Rotura del tendón del pectoral mayor: técnica de reparación abierta durante periodo agudo / Pectoralis major tendon rupture: open repair technique during acute period

La rotura del tendón del pectoral mayor es considerada una lesión infrecuente en lo descrito en la literatura, pero esa lesión ha tenido un aumento exponencial en sus reportes a partir de los años 90. A continuación, presentamos la resolución quirúrgica de una rotura completa del tendón del pectoral mayor mediante una técnica simple y reproducible en un hombre de 34 años, sometido a una alta demanda física diaria. Tenemos ya publicado diferentes técnicas de reparación en periodo agudo como reconstrucción en lesiones crónicas. Nosotros presentamos una técnica de reparación para rotura aguda que consiste en la reinserción mediante anclas de titanio en su huella insercional mediante una configuración de suturas que forma un constructo estable y resistente, que permita al paciente rehabilitarse en forma precoz y satisfactoria para intentar volver al mismo nivel de actividad pre lesional. Con eso, aportamos al especialista una manera sencilla de enfrentarse y planificar la reparación de ese tipo de lesiones infrecuentes que no siempre estamos acostumbrados a resolver.

Pectoralis major tendon rupture is an infrequent injury in what has been described in the literature so far. Lately, an exponential increase in reported cases of this injury has been observed. We present a simple and reproducible surgical technique in a 34 years old male subject to a high daily physical demand. Different techniques have been published for tendon repair during the acute period as well as reconstruction in chronic lesions. We present a technique for acute rupture that consists of the reinsertion by means of titanium anchors in its insertional footprint through a suture configuration that forms a stable and resistant construct, that allows the patient to be rehabilitated in an early and satisfactory manner with the objective to return to the same Level of pre-injury activity. With this we provide the specialist with a simple way to manage the repair of these infrequent injuries.

Correlación entre la anatomía acromial y roturas del manguito rotador: estudio caso-control / Relationship between acromial anatomy and rotator cuff tears: a case control-study

Determinar si existe correlación entre la anatomía acromial documentada por radiología y la presencia de roturas del manguito rotador (MR) evaluadas en forma artroscópica. Hipótesis: Existe correlación positiva entre la morfología acromial y las roturas del MR. Métodos: Serie retrospectiva caso-control de 279 casos consecutivos tratados mediante cirugía artroscópica. Se analizaron 2 cohortes; un grupo con roturas completas del MR (N = 155) y un grupo control, tratados por inestabilidad glenohumeral (N = 124) a los que se documentó indemnidad del MR durante la artroscopia. Se documentó la anatomía acromial preoperatoria mediante radiografías de hombro anteroposterior verdadera y axial subacromial y se midieron la pendiente acromial según Bigliani (B), la inclinación acromial según Kitay (K) y el índice acromial según Nyffeler (AI). Resultados: Las diferencias entre los valores promedios de B y K entre grupos no fueron significativas (p = 0,6 y p = 0,3). No existió correlación entre B y AI (r = 0,054; p = 0,377). Evidenciamos una correlación positiva en ambos grupos entre la inclinación acromial (r = 0,2; p = 0,008) y la pendiente acromial (r = 0,1; p = 0,03). Encontramos diferencias significativas en el IA entre grupos, que fue mayor para los casos (p = 0,01). Conclusión: En los resultados de las mediciones radiológicas de la anatomía acromial en nuestra población, documentamos una correlación significativa entre extensión del AI y roturas del MR confirmadas durante artroscopia...

To study the anatomical relationship between acromial morphology documented on X- rays and rotator cuff (RC) tears evaluated using arthroscopy. Hypothesis: There is a positive correlation as regards acromial morphology and RC tears. Methods:A retrospective, case control series of 279 consecutives cases, who underwent arthroscopic surgery were included in this study; cases were separated into 2 cohorts; one group with complete RC tears (N=155) and a control group treated for glenohumeral instability (N=124) with indemnity of the RC confirmed during arthroscopy. Pre-operative acromial anatomy was documented with X- rays – true anteroposterior and sub-acromial outlet views – measuring the acromial slope according to Bigliani (B), acromial tilt according to Kitay (K), and acromial index according to Nyffeler (AI). Results: The differences in the mean values of B and K between groups were not significant (P=.6 and P=.3). There was no correlation between B and AI (r= 0.05; P=.3). A positive correlation was observed between the acromial tilt (r= 0.2; P=.008) and acromial slope (r= 0.1; P=.03). A significant difference was found regarding AI, with greater values in the case group (P=.01). Conclusion:In this study, the acromial slope according to Bigliani, and acromial tilt according to Kitay, does not correlate with RC tears. A positive correlation of the AI with RC tears was observed...

[Isokinetic assessment post-ACL reconstruction: comparison of the semitendinous/gracilis and bone-tendon-bone techniques]. / Evaluación isocinética postreconstruccióón de ligamento cruzado anterior: comparación de dos técnicas.

UNLABELLED: The purpose of this study is to detect the differences in the isokinetic assessment after anterior cruciate ligament (ACL) reconstruction with the bone-patellar tendon-bone (BTB) and semitendinous/gracilis (STG) techniques. METHODS: Ninety-five patients with a minimum follow-up of six months were assessed with a Cybex 6000 dynamometer during concentric contraction at 60 degrees/s. The BTB technique was used in 27 patients and the STG technique in 68. The ANOVA and Pearson tables were used to analyze the flexion and extension strength deficit, peak torque (PT) strength in flexion and extension (Nm) and the muscle balance. RESULTS: Mean loss of strength in flexion was 18.82% with BTB and 11.05% with STG (p = 0.04). Mean loss of strength in extension was 24.04% with BTB and 17.1% with STG (p = 0.75). The mean PT strength in flexion was 113.2 Nm (38-203) for BTB and 128.4 Nm (73-219) for STG (p = 0.603). The mean PT strength in extension was 187.2 Nm (68-363) for BTB and 194 Nm (107-339) for STG (p = 0.102). The mean muscle balance was 73.4% for STG and 68.6% for BTB (p = 0.961). CONCLUSION: The flexion strength was more compromised after BTB reconstruction compared to the STG procedure. We documented a trend towards loss of PT strength in flexion and extension and muscle balance with flexor predominance post-BTB reconstruction.