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1.
Arthroscopy ; 37(4): 1192-1193, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33812522

RESUMEN

Although most reports in the literature suggest that the knee anterolateral structures contribute to the anterolateral rotational stability of the knee, the extent of its contribution is still controversial. There are many dynamic structures that also affect the stability of the knee joint, including the iliotibial band and quadriceps muscle. Although not all of the dynamic structures surrounding the knee influence stability associated with the anterior cruciate ligament, we recommend that cadaveric, biomechanical analysis of the knee anterolateral ligament and related structures include tensioning of all knee dynamic structures to avoid potential biases.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Inestabilidad de la Articulación , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos , Cadáver , Humanos , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Rango del Movimiento Articular
2.
Medicine (Baltimore) ; 100(11): e24846, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725956

RESUMEN

ABSTRACT: This research discussed clinical outcomes of anterior cruciate ligament reconstruction accompanied by conservative treatment for grade 2 medial collateral ligament injury, and comparison was performed between double-bundle and single-bundle anterior cruciate ligament reconstruction.Clinical information was retrospectively collected for 41 cases suffering anterior cruciate ligament injuries accompanied by grade 2 medial collateral ligament injuries. Within 14 days after their injuries 22 cases received single-bundle anterior cruciate ligament reconstruction (SB group), while 19 were treated with double-bundle medial collateral ligament reconstruction (DB group). Physical statuses were estimated based on International Knee Documentation Committee (IKDC) and Lysholm scores, Lachman, pivot shift and manual valgus test, and range of motion (ROM), while side-to-side difference was estimated through KT 2000 arthometer.Anterior cruciate ligament reconstruction accompanied by conservative treatment showed significantly improved anteroposterior, rotational and valgus stability, and IKDC and Lysholm scores (in comparison to pre-operative status, P < .05). Incidence of pivot shift was dramatically lower in DB group (2/19) than in SB group (7/22 and 2/22; P = .028). No substantial dissimilarity existed between DB and SB groups either in Lachman and valgus tests, KT 2000, ROM, IKDC, or Lysholm scores.Anterior cruciate ligament reconstruction accompanied by conservative treatment could achieve outstanding stability and functional manifestations for cases facing anterior cruciate ligament injury accompanied by grade 2 medial collateral ligament injury. Moreover, double-bundle anterior cruciate ligament reconstruction is superior to single-bundle operation in treating rotational instability of the knee.Level of evidence: Retrospective comparative study, Level III.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/métodos , Inestabilidad de la Articulación/cirugía , Traumatismos de la Rodilla/cirugía , Ligamento Colateral Medial de la Rodilla/lesiones , Adolescente , Adulto , Femenino , Humanos , Inestabilidad de la Articulación/etiología , Traumatismos de la Rodilla/complicaciones , Articulación de la Rodilla/fisiopatología , Masculino , Ligamento Colateral Medial de la Rodilla/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
3.
Acta Chir Orthop Traumatol Cech ; 88(1): 39-44, 2021.
Artículo en Checo | MEDLINE | ID: mdl-33764866

RESUMEN

PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Inestabilidad de la Articulación , Lesiones del Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos , Cadáver , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Rango del Movimiento Articular
4.
Head Face Med ; 17(1): 11, 2021 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-33773589

RESUMEN

BACKGROUND: Temporomandibular joint (TMJ) 'closed lock' is a clinical condition causing TMJ pain and limited mouth opening (painful locking). Recent studies suggest an increasing prevalence of degenerative joint disease associated with the onset of TMJ closed lock in adolescents and young adults. Early interventions are recommended, but the curative effect of standard therapies remains controversial. In this retrospective study, an alternative method of non-surgical treatment of TMJ closed lock is presented, and its long-term efficacy has been observed. METHODS: Forty adolescents and young adults, aged 16 to 30 years old, with distinct combination of symptoms of TMJ closed lock, were enrolled. Patients received anesthetic blockages of the auriculotemporal nerve, then performed mandibular condylar movement exercise for 10 min, and subsequently received hypertonic dextrose prolotherapy in retro-discal area of TMJ. Clinical assessments at baseline and at follow-up (2 weeks, 2 months, 6 months, and 5 years) included intensity and frequency of TMJ pain, mandibular range of motion, TMJ sounds, and impairment of chewing. RESULTS: Cone beam CT images of the TMJs revealed joint space changes in all patients and degenerative bone changes in 20% (8/40) of the patients. The patients were diagnosed as having disc displacement without reduction with limited opening. Successful reduction of displaced disc had been achieved in the treatment. And pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved since 2 weeks' follow-up. The overall success rate kept at a high level of 97.5% (39/40) at 6 months and 5 years' follow-up. CONCLUSIONS: The technique combining mandibular condylar movement exercise with auriculotemporal nerve block and dextrose prolotherapy is straightforward to perform, inexpensive and satisfactory to young patients with TMJ closed lock.


