Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 66
Filtrar
1.
Orthop J Sports Med ; 10(1): 23259671211069960, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35071661

RESUMO

BACKGROUND: Anatomic anterior cruciate ligament reconstruction (ACLR) is preferred over nonanatomic ACLR. However, there is no consensus on which point the tunnels should be positioned among the broad anatomic footprints. PURPOSE/HYPOTHESIS: To identify the ideal combination of tibial and femoral tunnel positions according to the femoral and tibial footprints of the anteromedial (AM) and posterolateral (PL) anterior cruciate ligament bundles. It was hypothesized that patients with anteromedially positioned tunnels would have better clinical scores, knee joint stability, and graft signal intensity on follow-up magnetic resonance imaging (MRI) than those with posterolaterally positioned tunnels. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 119 patients who underwent isolated single-bundle ACLR with a hamstring autograft from July 2013 to September 2018 were retrospectively investigated. Included were patients with clinical scores and knee joint stability test results at 2-year follow-up and postoperative 3-dimensional computed tomography and 1-year postoperative MRI findings. The cohort was divided into 4 groups, named according to the bundle positions in the tibial and femoral tunnels: AM-AM (n = 33), AM-PL (n = 26), PL-AM (n = 29), and PL-PL (n = 31). RESULTS: There were no statistically significant differences among the 4 groups in preoperative demographic data or postoperative clinical scores (Lysholm, Tegner, and International Knee Documentation Committee subjective scores); knee joint stability (anterior drawer, Lachman, and pivot-shift tests and Telos stress radiographic measurement of the side-to-side difference in anterior tibial translation); graft signal intensity on follow-up MRI; or graft failure. CONCLUSION: No significant differences in clinical scores, knee joint stability, or graft signal intensity on follow-up MRI were identified between the patients with anteromedially and posterolaterally positioned tunnels.

2.
BMC Musculoskelet Disord ; 23(1): 32, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983471

RESUMO

BACKGROUND: This study aimed to evaluate the efficacy of viscosupplementation after arthroscopic partial meniscectomy. METHOD: A randomized controlled trial of 47 patients who underwent arthroscopic partial meniscectomy was conducted between March 2020 and March 2021. Patients were randomized into two groups: a viscosupplementation group (n = 23) and a control group (n = 24). A single-dose intraarticular hyaluronic acid injection was used as viscosupplementation. The 100 mm visual analogue scale (VAS) for pain assessment was measured at baseline and at 1 day, 2 weeks, 6 weeks, and 3 months post-surgery. The International Knee Documentation Committee (IKDC), Tegner, Lysholm, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and range of motion (ROM) of the knee were measured at baseline, 2 weeks, 6 weeks, and 3 months. RESULTS: The 100 mm VAS score for pain was significantly lower in the viscosupplementation group at 2 weeks post-surgery (27.5 mm vs. 40.7 mm, P = 0.047). ROM was significantly greater in the viscosupplementation group than in the control group at 2 weeks (131.5° vs. 121.0°, P = 0.044) post-surgery. No significant differences were observed in the IKDC or in the Tegner, Lysholm, and WOMAC scores between the two groups. CONCLUSIONS: Viscosupplementation after arthroscopic partial meniscectomy significantly reduced pain at 2 weeks post-surgery and improved ROM of the knee at 2 weeks post-surgery. There might be some benefits in terms of pain and functional recovery of viscosupplementation after arthroscopic surgery. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. TRIAL REGISTRATION: This randomized controlled trial was registered at cris.nih.go.kr # KCT0004921 .


Assuntos
Osteoartrite do Joelho , Viscossuplementação , Artroscopia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Meniscectomia/efeitos adversos , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento
3.
Orthop J Sports Med ; 9(2): 2325967120985153, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33709007

RESUMO

BACKGROUND: There is currently no consensus on the optimal placement of the tibial tunnel for remnant-preserving posterior cruciate ligament (PCL) reconstruction. PURPOSE/HYPOTHESIS: The purpose of this study was to compare the clinical and radiologic outcomes of remnant-preserving PCL reconstruction using anatomic versus low tibial tunnels. We hypothesized that the outcomes of low tibial tunnel placement would be superior to those of anatomic tibial tunnel placement at the 2-year follow-up after remnant-preserving PCL reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively reviewed the data for patients who underwent remnant-preserving PCL reconstruction between March 2011 and January 2018 with a minimum follow-up of 2 years (N = 63). On the basis of the tibial tunnel position on postoperative computed tomography, the patients were divided into those with anatomic placement (group A; n = 31) and those with low tunnel placement (group L; n = 32). Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity level), range of motion, complications, and stability test outcomes at follow-up were compared between the 2 groups. Graft signal on 1-year follow-up magnetic resonance imaging scans was compared between 22 patients in group A and 17 patients in group L. RESULTS: There were no significant differences between groups regarding clinical scores or incidence of complications, no between-group differences in posterior drawer test results, and no side-to-side difference on Telos stress radiographs (5.2 ± 2.9 mm in group A vs 5.1 ± 2.8 mm in group L; P = .900). Postoperative 1-year follow-up magnetic resonance imaging scans showed excellent graft healing in both groups, with no significant difference between them. CONCLUSION: The clinical and radiologic outcomes and complication rate were comparable between anatomic tunnel placement and low tibial tunnel placement at 2-year follow-up after remnant-preserving PCL reconstruction. The findings of this study suggest that both tibial tunnel positions are clinically feasible for remnant-preserving PCL reconstruction.

