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1.
Am J Sports Med ; 47(14): 3483-3490, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718248

RESUMO

BACKGROUND: All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors. PURPOSE: To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm2; n = 31), group B (BMD, 0.4-0.6 g/cm2; n = 32), and group C (BMD, >0.6 g/cm2; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21). RESULTS: On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) (P = .001). The DA was deeper in patients with a higher BMD at time zero (r = 0.374; P = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA (r = 0.769; P < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) (P = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) (P = .550). CONCLUSION: In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.

2.
Arthroscopy ; 35(12): 3211-3218, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31708353

RESUMO

PURPOSE: To evaluate the clinical and structural outcomes of arthroscopic side-to-side repair of large U-shaped full-thickness rotator cuff tears (FTRCTs) by assessing the functional score of the patients and the integrity of the tendon repair using magnetic resonance imaging with a minimum follow-up duration of 2 years. METHODS: In this case series, 59 consecutive patients who underwent arthroscopic side-to-side repair of large U-shaped FTRCTs, with a minimum follow-up duration of 2 years (range 25 to 72 months), were retrospectively enrolled. The mean patient age was 58.6 years. Patients' functional scores and integrity of the tendon repairs were evaluated. RESULTS: The mean visual analog scale score improved from 5.7 ± 2.1 preoperatively to 2.4 ± 1.3 postoperatively (P < .001). The mean range of motion (forward flexion) improved from 152.7° ± 11.4° to 164.5° ± 9.5° (P < .001). The mean Constant-Murley score improved from 57.3 ± 7.2 preoperatively to 77.8 ± 6.9 postoperatively (P < .001). Postoperative magnetic resonance imaging examinations demonstrated cuff integrity with a retear rate of 54.2%. The retear rate of patients who underwent anchor fixation to the medial row (45%) was significantly lower than that of patients who underwent simple side-to-side repair (73.7%) (P = .039). The University of California at Los Angeles shoulder rating and Constant-Murley scores were not significantly different between the healed and retear groups (P = .639 and P = .863, respectively). CONCLUSIONS: Arthroscopic side-to-side repair of large U-shaped FTRCTs demonstrated satisfactory clinical outcomes. However, the retear rate was higher than expected when simple side-to-side fixation was performed without footprint fixation. Therefore, medial row fixation is recommended if arthroscopic side-to-side repair is performed. LEVEL OF EVIDENCE: III, comparative therapeutic trial.

3.
Comput Methods Programs Biomed ; 182: 105063, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505380

RESUMO

BACKGROUND AND OBJECTIVE: Rotator cuff muscle tear is one of the most frequent reason of operations in orthopedic surgery. There are several clinical indicators such as Goutallier grade and occupation ratio in the diagnosis and surgery of these diseases, but subjective intervention of the diagnosis is an obstacle in accurately detecting the correct region. METHODS: Therefore, in this paper, we propose a fully convolutional deep learning algorithm to quantitatively detect the fossa and muscle region by measuring the occupation ratio of supraspinatus in the supraspinous fossa. In the development and performance evaluation of the algorithm, 240 patients MRI dataset with various disease severities were included. RESULTS: As a result, the pixel-wise accuracy of the developed algorithm is 0.9984 ± 0.073 in the fossa region and 0.9988 ± 0.065 in the muscle region. The dice coefficient is 0.9718 ± 0.012 in the fossa region and 0.9463 ± 0.047 in the muscle region. CONCLUSIONS: We expect that the proposed convolutional neural network can improve the efficiency and objectiveness of diagnosis by quantifying the index used in the orthopedic rotator cuff tear.


