Periarticular Infiltration Compared to Single Femoral Nerve Block in Total Knee Arthroplasty: A Prospective Randomized Study.

Objective To compare patients undergoing total knee arthroplasty (TKA) under spinal anesthesia and single femoral nerve block (FNB) with subjects undergoing TKA under spinal anesthesia and periarticular infiltration (PAI). Materials and Methods A total of 100 patients undergoing primary TKA were randomized into two groups. Group 1 included patients undergoing surgery under FNB associated with spinal anesthesia, while group 2 included patients undergoing TKA under IPA and spinal anesthesia. The assessment of these subjects in the early postoperative period included pain, active flexion, active extension, elevation of the extended limb, and morphine use. Results There was no significant difference in the types of analgesia concerning pain, the elevation of the extended limb, and morphine use. Active flexion and extension were better in the PAI group ( p = 0.04 and p = 0.02 respectively). Conclusion We conclude that the techniques are similar regarding pain control, limb elevation, and morphine use. The use of IPA provided better active flexion and extension during the hospital stay compared to single FNB in patients undergoing TKA.

To Retain or Resurface the Patella in Primary Total Knee Arthroplasty: A Comparative Study.

Objective To evaluate and compare clinically and functionally patients undergoing primary total knee arthroplasty (TKA) with preservation or replacement of the patella. Methods In a cross-sectional study, the functional results were evaluated and compared, using the Western Ontario and McMaster Universities (WOMAC) and Lequesne scores, of 158 patients undergoing primary TKA (162 knees); in 81 knees the patella was submitted to arthroplasty and in 81 the joint surface of the patella was preserved. Results No significant differences were identified in terms of the Lequesne score (p = 0.585), global WOMAC score (p = 0.169), nor in terms of its subdivisions regarding stiffness (p = 0.796) and functional capacity (p = 0.190). There was a significant difference only in terms of the subdivision that evaluates pain in the WOMAC score, being lower in the group undergoing patellar arthroplasty (p = 0.036). Conclusion In the present study, there was no difference in functional assessment in patients who underwent or not patellar replacement during primary knee arthroplasty surgery. However, individuals in whom the patella was preserved reported more pain.

To Retain or Resurface the Patella in Primary Total Knee Arthroplasty: A Comparative Study / Preservar ou substituir a patela durante a artroplastia total de joelho: Estudo comparativo

Abstract Objective To evaluate and compare clinically and functionally patients undergoing primary total knee arthroplasty (TKA) with preservation or replacement of the patella. Methods In a cross-sectional study, the functional results were evaluated and compared, using the Western Ontario and McMaster Universities (WOMAC) and Lequesne scores, of 158 patients undergoing primary TKA (162 knees); in 81 knees the patella was submitted to arthroplasty and in 81 the joint surface of the patella was preserved. Results No significant differences were identified in terms of the Lequesne score (p = 0.585), global WOMAC score (p = 0.169), nor in terms of its subdivisions regarding stiffness (p = 0.796) and functional capacity (p = 0.190). There was a significant difference only in terms of the subdivision that evaluates pain in the WOMAC score, being lower in the group undergoing patellar arthroplasty (p = 0.036). Conclusion In the present study, there was no difference in functional assessment in patients who underwent or not patellar replacement during primary knee arthroplasty surgery. However, individuals in whom the patella was preserved reported more pain.

Resumo Objetivo Avaliar e comparar clínica e funcionalmente pacientes submetidos a artroplastia total primária do joelho (ATJ) com preservação ou substituição da patela. Métodos Em um estudo transversal, foram avaliados e comparados os resultados funcionais, usando escores de Western Ontario and McMaster Universities (WOMAC, na sigla em inglês) e Lequesne, de 158 pacientes submetidos a artroplastia total primária o joelho (162 joelhos), sendo que em 81 joelhos a patela foi submetidaa artroplastiae em 81 a superfície articular da patela foi preservada. Resultados Não foram identificadas diferenças significativas quanto ao escore de Lequesne (p = 0,585), escore global de WOMAC (p = 0,169), nem quanto às subdivisões deste quanto a rigidez (p = 0,796) e a capacidade funcional (p= 0,190). Evidenciou-se diferença significativa apenas quanto à subdivisão que avalia a dor no escore de WOMAC, sendo menor no grupo submetido a artroplastia patelar (p = 0,036). Conclusão No presente estudo, não houve diferença na avaliação funcional em pacientes submetidos a substituição ou não da patela durante a cirurgia de artroplastia primária do joelho. Entretanto, os indivíduos nos quais a patela foi preservada relataram mais dor.