Asunto(s)
Luxaciones Articulares , Proloterapia , Adolescente , Adulto , Terapia por Ejercicio , Glucosa , Humanos , Nervio Mandibular , Rango del Movimiento Articular , Estudios Retrospectivos , Articulación Temporomandibular , Resultado del Tratamiento , Adulto Joven
5.
Medicine (Baltimore) ; 100(10): e25129, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725914

RESUMEN

ABSTRACT: A neglected Monteggia fracture is defined as the fracture of the proximal ulna associated with radial head dislocation (RHD) without undergoing any treatment for 4 weeks or more after injury. One-stage operation of ulnar corrective osteotomy and open reduction of RHD might result in many complications. Therefore, a two-stage strategy, including ulnar osteotomy (UO) with or without annular ligament reconstruction (ALR), was adopted at our institute since 2010.We performed a retrospective review of 51 patients with neglected Monteggia fracture between January 2010 and January 2018. Patients with bilateral problems or concomitant injuries in the ipsilateral extremity were excluded. Radiological and clinical data were collected from Hospital Database and clinical visits. All patients were divided into 2 groups based on the status of the ALR: the UO alone (UO) group and the ALR group.There were 15 patients in the UO group and 36 patients in the ALR group. The age in the UO group (6.1 ±â€Š2.3, year) was significantly younger than the ALR group (9.8 ±â€Š2.8, year) (P < .001). Concerning the duration from initial injury to surgery, there was a significant difference between the UO group (8.6 ±â€Š3.2 months) and the ALR group (23.3 ±â€Š12.6 months, P < .001). Concerning the preoperative elbow function, there was no significant difference between the UO group (67.6 ±â€Š5.0) and the ALR group (66.6 ±â€Š4.4) according to the Mayo elbow performance score (MEPS) (P = .51). Concerning the postoperative parameters, including postoperative ROM of the joint, removal of external fixator (6.7 ±â€Š0.8, 6.9 ±â€Š0.9 weeks) (P = .55), lengthening (8.9 ±â€Š2.5, 10.3 ±â€Š2.5 mm) (P = .10) and MEPS (92.7 ±â€Š2.1, 91.6 ±â€Š2.1) (P = .08), there was no significant difference between the UO group and ALR group.Two-stage strategy is a reasonable choice for selected patients with long-lasting RHD with ulnar deformity.


Asunto(s)
Articulación del Codo/cirugía , Ligamentos Articulares/cirugía , Fractura de Monteggia/cirugía , Reducción Abierta/métodos , Cúbito/cirugía , Niño , Preescolar , Articulación del Codo/lesiones , Fijadores Externos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Reducción Abierta/instrumentación , Osteotomía , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de Tiempo , Tiempo de Tratamiento , Resultado del Tratamiento
6.
Medicine (Baltimore) ; 100(12): e23794, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761628

RESUMEN

ABSTRACT: Diffuse pigmented villonodular synovitis (PVNS) of knee is a rare benign disease that has a destructive clinical course. Synovectomy and adjuvant radiotherapy (RT) have been reported as treatment options but literatures reporting functional outcomes were sparse. This study aimed to evaluate the long-term functional outcomes and disease control among treatment modalities through the 22 years of experience.A single-center database was searched for patients who received synovectomy of knee with the pathologic diagnosis of PVNS. General data, treatment modalities, and recurrent status were retrospectively collected from medical records. Functional outcomes were evaluated by Western Ontario and McMaster Universities Osteoarthritis Index through phone interviews by an independent orthopedist.From January 1995 to December 2017, 24 patients with diffuse PVNS of knee were identified, including 19 receiving open synovectomy (OP) and 5 undergoing arthroscopic surgery. Adjuvant RT was performed on 14 patients with a median dose of 35 Gy (range 20-40 Gy). After median follow up of 6 years, recurrences were recorded in 10 cases. The recurrence rate was significantly lower in the OP + RT group than the OP group (8.3% vs 57.1%, P = .038). Among those with preserved knee joints, there was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index score and stiffness score between patients in the OP + RT and OP groups.For patients with diffuse PVNS of knee, the addition of moderate-dose adjuvant RT following OP provided excellent local control while maintaining good joint function with limited treatment-related morbidity. Our study emphasized the importance of moderate dose RT in diffuse PVNS of knee joint.