Assuntos
Algoritmos , Aprendizado Profundo , Músculo Esquelético/fisiopatologia , Atrofia Muscular/fisiopatologia , Manguito Rotador/fisiopatologia , Automação , Humanos , Imagem por Ressonância Magnética , Músculo Esquelético/diagnóstico por imagem , Atrofia Muscular/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem
4.
J Shoulder Elbow Surg ; 28(12): 2317-2325, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31377005

RESUMO

BACKGROUND: There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. METHODS: We retrospectively reviewed 57 patients who underwent arthroscopic or open débridement for acute shoulder infection between 2001 and 2015. Arthroscopic débridement was performed in 27 patients, and open débridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2, n = 21, erosions seen in MRI but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). RESULTS: The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/10) and 15.4% (2/13) in group 1; 75% (9/12) and 11.1% (1/9) in group 2; and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell, erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P < .05). CONCLUSIONS: When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic débridement was above 75%. Therefore, if preoperative MRI showed erosions, open débridement is more likely to be appropriate than arthroscopic débridement.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/cirurgia , Desbridamento/métodos , Cabeça do Úmero/diagnóstico por imagem , Articulação do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/sangue , Artroscopia , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Feminino , Humanos , Contagem de Leucócitos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Radiografia , Recidiva , Estudos Retrospectivos , Ombro , Resultado do Tratamento , Adulto Jovem
5.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 4005-4013, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410527

RESUMO

PURPOSE: This study aimed to compare the clinical outcomes between single on-lay and double on-lay subpectoral biceps tenodesis (SPBT) using all-suture type anchor in patients with concomitant long head of the biceps tendon (LHBT) lesions and rotator cuff tears. METHODS: The study included 130 patients who underwent SPBT using all-suture type anchor and arthroscopic rotator cuff repair. Single and double anchor on-lay fixations were performed in 69 patients (group A) and 61 patients (group B), respectively. In 16 patients of group A and 36 patients of group B, a metallic wire was embedded at tenodesis site and difference of wire location pre-and postoperatively was measured using simple radiography. RESULTS: In both groups, the mean visual analogue scale (VAS) score during motion, the mean UCLA and constant scores significantly improved at the last follow-up (all p < 0.001). These scores were not significantly different between two groups. However, postoperatively, a significant difference was observed in the incidence of cosmetic deformity between two groups (p = 0.019). The cosmetic deformity was noted in 9 (13.0%) patients (Popeye deformity 7.2% and biceps softening 5.8%) in group A and 1 (1.6%) patient (Popeye deformity) in group B. In the subgroup analysis on biceps migration after the surgery, the mean migration distance of metal wire was 2.5 ± 3.0 mm in group A and 1.9 ± 2.6 mm in group B (n.s.). No patient had migration of > 10 mm. CONCLUSIONS: SPBT using all-suture type anchor was a favorable treatment option for lesions of the LHBT with rotator cuff tear. The clinical relevance of this study is the finding that double on-lay fixation with all-suture type anchor would result less cosmetic deformity than the single on-lay fixation for those who need subpectoral biceps tenodesis. LEVEL OF EVIDENCE: III.


Assuntos
Âncoras de Sutura , Tenodese/métodos , Adulto , Idoso , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Manguito Rotador/cirurgia , Traumatismos dos Tendões/cirurgia , Escala Visual Analógica
6.
Arthroscopy ; 35(8): 2284-2292, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31350085

RESUMO

PURPOSE: This study aimed to identify the difference in postoperative perianchor bone reactions in different groups of patients who underwent rotator cuff tear repairs with all-suture-, bioabsorbable screw-, and PEEK (polyether ether ketone)-type suture anchors. Furthermore, the rate of rotator cuff retear and its association with perianchor bone reactions based on the different anchors used were investigated. Moreover, their impact on the clinical outcome of patients was examined. METHODS: The study included 213 patients who underwent arthroscopic single-row repair and were divided into 3 groups according to the suture anchor used: all-suture (n = 137), biodegradable (n = 36), and PEEK (n = 40) anchor groups. The clinical outcomes and magnetic resonance imaging findings were evaluated at a mean follow-up of 9.6 months. The perianchor bone reaction at the anchor site was categorized according to grades. Patients were classified based on repair integrity into the healed and retear groups with Sugaya type I to III and Sugaya type IV to V, respectively. RESULTS: No statistically significant differences in Constant scores and retear rates were observed between the groups (P = .934 and P = .548, respectively). Magnetic resonance imaging showed that the total number of perianchor cysts formed postoperatively was 23 (10.8% [23 of 213 patients]). Moreover, the proportions of perianchor cysts were 8.8%, 16.7%, and 12.5% in the all-suture-type, bioabsorbable-, and PEEK-type anchor groups, respectively (P = .485). In the retear group, the incidence rate was significantly increased with higher grades of perianchor bone reaction (P = .001). The tear size and perianchor bone reaction were found to be independent factors that affected the incidence of retear. CONCLUSIONS: Perianchor cyst formation was observed in 10.8% of cases after the use of suture anchors for arthroscopic rotator cuff repair. No significant differences were observed among all-suture-type, bioabsorbable-type, and PEEK-type anchors in terms of visual analog scale and Constant scores, retear rates, and perianchor bone reactions. However, the retear rate was associated with a greater perianchor cystic reaction and larger tear size. LEVEL OF EVIDENCE: Level III, retrospective comparative trial.