4.
Knee Surg Sports Traumatol Arthrosc ; 29(6): 1936-1943, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32914218

RESUMO

PURPOSE: To compare clinical and radiological outcomes and failure rates between anatomical and high femoral tunnels in remnant-preserving single-bundle posterior cruciate ligament (PCL) reconstruction. METHODS: 63 patients who underwent remnant-preserving single-bundle PCL reconstruction between 2011 and 2018 with a minimum 2-year follow-up were retrospectively reviewed. Patients were divided into two groups according to the femoral tunnel position: group A (33 patients with anatomical femoral tunnel) and group H (30 patients with high femoral tunnels). The femoral tunnel was positioned at the center (group A) or upper margin (group H) of the remnant anterolateral bundle. The position of the femoral tunnel was evaluated using the grid method on three-dimensional computed tomography. Clinical and radiological outcomes and failure rates were compared between the groups at the 2-year follow-up. RESULTS: The position of the femoral tunnel was significantly high in group H than in group A (87.4% ± 4.2% versus 76.1% ± 3.7%, p < 0.001). Clinical outcomes were not significantly different between the two groups in terms of the clinical scores (International Knee Documentation Committee subjective, Lysholm, and Tegner activity scores), range of motion, and posterior drawer test. Radiological outcomes also showed no intergroup differences in the side-to-side differences of posterior tibial translation and osteoarthritis progression. Side-to-side difference on the Telos stress radiograph was 5.2 ± 2.9 mm in group A and 5.2 ± 2.7 mm in group H (n.s.). There were four failures in group A (12.1%) and one in group H (3.3%). The differences between the groups were not statistically significant. CONCLUSION: The clinical and radiological outcomes and failure rates of the high femoral tunnels were comparable with those of the anatomical femoral tunnels at the 2-year follow-up after remnant-preserving single-bundle PCL reconstruction. The findings of this study suggest that high femoral tunnels can be considered an alternative in remnant-preserving single-bundle PCL reconstruction. LEVEL OF EVIDENCE: III.


Assuntos
Fêmur/cirurgia , Reconstrução do Ligamento Cruzado Posterior/métodos , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/cirurgia , Adolescente , Adulto , Idoso , Artroscopia/métodos , Feminino , Fêmur/diagnóstico por imagem , Fêmur/fisiopatologia , Seguimentos , Humanos , Escore de Lysholm para Joelho , Masculino , Pessoa de Meia-Idade , Exame Físico , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/fisiopatologia , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Falha de Tratamento , Adulto Jovem
5.
J Knee Surg ; 34(12): 1310-1317, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32369841

RESUMO

This study aimed to investigate the effect of anterolateral ligament reconstruction (ALLR) in revision anterior cruciate ligament reconstruction (ACLR) with high-grade pivot shift. The hypothesis was that revision ACLR combined with ALLR (RACLR with ALLR group) would show superior clinical outcomes to those of isolated revision ACLR. We retrospectively evaluated consecutive patients who underwent revision ACLR (RACLR) combined with ALLR between October 2015 and January 2017. The indication for combination of ALLR with revision ACLR was failed ACLR with ≥G2 pivot-shift instability. The control group included patients who underwent isolated revision ACLR (isolated RACLR group) for the same indication between July 2013 and September 2015. Exclusion criteria were ≤G1 pivot-shift instability, multiple ligament reconstruction, bilateral ligament injury, double-bundle reconstruction, insufficient medical records, postoperative infection, and follow-up loss at postoperative 2 years. Clinical scores, stability tests, and failure rates were compared between groups at the 2-year follow-up. The RACLR with ALLR group had 18 patients (mean age, 32.9 ± 10.8 years) and the RACLR group had 21 patients (mean age, 29.6 ± 10.2 years). Clinical scores at the 2-year follow-up showed no significant differences between groups. However, the RACLR with ALLR group showed better stability in the Lachman test (p = 0.005), pivot-shift test (p = 0.030), and side-to-side difference in stress radiographs (3.9 ± 3.0 mm vs. 5.9 ± 2.8 mm, p = 0.018) than the isolated RACLR group. The RACLR with ALLR group had two failures (11.1%), and the RACLR group had three failures (14.3%). In conclusion, ALLR in revision ACLR with high-grade pivot shift improves anteroposterior stability as well as rotational stability at 2-year follow-up. Therefore, ALLR is recommended with revision ACLR, especially in patients with high-grade pivot shift. This is a Level III, retrospective cohort review.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamentos , Estudos Retrospectivos , Adulto Jovem
6.
Knee Surg Sports Traumatol Arthrosc ; 29(4): 1269-1275, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32712684

