveric (8.96 mm; 95% CI: 7.24-10.69 mm; P<0.001) studies, whereas different results in terms of femoral tunnel obliquity were noted for the subgroup with cadaveric (10.62°; 95% CI: -6.12° to 27.37°; P = 0.21) and noncadaveric (15.86°; 95% CI: 8.11°-23.60°; P<0.001) studies. CONCLUSION: Anatomic ACL reconstruction resulted in the femoral tunnel length and femoral tunnel obliquity in the coronal plane being shorter and more oblique, respectively, as compared with nonanatomic ACL reconstruction. LEVEL OF EVIDENCE: Therapeutic study, Level III.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Fémur , Tibia , Tomografía Computarizada por Rayos X , Lesiones del Ligamento Cruzado Anterior/diagnóstico , Lesiones del Ligamento Cruzado Anterior/cirugía , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Masculino , Tibia/diagnóstico por imagen , Tibia/cirugía
11.
Zhonghua Wai Ke Za Zhi ; 58(3): 203-208, 2020 Mar 01.
Artículo en Chino | MEDLINE | ID: mdl-32187923

RESUMEN

Objective: To explore the short-term effectiveness of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint. Methods: A retrospective study was performed on 17 patients with anterior cruciate ligament injury combined with varus deformity of knee joint who underwent arthroscopic combined with dual-plane high tibial osteotomy at Department of Bone and Joint, the Affiliated Hospital of Southwest Medical University from January 2017 to June 2018.There were 11 males (11 knees) and 6 females (6 knees), aged 41.3 years (range: 32 to 49 years) .During the surgery, the weight bearing line of lower extremity was set to 62.5% position of the tibial plateau on coronal plane. The tibial slope was adjusted to the normal range on sagittal plane, and anterior cruciate ligament was reconstructed to improve the stability of knee joint.At final follow up, full length weight bearing X ray was used to evaluate the position of weight bearing line, femoral tibial angle and tibial slope pre- and post-operatively.The Lysholm scores, Hospital for Special Surgery score, Tegner knee activity scores and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test, KT-1000 side-to-side difference and pivot-shift test were used to estimate the knee joint stability. Results: The patients were followed up for 1.8 years(range:1.2 to 2.5 years). No complication such as infection, deep vein thrombosis, graft failure, nonunion or delayed union was observed.The weight bearing line was corrected from (28.48±2.24)% preoperatively to (57.43±1.02)% postoperatively (t=46.80, P=0.00) .The femoral tibial angle was improved from (172.31±3.37) ° preoperatively to (178.91±1.34) ° postoperatively(t=10.46, P=0.00). The tibial slope was decreased from (14.29±1.26) ° preoperatively to (9.31±0.79) ° postoperatively (t=24.59, P=0.00) . The KT-1000 side-to-side difference decreased from (7.95±1.19) mm preoperatively to (1.79±0.49)mm postoperatively(t=18.34, P=0.00). At the last follow-up, Lysholm score, Hospital for Special Surgery score, Tegner score, and the IKDC knee evaluation score of patients showed significant improvement from preoperative(P<0.05). Conclusion: Arthroscopic combined with dual-plane high tibial osteotomy can get a good short term efficacy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint which can significantly improve the alignment of lower extremity and knee joint stability.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Artroscopía , Articulación de la Rodilla/cirugía , Osteotomía , Adulto , Femenino , Humanos , Articulación de la Rodilla/anomalías , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(3): 323-329, 2020 Mar 15.
Artículo en Chino | MEDLINE | ID: mdl-32174077

