RESUMO
The life situation of many patients changes after an anterior cruciate ligament (ACL) rupture and subsequent reconstruction, and this may affect their health-related quality of life in many ways. It is well known that the overall clinical results after ACL reconstruction are considered good, but pre-operative predictive factors for a good post-operative clinical outcome after ACL reconstruction have not been studied in as much detail. The purpose of this study was to identify pre-operative factors that predict a good post-operative outcome as measured by the Short Form 36 (SF-36) and Knee Osteoarthritis Outcome Score (KOOS) 3-6 years after ACL reconstruction. Seventy-three patients scheduled for ACL reconstruction were clinically examined pre-operatively. The SF-36 and KOOS questionnaires were sent by mail to these patients 3-6 years after reconstruction. Predictive factors for health-related quality of life were investigated using a stepwise regression analysis. In conclusion, pre-operative factors, such as pivot shift, knee function, and range of motion, may predict a good post-operative outcome and explain up to 25% in terms of health-related quality of life after ACL reconstruction. Furthermore, it appears that the patients' pre-injury and pre-operative Tegner activity levels are important predictors of post-operative health-related quality of life.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/reabilitação , Qualidade de Vida , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Adolescente , Adulto , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Humanos , Articulação do Joelho/fisiologia , Masculino , Atividade Motora/fisiologia , Análise Multivariada , Medição da Dor , Período Pré-Operatório , Prognóstico , Análise de Regressão , Perfil de Impacto da Doença , Adulto JovemRESUMO
Ten patients, age 60 (48-75 years), with osteoarthritis (OA) of the hip and 10 patients, age 82.5 (60-90 years), with fracture of the collum femoris (FCF; minimum Garden stage III) underwent an open biopsy procedure from the internal obturator tendon in conjunction with a total hip replacement. The histological evaluation revealed that all tendon samples in the OA group revealed scar tissue; the corresponding was found in 50% of patients in the FCF group (P=0.02). There were also more GAGs (P=0.023) and calcium deposits (P=0.001) in the samples from the OA group. The ultrastructural evaluation revealed fewer small and medium-sized fibrils (P=0.001) and more non-collagenous extracellular matrix (ECM) (P=0.003) in the OA group. Taken together, the samples from the internal obturator tendon in the OA group revealed a more degenerative appearance with more scar tissue, change in fibril diameter distribution and more non-collagenous ECM. Our findings suggest that OA and periarticular tendinopathy are closely linked. Further research is needed to determine whether musculotendinous changes in the deep rotators are sequelae of joint pathology, or a contributing factor in the development of degenerative joint change.
Assuntos
Articulação do Quadril/ultraestrutura , Osteoartrite do Quadril/etiologia , Tendinopatia/complicações , Tendões/ultraestrutura , Idoso , Idoso de 80 Anos ou mais , Matriz Extracelular , Feminino , Indicadores Básicos de Saúde , Articulação do Quadril/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/patologia , Fatores de Risco , Estatística como Assunto , Tendinopatia/patologia , Tendinopatia/cirurgia , Tendões/patologia , Tendões/cirurgiaRESUMO
The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using the four-strand semitendinosus-gracilis (ST/G) autograft in male (n=141) vs female (n=103) patients. The patients were operated on between 1996 and 2005, using interference screw fixation and drilling the femoral tunnel through the anteromedial portal. The pre-operative assessments and demographics, apart from age (males 29 years, females 26 years; P=0.02), were comparable at the time of surgery. At 25 (23-36) months post-operatively, no significant differences were found between the study groups in terms of anterior side-to-side knee laxity, manual Lachman test, Tegner activity level, Lysholm knee score, range of motion or donor-site morbidity. Both study groups improved significantly in most clinical assessments and functional scores compared with their pre-operative values. Two years after ACL reconstruction using ST/G autografts, there were no significant differences between male and female patients in terms of clinical outcome or functional scores.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirurgia , Fatores Sexuais , Resultado do Tratamento , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior , Feminino , Humanos , Instabilidade Articular , Masculino , Pessoa de Meia-Idade , Dor , Medição da Dor , Estudos Retrospectivos , Estatística como Assunto , Suécia , Adulto JovemRESUMO