RESUMO

PURPOSE: It is generally agreed that surgical treatment is warranted for acute posterior cruciate ligament (PCL) avulsion fracture with displacement. However, the amount of displacement that warrants surgical treatment has not been defined. The purpose of this study was to determine the optimal cut-off value for displacement of posterior cruciate ligament avulsion fracture in determining non-operative treatment and to compare the results of non-operative treatment in acute isolated PCL avulsion fractures with non-operative treatment of acute PCL injury. METHODS: Between 2007 and 2017, 30 consecutive patients with acute isolated PCL avulsion fractures and 70 consecutive patients with acute isolated PCL injuries, all of whom underwent non-operative treatment (cast immobilization with > 2 years of follow-up) were retrospectively analyzed. Clinical scores including the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score, as well as side-to-side differences on stress radiographs, were compared between the PCL avulsion fracture and PCL injury groups at the final follow-up. The failure rates of non-operative treatment were also compared. The predictive value of the amount of fracture displacement for successful non-operative treatment was calculated using area under the receiver operating characteristic curve (AUROC). The optimal cut-off of the amount of fracture displacement to determine non-operative treatment was based on the maximal sum of sensitivity and specificity. RESULTS: The two groups exhibited comparable clinical scores and mean side-to-side differences on stress radiographs. There were 5 (16.6%) failures of non-operative treatment in the PCL avulsion fracture group and 19 (27.1%) failures in the PCL injury group. (n.s) There was a significant positive correlation between the amount of initial avulsion fracture displacement and side-to-side difference in posterior stress radiographs at final follow up (P < 0.001). The optimal cut-off value for the amount of fracture displacement in PCL avulsion fracture to predict failure of non-operative treatment was 6.7 mm (AUROC = 1.0). CONCLUSION: The outcomes of non-operative treatment of acute isolated PCL avulsion fractures were comparable to those of patients with acute isolated PCL injuries. Acute PCL avulsion injuries with displacement of less than 6.7 mm should be considered for non-operative treatment. LEVEL OF EVIDENCE: IV.


Assuntos
Fratura Avulsão/patologia , Fratura Avulsão/terapia , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/patologia , Fraturas da Tíbia/patologia , Fraturas da Tíbia/terapia , Adulto , Tratamento Conservador , Feminino , Fixação de Fratura , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/cirurgia , Humanos , Escore de Lysholm para Joelho , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Fraturas da Tíbia/cirurgia , Falha de Tratamento
7.
Cartilage ; 13(1_suppl): 1092S-1104S, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-32476445

RESUMO

OBJECTIVE: To compare the efficacy and safety of costal chondrocyte-derived pellet-type autologous chondrocyte implantation (CCP-ACI) with microfracture (MFx) for repair of articular cartilage defects of the knee. DESIGN: Thirty subjects with an International Cartilage Repair Society (ICRS) grade 3 to 4 chondral defect (2-10 cm2 in area; ≤4 cm3 in volume) were randomized at a ratio of 2:1 (CCP-ACI:MFx). Twenty patients were allocated in the CCP-ACI group and 10 patients in the MFx group. CCP-ACI was performed by harvesting costal cartilage at least 4 weeks before surgery. Implantation was performed without any marrow stimulation. Efficacy and safety were assessed at weeks 8, 24, and 48 after surgery according to the magnetic resonance observation of cartilage repair tissue (MOCART) score and clinical outcomes. RESULTS: MOCART scores improved from baseline to 24 and 48 weeks postoperatively in both treatment groups. The improvement in MOCART scores in the CCP-ACI group was significantly greater than that in the MFx group at 24 and 48 weeks (39.1 vs 21.8 and 43.0 vs 24.8, respectively). The proportions of complete defect repair and complete integration were significantly higher in the CCP-ACI group than the MFx group at 48 weeks. Improvement in Lysholm score and KOOS subscores, including Function (Sports and Recreational Activity) and knee-related quality of life was significantly greater in the CCP-ACI group than the MFx group at 48 weeks (35.4 vs 31.5, 35.7 vs 28.5, and 27.9 vs 11.6, respectively). CONCLUSION: Treatment of cartilage defects with CCP-ACI yielded satisfactory cartilage tissue repair outcomes, with good structural integration with native cartilage tissue shown by magnetic resonance imaging at 24 and 48 weeks after surgery. LEVEL OF EVIDENCE: Level 1: Randomized controlled study.