Biomechanical Evaluation of Different Tibial Fixation Methods in the Reconstruction of the Anterolateral Ligament in Swine Bones.

Objective The present study aims to evaluate different methods of tibial fixation in the reconstruction of the anterolateral ligament (ALL). In addition, the present paper aims to compare the effectiveness of these methods and their mechanisms of failure in swine knees. Methods A total of 40 freshly frozen swine limbs were divided into 4 groups of 10 specimens, according to the tibial fixation technique used. In group A, the tibial fixation of the tendon graft was made through an anchor passing the graft. In group B, the tibial fixation was performed through a metal interference screw in a single bone tunnel. In group C, the tibial fixation included an anchor associated with a tendinous suture (but not with a wire crossing the tendon). In group D, two confluent bony tunnels were drilled and combined with an interference screw in one of them. Results The lowest mean force (70.56 N) was observed in group A, and the highest mean force (244.85 N) was observed in group B; the mean values in the other 2 groups ranged from 171.68 N (group C) to 149.43 N (group D). Considering the margin of error (5%), there was a significant difference between the groups ( p < 0.001). Conclusion Fixation with an interference screw in a single tunnel bone showed the highest tensile strength among the evaluated techniques.

Biomechanical Evaluation of Different Tibial Fixation Methods in the Reconstruction of the Anterolateral Ligament in Swine Bones / Avaliação biomecânica de diferentes métodos de fixação tibial na reconstrução do ligamento anterolateral em ossos suínos

Abstract Objective The present study aims to evaluate different methods of tibial fixation in the reconstruction of the anterolateral ligament (ALL). In addition, the present paper aims to compare the effectiveness of these methods and theirmechanisms of failure in swine knees. Methods A total of 40 freshly frozen swine limbs were divided into 4 groups of 10 specimens, according to the tibial fixation technique used. In group A, the tibial fixation of the tendon graft wasmade through an anchor passing the graft. In group B, the tibial fixation was performed through a metal interference screw in a single bone tunnel. In group C, the tibial fixation included an anchor associated with a tendinous suture (but not with a wire crossing the tendon). In group D, two confluent bony tunnels were drilled and combined with an interference screw in one of them. Results The lowest mean force (70.56 N) was observed in group A, and the highest mean force (244.85 N) was observed in group B; the mean values in the other 2 groups ranged from 171.68 N (group C) to 149.43 N (group D). Considering the margin of error (5%), there was a significant difference between the groups (p < 0.001). Conclusion Fixation with an interference screw in a single tunnel bone showed the highest tensile strength among the evaluated techniques.

Resumo Objetivo Avaliar a força de resistência à tração de diferentesmétodos de fixação tibial na reconstrução do ligamento anterolateral (LAL). Além disso, comparar os mecanismos de falha da fixação tibial dessa reconstrução em joelhos suínos. Métodos Foram usados 40 membros recém-congelados de suínos, divididos em quatro grupos de dez espécimes, conforme as técnicas de fixação tibial usadas. No grupo A, a fixação tibial do enxerto tendíneo foi feita por meio de uma âncora e seu fio transpassou o enxerto. No grupo B, a fixação tibial foi feita por meio de parafuso de interferência metálico em túnel ósseo único. No grupo C, a fixação tibial incluiu uma âncora associada à sutura de ponto sobre o tendão (sem a presença de fio que transpassasse o tendão) e, no grupo D, foram usados dois túneis ósseos confluentes associados a um parafuso de interferência em um dos túneis. Resultados A força média menos elevada (70,56 N) ocorreu no grupo A e a mais elevada (244,85 N), no grupo B; as médias dos outros dois grupos variaram entre 171,68N (grupo C) e 149,43 N (Grupo D). Considerando-se a margem de erro fixada (5%), foi observada diferença significativa entre os grupos (p < 0,001). Conclusão A fixação com parafuso de interferência em túnel ósseo único apresentou a maior força de resistência à tração dentre as técnicas avaliadas. Abstract Objective The present study aims to evaluate different methods of tibial fixation in the reconstruction of the anterolateral ligament (ALL). In addition, the present paper aims to compare the effectiveness of these methods and theirmechanisms of failure in swine knees.

