[Cost analysis and economic impact of anterior cruciate ligament reconstruction]. / Análisis de costo e impacto económico de la reconstrucción de ligamento cruzado anterior (LCA).

INTRODUCTION: Health economics studies play an important role in all healthcare systems. The purpose of the latter is to offer effective and low-cost treatments. OBJECTIVE: Analyze the costs and the economic impact of the comprehensive ACL treatment. MATERIAL AND METHODS: An average cost study was done of primary ACL reconstruction. We studied 104 patients during 2005, 79 males and 25 females, with mean age 31.5 years. The assessment of the preoperative, operative and postoperative costs was related to each patient's socioeconomic stratum (SES). RESULTS: The hamstrings were the most frequently used graft (71%) versus the bone-patellar tendon-bone graft (BTB) (29%). Socioeconomic strata 2 and 3 were predominant. The following were the most frequent hamstrings implants used: Rigidfix/Intrafix and Endobutton/Xtralok, while the most frequent BTB grafts used were the metallic interference screws. No difference was found between the types of grafts and the SES in the preoperative and postoperative costs, including imaging studies, hospital say and rehabilitation. However, differences were found among the different groups in the cost of surgery, resulting from the type of implant used. The mean cost for SES 1 and 2 was $6475.20, for SES 3 and 4, $8057.51, and for SES 5 and 6, $16,242.5. The vulnerable population (SES 1) needs 7.34-fold its monthly income to pay for the comprehensive treatment, while the middle stratum (SES 3) needs 3.27-fold its monthly income. CONCLUSIONS: The comprehensive cost of treatment is proportionally higher than the patients' income. It is important to point out that the systems using state-of-the-art technology, which in another setting would be inaccessible, have significant advantages when compared with the less expensive systems. Thus the economically vulnerable SES benefit from the subsidy granted by the National Institutes of Health.

[Meniscal repair in patients with chronic lesions]. / Reparación meniscal en pacientes con lesiones crónicas.

OBJECTIVE: To analyze the subjective and objective outcome of arthroscopic meniscal repair in patients with chronic meniscal lesions. METHODS: A group of patients that underwent arthroscopic meniscal repair of chronic tears with a minimum follow-up of six months was retrospectively evaluated. Physical examination oriented at finding persistent meniscal lesions was performed. IKDC, Lysholm and Tegner scores were applied, and a control magnetic resonance imaging (MRI) was performed. RESULTS: Twenty seven menisci in 25 patients were repaired. There were 21 male and 4 female patients with a mean age of 29.6 +/- 8.2 years (20-45). Mean time from lesion to surgery was 25.24 +/- 26 months (6-120). 27. There was significant improvement in all parameters evaluated in 21 patients. Four patients were found to have signs and symptoms of persistent meniscal tears. Abnormal increased signal intensity in the repaired menisci was observed by MRI in all patients, not correlating with clinical findings. CONCLUSIONS: Short-term success rate of 85% was obtained with arthroscopic repair of chronic meniscal lesions in this study, which supports the fact that a long period of time before surgery does not necessarily lead to failure. It is valid to perform a meniscal repair in patients with chronic tears as long as the proper surgical technique and an adequate rehabilitation protocol are used.

Minimally invasive quadriceps tendon harvest.

Quadriceps tendon (QT) is becoming a popular graft for primary and revision ligament surgery. A subcutaneous technique for graft harvesting a QT is presented. Special closed tendon strippers were designed; these devices have 10- and 11-mm inner diameters and are stronger and sharper than regular hamstrings strippers. In the mid-line of the patellar upper pole, a 2-cm longitudinal incision is made, a 20- x 10-mm bone plug is created with an oscillating saw, and the tendon stripper is positioned and advanced into the thigh, dissecting the QT until the desired length, usually 10 cm, is obtained. The graft can be released by making a stab incision at the device's tip or by ventrally pointing and turning the tendon stripper to amputate the graft's end. The QT graft can be prepared in several fashions for 1- or 2-bundle ligament reconstructions. The technique was tested and refined in 3 cadaver specimens and has been used at our institution since 2003 in 18 primary posterior cruciate ligament reconstructions with no problems. This minimally invasive technique is safe, provides a consistently good-quality graft with excellent cosmetic results, and is simple and easily reproducible.

Artroscopía y osteotomía proximal de tibia tipo Maquet en el tratamiento del genu varo / Arthroscopy and Maquet proximal tibial osteotomy for treatment of genu varus

La osteotomía correctora de varo en la rodilla es un tratamiento extraarticular que cuando se asocia a la artroscopía, es posible mejorar el pronóstico funcional de la rodilla. Se incluyen 48 pacientes (53 rodillas) con diagnóstico de genu varo, con una edad promedio de 55 años 5 meses y con un seguimiento de 25 meses. A todos se les efectuó una artroscopía en el mismo tiempo quirúrgico de la realización de la osteotomía proximal de tibia tipo Maquet para el diagnóstico y tratamiento de las lesiones asociadas de la rodilla. De los 48 pacientes, a 11 de ellos se les contraindicó la osteotomía debido a los cambios degenerativos del compartimento lateral, programándose en fechas posteriores para un reemplazo articular total. De los restantes pacientes se obtuvieron 23 resultados excelentes, 16 buenos, 2 regulares y 1 malo. La artroscopía asociada a la osteotomía proximal de tibia tipo Maquet en el tratamiento del genu varo es un método objetivo de evaluación, que permite detectar y tratar las lesiones articulares asociadas mejorando los resultados funcionales a mediano plazo.