Asunto(s)
Artroscopía/efectos adversos , Recurrencia Local de Neoplasia/epidemiología , Sinovectomía/métodos , Sinovitis Pigmentada Vellonodular/terapia , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Radioterapia Ayuvante/efectos adversos , Rango del Movimiento Articular , Sinovectomía/efectos adversos , Sinovitis Pigmentada Vellonodular/epidemiología , Sinovitis Pigmentada Vellonodular/patología , Resultado del Tratamiento , Adulto Joven
7.
Medicine (Baltimore) ; 100(11): e24996, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725972

RESUMEN

PURPOSE: Though the previous studies had described various surgical techniques for the treatment of mallet finger injuries, consensus on which technique was the most effective and appropriate surgical methods had not yet reached. This review aimed to systematically compare the effectiveness and safety of the treatment for mallet finger injuries via Kirschner wire fixation versus suture anchor technique to recommend an optimum option. METHODS: All literatures published until December 31, 2019 compared Kirschner wire fixation versus suture anchor technique to treat mallet finger were acquired through a comprehensive search in multiple databases. A meta-analysis was performed by the Cochrane Collaboration's RevMan 5.3 software. RESULTS: A total of 8 trials with 362 cases consisted of 4 randomized controlled trials and 4 prospective studies. The results suggested that the groups treated with kirschner wire fixation experienced more significant advantage in less complications than suture anchor groups (P  < .05). On the other hand, no significant differences were found in terms of the total active range motion of the distal interphalangeal joint, the average distal interphalangeal joint extensor lag, Visual Analogue Scale scores, recurrence, as well as functional assessment at the final follow-up (P > .05, respectively) between the two surgical procedures. CONCLUSIONS: No obvious superiority were shown for the effectiveness between the two surgical interventions based on the above results. But in view of the less economic spending and complications, Kirschner wire fixation should be a better alternative relative to the suture anchor technique for inevitable surgical treatment of mallet finger lesions. However, a prudent attitude is still necessary to choose the two operative managements before a large sample and high-quality randomized controlled trials had been performed.


Asunto(s)
Hilos Ortopédicos , Traumatismos de los Dedos/cirugía , Fijación Interna de Fracturas/instrumentación , Deformidades Adquiridas de la Mano/cirugía , Anclas para Sutura , Adulto , Femenino , Traumatismos de los Dedos/fisiopatología , Articulaciones de los Dedos/fisiopatología , Articulaciones de los Dedos/cirugía , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , Masculino , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Rango del Movimiento Articular , Resultado del Tratamiento
8.
No Shinkei Geka ; 49(2): 452-457, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33762472

RESUMEN

Case 1: A 73-year-old man who had undergone neurolysis for right cubital tunnel syndrome complained of difficulty using chopsticks. Froment's sign test showed that the interphalangeal(IP)joint of the right thumb that had flexed preoperatively was extended. This finding was considered to indicate recovery from ulnar neuropathy, and the patient was closely followed up. One year later, the patient was unable to push a camera shutter button and was unable to flex the IP joint of the thumb and the distal interphalangeal(DIP)joint of the index finger, a characteristic symptom of anterior interosseous nerve(AIN)palsy. Therefore, the patient underwent AIN neurolysis and subsequently reported slight improvement in his condition. Case 2: A 60-year-old woman reported difficulty performing computer mouse clicks with her right hand. As flexing the index finger DIP joint was difficult, a local lesion was suspected, and the patient was closely followed up. One year later, the patient was unable to push the button of a ballpoint pen with her thumb. Extension of the thumb and index finger indicated AIN palsy. The patient refused treatment and was only followed up. The following year, the patient reported that the weakness improved. Simultaneous flexion palsy of the thumb and index finger can lead to a diagnosis of AIN palsy. However, flexion palsy of a single finger in incomplete AIN palsy, as reported here, is often overlooked because of its similarity to the flexor tendon rupture. Awareness regarding this incomplete form of AIN palsy is needed for early and correct diagnosis.