Assuntos
Cartilagem Articular , Fraturas de Estresse , Cartilagem Articular/cirurgia , Condrócitos/transplante , Humanos , Estudos Prospectivos , Qualidade de Vida , Transplante Autólogo/métodos
8.
Am J Sports Med ; 48(11): 2718-2725, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32762564

RESUMO

BACKGROUND: Previous studies have reported patellofemoral cartilage degeneration and analyzed the factors affecting degeneration after open-wedge high tibial osteotomy (OWHTO). However, no studies have evaluated patellofemoral cartilage degeneration or examined the factors affecting degeneration after closed-wedge high tibial osteotomy (CWHTO). PURPOSE: To investigate and compare patellofemoral cartilage degeneration after CWHTO and OWHTO via arthroscopic evaluation and to analyze the factors affecting the degeneration. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 54 CWHTOs and 50 OWHTOs were performed with first-look arthroscopy between 2013 and 2017 at one institution. Hardware removal and second-look arthroscopy were performed, on average, 30.2 months after CWHTO and 26.8 months after OWHTO (P = .178). Patient characteristics did not differ significantly between the groups. Radiographically, the mechanical axis, posterior tibial slope, and modified Blackburne-Peel ratio were evaluated. Arthroscopically, the percentage of patient with patellofemoral cartilage degeneration was evaluated according to the International Cartilage Repair Society grading system. Logistic regression analysis was used to identify the factors affecting patellofemoral cartilage degeneration in terms of demographics and the change of mechanical axis (correction angle), tibial posterior slope angle, and modified Blackburne-Peel ratio. The Anterior Knee Pain Scale was used for clinical comparison between the patellofemoral degenerative and nondegenerative groups. RESULTS: No significant differences were observed in pre- and postoperative radiographic results between the CWHTO and OWHTO groups, except that the postoperative modified Blackburne-Peel ratio was significantly smaller among the OWHTOs. The percentage of patients with patellofemoral cartilage degeneration were 29.6% in the CWHTO group and 44% in the OWHTO group (P = .156) at second-look arthroscopy. The correction angle was the only significant factor affecting cartilage degeneration in the CWHTO group (odds ratio, 2.324; P = .013; cutoff value, 9.6°) and the OWHTO group (odds ratio, 1.440; P = .041; cutoff value, 10.1°). The postoperative Anterior Knee Pain Scale score was significantly lower in the patellofemoral degenerative group as compared with the nondegenerative group among the OWHTO group (81.6 vs 76.4; P = .039); among the CWHTO group, there was a lower tendency in the degenerative group, but this was without significance (81.1 vs 79.6; P = .367). CONCLUSION: Patellofemoral cartilage degeneration progressed after CWHTO and OWHTO with large alignment correction. High tibial osteotomy should be selected with careful consideration of the osteoarthritic status of the patellofemoral joint and required correction angle, regardless of applying a closed- or open-wedge technique.


Assuntos
Cartilagem , Osteoartrite do Joelho , Osteotomia , Cartilagem/patologia , Estudos de Coortes , Humanos , Articulação do Joelho , Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Estudos Retrospectivos , Tíbia
10.
Orthop J Sports Med ; 8(2): 2325967120904328, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32656288

RESUMO

BACKGROUND: Meniscal allograft transplant requires precise matching of the size of the allograft with the dimensions of the recipient knee. Estimation of contralateral meniscal size on magnetic resonance imaging (MRI) has been considered the ideal method to measure menisci before transplant. We questioned whether a contralateral intact meniscus with meniscal injury in the opposite compartment could be used as a reference to determine allograft size. Our question was derived from knowledge of meniscal injury influencing structures of the opposite compartment of the knee, including the meniscus. PURPOSE: To compare meniscal dimensions between intact meniscus with meniscal injury in the opposite compartment and normal meniscus with a normal opposite compartment. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: This observational, cross-sectional study was performed between 2016 and 2017. The control group consisted of 200 knees with normal medial and lateral menisci. The medial intact group consisted of 150 cases of medial intact meniscus with injured lateral meniscus, and the lateral intact group consisted of 150 cases of lateral intact meniscus with injured medial meniscus. All patients were male. Mean age, height, and weight did not differ among groups. We investigated meniscal dimensions on MRI, including anteroposterior and mediolateral lengths, distance between the anterior and posterior horns (AHPH distance), and widths and heights of the anterior and posterior horns and midbody. RESULTS: Most medial meniscal dimensions were similar between the control and medial intact groups, but the AHPH distance was smaller in the medial intact group (P < .001). Likewise, most lateral meniscal dimensions were similar between the control and lateral intact groups, but the AHPH distance was smaller in the lateral intact group (P < .001). CONCLUSION: Most dimensions of the intact meniscus with meniscal injury in the opposite compartment were similar to those of the normal meniscus with normal opposite compartment. Measuring the dimensions of the contralateral intact meniscus with meniscal injury in the opposite compartment on MRI can be an appropriate method to determine meniscal allograft size.