Assessment of the alpha angle and mobility of the hip in patients with noncontact anterior cruciate ligament injury.

PURPOSE: To evaluate the alpha angle of the hip in patients with noncontact anterior cruciate ligament (ACL) injury and compare it with patients without injury. In addition, external and internal rotation of the hip was assessed and correlated with the alpha angle. METHODS: The alpha angle of the ipsilateral hip was assessed in 41 subjects with non-contact ACL tear and compared with 39 subjects with no tear. The external and internal rotation of the ipsilateral hip was also evaluated. RESULTS: The alpha angle was larger in subjects with noncontact ACL injury. The mean was 70.31° (±13.92°) compared with 58.55° (±13.95°) in the control group (p < 0.001). The groups were similar when considering the external, internal, and sum of rotation of the ipsilateral hip. There was no correlation between the alpha angle and decreased rotational range of motion of the hip in either group (p > 0.05). CONCLUSION: Patients with noncontact ACL injury presented a greater alpha angle when compared with the group without tear. There was no difference in the rotational mobility of the hip between groups, nor was there a correlation between the increase in the alpha angle and the decrease in the rotational mobility of the hip.

Reconstruction of the anterior cruciate ligament by means of an anteromedial portal and femoral fixation using Rigidfix / Reconstrução do ligamento cruzado anterior pelo portal anteromedial e fixação femoral com Rigidfix

Objective: To evaluate a series of patients who underwent surgery for reconstruction of the anterior cruciate ligament with flexor tendons, by means of the anteromedial transportal technique using Rigidfix for femoral fixation, and to analyze the positioning of the pins by means of tomography. Methods: Thirty-two patients were included in the study. The clinical evaluation was done using the Lysholm, subjective IKDC and Rolimeter. All of them underwent computed tomography with 3D reconstruction in order to evaluate the entry point and positioning of the Rigidfix pins in relation to the joint cartilage of the lateral condyle of the femur. Results: The mean Lysholm score obtained was 87.81 and the subjective IKDC was 83.72. Among the 32 patients evaluated, 43% returned to activities that were considered to be very vigorous, 9% vigorous, 37.5% moderate and 12.5% light. In 16 patients (50%), the distal entry point of the Rigidfix pin was located outside of the cartilage (extracartilage); in seven (21.87%), the distal pin injured the joint cartilage (intracartilage); and in nine (28.12%), it was at the border of the lateral condyle of the femur. Conclusion: The patients who underwent ACL reconstruction by means of the anteromedial transportal using the Rigidfix system presented satisfactory clinical results over the length of follow-up evaluated. However, the risk of lesions of the joint cartilage from the distal Rigidfix pin needs to be taken into consideration when the technique via an anteromedial portal is used. Further studies with larger numbers of patients and longer follow-up times should be conducted for better evaluation...