7.
Arthroscopy ; 35(2): 314-322, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30611590

RESUMO

PURPOSE: The present study investigates the intra-articular findings and clinical outcomes after arthroscopic surgery in patients after age 40 with chronic anterior shoulder instability. METHODS: Fifty patients older than 40 years who underwent arthroscopic stabilization for recurrent anterior shoulder dislocation were analyzed. RESULTS: The mean age at the time of surgery was 44.8 years (range, 40-72 years), and the mean duration of follow-up was 45 months (range, 28-150 months). The mean visual analog scale score for pain with motion significantly improved from 4.1 preoperatively to 1.7 at the last follow-up (P < .001). The range of motion in the affected shoulder revealed limitations of 9.4° in forward flexion and 17.8° in external rotation compared with the unaffected shoulder. Both the Constant and Rowe scores significantly improved (P < .001 and P < .001, respectively). Recurrence, which includes dislocation and subluxation, occurred in 14% postoperatively. Anteroinferior labral lesion was seen in 92% of patients. Associated lesions included superior labrum anterior to posterior lesion (22%), midsubstance capsular tear (10%), and Hill-Sachs lesion (92%). Rotator cuff tears were found in 18%-partial-thickness tear in 10% and full-thickness tear, which was repaired with suture anchor, in 8%. Among the intra-articular lesions, there was no significant relation with recurrent instability or functional outcome as a single factor. CONCLUSIONS: In patients with chronic anterior shoulder instability who were older than 40 years, the clinical results after arthroscopic surgery showed statistically significant improvement with good muscle strength recovery. The quality of labral lesion, size of the Hill-Sachs lesion, and glenoid defect showed positive correlation with the number of preoperative dislocation. The intra-articular pathologies were varied, however no single articular lesion had significant impact on the recurrence rate. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Artroscopia , Instabilidade Articular/cirurgia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Adulto , Idoso , Lesões de Bankart/etiologia , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular , Período Pós-Operatório , Amplitude de Movimento Articular , Recidiva , Lesões do Manguito Rotador/etiologia , Escápula/fisiopatologia , Luxação do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Âncoras de Sutura , Resultado do Tratamento
8.
Am J Sports Med ; 47(5): 1254-1262, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29723036

RESUMO

BACKGROUND: Few studies to date have compared clinical outcomes in patients who have undergone medial patellofemoral ligament (MPFL) reconstruction using the suture anchor and double transpatellar tunnel fixation methods. This meta-analysis therefore compared the clinical results, including the patellar redislocation rate and improvement in functional scores, of suture anchor and double transpatellar tunnel fixation. HYPOTHESIS: The recurrence rate and improvement in functional outcomes after surgery would be similar using the suture anchor and double transpatellar tunnel fixation methods. STUDY DESIGN: Meta-analysis. METHODS: Studies evaluating MPFL reconstruction using either the suture anchor or double transpatellar tunnel technique for patellar site fixation were included if they reported the patellar redislocation rate after surgery and/or validated patient-reported outcomes such as the Kujala and Lysholm scores. RESULTS: Twenty-one studies were included in this meta-analysis. The mean patellar redislocation rates were similar using the suture anchor (3.2% [95% CI, 1.6%-6.2%]) and double transpatellar tunnel (3.4% [95% CI, 2.1%-5.4%]) techniques ( P = .879). The mean improvement in the Kujala score from before to after MPFL reconstruction was greater using the suture anchor (37.2 [95% CI, 31.1-43.4]) method than the double transpatellar tunnel method (28.7 [95% CI, 21.2-36.1]) ( P = .018). However, the mean improvement in the Lysholm score did not differ significantly using the 2 techniques. CONCLUSION: The patellar redislocation rate did not differ significantly in patients who underwent MPFL reconstruction using the suture anchor and double transpatellar tunnel fixation methods. The suture anchor fixation method, however, resulted in a greater degree of improvement in patient-reported outcomes.