11.
Am J Sports Med ; 48(10): 2370-2375, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692971

RESUMO

BACKGROUND: The purpose of this study was to evaluate the clinical score and stability after meniscal allograft transplantation (MAT) after a previous anterior cruciate ligament (ACL) reconstruction. HYPOTHESIS: Medial MAT would improve anteroposterior stability, and lateral MAT would improve rotational stability. STUDY DESIGN: Cohort study; Level of evidence, 3. METHOD: We retrospectively investigated 31 cases of MAT after a previous total or nearly total meniscectomy and ACL reconstruction between November 2008 and June 2017. Cases were divided into medial (16 cases) and lateral (15 cases) MAT groups. The patients were assessed preoperatively and at the 2-year follow-up. RESULTS: In the medial MAT group, the International Knee Documentation Committee, Lysholm, Lysholm instability, and Tegner scores improved significantly at the 2-year follow-up, and there were also significant improvements in the anterior drawer, Lachman, and pivot-shift tests. In the lateral MAT group, the Lysholm and Tegner scores improved significantly at the 2-year follow-up, as had the anterior drawer and Lachman tests but not the pivot-shift test. The medial MAT group showed significant improvement in side-to-side difference on Telos stress radiographs, from 6.5 mm (preoperatively) to 3.6 mm (2-year follow-up) (P = .001), while the lateral MAT group showed no significant change. There was no progression of arthritis in either group. CONCLUSION: Medial MAT improved not only anteroposterior stability but also rotational stability in the meniscus-deficient ACL-reconstructed knee. Lateral MAT showed improvements in the anterior drawer and Lachman tests but not in the pivot-shift test or side-to-side difference on Telos stress radiographs in meniscus-deficient ACL-reconstructed knees. Instability and pain are indications for MAT in meniscus-deficient ACL-reconstructed knees.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Menisco/transplante , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho/cirurgia , Estudos Retrospectivos
12.
Arthroscopy ; 36(9): 2513-2522, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32554076

RESUMO

PURPOSE: To compare the clinical outcomes and failure rates of revision anterior cruciate ligament reconstruction (ACLR) between young and middle-aged surgery patients. METHODS: Patients who underwent revision ACLRs between January 2008 and June 2017 with a minimum 2-year follow-up were retrospectively evaluated. Patients were divided into 2 groups according to age: ≥40 years (group A) and <40 years (group B). Detailed patient demographic data, preoperative radiographic data, and concurrent meniscal and chondral lesion were reviewed. Clinical scores, laxity tests results, and graft failures were compared between groups at the final follow-up. RESULTS: Eighty-six patients (group A, n = 24, 46.6 ± 4.5 years; group B, n = 62, 26.2 ± 6.3 years) were included in this study. Demographic data showed that the time interval from primary to revision ACLR was longer in group A than in group B (96.2 ± 80.9 vs. 52.0 ± 42.1 months, P = .011). Group A had a higher prevalence of chondral defects of the trochlea (P = .016). No significant differences were identified in the prevalence and severity of meniscal lesions. At the final follow-up, all clinical scores were improved postoperatively but did not differ significantly between the groups. No significant differences were identified in side-to-side difference on Telos stress radiographs (group A, 6.3 ± 5.0 mm; group B, 5.6 ± 3.8 mm; P = .403) and graft failure rate (group A, 33.3%; group B, 30.6%; P = .358) at the final follow-up. CONCLUSIONS: The current study showed that the clinical outcomes of revision ACLRs in patients improved significantly in patients younger than 40 years and were comparable to those observed in patients older than 40 years at a minimum 2-year follow-up. LEVEL OF EVIDENCE: III.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Doenças das Cartilagens/cirurgia , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Arthroscopy ; 36(10): 2718-2727, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32554080

