Modificaciones en la altura patelar por el uso del injerto hueso-tendón-hueso / Changes in patellar height due to bone-tendon-bone graft

Objetivo: Las complicaciones asociadas al uso de injertos del ligamento cruzado anterior (LCA) son frecuentes. Los cambios en la altura, sobre todo de la patela baja, pueden ser la razón de la aparición de dolor en la zona anterior de la rodilla. Diversos estudios han asociado la reconstrucción del LCA mediante la técnica de injerto hueso-tendón-hueso con patela baja. Métodos: Cuarenta y tres pacientes con reconstrucción del LCA mediante injerto hueso-tendón-hueso fueron incluidos en el presente estudio. Todos los pacientes fueron sometidos a la misma cirugía, con el cierre del paratendón del tendón rotuliano. Se realizó un estudio radiológico antes de la cirugía y 2 años después de la misma. En todos los casos se estudió el índice Insall-Salvati, el corte axial y la inclinación patelar. Como control se utilizó la rodilla sana contralateral del paciente. Resultados: No se encontraron diferencias significativas entre el estudio preoperatorio y el realizado tras 2 años de la cirugía. Conclusiones: El uso del tendón patelar con cierre del paratendón en la reconstrucción del LCA no ha demostrado modificar la altura patelar en estudios radiológicos a los 2 años de seguimiento

Purpose: Complications related to anterior cruciate ligament (ACL) graft are common. Change in height, especially patella baja, can be a cause of anterior knee pain. Several studies have related ACL reconstruction with bone-tendon-bone graft to patella baja. Methods: Forty-three patients with ACL reconstruction using a with bone-tendon-bone graft were included in this study. All patients underwent the same surgery, with closure of the paratenon of the patellar tendon. A radiological study was performed before surgery and 2 years after surgery. The Insall-Salvati index, axial view and patellar tilt were analyzed in all patients. The healthy contralateral knees were used as the control group. Results: No significant differences were observed from the preoperative measurements or at the 2-year follow-up. Conclusions: The use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years

Changes in patellar height due to bone-tendon-bone graft. / Modificaciones en la altura patelar por el uso del injerto hueso-tendón-hueso.

PURPOSE: Complications related to anterior cruciate ligament (ACL) graft are common. Change in height, especially patella baja, can be a cause of anterior knee pain. Several studies have related ACL reconstruction with bone-tendon-bone graft to patella baja. METHODS: Forty-three patients with ACL reconstruction using a with bone-tendon-bone graft were included in this study. All patients underwent the same surgery, with closure of the paratenon of the patellar tendon. A radiological study was performed before surgery and 2 years after surgery. The Insall-Salvati index, axial view and patellar tilt were analyzed in all patients. The healthy contralateral knees were used as the control group. RESULTS: No significant differences were observed from the preoperative measurements or at the 2-year follow-up. CONCLUSIONS: The use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years.

Assessing long-term return to play after hip arthroscopy in football players evaluating risk factors for good prognosis.

PURPOSE: Groin pain is the third most common disease in football players and has often been associated with hip pathology such as femoroacetabular impingement and labral lesions. Hip arthroscopy offers possibilities of function restoration via minimally invasive procedures. The aim of this study is to evaluate professional football player's injuries and their return to play after hip arthroscopy for FAI and labral injuries. METHODS: Patients that underwent hip arthroscopy between 2009 and 2014 were selected retrospectively. From this population, only professional soccer players competing at national level were included (Tegner 10). Arthroscopic surgery was proposed in patients with persistent pain. All patients were assessed for VAS score preoperatively and at 3, 6, 12 and 24 months post-op. HOS (sport and DLA) and mHHS tests were performed at the same time periods. RESULTS: All patients were men with a mean age of 26.5 ± 7.1 years old. Preoperative VAS (7.4 ± 1.3), HOS ADL (67.7 ± 5.5), HOS sport (37.6 ± 18.7) and mHHS (72.5 ± 8.8) showed improved scores during long-term follow-up. Time to return to play was 10.8 months (SD ± 4.3), with range between 4 and 20 months. Mean follow-up was 45.4 ± 15.6 months (range from 26 to 72 months). No differences were observed between non-active and active patients at final follow-up with respect to chondral lesions, but significant differences were observed with reference to management of the labrum (p = 0.031), where a higher rate of labrectomies existed among inactive patients and a higher rate of suture among active patients. CONCLUSIONS: Hip arthroscopy is a safe procedure with very good return to play results, but for optimized return to football one should consider patient age at the time of surgery, the condition of the labrum and low scores on the Harris Hip Score (mHHS) and HOS (sport version) as predictive factors for poor prognosis. Level of evidence IV.

Hip arthroscopy complications regarding surgery and early postoperative care: retrospective study and review of literature.

PURPOSE: The purpose is to describe the rate of complications in a series of hip arthroscopies performed at our center, as well as perform a systematic review of the current literature in order to compare our outcomes. METHODS: Two hundred and fifty-eight patients affected of femoroacetabular impingement and treated with hip arthroscopy have been studied. All minor and major complications were studied during the first postsurgery year. Furthermore, a systematic review was performed comparing major and minor complications with our series. Two attending orthopedic surgeons selected the different studies with the same inclusion and exclusion criteria, remaining with 48 studies that have been reviewed and included in the present study. RESULTS: Mean age was 36.6 years old (SD 17.45), and the ratio men:women was 137:121. The mean complication rate observed was 14.34% (37/258) of global complications. Only three patients showed major complications: femoral neck fracture, septic arthritis and avascular necrosis of the femoral head. Any of these patients had permanent side effects. CONCLUSIONS: Hip arthroscopy has a low rate of major complications, but a higher number of minor complications that could be avoided with certain preventive measures.