Assuntos
Luxação Patelar/cirurgia , Ligamento Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Humanos , Articulação do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Medidas de Resultados Relatados pelo Paciente , Âncoras de Sutura , Técnicas de Sutura
9.
Clin Orthop Relat Res ; 476(5): 946-960, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29406457

RESUMO

BACKGROUND: Implant survivorship is reported to be lower and complications, particularly bearing dislocation, are reported to be more frequent in Asian than in Western patients with medial knee osteoarthritis (OA) undergoing Oxford® Phase III unicompartmental knee arthroplasty (UKA). To date, however, these complications have not been compared between these groups of patients. QUESTIONS/PURPOSES: The purpose of this study was to perform a meta-analysis comparing the standardized incidence rates of (1) all-cause reoperation; (2) reoperation related to bearing dislocation; and (3) reoperation related to progression of lateral compartment arthritis in Asian and Western patients with medial knee OA who underwent Oxford Phase III UKA. METHODS: We searched MEDLINE® (January 1, 1976, to May 31, 2017), EMBASE® (January 1, 1985, to May 31, 2017), and the Cochrane Library (January 1, 1987, to May 31, 2017) for studies that reported complications of Oxford Phase III UKAs. Studies were included if they reported reoperation rates attributable to bearing dislocation and/or progression of lateral knee OA after surgery with this implant. Twenty-seven studies were included in this systematic review and 16 studies with followups > 5 years were included in the meta-analysis. These rates were converted to standardized incidence rate (that is, reoperations per 100 observed component years) based on mean followup and number of involved knees in each study. After applying prespecified inclusion and exclusion criteria, the studies were categorized into two groups, Asian and Western, based on hospital location. Twenty-five studies, containing 3152 Asian patients and 5455 Western patients, were evaluated. Study quality was assessed by the modified Coleman Methodology score (MCMS). Although all studies were Level IV, their mean MCMS score was 66.92 (SD, 8.7; 95% confidence interval [CI], 63.5-70.3), indicating fair quality. Because the heterogeneity of all subgroup meta-analyses was high, a random-effects model was used with estimations using the restricted maximum likelihood method. RESULTS: There was no difference in the proportion of Asian patients versus Western patients undergoing reoperation for any cause calculated as 100 component observed years (1.022 of 3152 Asian patients; 95% CI, 0.810-1.235 versus 1.300 of 5455 Western patients; 95% CI, 1.067-1.534; odds ratio, 0.7839; 95% CI, 0.5323-1.1545; p = 0.178). The mean reoperation rate attributable to bearing dislocation per 100 observed years was higher in Asian than in Western patients (0.525; 95% CI, 0.407-0.643 versus 0.141; 95% CI, 0.116-0.166; odds ratio, 3.7378; 95% CI, 1.694-8.248; p = 0.001) Conversely, the mean reoperation rate attributable to lateral knee OA per 100 observed years was lower in Asian than in Western patients (0.093; 95% CI, 0.070-0.115 versus 0.298; 95% CI, 0.217-0.379; odds ratio, 0.3114; 95% CI, 0.0986-0.9840; p < 0.001). CONCLUSIONS: Although total reoperation rates did not differ in the two populations, reoperation for bearing dislocation was more likely to occur in Asian than in Western patients, whereas reoperation for lateral knee OA progression was more likely to occur in Western than in Asian patients after Oxford Phase III UKA. Although possible explanations for these findings may be hypothesized, additional randomized, prospective comparative studies are needed. However, better survival outcomes after UKA may require consideration of ethnicity and lifestyle choices in addition to traditional surgical technique and perioperative care. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Artroplastia do Joelho/instrumentação , Grupo com Ancestrais do Continente Asiático , Grupo com Ancestrais do Continente Europeu , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Falha de Prótese , Idoso , Artroplastia do Joelho/efeitos adversos , Fenômenos Biomecânicos , Progressão da Doença , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/etnologia , Osteoartrite do Joelho/fisiopatologia , Desenho de Prótese , Amplitude de Movimento Articular , Reoperação , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
Knee Surg Sports Traumatol Arthrosc ; 26(8): 2371-2380, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29189882