RESUMO

PURPOSE: To investigate the influence of medial and lateral posterior tibial slope (PTS) on long-term clinical outcomes and survivorship after anterior cruciate ligament (ACL) reconstruction using hamstring autografts. METHODS: A total of 232 patients (mean age, 28.2 ± 8.9 years) who underwent primary ACL reconstruction from October 2002 to July 2007 were retrospectively reviewed. Patients with multiple ligament reconstruction, total meniscectomy, contralateral knee surgery before ACL reconstruction, open growth plate, and less than 10-year follow-up were excluded in the study. The medial and lateral PTS were measured from preoperative magnetic resonance imaging. Based on Li et al.'s previous study, the patients were divided into 2 groups according to their medial PTS (≤5.6° vs >5.6°) and lateral PTS (≤3.8° vs >3.8°), respectively. Clinical outcomes (clinical scores, stability tests and failure rate) were compared between the groups at the last follow-up. Furthermore, survival analysis was performed using the Kaplan-Meier method. RESULTS: All clinical scores (International Knee Documentation Committee subjective, Lysholm, and Tegner activity scores) and stability tests (physical examinations and side-to-side difference in Telos stress radiographs) were insignificantly different between the 2 groups classified based on medial or lateral PTS. However, the failure rate was significantly higher in patients with medial PTS >5.6° (16.1% vs 5.1%, P = .01) or lateral PTS >3.8° (14.5% vs 4.7%; P = .01). The odds ratios of graft failure due to increased medial and lateral PTS were 3.18 (95% confidence interval, 1.22-8.28; P = .02) and 3.43 (95% confidence interval, 1.29-9.09; P = .01), respectively. In addition, the 10-year survivorship was significantly lower in patients with medial PTS >5.6° (83.9% vs 94.9%, P = .01) or lateral PTS >3.8° (85.5% vs 96.0%; P = .01). CONCLUSIONS: Increased medial (>5.6°) and lateral (>3.8°) PTS were associated with higher failure rate and lower survivorship at a minimum of 10-year follow-up after primary ACL reconstruction using hamstring autografts. LEVEL OF EVIDENCE: Level III, retrospective comparative trial.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Autoenxertos , Músculos Isquiossurais/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Articulação do Joelho/cirurgia , Escore de Lysholm para Joelho , Imageamento por Ressonância Magnética , Masculino , Meniscectomia , Pessoa de Meia-Idade , Período Pré-Operatório , Radiografia , Estudos Retrospectivos , Transplante Autólogo , Falha de Tratamento , Adulto Jovem
14.
Knee ; 27(3): 884-890, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563438

RESUMO

PURPOSE: This study was performed to analyze the effect of anterior bone plug positioning on clinical and radiological outcomes in patients undergoing medial meniscus allograft transplantation (M-MAT) following anterior cruciate ligament reconstruction (ACLR). METHODS: Data from 24 patients who underwent M-MAT following meniscectomy and ACLR from November 2008 to June 2017 were retrospectively investigated. Patients were divided into either the centrally positioned group (group C) or the medially positioned group (group M) based on the location of the anterior bone plug for M-MAT. Clinical and radiographic follow-up was performed at two years postoperatively. International Cartilage Repair Society (ICRS) grades of chondral lesion, graft extrusion, and meniscus signal intensity were evaluated by magnetic resonance imaging (MRI) at one year postoperatively. RESULTS: There were no significant differences in demographics including follow-up time of two years between the two groups. There were no significant differences in postoperative subjective International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores between groups. Furthermore, there were no significant differences in osteoarthritis progression or ICRS grade on MRI. However, group C showed significantly less absolute graft extrusion (P = .008) and relative graft extrusion (P < .0001) on one-year follow-up MRI, relative to group M. Meniscus signal intensity tended to be better in group C, although this difference was not statistically significant (P = .092). CONCLUSION: The centrally positioned group showed significantly less graft extrusion on MRI compared to the medially positioned group; however, there were no statistically significant differences in clinical outcomes between the two groups.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/transplante , Adulto , Aloenxertos , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia
15.
Orthop J Sports Med ; 8(5): 2325967120917660, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32490024

RESUMO

BACKGROUND: Several surgical methods have been developed for medial patellofemoral ligament reconstruction (MPFLR). However, the question of which patellar fixation method, suture anchor (SA) or transosseous tunnel (TO) fixation, achieves better overall outcomes remains to be answered. HYPOTHESIS: SA patellar fixation will present comparable clinical outcomes and a lower complication rate compared with TO patellar fixation for MPFLR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively reviewed the outcomes of 46 patients who underwent MPFLR with either TO fixation (n = 21; mean age, 24.4 ± 6.1 years) or SA fixation (n = 25; mean age, 24.1 ± 12.1 years) for the treatment of recurrent patellar dislocation. Clinical findings (International Knee Documentation Committee [IKDC] subjective score, Lysholm score, and Tegner activity score), radiological findings (congruence angle and patellar tilt angle), and complications (redislocation, patellar fracture, patellofemoral osteoarthritis progression, infection, and stiffness) were compared between the TO and SA groups at the 2-year follow-up visit. RESULTS: The mean postoperative IKDC subjective and Lysholm scores did not differ significantly between groups. However, postoperative Tegner activity scores were significantly higher in the TO group than in the SA group (TO, 5.8 ± 1.4; SA, 4.9 ± 1.2; P = .012). Congruence angle did not differ significantly between the groups (TO, -3.2 ± 22.8; SA, -7.6 ± 17.8; P = .464). Patellar tilt angle was lower in the TO group than in the SA group (TO, 10.5 ± 5.4; SA, 13.7 ± 2.8; P = .015). During the follow-up period, the TO group had 1 redislocation and 2 patellar fractures, whereas the SA group had no redislocations or fractures. Patellofemoral osteoarthritis progression was significantly higher in the TO group than in the SA group at the 2-year follow-up visit (TO, 9/21; SA, 2/25; P = .006). CONCLUSION: Both TO and SA patellar fixation methods for MPFLR showed improved clinical outcomes. When compared with TO fixation, SA fixation presented comparable clinical outcomes and a lower complication rate.

