Popliteomeniscal fascicles tears with lateral meniscus instability: outcomes of arthroscopic surgical technique at mid-term follow-up.

PURPOSE: The popliteomeniscal fascicles (PMFs) are a crucial part of the posterolateral corner of the knee. They provide stability to the lateral meniscus and stabilize the joint during tibial internal rotation. The clinical diagnosis of a torn PMFs is difficult, and magnetic resonance imaging (MRI) may be inconclusive as well. The aim of the present study was to report the outcomes of a continuous series of patients affected by PMF lesions and treated with an arthroscopic repair. METHODS: Seventeen patients (average age of 22 ± 3.6 years) with PMF lesions and lateral meniscus instability were prospectively enrolled. All patients were evaluated with clinical examination, International Knee Documentation Committee (IKDC), Lysholm and Tegner scores and 1.5 T MRI. All patients had the same arthroscopic procedure consisting of meniscal repair with an all-inside meniscal repair system (mean 2.2 ± 0.77 anchors) and followed with the same postoperative protocol. RESULTS: All patients were available at a mean follow-up of 68 ± 24 months (range 49-84 months). Mean IKDC increased from 60.2 ± 13.5 to 83.1 ± 12, mean Lysholm score improved from 56.7 ± 8.2 to 89.8 ± 3.2, and mean Tegner score improved from 2.9 ± 1.3 to 6.5 ± 2. No intraoperative or postoperative complications were reported. MRI evaluation at 6-month follow-up showed successful healing of the menisco-popliteal fascicles in all cases. CONCLUSIONS: The diagnosis and treatment of tears of the PMFs is still debated. Diagnostic confirmation of tearing of the PMFs is usually determined at the time of arthroscopy. Meniscal repair with an all-inside meniscal repair system appears to be an excellent treatment option, since it yields good functional results at mid-term follow-up, no local complications, and complete radiographic healing at 6-month follow-up MRI. Further studies are needed to confirm these promising early results. LEVEL OF EVIDENCE: Case series, 4.

Liner dissociation in total hip arthroplasty: a systematic review.

OBJECTIVE: Liner dissociation (LD) is a rare catastrophic mechanical failure of total hip arthroplasty (THA). The study aims at reviewing the available literature regarding liner dissociations to point out their prevalence, describing any possible association and highlighting the surgical management at the time of revision. MATERIALS AND METHODS: A systematic review of the literature was conducted from January 2002, until February 2022, according to the PRISMA guidelines. The main keywords were: "dissociation" AND "liner" OR "hip arthroplasty" OR "THA" and their MeSH terms in any possible combination. Cases of liner dissociation with all levels of evidence of any age published in indexed journals were included. The study quality of all included studies was evaluated using the MINORS criteria. The kappa (k) value was used to assess the consensus between reviewers in the selection of articles and methodological quality assessment. Finally, a sub-analysis was performed specifically concerning the elderly population. RESULTS: Thirty-one manuscripts met the inclusion criteria of the systematic review (21 case reports and 10 case series). 124 LD in 123 patients, (53% females and 47% males) were evaluated. The overall prevalence of LD was 0.15%. The mean age at surgery was of 56.5 years (range 31-75 years). LD occurred in a primary surgery setting in 86% of the cases, at a mean time of presentation of 45.8 months after replacement surgery. 39.5% of the cups and 8.8% of the stems required revision. The mean follow-up after the revision was 18.4 months. Complications after revision occurred in 19.6% of cases, including 3 cases of re-dissociations. Re-revision was required in 13.6% of the revisions. The sub-analysis of the elderly population included 28 cases of LD identified in 10 manuscripts, with an average age of 73.5 years. CONCLUSIONS: LD is a rare but catastrophic mechanical complication of modular THA that requires implant revision. The LD is not related to a specific prosthetic implant, liner material or design, acetabular positioning within the safe zone or age group.

CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis.