The aim of the study was to analyse and compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using patellar tendon autografts in three groups of patients. The groups were determined by knee laxity as measured with the KT-1000 arthrometer at the follow-up two to five years after the reconstruction. Group A (n=15) had an anterior side-to-side laxity difference of <-3 mm (i.e. the reconstructed knee was less lax than the contralateral non-injured knee), Group B (n=376) had a difference of > or = -1, but < or = +2 mm and Group C (n=38) had a difference of > or g=6 mm. All the patients had a normal contralateral knee. In Group A, 7/15 (47%) patients and, in Group B, 82/375 (22%) patients had an extension deficit of > or =5 degrees (P=0.052). The corresponding values in terms of flexion deficit were 8/15 (53%) and 99/375 (26%) respectively (P=0.04) (one missing value in Group B). In Group C, 14/38 (37%) had an extension deficit (P=0.04; Group B vs Group C). Group C displayed worse results than Group B in terms of the Lysholm score and the one-leg-hop test (P=0.001 and P=0.011 respectively). The corresponding comparison between Group A and Group B revealed no significant differences. We conclude that a considerable number of patients showed persisting deficits in range of motion (ROM) after an ACL reconstruction. No major differences were found if they were analysed in subgroups with decreased, near normal or with increased knee laxity. The worst residual functional impairment, as measured with the Lysholm score and one-leg-hop test, was found in the group with increased knee laxity and most ROM deficits in the knees with decreased laxity.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior , Feminino , Humanos , Instabilidade Articular/classificação , Traumatismos do Joelho/reabilitação , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Ruptura , Resultado do TratamentoRESUMO
The authors review the current knowledge on donor site-related problems after using different types of autografts for anterior cruciate ligament (ACL) reconstruction and make recommendations on minimizing late donor-site problems. Postoperative donor-site morbidity and anterior knee pain following ACL surgery may result in substantial impairment for patients. The selection of graft, surgical technique, and rehabilitation program can affect the severity of pain that patients experience. The loss or disturbance of anterior sensitivity caused by intraoperative injury to the infrapatellar nerve(s) in conjunction with patellar tendon harvest is correlated with donor-site discomfort and an inability to kneel and knee-walk. The patellar tendon at the donor site has significant clinical, radiographic, and histologic abnormalities 2 years after harvest of its central third. Donor-site discomfort correlates poorly with radiographic and histologic findings after the use of patellar tendon autografts. The use of hamstring tendon autografts appears to cause less postoperative donor-site morbidity and anterior knee problems than the use of patellar tendon autografts. There also appears to be a regrowth of the hamstring tendons within 2 years of the harvesting procedure. There is little known about the effect on the donor site of harvesting fascia lata and quadriceps tendon autografts. Efforts should be made to spare the infrapatellar nerve(s) during ACL reconstruction using patellar tendon autografts. Reharvesting the patellar tendon cannot be recommended due to significant clinical, radiographic, and histologic abnormalities 2 years after harvesting its central third. It is important to regain full range of motion and strength after the use of any type of autograft to avoid future anterior knee problems. If randomized controlled trials show that the long-term laxity measurements following ACL reconstruction using hamstring tendon autografts are equal to those of patellar tendon autografts, we recommend the use of hamstring tendon autografts because there are fewer donor-site problems.
Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Artralgia/etiologia , Instabilidade Articular/etiologia , Articulação do Joelho/fisiopatologia , Transferência Tendinosa/efeitos adversos , Tendões/transplante , Artralgia/prevenção & controle , Biópsia , Seguimentos , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Amplitude de Movimento Articular , Tendões/metabolismo , Tendões/patologia , Transplante Autólogo , Resultado do TratamentoRESUMO
We performed a prospective study of 117 patients (119 shoulders) with symptomatic, recurrent anterior posttraumatic shoulder instability to compare open versus arthroscopic reconstruction. Arthroscopic reconstructions (N = 66) were performed using bioabsorbable tacks (Suretac fixators), whereas open reconstructions (N = 53) were performed with suture anchors. All of the patients had a Bankart lesion. Independent observers examined 108 of the 119 shoulders (91%) at a median follow-up period of 28 months (range, 24 to 63) for the arthroscopic group and 36 months (range, 24 to 63) for the open group. The recurrence rate, including both dislocations and subluxations, was 9 of 60 (15%) in the arthroscopic group, compared with 5 of 48 (10%) in the open group. At follow-up, the Rowe score was 93 points (range, 39 to 100) and the Constant score was 91 points (range, 56 to 100) in the arthroscopic group, compared with 89 points (range, 53 to 100 and 57 to 100 for the Rowe and Constant scores, respectively) for both scores in the open group. The only significant difference was in external rotation in abduction, which was 90 degrees (range, 50 degrees to 135 degrees) in the arthroscopic group and 80 degrees (range, 25 degrees to 115 degrees) in the open group. Both methods produced stable and well-functioning shoulders in the majority of patients.
Assuntos
Artroscopia/métodos , Luxação do Ombro/cirurgia , Adolescente , Adulto , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Articulação do Ombro/cirurgia , Estatísticas não Paramétricas , Técnicas de SuturaRESUMO
This study performed an unbiased reexamination of patients who at least 2 years previously had undergone an arthroscopic extra-articular Bankart repair and prospectively evaluated the development of degenerative changes in the shoulder. Two unbiased observers who had never seen the patients before and had in no way been involved in the treatment of the patients were given unlimited access to the patients' files, surgical reports, and radiographs. Of the 80 patients 72 (90%) attended the follow-up 42.5 months (24-66) after the index procedure. Failures in terms of stability (redislocations and subluxations) were recorded in 14% of the patients. The Rowe score was 97 points (51-100), the Constant score was 94 (56-100) in injured shoulders and 97 points (80-100) in noninjured shoulders (P = 0.002). A return to the preinjury level of activity was recorded in 73% of the patients. There was a significant increase in degenerative changes between the pre- and postoperative radiographic assessments (P < 0.0001). At 2- to 5-year follow-up therefore the extra-articular arthroscopic Bankart repair resulted in stable and well-functioning shoulders in a high percentage of patients. However, the signs of radiographic degenerative changes increased between the preoperative assessments and the 2- to 5-year follow-up.
Assuntos
Ligamentos Articulares/cirurgia , Lesões do Ombro , Artroscopia , Humanos , Ligamentos Articulares/diagnóstico por imagem , Procedimentos Ortopédicos , Radiografia , Ombro/diagnóstico por imagem , Resultado do TratamentoRESUMO
This prospective randomized evaluated the effect of preconditioning patellar tendon autografts before implantation and fixation during anterior cruciate ligament (ACL) reconstruction. Fifty-three patients with a unilateral ACL rupture were included in the study. One group of patients had their patellar tendon autograft preconditioned by passive stretching at a constant load of 39 N for 10 min immediately prior to implantation (group P). The other group underwent no preconditioning before the implantation of the graft (group NP). The follow-up examination was performed by independent observers after 26 months (23-29) in group P and after 25 months (23-30) in group NP (n.s.). At follow-up the KT-1000 laxity test revealed a total side-to-side difference of 2.5 mm (-1.5 to +8.5) in group P and 3.0 mm (-7 to +6.5) in group NP (n.s.). The Lysholm score was 86 points (47-100) in group P and 94 points (44-100) in group NP (n.s.). The Tegner activity level was 6 (2-9) in group P and 7 (3-9) in group NP (n.s.). There was no significant difference between the study groups regarding IKDC classification. Patients who underwent ACL reconstruction using a preconditioned patellar tendon autograft had no advantages in terms of restoration of laxity or clinical outcome at 2-year follow-up.
Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Artroscopia/métodos , Procedimentos de Cirurgia Plástica/métodos , Tendões/transplante , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ligamento Patelar , Ruptura , Tendões/fisiologia , Resistência à Tração , Transplante Autólogo , Resultado do Tratamento , Suporte de CargaRESUMO
The aim of this study was to evaluate the use of a knee brace after arthroscopic anterior cruciate ligament reconstruction using central third patellar tendon autografts. Fifty patients were randomly allocated to two groups. The patients in Group A wore a brace for three weeks postoperatively, while the patients in Group B were rehabilitated without the use of a brace. Pre-operatively, the groups were comparable in terms of age, sex, activity level, knee laxity and muscle strength. The follow-up examination was performed by one independent observer. All the patients were followed up for a minimum of two years. At the follow-up, there were no significant differences between the study groups in terms of the Tegner activity level, Lysholm score, IKDC evaluation system, one-leg-hop quotient, KT-1000 measurements and isokinetic torque. Using the visual analogue scale, the patients in Group A evaluated their pain during the first two post-operative weeks as 1.0 (0-7), compared with 2.3 (0-9) in Group B (P= 0.04). Furthermore, the patients in Group A had a tendency towards fewer problems with swelling, haemathrosis and wound leakage during the early post-operative period (P=0.08). We conclude that the patients who were rehabilitated with the use of a brace had less pain and a tendency towards fewer complications during the early post-operative period than the patients who were rehabilitated without the use of a brace. However, there were no differences in terms of function or knee laxity at the two-year follow-up.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Braquetes , Articulação do Joelho , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior , Distribuição de Qui-Quadrado , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Locomoção/fisiologia , Masculino , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular/fisiologia , Ruptura/diagnóstico , Ruptura/terapia , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
The aim of the study was to examine whether the KT-1000 arthrometer was reliable when it came to distinguishing between a group of patients with a chronic anterior cruciate ligament (ACL) rupture and a group of patients without an ACL rupture, and to examine the reproducibility of the examination between two experienced examiners. The aim was also to examine whether the KT-1000 measurements were dependent on whether the patients were awake or under anaesthesia. The study comprised 40 patients: Group A consisted of 20 patients who had a chronic unilateral ACL rupture and Group B consisted of 20 patients who were scheduled for arthroscopy due to knee problems other than an ACL rupture. The KT-1000 examination was performed before surgery by two experienced physiotherapists (PT I and PT II). PT II subsequently performed a retest of the patients under anaesthesia. The mean anterior side-to-side laxity difference between PT I and PT II was 0.2 mm in Group A and 1.8 mm in Group B (n.s., P=0.03). The anterior side-to-side measurements of knee laxity revealed significant differences between Group A and Group B, independent of who the measurements were made by when the patients were awake (PT I P=0.011, PT II P=0.001). However, no significant difference (P=0.063) was found when the patients were under anaesthesia. The interclass correlation coefficient (ICC) between PT I and PT II in Group A was 0.55 (P=0.005) for the anterior side-to-side laxity, while it was 0.60 (P=0.002) in Group B. There were no significant differences within Group A or Group B between the measurements made when people were awake compared with those under anaesthesia. The conclusions of the study were that the KT-1000 arthrometer was able to distinguish a group of patients with an ACL rupture from a group without one. The reproducibility of the KT-1000 measurements of anterior knee laxity between two experienced examiners was considered as fair. Furthermore, the measurements were not dependent on whether the patients were awake or under anaesthesia.