16.
Am J Sports Med ; 48(5): 1236-1245, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32125878

RESUMO

BACKGROUND: Because articular chondrocyte-based autologous chondrocyte implantations (ACIs) have restrictively restored articular cartilage defects, alternative cell sources as a new therapeutic option for cartilage repair have been introduced. PURPOSE: To assess whether implantation of a costal chondrocyte-derived pellet-type (CCP) ACI allows safe, functional, and structural restoration of full-thickness cartilage defects in the knee. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: In this first-in-human study, 7 patients with symptomatic, full-thickness cartilage lesions were enrolled. The chondrocytes isolated from the patients' costal cartilage were expanded, followed by 3-dimensional pellet culture to prepare the CCP-ACI. Implantation of the pellets was performed via minimal arthrotomy and secured with a fibrin sealant. Clinical scores, including the International Knee Documentation Committee (IKDC) subjective, Lysholm, and Tegner activity scores, were estimated preoperatively and at 1, 2, and 5 years postoperatively. High-resolution magnetic resonance imaging was also performed to evaluate cartilage repair as well as to calculate the MOCART (magnetic resonance observation of cartilage repair tissue) score. RESULTS: The costal chondrocytes of all patients formed homogeneous-sized pellets, which showed the characteristics of the hyaline cartilaginous tissue with lacunae-occupied chondrocytes surrounded by glycosaminoglycan and type II collagen-rich extracellular matrix. There were no treatment-related serious adverse events during the 5-year follow-up period. Significant improvements were seen in all clinical scores from preoperative baseline to the 5-year follow-up (IKDC subjective score, 34.67 to 75.86; Lysholm score, 34.00 to 85.33; Tegner activity score, 1.17 to 4.67; and MOCART score, 28.33 to 83.33). Two patients had complete defect filling on magnetic resonance imaging evaluation at 1 year. Moreover, at 5 years postoperatively, complete defect filling was observed in 4 patients, and hypertrophy or incomplete defect filling (50%-100%) was observed in 2 patients. CONCLUSION: The overall results of this clinical study suggest that CCP-ACI can emerge as a promising therapeutic option for articular cartilage repair with good clinical outcomes and structural regeneration and with stable results at midterm follow-up. REGISTRATION: NCT03517046 ( ClinicalTrials.gov identifier).


Assuntos
Cartilagem Articular , Condrócitos/transplante , Articulação do Joelho/cirurgia , Procedimentos Ortopédicos , Cartilagem Articular/cirurgia , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Transplante Autólogo , Resultado do Tratamento
17.
Arch Orthop Trauma Surg ; 140(3): 383-390, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31970504

RESUMO

INTRODUCTION: A flexible reamer system (FRS) for transportal anterior cruciate ligament reconstruction (ACLR) has been developed to overcome the technical challenges of a rigid reamer system. The purpose of this study was to investigate the safety and effectiveness of the two-portal technique using an FRS by evaluating femoral tunnel geometry. METHODS: This study included 30 patients (mean age 30 ± 12.1) who underwent transportal single-bundle ACLR. Operations were performed with the two-portal technique using an FRS. Three-dimensional computed tomography was performed for all patients 2 days after the operation. The femoral tunnel position, femoral graft bending angle, femoral tunnel length, and posterior wall breakage were evaluated. These radiologic outcomes were compared to previous literature-reported outcomes. RESULTS: The mean distances (measured as a percentage) from the posterior wall and the intercondylar notch roof to the femoral tunnel center were 29.6 ± 5.5% and 20.1 ± 6.7%, respectively. The femoral graft bending angle (108.4° ± 6.9°) was similar to that associated with the traditional transportal technique using a rigid reamer system, but it was less acute than that associated with the three-portal technique using an FRS. The femoral tunnel length (32.8 ± 4.5 mm) was also similar to the results of the traditional transportal technique using a rigid reamer system, but it was shorter than that of three-portal technique using an FRS. The prevalence of posterior wall breakage was as low as the reported outcomes of the outside-in technique (2 cases, 6.6%). CONCLUSIONS: The two-portal technique for transportal ACLR using an FRS can achieve comparable femoral graft bending angle and femoral tunnel length compared with the conventional three-portal technique using the rigid reamer system and had a low risk of posterior wall breakage. Therefore, the two-portal technique using the FRS can be considered a safe and effective method for transportal ACLR. LEVEL OF EVIDENCE: Retrospective case series; level of evidence, 4.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/instrumentação , Reconstrução do Ligamento Cruzado Anterior/métodos , Humanos , Estudos Retrospectivos , Adulto Jovem
18.
Arthroscopy ; 36(4): 1074-1082, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31948720