Objetivo: Avaliar uma série de pacientes submetidos à cirurgia de reconstrução do ligamento cruzado anterior com tendões flexores pela técnica transportal anteromedial com o uso de Rigidfix para fixação femoral e analisar o posicionamento dos pinos por meio de tomografia. Métodos: Foram incluídos no estudo 32 pacientes. A avaliação clínica foi feita com os escores de Lysholm, IKDC subjetivo e Rolimeter. Todos foram submetidos a tomografia computadorizada com reconstrução em 3D para avaliação do ponto de entrada e do posicionamento dos pinos do Rigidfix em relação à cartilagem articular do côndilo lateral do fêmur. Resultados: A média do escore de Lysholm obtido foi de 87,81 e do IKDC subjetivo, de 83,72. Dos 32 pacientes avaliados, 43% retornaram a atividades consideradas muito vigorosas, 9% a vigorosas, 37,5% a moderadas e 12,5% a leves. Em 16 pacientes (50%), o ponto de entrada do pino distal do Rigidfix foi localizado fora da cartilagem (extracartilagem), em sete (21,87%) o pino distal lesou a cartilagem articular (intracartilagem) e em nove (28,12%) ficou na borda da cartilagem articular do côndilo lateral do fêmur. Conclusão: Os pacientes submetidos à reconstrução do LCA com o sistema Rigidfix pela técnica transportal anteromedial apresentaram um resultado clínico satisfatório no tempo de seguimento avaliado. Entretanto, o risco de lesão da cartilagem articular pelo pino distal do Rigidfix deve ser considerado quando a técnica via portal anteromedial é usada. Outros estudos com maior número de pacientes e com um tempo de seguimento mais longo devem ser feitos para melhor avaliação...

Comparative study between mono-bundle bone-patellar tendon-bone, double-bundle hamstring and mono-bundle bone-patellar tendon-bone combined with a modified Lemaire extra-articular procedure in anterior cruciate ligament reconstruction.

PURPOSE: The aim of the study was to compare three different procedures performed by the same surgeon: mono-bundle patellar tendon reconstruction (bone-patellar tendon-bone, BPTB), double-bundle hamstring reconstruction (DBH) and mono-bundle patellar tendon combined with extra-articular reconstruction (Lemaire) (BPTB + L). METHODS: A total of 75 patients (25 in each group) were evaluated at a mean follow-up of 25 months. Laxity was assessed pre- and post-operatively with Telos™ stress radiographs (15 kg). The amount of anterior tibial translation (ATT) corrected by the surgery was quantified. Secondary outcomes were International Knee Documentation Committee (IKDC) scores, pivot shift grading, pain complaints, sensory deficits, subsequent surgical procedures, return to sports and patients' ability to kneel or squat on their affected knee. RESULTS: Absolute correction of ATT for the internal compartment was not statistically significant [analysis of variance (ANOVA), p=0.377]. For the external compartment BPTB + L (8.2 mm) showed superiority over DBH (5.6 mm) and BPTB (4.1 mm) (ANOVA, p=0.0001, Tukey's test). Kneeling was better in the DBH group (ANOVA, p=0.0001, Tukey's test). In 22 patients it felt normal, while only in seven in the BPTB and eight in the BPTB + L groups. Sensory deficits were present in 11 patients from the DBH group, while in 17 in the BPTB and 19 in the BPTB + L groups (ANOVA, p=0.052). Mean IKDC values, presence of anterior knee pain, subsequent operations, ability to squat and return to sports were not statistically different between groups. CONCLUSIONS: Absolute correction of ATT was not statistically different for the medial compartment, but the patellar tendon reconstruction combined with the extra-articular procedure achieved the best lateral compartment ATT correction. Sensory deficits and kneeling seem to be worse in the groups where the patellar tendon is harvested.

Imaging in patellofemoral instability: an abnormality-based approach.

Imaging in patellofemoral instability confirms the diagnosis and guides treatment. It is essential to the accurate diagnosis of the root causes and their adequate treatment. A structured approach must be used to identify the factors causing instability, and more than 1 imaging modality may provide similar information. This article revises the acute findings and the abnormalities present in the acute and the chronic settings.

Double-bundle bone-patellar tendon-bone and gracilis in ACL reconstruction.

An original technique for the reconstruction of the anterior cruciate ligament is explained. Two bundles are reconstructed using the central third of the patellar tendon and the gracilis tendon, passed through four tunnels but requiring only two interference screws for fixation. Level of evidence V.