RESUMO

PURPOSE: Although anatomical and independent drilling techniques, such as transportal (TP) technique, have become more popular in anterior cruciate ligament (ACL) reconstruction, the TP technique has not been shown to yield superior clinical or functional outcomes compared to the transtibial (TT) technique. The aim of the current meta-analysis was to compare clinical outcomes of the TP and TT techniques, as determined by patient-reported outcome scores and knee joint laxity tests. It was hypothesized that the TP and TT techniques of ACL reconstruction would yield similar patient-reported functional outcomes and similar results on knee joint laxity tests. METHODS: Studies were included if they reported at least one of the following clinical outcomes: IKDC score, IKDC examination, Lysholm knee score, and Tegner activity score. Knee stability was evaluated by single or multiple parameters of the following knee laxity examinations: the Lachman test, the pivot shift test, and side-to-side difference on the instrumented knee laxity test. RESULTS: Sixteen studies were finally included in this meta-analysis. The proportions of patients with normal grade on the IKDC examination [odds ratio (OR) 2.23; 95% confidence interval (CI) 1.41-3.53; P = 0.0006] and Lysholm score (mean difference 1.27; 95% CI 0.23-2.31; P = 0.02) after surgery were higher with the TP than with the TT technique, but there were no differences in IKDC and Tegner scores. The postoperative proportion of normal knee joint stability was significantly higher with the TP than the TT technique, on both Lachman (OR 2.29; 95% CI 1.35-3.92; P = 0.002) and pivot shift (OR 2.13; 95% CI 1.12-4.05; P = 0.02) tests. The pooled mean side-to-side difference was 0.73 mm lower with the TP than the TT technique (95% CI - 1.14 to - 0.32 mm; P = 0.0005). CONCLUSION: This meta-analysis showed that the clinical outcomes of ACL reconstruction were better with the TP than the TT technique, both on knee functional outcome scales and knee laxity tests. The findings thus suggest that the TP technique would be a better option for single-bundle ACL reconstruction compared to the TT technique. LEVEL OF EVIDENCE: III.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Fêmur/cirurgia , Tíbia/cirurgia , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Escore de Lysholm para Joelho , Medidas de Resultados Relatados pelo Paciente , Análise de Regressão , Resultado do Tratamento
11.
Jpn J Clin Oncol ; 46(9): 845-9, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27365524

RESUMO

OBJECTIVE: To elucidate the clinical benefit and safety of low-dose chemotherapy using methotrexate and vinblastine in patients (mostly adults) with progressive and/or symptomatic fibromatosis. METHODS: Patients were enrolled if they were treated with methotrexate and vinblastine chemotherapy for recurrences after surgical excision or newly diagnosed aggressive fibromatosis that was not amenable to surgical resection at the Korea University Medical Center from May 2008 to February 2016. RESULTS: Twenty-two patients were treated with this regimen, and 21 were eligible for safety and efficacy analysis. Eleven (52%) of 21 patients showed a documented partial response (PR), and 11 showed stable disease (SD) by the end of treatment. All the patients who achieved PR reported a significant reduction in pain and improvement in the function of the affected lesions. Median progression-free survival was not reached at the time of analysis. The most common adverse event was abnormalities of the liver transaminases (overall 84.2%). The most common grade 3 or higher toxicity was neutropenia (36.8%), but no febrile neutropenic event was observed. The elevated levels of transaminases were normalized by reducing the dose of methotrexate or delaying treatment. CONCLUSIONS: Low-dose chemotherapy with methotrexate and vinblastine for 1 year was effective and well tolerated by adult patients with aggressive, recurrent fibromatosis.