PURPOSE: Medial open-wedge high tibial osteotomy (MOWHTO) is an accepted option in the treatment of medial compartment osteoarthritis of the knee in young and active patients. Functional results are closely correlated to the correction of the mechanical axis of the lower limb. Although several angular and geometrical methods and values have been proposed in the past, the ideal target is still debated. In addition, it is important to have a deep correlation between the planned correction and the achieved correction after surgery. The aim of the present systematic review was to identify the ideal coronal correction after MOWHTO and the most accurate method to achieve it. METHODS: A systematic review of the literature was completed on July 3rd 2020 in the Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the Medical Subject Headings (MeSH) terms: "high tibial osteotomy" AND "accuracy" OR "planning". RESULTS: 28 studies were included; 18 were focused on computer-assisted surgery (CAS) and 10 on patient-specific instrumentation (PSI). There were 598 patients in the CAS group and 501 in the control group; the rate of outliers was 16% and 38.2% respectively (P = 0.04), while there was no significant difference between the two groups (SMD = - 0.10; 95% CI 1.31 to 1.12; P = n.s.) in terms of coronal accuracy. Likewise, there were 318 patients in the PSI group and 40 in the control group; the rate of outliers was 15% and 40% respectively (P = 0.98), while there was no significant difference between the two groups (SMD = 0.01; 95% CI 0.58 to 0.59; P = 0.98). CONCLUSIONS: A statistically significant reduced outlier rate and a non-significant increased accuracy emerged with the use of CAS when compared to the traditional surgical technique, whereas the results of PSI were still inconclusive. In addition, it emerged clearly that no consensus still exists on the ideal correction target to be achieved after surgery. LEVEL OF EVIDENCE: III.

Una mirada al cuidado de enfermería percibido por adolescentes en una unidad de hemodiálisis / A look at the nursing care perceived by adolescents in a hemodialysis unit / Um olhar sobre o cuidado de enfermagem percebido por adolescentes em unidade de hemodiálise

Introducción: El presente trabajo de investigación se orientó en dar a conocer la percepción de las y los adolescentes sobre el cuidado brindado por el personal de enfermería en una unidad de hemodiálisis, para a través de ello poder identificar las necesidades que no siempre suelen expresar, con lo anterior lograr optimizar la atención brindada, generando evidencia científica que funja de apoyo a otros profesionales del área de la salud. Objetivo: Analizar la percepción que tienen las y los adolescentes con enfermedad renal crónica sobre el cuidado brindado por enfermería en una unidad de hemodiálisis. Metodología: Se trata de un estudio de tipo cualitativo, fenomenológico bajo el enfoque filosófico de Merleau Ponty, con diseño descriptivo, efectuado mediante entrevistas semiestructuradas, notas de campo y observación participante a tres informantes en etapa de vida adolescente, que asisten a recibir tratamiento de sustitución renal tipo hemodiálisis tres veces a la semana, en una unidad médica de alta especialidad, la selección de los informantes fue por conveniencia, quienes se les solicito previa autorización a través del consentimiento informado. El proceso de análisis de datos fue orientado por el propuesto por los autores (Rodríguez, Gil y García, 1996), se efectuó un rigor metodológico desarrollado por, (Guba y Lincoln, 1989). Resultados: Se obtuvieron cuatro categorías de los datos dados por los informantes de esta investigación, siendo 1) Percepción del adolescente respecto al cuidado brindado por enfermería en hemodiálisis, 2) El cuidado en el proceso de hemodiálisis, 3) El mundo de la hemodiálisis, 4) Corporeidad desde la mirada del adolescente. Conclusiones: Una de las características esenciales sobre el cuidado de enfermería es, la comunicación e interacción constante entre enfermera-usuario, esta apertura hacia un mundo desconocido, para los adolescentes, es visto como una interacción agradable y la perciben como necesaria, que les ayude a pasar un momento agradable n su tratamiento de hemodiálisis. El cuidado debe ser acompañado de la comprensión y conocimiento del paciente respecto a sus necesidades con base a su percepción, esto dado a través de sus actuaciones de comunicación, mediante una adecuada percepción, el usuario adolescente logra comprender el cuidado que le otorga el personal de enfermería dentro de una unidad de hemodiálisis, la intercomunicación entre enfermera-adolescente marca una gran diferencia para lograr conocer la forma en que están viviendo su ERC, los adolescentes a través de su cuerpo, de su mundo y la manera en verse a sí mismos.