Aplicación coadyuvante de plasma rico en factores de crecimiento en rotura bilateral de tendón cuadricipital / Adjuvant administration of plasma rich in growth factors for bilateral quadriceps tendon tear

Antecedentes: Las roturas bilaterales de tendones cuadricipitales son enfermedades de muy baja frecuencia. Las reparaciones quirúrgicas suelen ser los tratamientos más adecuados y exigen tiempos de recuperación de varios meses. Métodos: Presentamos el caso de un paciente con rotura bilateral de tendones cuadricipitales tras un traumatismo de baja energía, que fue tratado mediante sutura transpatelar quirúrgica reforzada con plasma rico en factores de crecimiento (PRGF-Endoret). Resultados: Los resultados a corto plazo evidenciaron una recuperación funcional y mediante imagen en poco más de dos meses. Conclusiones: La utilización de PRGF asociado a la cirugía habitual puede ayudar a la realización de una rehabilitación precoz.

Background: Bilateral quadriceps tendon tears are infrequent conditions. Surgical repairs are the most appropriate treatments and they involve several months of recovery. Methods: We report the case of a patient with bilateral quadriceps tendon tear resulting from low energy trauma. He was treated with surgical transpatellar suturing reinforced with plasma rich in growth factors (PRGF-Endoret). Results: Short-term results showed functional and radiological recovery at the two-months follow-up. The use of PRGF together with usual surgery may contribute to early rehabilitation.

[Adjuvant administration of plasma rich in growth factors for bilateral quadriceps tendon tear]. / Aplicación coadyuvante de plasma rico en factores de crecimiento en rotura bilateral de tendón cuadricipital.

BACKGROUND: Bilateral quadriceps tendon tears are infrequent conditions. Surgical repairs are the most appropriate treatments and they involve several months of recovery. METHODS: We report the case of a patient with bilateral quadriceps tendon tear resulting from low energy trauma. He was treated with surgical transpatellar suturing reinforced with plasma rich in growth factors (PRGF-Endoret). RESULTS: Short-term results showed functional and radiological recovery at the two-months follow-up. The use of PRGF together with usual surgery may contribute to early rehabilitation.

[Treatment of late onset Perthes disease with hip arthroscopy and arthrodiastasis with an external fixator. Case report]. / Tratamiento de la enfermedad de perthes tardía mediante artroscopía de cadera y artrodistasis con fijador externo. A propósito de un caso y revisión de la literatura.

BACKGROUND: The prognosis of late onset Perthes cases is usually poor and the proposed treatments vary based on the surgeon's preferences and experience, as well as on the available resources. Most of them are salvage procedures with a short follow-up and non-standardized application criteria. METHODS: Hip arthroscopy and arthrodiastasis with external fixator are indicated for certain situations in Perthes disease. Based on the results obtained with each of these techniques separately, both of them were used to treat a case of Perthes disease involving a poor prognosis. RESULTS: Results two years after surgery are good. CONCLUSIONS: The use of both techniques together may produce a good result in these patients.

Osteocartilaginous lesions of the talus in soccer players.

OBJECTIVE: The objective of this study is to describe the results of arthroscopic debridement for talar lesions in a population of soccer players. PATIENTS: Patients were sixteen soccer players with osteochondral talar lesions, treated surgically between 1999 and 2004. INTERVENTIONS: All patients were diagnosed clinically. Complementary imaging studies included X-ray, scintigraphy, and magnetic resonance imaging. All patients underwent arthroscopic debridement. MAIN OUTCOME MEASUREMENTS: At 3.56 years of follow up, patient status was assessed using a visual analog scale (VAS) and the Ogilvie-Harris scale. The mean time to return to sports at the same level as that before the start of symptoms was evaluated. RESULTS: The Ogilvie-Harris score showed 81.75% excellent results and 18.25% good results. The VAS score was 0.26 (0-2.2). Among the total, 93.75% of patients resumed sports activities at the same level as that before surgery. CONCLUSIONS: Arthroscopic debridement of talar osteochondral lesions in soccer players provides excellent results. We consider this option the treatment of choice in this population.

Osteochondritis dissecans: a historical review and its treatment with cannulated screws.

The etiology of osteochondritis dissecans and the results of treating the early stages with arthroscopic fixation using cannulated screws is discussed. Arthroscopic surgery was performed on 14 patients with osteochondritis dissecans, and the osteochondral fragment was fixed with one or two screws. A second arthroscopic procedure was necessary to assess the lesion and remove the screws. Ambulation without weight bearing is allowed during the first 2 months postoperatively. Full range of motion is encouraged. The results indicate that all patients returned to their previous sport 3-11 months postsurgery. The authors conclude that fixation with cannulated screws is the ideal method of treating osteochondritis dissecans when the osteochondral fragment is still in its bed.