RESUMEN

Objective: To evaluate the effectiveness of femoral oval tunnel technique versus round tunnel technique in single-bundle anterior cruciate ligament (ACL) reconstruction. Methods: Between March 2016 and February 2018, 125 patients who underwent anatomical single-bundle ACL reconstruction with hamstring tendon and met the inclusive criteria were included in the retrospective study. Of the included patients, 43 patients underwent ACL reconstruction using oval tunnel technique (group A) and 82 patients with round tunnel technique (group B). There was no significant difference between the two groups in terms of age, gender, body mass index, the interval between injury and operation, the injured side, the cause of injury, and preoperative Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner score, and the outcome of KT-1000 measurement ( P>0.05). At 3, 6, 12, and 24 months after operation, the knee function scores (Lysholm score, IKDC score, Tegner score) were recorded; and KT-1000 was used to evaluate the knee stability. The position and shape of the tunnels were evaluated by the three-dimensional CT (3D-CT) at 1 day after operation; and MRI was performed at 6, 12, and 24 months to calculate the signal/noise quotient (SNQ) of ACL grafts. Secondary arthroscopy was conducted to estimate the graft status, synovial coverage, and tension. Results: All patients were followed up 12-26 months (mean, 23 months). Two patients in group A and 5 patients in group B presented with redness and swelling of the surgical site, 1 patient in group B sustained a tibial tunnel fracture, and 1 patient in group A had postoperative stiffness. The Lysholm score, IKDC score, and Tegner score were significantly higher in group A than in group B at the different time points ( P<0.05) except for the Tegner score at 3 months. The outcomes of KT-1000 measurement were significantly lower in group A than in group B ( P<0.05). The entrances of the femoral tunnel and tibial tunnel in both groups were within the ACL anatomical footprint confirmed by 3D-CT. No re-rupture of ACL occurred confirmed by the MRI. There was no significant difference in SNQs of the middle and distal grafts between the two groups at 6 months ( P>0.05), whereas the SNQ of the proximal grafts in group A was significantly lower than that in group B ( P<0.05). The SNQs of the proximal, middle, and distal grafts in group A were significantly lower than those in group B at 12 and 24 months after operation ( P<0.05). Twenty-one patients in group A and 38 patients in group B underwent secondary arthroscopy and the results showed no significant difference in graft status, synovial coverage, and tension between the two groups ( P>0.05). Conclusion: The effectiveness and graft maturity of the femoral oval tunnel technique were superior to the round tunnel technique. The single-bundle ACL reconstruction with femoral oval tunnel technique can obtain a better knee function.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior , Artroscopía , Fémur , Humanos , Estudios Retrospectivos , Resultado del Tratamiento
13.
Bone Joint J ; 102-B(2): 239-245, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009437

RESUMEN

AIMS: Anterior cruciate ligament (ACL) surgery in children and the adolescent population has increased steadily over recent years. We used a national database to look at trends in ACL reconstruction and rates of serious complications, growth disturbance, and revision surgery, over 20 years. METHODS: All hospital episodes for patients undergoing ACL reconstruction, under the age of 20 years, between 1 April 1997 and 31 March 2017, were extracted by procedure code from the national Hospital Episode Statistics (HES). Population standardized rates of intervention were determined by age group and year of treatment. Subsequent rates of serious complications including reoperation for infection, growth disturbance (osteotomy, epiphysiodesis), revision reconstruction, and/or contralateral ACL reconstruction rates were determined. RESULTS: Over the 20 year period, 16,125 ACL reconstructions were included. The mean age of patients was 16.9 years (SD 2.0; 27.1% female, n = 4,374/16,125). The majority of procedures were observed in the 15 to 19 years age group. The rate of ACL reconstruction increased 29-fold from 1997 to 1998, to 2016 to 2017. Within 90 days of ACL reconstruction, the rate of reoperation for infection was 0.31% (95% confidence interval (CI) 0.23 to 0.41, n = 50/16,125) and the rate of pulmonary embolism was 0.037% (95%.CI 0.014 to 0.081, n = 6/16,125). Of those with minimum five-year follow-up following ACL reconstruction (n = 7,585), 1.00% of patients subsequently underwent an osteotomy (95% CI 0.79 to 1.25, n = 76/7,585), 0.09% an epiphysiodesis (95% CI 0.04 to 0.19, n = 7/7,585), 7.46% revision ACL reconstruction (95% CI 6.88 to 8.08, n = 566/7,585), and 6.37% contralateral ACL reconstruction (95% CI 5.83 to 6.94, n = 483/7,585). CONCLUSION: Rates of paediatric and adolescent ACL reconstruction have increased 29-fold over the last 20 years. Despite the increasing rate in the younger population, the risk of serious complications, including further surgery for growth disturbance is very low. The results of our study provide a point of reference for shared decision making in the management of ACL injury in the paediatric and adolescent population. Cite this article: Bone Joint J 2020;102-B(2):239-245.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Adolescente , Lesiones del Ligamento Cruzado Anterior/epidemiología , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Reconstrucción del Ligamento Cruzado Anterior/estadística & datos numéricos , Niño , Preescolar , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Reoperación/estadística & datos numéricos , Reino Unido/epidemiología , Adulto Joven
14.
Zhongguo Zhen Jiu ; 40(2): 142-6, 2020 Feb 12.
Artículo en Chino | MEDLINE | ID: mdl-32100498