Introductión The present research work was aimed at making known the perception of adolescents about the care provided by nursing staff in a hemodialysis unit, in order to identify the needs that they do not always express, with what above, to optimize the care provided, generating scientific evidence that supports other professionals in the health area. Methodology: This is a qualitative, phenomenological study under the philosophical approach of Merleau Ponty, with a descriptive design, carried out through semi-structured interviews, field notes and participant observation of three informants in the adolescent stage of life, who attend to receive treatment of Hemodialysis-type renal replacement three times a week, in a highly specialized medical unit, the selection of the informants was for convenience, who were requested prior authorization through informed consent. The data analysis process was guided by the one proposed by the authors (Rodríguez, Gil and García, 1996), a methodological rigor developed by, (Guba and Lincoln, 1989) was carried out. Results: Four categories were obtained from the data given by the informants of this research, being 1) Perception of the adolescent regarding the care provided by nursing in hemodialysis, 2) The care in the hemodialysis process, 3) The world of hemodialysis, 4) Corporeity from the adolescent's gaze. Conclusions: One of the essential characteristics of nursing care is constant communication and interaction between nurse-user, this openness to an unknown world, for adolescents, is seen as a pleasant interaction and they perceive it as necessary, to help them to have a good time in your hemodialysis treatment. The care must be accompanied by the understanding and knowledge of the patient regarding their needs based on their perception, this given through their communication actions, through an adequate perception, the adolescent user manages to understand the care that the staff gives them. nursing within a hemodialysis unit, the intercommunication between the nurse-adolescent makes a great difference in getting to know the way they are living their CKD, adolescents through their body.

"Introdução: O presente trabalho de pesquisa teve como objetivo divulgar a percepção dos adolescentes sobre o cuidado prestado pela equipe de enfermagem em uma unidade de hemodiálise, por meio desta poder identificar as necessidades que nem sempre expressam, alcançando assim a otimização da assistência prestada, gerando cientificidade. evidências que apóiam outros profissionais da área da saúde. Objetivo: Analisar a percepção que os adolescentes com doença renal crônica têm sobre o cuidado prestado pela enfermagem em uma unidade de hemodiálise. Metodologia: Trata-se de um estudo qualitativo fenomenológico sob a abordagem filosófica de Merleau Ponty, com desenho descritivo, realizado por meio de entrevistas semiestruturadas, notas de campo e observação participante de três informantes na fase de adolescência, que comparecem para receber tratamento. de substituição renal do tipo hemodiálise três vezes por semana, em unidade médica altamente especializada, a seleção dos informantes foi por conveniência, aos quais foi solicitada autorização prévia mediante consentimento informado.O processo de análise dos dados foi norteado pelo proposto pelos autores (Rodríguez, Gil e García, 1996), foi realizado um rigor metodológico desenvolvido por, (Guba e Lincoln, 1989). Resultados: Quatro categorias foram obtidas a partir dos dados fornecidos pelos informantes desta pesquisa, sendo 1) Percepção do adolescente quanto ao cuidado prestado pela enfermagem em hemodiálise, 2) O cuidado no processo de hemodiálise, 3) O mundo da hemodiálise, 4) Corporeidade no olhar do adolescente. DISCUSSÃO: Após a realização do estudo com adolescentes em unidade de hemodiálise, evidencia-se nas falas que a percepção a partir de Merleau Ponty, permite ao ser iluminar-se, dar sentido ao nosso meio, sendo possível o que é percebido pelo nosso corpo, quem é o meio de conhecer o mundo, o que nos adolescentes se dá na área da hemodiálise. O processo de adolescer desde a hemodiálise gera muitas mudanças, sendo esta a forma como os adolescentes vivenciam, vivenciam e compreendem o cuidado prestado pelo profissional de enfermagem. Por existir uma relação estreita entre a doença que o usuário vivencia todos os dias e o tratamento hemodialítico que prolonga sua existência, gera-se neles uma atitude vulnerável em relação ao mundo. Porém, veem o mundo da hemodiálise para além de ser um local onde é prestado tratamento de substituição renal, para eles é um local onde existe a oportunidade de prolongar a vida, um local onde geram emoções diferentes a cada sessão. A corporeidade, a partir do olhar do adolescente, anda de mãos dadas e se congruente com as vantagens que seu corpo tem com a hemodiálise, isso porque o corpo humano tem a peculiaridade de ser conhecido aos olhos de Merleau Ponty como resultado de eventos físicos.

Orthopedic resident's learning curve for arthroscopic subscapularis tendon repair: short-term clinical and radiographic outcomes.