Asunto(s)
Dedos , Pulgar , Femenino , Dedos/cirugía , Humanos , Parálisis/diagnóstico , Parálisis/etiología , Paresia , Rango del Movimiento Articular , Pulgar/cirugía
9.
Medicine (Baltimore) ; 100(8): e24939, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663133

RESUMEN

BACKGROUND: Manual therapy is a common technique for the treatment of (CCS) cervicogenic cephalic syndrome, but the efficiency is various. The aim of the study is to evaluate the evidence pertaining to the efficiency and safety of using manual therapy to treat patients with CCS. METHODS: We searched the electronic databases including PubMed, ScienceDirect, and the Cochrane Library. Only randomized controlled trials (RCTs) were enrolled in this systematic review and cumulative meta-analysis. RESULTS: A total of 8 RCTs with 395 patients were included for meta-analysis. Patients who underwent manual therapy showed lower scores of visual analog scale (VAS) (weighted mean difference) WMD = 1.7, 95% confidence interval CI = 0.74-2.65, P = .0005); dizziness handicap inventory (DHI) (WMD = 0.66, 95%CI = 0.31-1, P = .0002); and neck disability index (NDI) (WMD = 0.59, 95%CI = 0.23-0.96, P = .002) and better rotation range of motion (ROM) of the cervical spine (WMD = -6.54, 95%CI = -7.60 to -5.48, P < .0001). However, these patients did not show much benefit from manual therapy with respect to the frequency of CCS episodes and head repositioning accuracy (HRA). No serious adverse effects were reported in our included studies lasting longer than 24 hours. CONCLUSIONS: Manual therapy offers an effective and safe approach to treat CCS with lower VAS, DHI, and NDI scores and better cervical spinal movement. Further high-quality RCTs are required to provide more conclusive evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO172740.


Asunto(s)
Dolor Crónico/terapia , Mareo/terapia , Manipulación Espinal/métodos , Dolor de Cuello/terapia , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Rango del Movimiento Articular , Síndrome
10.
Sensors (Basel) ; 21(5)2021 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-33668101

RESUMEN

Capturi ng hand motions for hand function evaluations is essential in the medical field. For many allied health professionals, measuring joint range of motion (ROM) is an important skill. While the universal goniometer (UG) is the most used clinical tool for measuring joint ROM, developments in current sensor technology are providing clinicians with more measurement possibilities than ever. For rehabilitation and manual dexterity evaluations, different data gloves have been developed. However, the reliability and validity of sensor technologies when used within a smart device remain somewhat unclear. This study proposes a novel electronically controlled sensor monitoring system (ECSMS) to obtain the static and dynamic parameters of various sensor technologies for both data gloves and individual sensor evaluation. Similarly, the ECSMS was designed to closely mimic a human finger joint, to have total control over the joint, and to have an exceptionally high precision. In addition, the ECSMS device can closely mimic the movements of the finger from hyperextension to a maximum ROM beyond any person's finger joint. Due to the modular design, the ECSMS's sensor monitoring board is independent and extensible to include various technologies for examination. Additionally, by putting these sensory devices through multiple tests, the system accurately measures the characteristics of any rotary/linear sensor in and out of a glove. Moreover, the ECSMS tracks the movement of all types of sensors with respect to the angle values of finger joints. In order to demonstrate the effectiveness of sensory devices, the ECSMS was first validated against a recognised secondary device with an accuracy and resolution of 0.1°. Once validated, the system simultaneously determines real angles alongside the hand monitoring device or sensor. Due to its unique design, the system is independent of the gloves/sensors that were tested and can be used as a gold standard to realise more medical equipment/applications in the future. Consequently, this design greatly enhances testing measures within research contact and even non-contact systems. In conclusion, the ECSMS will benefit in the design of data glove technologies in the future because it provides crucial evidence of sensor characteristics. Similarly, this design greatly enhances the stability and maintainability of sensor assessments by eliminating unwanted errors. These findings provide ample evidence for clinicians to support the use of sensory devices that can calculate joint motion in place of goniometers.