RESUMEN

OBJECTIVE: To observe the effect of electroacupuncture (EA) on the rehabilitation of knee joint function after anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 140 patients with ACL reconstruction were randomly divided into an observation group (58 cases recruited, 12 cases dropped out) and a control group (65 cases recruited, 5 cases dropped out). The patients in the control group were treated with routine rehabilitation treatment. The patients in the observation group, on the basis of the treatment in the control group, were treated with EA at Fengshi (GB 31), Futu (ST 32), Zusanli (ST 36), Shangjuxu (ST 37), Fenglong (ST 40), Xuanzhong (GB 39), Diji (SP 8) and Sanyinjiao (SP 6) on the affected side (2 Hz/100 Hz of dilatational wave, 2-5 mA). Each EA treatment lasted 20-30 min, twice a day for 7 days. The swelling degree (d), pain visual analogue scale (VAS), knee joint range of motion (ROM), scores of International Knee Documentation Committee (IKDC) subjective short form and scores of Lysholm were observed in the two groups 1 day, 1 month, 3 months, 6 months and 1 year after operation. RESULTS: One month and 3 months after operation, the swelling degree (d) and VAS scores in the observation group were lower than those in the control group (P<0.05); 6 months and 1 year after operation, there was no significant difference between the two groups on the swelling degree (d) and VAS scores (P>0.05). One month, 3 months, 6 months and 1 year after operation, the ROM of the knee joint in the observation group was higher than that in the control group (P<0.05), the IKDC score and Lysholm score were higher than those in the control group (P<0.05). Within one year, there were no relaxations, fractures and other related complications in the two groups. The pivot shift test, anterior drawer test and the Lachman test were all negative. CONCLUSION: EA combined with routine rehabilitation training could obviously reduce the pain of knee joint, improve the swelling degree, increase the ROM of knee joint, promote the functional recovery in patients with ACL reconstruction, which are superior to rehabilitation training alone.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/rehabilitación , Reconstrucción del Ligamento Cruzado Anterior , Electroacupuntura , Articulación de la Rodilla , Ligamento Cruzado Anterior , Lesiones del Ligamento Cruzado Anterior/cirugía , Humanos , Resultado del Tratamiento
17.
Sports Health ; 12(3): 271-278, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32091298