BACKGROUND: Arthroscopic subscapularis (SSC) repair is a technically demanding procedure with a long learning curve. As effective completion of resident's practical experience remains controversial, a prospective clinical study was performed to assess the functional and anatomical outcomes of subscapularis (SSC) arthroscopic repair by orthopedic residents. The pathological anatomy of the tears, the surgical approach and the difficulties encountered at the beginning of the learning curve were reported. MATERIALS AND METHODS: Between June 2009 and June 2010, 30 patients with rotator cuff tear were preoperatively evaluated with clinical exam, Constant and UCLA scores. Surgery was performed under arthroscopy by a team of three orthopedic surgeons in training. A SSC tear, if present, was recorded and treated. The same clinical exam and functional scores were repeated at minimum 6 months of follow-up. Subscapularis strength recovery and tendon healing were investigated with arthromagnetic resonance imaging. RESULTS: A SSC tear was observed in 11 cases out of 30 and treated arthroscopically. The clinical scores improved in all patients: the average Constant score increased from 34 ± 14 to 77 ± 11 and the UCLA score from 11 ± 5 to 29 ± 3. The SSC tests were negative in all patients with the exception of one. Tendon healing was observed in 10 out of 11 cases. CONCLUSIONS: Arthroscopic SSC repair performed by educated residents is possible and leads to good clinical and anatomical results. Surgery duration progressively improved as the learning curve advanced. LEVEL OF EVIDENCE: Level 2.

No relationship between critical shoulder angle and glenoid erosion after shoulder hemiarthroplasty: a comparative radiographic study.

INTRODUCTION: Symptomatic glenoid erosion is one of the most common causes of functional impairment after shoulder hemiarthroplasty. A decrease in the critical shoulder angle (CSA) has been associated with the development of shoulder arthritis. The inter-observer reliability of the CSA and the relationship between CSA and symptomatic glenoid erosion after shoulder hemiarthroplasty were investigated. MATERIALS AND METHODS: Twenty-eight patients with symptomatic glenoid erosion after anatomic hemiarthroplasty were compared to a control group of 30 patients with no signs of symptomatic glenoid erosion. The CSA was measured by two blinded shoulder surgeons at a mean follow-up of 105.2 and 54.7 months, respectively. The inter-observer reliability was calculated. RESULTS: The mean CSA in the control group in neutral, internal, and external rotations was 34°, 33°, and 33°, respectively. The corresponding values in the study group were 33°, 33°, and 33° (<0.01). The interclass correlation coefficient between the two examiners was 0.917 (P < 0.01), 0.924 (P < 0.01), and 0.948 (P < 0.01), respectively. The Mann-Whitney test between the control group and the study group were, respectively, 0.907, 0.932, and 0.602. CONCLUSION: There were no significant differences of CSA values between the two groups. Good inter-observer reliability was found for the CSA method.

Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review.

PURPOSE: Antibiotic-loaded bone cement has been widely used for the treatment of infected knee replacement, but its routine use in primary TKA remains controversial. The aim of this systematic review was to analyze the literature about the antimicrobial efficacy and safety of antibiotic-loaded bone cement for its prophylactic use in primary TKA. METHODS: A detailed and systematic search of the Pubmed, Medline, Cochrane Reviews and Google Scholar databases had been performed using the keyword "total knee arthroplasty" "total knee replacement" "total knee prosthesis" and "antibiotic-loaded bone cement" with no limit regarding the year of publication. We used modified Coleman scoring methodology (mCMS) to identify scientifically sound articles in a reproducible format. The review was limited to the English-language articles. RESULTS: Six articles met inclusion criteria. In total, 6318 arthroplasties were included in our study. 3217 of these arthroplasties received antibiotic-loaded bone cement and 3101 arthroplasties served as the control. There was no statistical difference between the two groups in terms of the incidence of deep or superficial surgical site infection. The average mCMS score was 67.6, indicating good methodological quality in the included studies. CONCLUSIONS: Present review did not reveal any significant difference in terms of rate of deep or superficial surgical site infection in patients receiving antibiotic-loaded bone cement compared with the control (plain bone cement) during primary TKA. The clinical relevance of this study was that the use of antibiotic-loaded bone cement did not significantly reduce the risk of infection in primary TKA. LEVEL OF EVIDENCE: III.