Assuntos
Antineoplásicos/uso terapêutico , Fibromatose Agressiva/tratamento farmacológico , Metotrexato/uso terapêutico , Vimblastina/uso terapêutico , Adolescente , Adulto , Idoso , Antineoplásicos/efeitos adversos , Intervalo Livre de Doença , Feminino , Febre/etiologia , Humanos , Estimativa de Kaplan-Meier , Fígado/enzimologia , Masculino , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neutropenia/etiologia , Estudos Retrospectivos , Transaminases/metabolismo , Resultado do Tratamento , Vimblastina/efeitos adversos , Adulto Jovem
12.
Am J Sports Med ; 43(5): 1091-8, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25740834

RESUMO

BACKGROUND: Although the prevalence of rotator cuff tear (RCT) in the general population has been analyzed, little information is available on the status of the opposite-side rotator cuff in patients who have undergone arthroscopic rotator cuff repair. PURPOSE/HYPOTHESIS: To identify the characteristics of the contralateral shoulder and to identify factors associated with RCT of the contralateral shoulder in patients who underwent surgery for symptomatic RCT. The hypothesis was that the prevalence of RCT in the contralateral shoulder would be higher in patients with increasingly larger cuff tears requiring surgical intervention. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study cohort consisted of 140 patients with RCT who underwent arthroscopic rotator cuff repair. Opposite-shoulder rotator cuff tendons of all patients were evaluated by ultrasonography. Demographic information and factors related to contralateral RCT were investigated, and risk factors associated with contralateral RCT were assessed. RESULTS: Of the 140 patients who underwent arthroscopic rotator cuff repair, 54 (38.6%) had an RCT of the contralateral shoulder. Of 51 patients with partial-thickness and small-sized full-thickness tears of the operated shoulder, 35 (68.6%) had no tears; 14 (27.5%) had partial-thickness tears; and 2 (3.9%) had small-sized full-thickness tears of the contralateral shoulder. Of 75 patients with medium-sized full-thickness tears, 43 (57.3%) had no tears; 12 (16%) had partial-thickness tears; and 20 (26.7%) had full-thickness tears of the contralateral shoulder. Of 14 patients with large to massive full-thickness tears, 8 (57.1%) had no tears; 1 (7.1%) had a partial-thickness tear; and 5 (35.7%) had full-thickness tears of the contralateral shoulder. The prevalence of RCT of the contralateral shoulder differed significantly among groups classified by tear size (P=.007). The mean American Shoulder and Elbow Surgeons score was significantly lower in the RCT than in the nontear group (55.8±16.9 vs 61.6±13.3; P=.03). Of 29 subjects with symptomatic tears involving the nondominant arm, 17 (58.6%) had contralateral asymptomatic RCT, compared with 37 of 111 (33.3%) subjects with symptomatic tears involving the dominant arm (P=.007). CONCLUSION: The prevalence of RCT of the contralateral asymptomatic shoulder tends to be higher in patients with more symptomatic RCT on one side, in patients with medium-sized or larger RCT in the operated shoulder, and in patients with symptomatic RCT in the nondominant arm.


Assuntos
Artroscopia/métodos , Manguito Rotador/cirurgia , Ombro/cirurgia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Ruptura
13.
Knee ; 21(2): 600-4, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23692815

RESUMO

Sleeve fractures are generally restricted to children or adolescents, and usually occur at the lower patella pole. Here we report on a superior pole sleeve fracture in an adult that occurred following forceful passive physiotherapy after cast immobilization. To our knowledge, this is the first report of a superior pole sleeve fracture in an otherwise healthy adult. The case highlighted that a diagnosis of a superior patella pole sleeve fracture in an adult can easily be missed because it is a rare injury, and hence is unlikely to be suspected by physicians.