RESUMEN

BACKGROUND: Reductions in muscle size are common after anterior cruciate ligament reconstruction (ACLR) and may contribute to suboptimal patient outcomes. However, few studies have quantified postoperative alterations in muscle quality and evaluated its associations with patient-reported function. HYPOTHESES: Rectus femoris cross-sectional area (CSA) will decrease postoperatively but improve at return to activity (RTA), rectus femoris muscle quality (percentage fat [PF]) will increase postoperatively and be greater at RTA compared with preoperative values, and rectus femoris CSA and PF will be associated with International Knee Documentation Committee (IKDC) scores at both postoperative time points. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 26 individuals who sustained an ACL injury and underwent reconstructive surgery were evaluated preoperatively (T0), 9 weeks post-ACLR (T1), and at RTA. Rectus femoris CSA and PF were evaluated bilaterally via ultrasound imaging, and patient-reported function was assessed using the IKDC score. RESULTS: Bilateral reductions in rectus femoris CSA were noted from T0 to T1 (P < 0.01). Only the uninvolved limb returned to preoperative CSA (P = 0.80), as the involved limb failed to return to preoperative levels at RTA (P = 0.04). No significant changes in rectus femoris PF were observed across time points (P > 0.05). Lesser PF (P < 0.01) but not CSA (P = 0.75) was associated with higher IKDC score at T1. Lesser PF (P = 0.04) and greater CSA (P = 0.05) was associated with higher IKDC score at RTA. CONCLUSION: Substantial atrophy occurs bilaterally after ACLR, and the involved limb does not return to preoperative muscle size despite the patient completing rehabilitation. Quadriceps muscle morphology is associated with patient-reported function and may be an important rehabilitation target after ACLR. CLINICAL RELEVANCE: Quadriceps atrophy and poor muscle quality may contribute to suboptimal patient functioning and quadriceps dysfunction and may be important in RTA decision making. Assessing muscle morphology using ultrasound may be a feasible and clinically beneficial tool in patients after ACLR.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/patología , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Medición de Resultados Informados por el Paciente , Músculo Cuádriceps/patología , Adolescente , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Reconstrucción del Ligamento Cruzado Anterior/rehabilitación , Humanos , Debilidad Muscular/diagnóstico por imagen , Debilidad Muscular/etiología , Atrofia Muscular/diagnóstico por imagen , Atrofia Muscular/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Músculo Cuádriceps/diagnóstico por imagen , Ultrasonografía
18.
Arthroscopy ; 36(2): 613-614, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32014189

RESUMEN

The results of anterior cruciate ligament repair are not satisfactory. While some cohort studies reported optimistic outcomes, even using augmentation and modern rehabilitation procedures, repair of anterior cruciate ligament ruptures should not be done outside well-designed studies as the overwhelming literature is quite negative on short-term results. The steps from basic science through animal surgery to clinical studies have still not resulted in techniques for daily use.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Animales , Ligamento Cruzado Anterior/cirugía , Grupos Control
20.
Br J Anaesth ; 124(3): 299-307, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31980156

RESUMEN

BACKGROUND: Pain after anterior cruciate ligament reconstruction (ACLR) with autologous hamstring graft can be attributed to both arthroscopic surgery and the graft donor site. This study investigated whether donor site pain control was superior with the addition of either peri-hamstring injection or anterior division obturator nerve block in comparison with adductor canal block (ACB) alone. METHODS: Patients scheduled to undergo knee arthroscopy with ACLR using a graft from the ipsilateral hamstring were randomised to one of three groups. All patients received ACB and multimodal analgesia. Subjects in Group H received peri-hamstring local anaesthetic injection while subjects in Group O received an anterior division of the obturator nerve block, and subjects in Group C served as a control group (ACB alone). RESULTS: In 105 subjects undergoing ACLR, there was no significant difference between groups H, O, and C for the primary outcome of pain on movement as assessed by numerical rating scale (NRS) on knee flexion at 2 h after operation (P=0.11). There was no difference in NRS at any time point in the first 48 h after operation, nor was there a difference in oxycodone consumption between the three groups at 24 h (P=0.2). Worst knee pain was initially at the graft donor site in all three groups, which transitioned to anterior knee pain after 12 h. CONCLUSIONS: The addition of ultrasound-guided peri-hamstring injection or anterior division of obturator nerve block to ACB did not result in a significant reduction in pain or opioid consumption after ACLR with ipsilateral hamstring graft. CLINICAL TRIAL REGISTRATION: NCT01868282.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Tendones Isquiotibiales/trasplante , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Artroscopía/efectos adversos , Artroscopía/métodos , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nervio Obturador , Dimensión del Dolor/métodos , Dolor Postoperatorio/etiología , Recolección de Tejidos y Órganos/efectos adversos , Recolección de Tejidos y Órganos/métodos , Adulto Joven
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