Asunto(s)
Guantes Protectores , Mano , Rango del Movimiento Articular , Materiales inteligentes , Humanos , Reproducibilidad de los Resultados , Tecnología
11.
Sensors (Basel) ; 21(4)2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-33671966

RESUMEN

In recent years, flexible sensors for data gloves have been developed that aim to achieve excellent wearability, but they are associated with difficulties due to the complicated manufacturing and embedding into the glove. This study proposes a knitted glove integrated with strain sensors for pattern recognition of hand postures. The proposed sensing glove is fabricated at all once by a knitting technique without sewing and bonding, which is composed of strain sensors knitted with conductive yarn and a glove body with non-conductive yarn. To verify the performance of the developed glove, electrical resistance variations were measured according to the flexed angle and speed. These data showed different values depending on the speed or angle of movements. We carried out experiments on hand postures pattern recognition for the practicability verification of the knitted sensing glove. For this purpose, 10 able-bodied subjects participated in the recognition experiments on 10 target hand postures. The average classification accuracy of 10 subjects reached 94.17% when their own data were used. The accuracy of up to 97.1% was achieved in the case of grasp posture among 10 target postures. When all mixed data from 10 subjects were utilized for pattern recognition, the average classification expressed by the confusion matrix arrived at 89.5%. Therefore, the comprehensive experimental results demonstrated the effectiveness of the knitted sensing gloves. In addition, it is expected to reduce the cost through a simple manufacturing process of the knitted sensing glove.


Asunto(s)
Guantes Protectores , Mano , Postura , Fuerza de la Mano , Humanos , Reconocimiento de Normas Patrones Automatizadas , Rango del Movimiento Articular
12.
Sensors (Basel) ; 21(4)2021 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-33672802

RESUMEN

This study investigated the whole-body coordination patterning in successful and faulty spikes using self-organising map-based cluster analysis. Ten young, elite volleyball players (aged 15.5 ± 0.7 years) performed 60 volleyball spikes in a real-game environment. Adopting the cluster analysis, based on a self-organising map, whole-body coordination patterning was explored between successful and faulty spikes of individual players. The self-organising maps (SOMs) portrayed whole body, lower and upper limb coordination dissimilarities during the jump phase and the ball impact phases between the successful and faulty spikes. The cluster analysis illustrated that the whole body, upper limb and lower limb coordination patterning of each individual's successful spikes were similar to their faulty spikes. Range of motion patterning also demonstrated no differences in kinematics between spike outcomes. Further, the upper limb angular velocity patterning of the players' successful/faulty spikes were similar. The SPM analysis portrayed significant differences between the normalized upper limb angular velocities from 35% to 45% and from 76% to 100% of the spike movement. Although the lower limb angular velocities are vital for achieving higher jumps in volleyball spikes, the results of this study portrayed that the upper limb angular velocities distinguish the differences between successful and faulty spikes among the attackers. This confirms the fact that volleyball coaches should shift their focus toward the upper limb velocity and coordination training for higher success rates in spiking for volleyball attackers.


Asunto(s)
Rendimiento Atlético , Voleibol , Adolescente , Fenómenos Biomecánicos , Análisis por Conglomerados , Humanos , Extremidad Inferior , Movimiento , Rango del Movimiento Articular
13.
Arthroscopy ; 37(3): 843-844, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33673966

RESUMEN

Over the past 3 decades, arthroscopic Bankart repair has become the gold standard for anterior shoulder instability in the absence of significant bone loss. Glenoid curettage may seem unusual in the setting of Bankart repair, but the advantage of a bleeding bony surface in reconstructive procedures is nearly universal in sports medicine, from cartilage restoration in the knee to rotator cuff repair. Intuitively, maximizing the surface of bleeding bone should improve healing, but is it really necessary to remove undamaged cartilage to create a healing response? Perhaps not in general, but in high-risk patients with subcritical bone loss curettage it could make sense. It has been well established that as the amount of bone loss drifts above 10%, recurrent instability after standard Bankart repair begins to rise. For many surgeons, the amount of glenoid and humeral bone loss in this patient population would encourage additional stabilizing measures in the form of Latarjet or Bankart repair with the addition of remplissage. Anterior glenoid cartilage curettage could be an additional tool when treating patients in subcritical bone loss. Removing 5 mm of glenoid cartilage may allow for anchor placement further posterior on the glenoid face, thus further closing off of the anterior glenohumeral joint space while providing potential added biologic benefit of increased bone to capsulolabral apposition. The addition of remplissage could further enhance stability and help hold the humeral head posteriorly and perhaps obviate the need for a bone block procedure.