Assuntos
Lesões do Ligamento Cruzado Anterior , Instabilidade Articular/diagnóstico , Equipamentos Ortopédicos , Adolescente , Adulto , Anestesia , Humanos , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Valores de Referência , Reprodutibilidade dos Testes , Ruptura/diagnóstico , Estatísticas não ParamétricasRESUMO
The aim of this study was to evaluate the results after arthroscopic anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft in 99 patients, who were followed up prospectively for four to seven years. The pre-injury Tegner activity level was 7 compared with 5 at the four- to seven-year follow-up (P<0.0001). The preoperative Lysholm score was 74.5 points. At the two-year follow-up, the Lysholm score was 95 points, while it was 90 points at the four- to seven-year follow-up (P<0.0001 preoperative vs two years and preoperative vs four to seven years and P<0.0005 two years vs four to seven years). Using the IKDC evaluation system, 80% of the patients were classified as normal or nearly normal and 20% as abnormal or severely abnormal at the final follow-up. The KT-1000 laxity measurements revealed a side-to-side difference of 2.9 mm preoperatively, 0.6 at two years and 1.0 mm at four to seven years. Twenty-six patients underwent additional surgery during the follow-up period. The results after arthroscopic reconstruction of the anterior cruciate ligament appear to be satisfactory both at the short- and the medium-term follow-ups, but there appears to be some deterioration between the two-year and the four- to seven-year follow-up.
Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Artroscopia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Ligamento Cruzado Anterior/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Reoperação , Tendões/transplante , Resultado do TratamentoRESUMO
The aim of this study was to compare the outcome after anterior cruciate ligament reconstruction in recreational and competitive athletes, with a minimum follow-up of two years. Forty-nine patients (24 males and 25 females) who, at the time of the index injury, were classified as recreational athletes (Tegner level 2-5) were compared with 226 patients (61 females and 165 males) who, at the time of the index injury, were classified as competitive athletes (Tegner level 9-10). At the follow-up, no significant differences were found between the study groups in terms of the Lysholm score, IKDC evaluation system, one-leg-hop test, KT-1000 laxity measurements, anterior knee pain and the patients' subjective evaluation of the results. However, the competitive athletes displayed a significantly higher reduction in Tegner activity level than the recreational athletes. The functional and objective results after anterior cruciate ligament reconstruction were comparable for the recreational and competitive athletes. We, therefore, conclude that anterior cruciate ligament reconstruction could be recommended for recreational athletes as well as competitive athletes.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Traumatismos em Atletas/cirurgia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior , Artroscopia , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/reabilitação , Feminino , Seguimentos , Humanos , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Lesões do Menisco Tibial , Fatores de Tempo , Resultado do TratamentoRESUMO
This study compared the reliability (interchangeability) of magnetic resonance imaging (MRI) and ultrasonography (US) examinations of the patellar tendon after using central third patellar tendon autografts during anterior cruciate ligament reconstruction. Nineteen consecutive patients (7 women, 12 men) underwent bilateral MRI and US of the patellar tendons 27 (24-29) months after anterior cruciate ligament reconstruction using ipsilateral central third patellar tendon autografts. Two experienced radiologists blinded to one another evaluated the examinations. Measurements of the length of the noninjured patellar tendon showed the greatest reliability between MRI and US, with no systematic difference (P=0.48), a small mean difference (-0.1 mm), and an interclass correlation coefficient of 0.74. The measurements of the thickness and width of the noninjured side were also judged as reliable. However, on the injured side a lower reliability was found between MRI and US. We conclude that MRI and US are reliable (interchangeable) methods only for evaluating noninjured patellar tendons.
Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho/cirurgia , Imageamento por Ressonância Magnética , Tendões/transplante , Ultrassonografia , Adolescente , Adulto , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/patologia , Feminino , Humanos , Masculino , Patela , Reprodutibilidade dos Testes , Ruptura , Tendões/diagnóstico por imagem , Tendões/parasitologia , Coleta de Tecidos e Órgãos , Transplante AutólogoRESUMO
Our goal was to compare the results after anterior cruciate ligament reconstruction using either the traditional one-incision or the subcutaneous two-incision technique to harvest the central third of the patellar tendon, particularly concerning disturbances in anterior knee sensitivity and the patient's ability to walk on his or her knees. One surgeon performed anterior cruciate ligament reconstruction on 124 patients with unilateral ruptures and no history of previous incisions in the anterior knee region. The traditional one-incision graft harvesting technique was used in 58 patients and the subcutaneous two-incision technique was used in 66 patients. At 2 years, the International Knee Documentation Committee classification, Lysholm score, arthrometry side-to-side difference, and single-legged hop test showed no significant differences between groups. The area of insensitivity was a median of 24 cm2 in the traditional harvest group and 0 cm2 in the subcutaneous harvest group. The patients with subcutaneous harvest had a tendency toward fewer problems during walking on their knees than did the patients with traditional harvest. Our conclusion is that the subcutaneous two-incision graft harvesting technique caused less disturbance in anterior knee sensitivity and a tendency of less discomfort during walking on one's knees than the traditional one-incision technique.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Tendões/transplante , Coleta de Tecidos e Órgãos/métodos , Adolescente , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiopatologia , Pessoa de Meia-Idade , Patela , Estudos Prospectivos , Amplitude de Movimento Articular , Estatísticas não Paramétricas , Transplante Autólogo , Resultado do TratamentoRESUMO
PATIENTS AND METHODS: Eighteen consecutive patients who had recurrent, unidirectional, post-traumatic shoulder instability were included. All the patients underwent surgery with a standardized open Bankart technique involving absorbable suture anchors. CLINICAL RESULTS: No redislocations occurred during the study period of 31 months (range 25 to 38 months). The Rowe and Constant scores were 86 points (range 61 to 98 points) and 89 points (range 73 to 99 points), respectively. The strength measurements revealed 8.6 kg (range 3.8 to 15 kg) in 90 degrees abduction compared with 9.3 kg (range 2.2 to 16.5 kg) in the control shoulders (not significant). The external rotation in abduction was 65 degrees (range 20 degrees to 90 degrees) compared with 91 degrees (range 80 degrees to 105 degrees) in the control group (P < .001). RADIOGRAPHIC RESULTS: Signs of minor or moderate degeneration were found in 10 of 18 patients on the preoperative radiographs, in 15 of 18 at 7 months, and in 16 of 18 at 33 months (P < .05 before surgery vs 33 months). From the preoperative examination to the 7-month control, 7 of 18 patients had an increase in degenerative changes, and from the 7-month to the 33-month control, an increase was found in 8 of 18 (P = .008, before surgery vs 7 months; P = .005, 7 months vs 33 months). At the 7-month control, 8 of 18 patients had invisible or hardly visible drill holes, and 10 of 18 had visible or cystic drill holes at the site of implantation for the absorbable suture anchors. At the 33-month control, 10 of 18 patients had invisible or hardly visible drill holes, and 8 of 18 had visible or cystic drill holes (not significant, 7 months vs 33 months). CONCLUSION: The method resulted in stable shoulders in 17 of 18 patients. Degenerative changes were present on the radiographs in most of the patients and appeared to increase over time. Visible drill holes or drill holes with cystic changes were seen on the radiographs in a significant number of patients at the 7-month and the 33-month control and did not appear to heal during the follow-up period.
Assuntos
Implantes Absorvíveis , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos/instrumentação , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/reabilitação , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Probabilidade , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
Nineteen consecutive patients undergoing anterior cruciate ligament reconstruction using the central third of the ipsilateral patellar tendon were included in the study. Serial magnetic resonance images revealed that the donor-site gap in the tendon decreased with time (mean follow-up, 26 months). The thickness was significantly increased compared with the intact contralateral patellar tendon, regardless of when the magnetic resonance imaging was performed. Ultrasonography showed the same findings at a mean follow-up of 26 months. Histologic evaluation of the repair tissue in the central part of the tendon, as well as the tissue in the peripheral part of the patellar tendon at the donor site, revealed a significant increase in cellularity and vascularity as compared with normal control tendons. Thus, 2 years after the harvesting procedure, the patellar tendon displayed significant radiographic and histologic abnormalities. On the basis of these findings, reharvest of the patellar tendon, at least up to 2 years after primary harvest, cannot be recommended.
Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho/cirurgia , Tendões/patologia , Tendões/transplante , Adolescente , Adulto , Biópsia , Feminino , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/patologia , Imageamento por Ressonância Magnética , Masculino , Radiografia , ReoperaçãoRESUMO
The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction in middle-aged and young patients. From our database (including 604 patients with a follow-up rate of 95%), we extracted all the patients over 40 years of age (group A, n = 30) and compared them with a group of patients from the same material, aged between 20 and 24 years (group B, n = 37). The groups were comparable in terms of the male:female ratio and surgical techniques. The follow-up was performed by independent observers. The median follow-up period was 31 months (range, 22 to 60 months) in group A and 38 months (24 to 60 months) in group B (P =.014). Before injury, the Tegner activity level was 6 (4-9) in group A and 9 (4-9) in group B (P <.001). At follow-up, the Tegner activity level was 5 (3-9) in group A and 6 (3-9) in group B (P =.032). At the follow-up, there was no difference in terms of the Lysholm score, which was 91 (37-100) and 89 (38-100) points in group A and group B, respectively. Using the IKDC evaluation system, 10 patients (33%) were classified as normal, 12 (40%) as nearly normal, 6 (20%) as abnormal, and 2 (7%) as severely abnormal in group A, compared with 8 (22%) normal, 18 (48%) nearly normal, 10 (27%) abnormal, and 1 (3%) severely abnormal in group B (NS). The 1-leg hop quotient was 90% (52-167) in group A and 93% (70-118) in group B (P =.056). The KT-1000 measurement showed an anterior side-to-side laxity difference of 2.0 mm (-4 to 8.5 mm) in group A and 2.0 mm (-2.5 to 8.0 mm) in group B (not significant). The middle-aged patients were subjectively more pleased with the results than the younger patients. There were no differences in either early or late complications between the groups. At the index operation, 11 of 30 patients (37%) in group A and 1 of 37 (3%) in group B had cartilage lesions or degenerative changes (P <.001). Age does not appear to disqualify middle-aged patients with symptomatic ACL tears from undergoing reconstruction.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Adulto , Fatores Etários , Lesões do Ligamento Cruzado Anterior , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
The aim of this study was to compare the clinical and radiographic results using either absorbable or non-absorbable suture anchors in patients with recurrent unidirectional, post-traumatic shoulder dislocations. All patients had a Bankart lesion. One surgeon operated on 33 consecutive patients, 27 males and six females. Group A comprised 15 shoulders and group B 18 shoulders, all of which underwent a standardised open Bankart reconstruction using 3.7-mm TAG suture anchors. In group A, absorbable anchors were used, while in group B, non-absorbable ones were used. There was one re-dislocation in each group. In group A, the Rowe and Constant scores were 89 (69-98) and 89 (76-99) points, respectively. The corresponding values in group B were 87 (44-98) (not significant; NS) and 90 (71-100) points (NS). The strength measurements revealed 8.1 (3.8-12.3) kg in 90 degrees abduction in group A and 10.0 (6.7-12.0) kg in group B. Healthy control shoulders revealed 10.2 (4.5-13.2) kg (NS A and B versus controls). The external rotation in abduction was 70 degrees (40-90) in group A and 80 degrees (40-100) in group B. The value for the controls was 90 degrees (80-120) [P < 0.001 (A versus controls), P < 0.05 (A versus B) and P < 0.001 (B versus controls)]. The radiographs revealed that 9/15 (60%) in group A and 10/15 (66%) in group B had visible drill holes or cystic formations in conjunction with the drill holes (NS). Furthermore, 11/15 (73%) in group A and 10/15 (66%) in group B had signs of minor degeneration (NS). We conclude that, in terms of stability and clinical results, no differences were found between the study groups. Both groups demonstrated a restriction in external rotation as compared with the healthy shoulders in the same cohort. On the radiographs, visible drill holes or cystic formations in conjunction with the drill holes were seen with equal frequency, regardless of whether absorbable or non-absorbable suture anchors were used.