Assuntos
Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Patela/lesões , Patela/cirurgia , Moldes Cirúrgicos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico , Humanos , Imobilização , Imagem por Ressonância Magnética , Masculino , Patela/diagnóstico por imagem , Patela/patologia , Modalidades de Fisioterapia , Âncoras de Sutura , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Am J Sports Med ; 41(11): 2533-9, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23982399

RESUMO

BACKGROUND: Previous 3-dimensional computed tomography (3D CT) studies of knees after anterior cruciate ligament (ACL) reconstruction have compared femoral tunnel positions obtained using the transtibial and anteromedial drilling techniques. This study used postoperative in vivo 3D CT analysis to compare the locations of the femoral tunnel aperture among 3 drilling techniques used in ACL reconstruction: transtibial, anteromedial portal, and outside-in. HYPOTHESIS: The use of the transtibial drilling technique might result in a less anatomically accurate femoral tunnel placement than the anteromedial portal and outside-in techniques. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Immediate postoperative in vivo 3D CT was used to assess the location of the femoral tunnel aperture in 153 patients who underwent single-bundle ACL reconstruction using the transtibial (n = 42), anteromedial portal (n = 73), or outside-in (n = 38) techniques. Femoral tunnel positions were measured by an anatomic coordinate axis method in the low-to-high and deep-to-shallow directions of the distal femur at 90° of knee flexion. RESULTS: The low-to-high femoral tunnel positions were significantly higher in the transtibial group than in the anteromedial portal (P < .001) and outside-in (P < .001) groups. There were no differences among the 3 groups in the deep-to-shallow femoral tunnel positions (P = .773). CONCLUSION: The transtibial technique of anatomic reconstruction resulted in more highly positioned femoral tunnels in the low-to-high direction than did the anteromedial portal and outside-in techniques. However, no significant differences in the femoral tunnel location were observed in the deep-to-shallow direction.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Adolescente , Adulto , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Adulto Jovem
15.
Indian J Orthop ; 47(3): 313-6, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23798766

RESUMO

We report a case of localized nodular synovitis of the infrapatellar fat pad impinging on the patellofemoral joint causing limitation of extension. Arthroscopy involved use of a superolateral portal because location of lesion hindered access via a conventional anterior portal. The infrapatellar mass impinged in the patellofemoral joint upon knee extension and retracted upon flexion. Superior-superior triangulation allowed for complete excision of the mass.

16.
Orthopedics ; 35(7): e1104-7, 2012 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-22784909

RESUMO

A 19-year-old male professional Taekwondo athlete presented with a 2-year history of pain-free snapping of his right knee. He reported that his right knee joint gave way during games and training and that he could induce pain-free snapping between the proximal-to-fibular head and the lateral knee joint line. None of these physical findings suggested a meniscal pathology or ligamentous instability. Routine radiographs were normal. Magnetic resonance imaging of his right knee joint showed that the shape of the lateral meniscus was normal, and no lateral meniscus tears existed. On arthroscopic examination, popliteal hiatus view showed a posterosuperior popliteomeniscal fascicle tear between the posterior horn of the lateral meniscus and the posterior joint capsule just posteromedial to the popliteus tendon. With medial traction by probing, this popliteomeniscal tear made visible the significant subluxation of the posterior horn of the lateral meniscus to the center or anterior half of the tibial plateau. Based on the diagnosis of a posterosuperior popliteomeniscal tear of the right knee, Fast-Fix (Smith & Nephew, Andover, Massachusetts) was used for the direct repair of the peripheral portion of the lateral meniscus and joint capsule, targeting the popliteomeniscal junction. At 24 months postoperatively, the patient was performing athletic exercises relevant to his profession and was taking part in Taekwondo games, with no pain or recurrence of snapping. To the authors' knowledge, this is the first report of snapping of the lateral aspect of the knee due to a popliteomeniscal fascicle tear.


Assuntos
Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Traumatismos do Joelho/complicações , Traumatismos do Joelho/cirurgia , Artes Marciais/lesões , Técnicas de Sutura/instrumentação , Lesões do Menisco Tibial , Adulto , Humanos , Instabilidade Articular/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Radiografia , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Ruptura/cirurgia , Resultado do Tratamento
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