Asunto(s)
Cavidad Glenoidea , Inestabilidad de la Articulación , Luxación del Hombro , Articulación del Hombro , Artroscopía , Cartílago , Legrado , Cavidad Glenoidea/cirugía , Humanos , Inestabilidad de la Articulación/cirugía , Estudios Prospectivos , Rango del Movimiento Articular , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía
14.
Zhonghua Yi Xue Za Zhi ; 101(9): 611-614, 2021 Mar 09.
Artículo en Chino | MEDLINE | ID: mdl-33685040

RESUMEN

Heterotopic ossification(HO) and progressive bone formation(PBF) are main factors affecting the motion ability of target segments after cervical artificial disc replacement(CADR).The severity of pre-operative degeneration of target segment is the most important factor in the occurrence and progression of HO and PBF. The occurrence and progression of HO and PBF can be reduced basically through the improvement of degeneration evaluation system for intervertebral disc (including height, range of motion and osteophyte formation), uncovertebral joint and facet joint and standardization of surgical indication. The application of new anatomical prosthesis and improved surgical technique are also important factors to reduce the occurrence and development of HO and PBF.


Asunto(s)
Degeneración del Disco Intervertebral , Disco Intervertebral , Osificación Heterotópica , Reeemplazo Total de Disco , Vértebras Cervicales/cirugía , Estudios de Seguimiento , Humanos , Degeneración del Disco Intervertebral/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento
15.
Zhongguo Gu Shang ; 34(2): 101-7, 2021 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-33665994

RESUMEN

OBJECTIVE: To compare therapeutic effects of internal fixation with volar locking plate in treating extension and flexion type of distal radius fracture (DRF). METHODS: From January 2015 to June 2018, 103 patients with DRF were retrospectively analyzed. According to original fracture displacement direction, patients were divided into extension fracture(Colles) group and flexion fracture (Smith) group. In Colles fracture group, there were 24 males and 44 females aged from 20 to 79 years old with an average of (59.0±13.4) years old;according to AO classification, 9 patients of type A2, 13 patients of type A3, 16 patientsof type C1, 17 patients of type C2 and 13 patients of type C3;the time from injury to operation ranged from 2 to 9 days with an average of (3.9±0.8) days. In Smith fracture group, there were 15 males and 20 females, aged from 27 to 87 years old with an average of (60.1±15.3) years old;according to AO classification, 4 patienst of A2, 7 patients of A3, 14 patients of C1, 5 patients of C2 and 5 patients of C3;the time from injury to operation ranged from 2 to 6 days with an average of (4.1±0.9) days. Operation time, fracture healing time and postoperative complications were recorded between two groups. Disabilities of arm, shoulder and hand (DASH) score at 6 and 8 weeks, 6 and 8 months were used to evaluate functional recovery of affected limbs during each follow up. Volar tilt, radial inclination and radius height were measured at 8 months after operation. Mayo score was measured at 8 months after operation to evaluate recovery of limb function. RESULTS: All patients were followed up for 8 to 30 months with an average of (14.8±4.3) months, and no difference in follow up between two groups (P> 0.05). There were no statistical differences in operation time, fracture healing time and postoperative complications between two groups(P>0.05). DASH score at 6 and 12 weeks in Colles fracture group were (37.24±5.08) and (19.68±4.55), while in Smith fracture group were (39.05±4.79) and (23.44±4.21);Colles fracture group was better than that of Smith fracture group (P<0.001);while there were no differences in DASH score at 6 and 8 months between two groups (P>0.05). Volar tilt of Smith fracture group (11.1±3.1)° was better than that of Colles fracture group (8.6±4.1) °, and there were no significant difference in radial inclination and radius height between two groups(P>0.05). Also there was no significant difference in Mayo score between two group(P>0.05). CONCLUSION: Patients with Colles fracture and Smith fracture could receive good reduction and fixation through volar locking plate. The radiographic parameters of both groups recovered satisfactorily after operation. Recovery of volar tilt of Smith fracture group is better than that of Colles fracture group, and early recovery function of Colles fracture group is better than that of Smith group, but there is no significant difference in long-term wrist joint function and incidence of postoperative complications between two groups.