Assuntos
Implantes Absorvíveis , Luxação do Ombro/cirurgia , Suturas , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva , Luxação do Ombro/diagnóstico por imagemRESUMO
The aim of this study was to compare the results after arthroscopic anterior cruciate ligament reconstruction in female and male competitive athletes who had a pre-injury Tegner activity level of > or =7 and a non-injured contralateral anterior cruciate ligament. One hundred and thirty-three female and 296 male patients were followed at 38 (21-68) months after the index operation. All the patients were operated on by experienced knee surgeons using patellar tendon autografts and interference screw fixation. At the index operation the median age of the female patients was 23 (1645) years and the median age of the male patients was 26 (16-47) years. The reconstruction was performed a median of 10 (0-141) and 10 (0-203) months after the injury in women and men respectively. The patients were re-examined by independent observers. At the follow-up, the median Lysholm score was 89 (38-100) points in the female group and 90 (22-100) points in the male group (P=0.015). The IKDC evaluation system, subjective anterior knee pain, subjective evaluation of the results, the knee-walking test and the KT-1000 tests revealed no differences between the groups. The mean (+/-2 SD) pre-injury Tegner activity level was 8.1 (+/-1.9) (median 8 (7-10)) in the female group and 8.4 (+/-1.8) (median 9 (7-10)) in the male group (P=0.003). At the follow-up, the Tegner activity level was 6.2 (+/-3.8) in the female group and 6.8 (+/-3.6) in the male group (P=0.012). At the follow-up, the Tegner activity level had decreased by 1.9 (+/-3.8) for the women and 1.6 (+/-3.3) for the men, as compared with the pre-injury level (n.s.). The difference between the performed and the desired activity level at the follow-up was 1.1 (+/-3.2) in the female group and 0.9 (+/-3.0) in the male group (n.s.). In the female group 53/133 (40%) and in the male group 115/296 (39%) returned to the pre-injury activity level (n.s.). The median one-leg-hop quotient was 93 (0-116)% in the female group and 96 (0-130)% in the male group (P=0.006). Concomitant meniscal injuries prior to the index operation, at the index operation or during the follow-up period were found in 64/133 (48%) women and in 185/ 296 (62%) men (P<0.01). The main conclusion was that the overall results in female and male athletes were comparable two to five years after the anterior cruciate ligament reconstruction. However, concomitant meniscal injuries were more common in male than females athletes after anterior cruciate ligament injuries.
Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Artroscopia , Traumatismos em Atletas/cirurgia , Traumatismos do Joelho/cirurgia , Adolescente , Adulto , Traumatismos em Atletas/fisiopatologia , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Lesões do Menisco Tibial , Resultado do TratamentoRESUMO
The aim of this dissection study on cadaver and amputated specimens was to determine the position of the infrapatellar nerves in the anterior knee region, and to investigate whether it would be possible to harvest the patellar tendon through two small vertical incisions, leaving the infrapatellar nerves undamaged and the major part of the paratenon intact. The infrapatellar nerve did not pass through the area between the apex of the patella and the tibial tubercle in 1 of 60 specimens. The nerve passed through this area as one branch in 15 of 60 specimens, as two branches in 37 of 60, as three in 6 of 60, and as four in 1 of 60 specimens. The distance from the apex of the patella to the infrapatellar nerve or the uppermost branch of the nerve was 30 mm (+/- 27 mm [2 SD]). The distance from the tibial tubercle to the infrapatellar nerve or the lowermost branch of the nerve was 27 mm (+/- 27 mm [2 SD]). In one specimen, the infrapatellar nerve passed 10 mm distal to the tibial tubercle. In 4 of 60 specimens, a branch of the infrapatellar nerve passed just above the tibial tubercle, and in 2 of 60 a branch passed just above the apex of the patella. In 19 of 20 specimens in which the harvesting procedure was performed, the infrapatellar nerve or the nerve branches were undamaged. The length of the undamaged paratenon was 27 mm (+/- 23 mm [2 SD]). This study showed that it was possible to harvest consistent bone-patellar tendon-bone autografts through two vertical 25-mm incisions, leaving the infrapatellar nerve undamaged and the paratenon partially intact in the majority of the cadaver and amputated specimens.