Asunto(s)
Fracturas del Radio , Adulto , Anciano , Anciano de 80 o más Años , Placas Óseas , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Fracturas del Radio/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Articulación de la Muñeca , Adulto Joven
16.
Zhongguo Gu Shang ; 34(2): 126-30, 2021 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-33665998

RESUMEN

OBJECTIVE: To study mechanism of improvement of stress concentration on patellofemoral joint by stiletto needle releasing lateral patellar retinaculum guided by the theory of Jinshugu() and based on the finite element model of knee joint. and to elucidate the biomechanical mechanism of stiletto needle releasing changing patellar trajectory and reducing patellofemoral joint pressure. METHODS: CT data of knee joint from a normal male (aged 29, heighted 171 cm, weighted 58 kg) was selected. Starting with construction of three-dimensional model of knee joint by using finite element software, the finite element model of knee joint with complete tendonand bone structures were established through several steps, such as geometric reconstruction, reverse engineering, meshing, material assignment and loading analysis. The loading condition was set as 500 N load on knee joint, and the average tensile stress of quadriceps femoris tendon was about 200 N. To simulate the release of lateral patellar retinaculum by stiletto needle at 30 and 90 position of knee flexion in finite element model separately, and to compare the improvement of stress concentration of patellofemoral joint by stiletto needle intervention under different knee flexion conditions. RESULTS: The peak stress of patellofemoral joint and tibiofemoral joint decreased after stiletto needle releasing of patellofemoral lateral retinaculum compared with before intervention, which was(1) knee flexion at 30 degrees:patellar cartilage decreased by 0.498 MPa (decreased 9.06%), femoral trochlea decreased by 0.886 MPa(decreased 16.27%);(2) knee flexion at 90 degrees:patellar cartilage decreased by 0.558 MPa (decreased 8.6%), femoral trochlea decreasedby 0.607 MPa (decreased 9.94%). CONCLUSION: Releasing lateral patellofemoral retinaculum with stiletto needle could effectively alleviate the stress concentration of patellofemoral joint and reduce local stress peak value, which it is helpful to improve patellar trajectory and make stress distribution more uniform.


Asunto(s)
Articulación Patelofemoral , Adulto , Fenómenos Biomecánicos , Análisis de Elementos Finitos , Humanos , Articulación de la Rodilla , Masculino , Rótula , Músculo Cuádriceps , Rango del Movimiento Articular
17.
Zhongguo Gu Shang ; 34(1): 40-4, 2021 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-33666018

RESUMEN

OBJECTIVE: To investigate the biomechanical affect of percutaneous transforaminal endoscopic discectomy(PTED) on adjacent segments with different degrees of degeneration and related risk of adjacent segment diseases (ASD) caused by this operation. METHODS: A healthy male adult volunteer was selected, and the lumbosacral vertebra image data was obtained by CT scan, and the external contour of the bone structure was reconstructed. On this basis, the external contour of the bone structure was fitted by using the smooth curve in 3D-CAD software, and the complete three-dimensional finite element modelof the non degenerate L3-S1 segment and the degenerative models of the L3-L4 and L5-S1 segment were drawn forward. In L4, L5 segment simulating PTED surgery through the removal of right part of articular process and nucleus pulposus and anulus fibrosus. After PTED was simulated in the L4-L5 segment and the risk of ASD has been evaluated by six changes of biomechanical indicators in flexion, extension, left and right lateral bending, left and right axial rotation conditions. RESULTS: In the finite element model without adjacent segmental disc degeneration, the annulus fibrosus von Mises stress and intradiscal pressure of the PTED model showed only a slight increase under most stress conditions, and a slight decrease in a few conditions, and there was no significant change trend before and after surgery. In the original degenerated adjacent segment disc model, the biomechanical indicators related to disc degeneration in the pre- and post-PTED model showed significant deterioration, leading to an increased risk of potential adjacent spondylopathy. CONCLUSION: PTED surgery will not lead to the significant deterioration of postoperative biomechanical environment of non-degeneration adjacent intervertebral discs, and the original degeneration of adjacent intervertebral discs is a important risk factor for ASD.


Asunto(s)
Discectomía Percutánea , Degeneración del Disco Intervertebral , Disco Intervertebral , Adulto , Fenómenos Biomecánicos , Análisis de Elementos Finitos , Humanos , Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Masculino , Rango del Movimiento Articular
18.
Zhongguo Gu Shang ; 34(1): 80-5, 2021 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-33666025

RESUMEN

OBJECTIVE: To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery. METHODS: From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared. RESULTS: At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (P>0.05);there was no significant difference in YT20 score before operation (P>0.05), and YT20 score in patients with heterotopic ossification was significantly lower than that in patients without heterotopic ossification(P<0.05). CONCLUSION: The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.


Asunto(s)
Degeneración del Disco Intervertebral , Reeemplazo Total de Disco , Adulto , Anciano , Vértebras Cervicales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Degeneración del Disco Intervertebral/cirugía , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento
19.
Med Probl Perform Art ; 36(1): 27-33, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33647094

RESUMEN

BACKGROUND: Hand-held dynamometry is considered an efficient, effective, and portable means of objectively measuring lower extremity strength; however, it has yet to be studied specific to dance-relevant muscle performance. Also, dynamometry is often criticized for variability in results based on tester strength and sex. Use of an external stabilizing device has been suggested to minimize differences in outcomes between male and female testers by reducing variability associated with tester strength limitations. Therefore, this study used a barre-mounted, portable dynamometer stabilizing device to improve consistency of results among different testers for assessing hip and lower extremity muscle performance in dance-relevant positions. OBJECTIVE: To assess the intra and inter-rater reliability of a barre-mounted dynamometer stabilizing device in measuring muscle performance in common dance maneuvers. METHODS: Two testers assessed muscle performance of three common dance maneuvers--développé en avant, à la secondé, and arabesque--on 11 pre-professional and professional dancers on two separate occasions to establish intra- and inter-rater reliability of the barre-mounted dynamometer stabilizing device. RESULTS: Intra-rater reliability was moderate to high and inter-rater reliability of the device was excellent, with intraclass correlation coefficients ranging from 0.527-0.851 and 0.834-0.953, respectively, for all positions. CONCLUSIONS: The barre-mounted stabilizing device shows promise in mitigating tester strength or fatigue in assessing muscle performance of dancers. Initial assessment of the device suggests further study may be indicated to improve generalizability to applications of larger-scale muscle performance screening and assessment in dancers or other athletic populations who engage in movements that require extensive hip range of motion and multi-joint stability. CLINICAL RELEVANCE: Using a portable, barre-mounted stabilizing device in assessing multi-joint lower extremity muscle performance in dancers improves consistency of testing results. Application of this testing device into wider scale screenings could assist in developing normative data for a population that is lacking.


Asunto(s)
Baile , Femenino , Humanos , Masculino , Fuerza Muscular , Dinamómetro de Fuerza Muscular , Rango del Movimiento Articular , Reproducibilidad de los Resultados
20.
Med Probl Perform Art ; 36(1): 34-38, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33647095

RESUMEN

BACKGROUND: Patellofemoral chondropathy (PFC) is one of the most important causes of patellofemoral pain syndrome. PFC may occur as a result of anatomic reasons such as patellar malalignment and/or increased patellofemoral joint stresses. Most research on this subject has involved sports injuries and anatomic variations. The literature is scarce on PFC related to the dance. METHODS: Fourteen dancers (14 knees, all male) were found to have PFC based on MRI evaluations and clinical examinations between January 2010 and December 2019 (3 dancers were excluded due to prior surgeries of the knee). Age, sex, side of injury, range of motion, Q angle, types of dances, body mass index, and patellar specifics (alta, baja, Wiberg) were recorded for 11 dancers included in the study. We observed PFC at the femoral contact areas (FCA) and patellar contact areas (PCA) of Goodfellow description. RESULTS: Chondral lesions were observed at Gooodfellow areas FCA-3 in 2 dancers, FCA-4 in 5 dancers, PCA-2 in 10 dancers, PCA-3 in 10 dancers, and PCA-4 in 9 dancers. CONCLUSION: Dance styles that include frequent deep flexions and strolling on a flexed knee joint may be risk factors for chondral lesions in the contact area of the femur in male dancers.


Asunto(s)
Traumatismos de la Rodilla , Síndrome de Dolor Patelofemoral , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Síndrome de Dolor Patelofemoral/diagnóstico por imagen , Rango del Movimiento Articular
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