RESUMO

PURPOSE: To compare the clinical and magnetic resonance imaging (MRI) outcomes of meniscal repair using absorbable versus nonabsorbable sutures in patients undergoing concomitant anterior cruciate ligament reconstruction. METHODS: Data of 142 patients who underwent meniscal repair with concomitant anterior cruciate ligament reconstruction using either absorbable or nonabsorbable sutures for longitudinal meniscal tear were retrospectively reviewed. Inside-out suture technique was used for all meniscal repairs. Weight bearing and flexion (>90°) were allowed after 6 weeks postoperatively. Clinical evaluations were assessed by the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score preoperatively and at 2-year follow-up. MRI outcomes at 1-year follow-up were compared to identify the successful healing (complete or partial healing) rate and incidence of additional meniscal tears. Subgroup analysis was performed to evaluate the results of medial or lateral meniscus. RESULTS: Eighty patients underwent meniscal repair using absorbable sutures (mean age, 26.3 ± 11.9 years) and 62 patients with nonabsorbable sutures (mean age, 27.2 ± 10.0 years). There were no differences in zone and length of meniscal tears and stability tests between the groups. At a 2-year follow-up, all clinical scores had improved in both groups but did not differ significantly between the groups. Successful healing rate based on 1-year postoperative MRI was not significantly different between the absorbable and nonabsorbable sutures (93.7% vs 96.8%, P = .469). However, the absorbable sutures showed a lower additional tear incidence than the nonabsorbable sutures (2.5% vs 9.6%, P = .031). Subgroup analysis showed that the successful healing rate was not significantly different between the suture materials in both the medial and lateral menisci. CONCLUSIONS: The use of absorbable sutures leads to comparable healing rates to and lower incidence of additional tears than nonabsorbable sutures in patients undergoing meniscal repair with anterior cruciate ligament reconstruction. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic trial.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Artroscopia/métodos , Menisco/diagnóstico por imagem , Suturas , Lesões do Menisco Tibial/cirurgia , Adulto , Aloenxertos , Reconstrução do Ligamento Cruzado Anterior/métodos , Autoenxertos , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Tíbia/transplante
19.
Knee Surg Sports Traumatol Arthrosc ; 28(6): 1909-1918, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31384982

RESUMO

PURPOSE: This study aimed to compare patient demographics, associated lesions (concurrent meniscal and chondral injuries), and clinical outcomes between revision and re-revision anterior cruciate ligament reconstructions. METHODS: Patients who underwent revision or re-revision anterior cruciate ligament reconstruction between 2008 and 2016 with a minimum 2-year follow-up were retrospectively evaluated. Detailed patient demographic data, radiographic preoperative tunnel diameters, posterior tibia slope, and concurrent meniscal and chondral lesion were reviewed. Clinical scores and laxity tests' results were compared between the groups at the last follow-up. RESULTS: Eighty-two patients (mean age, 33.8 ± 9.9 years; revision group, n = 62; re-revision group, n = 20) were included. The re-revision group showed a higher grade for preoperative arthritis (P < 0.001); more severe preoperative bone defects of the femoral (13.8 ± 2.6 vs 11.7 ± 2.7 mm, P = 0.004) and tibial tunnels (14.6 ± 2.4 vs 13.0 ± 2.3 mm, P = 0.010); and a higher prevalence of subtotal medial meniscectomy (P = 0.008) and chondral defects of the medial (P = 0.006) and lateral femoral condyles (P < 0.001), patella (P = 0.040), and trochlea (P = 0.036). At the final follow-up, the clinical scores did not differ significantly between the groups. However, the re-revision group showed more instability in the anterior drawer (P = 0.001), Lachman (P < 0.001), and pivot-shift (P < 0.001) tests, while a side-to-side difference was observed on the Telos stress radiographs (7.1 ± 4.7 vs 4.9 ± 3.7 mm, P = 0.038). CONCLUSION: These findings showed that the patients who underwent re-revision had poor prognostic factors as compared with those who underwent revision anterior cruciate ligament reconstruction. Although the clinical scores did not differ significantly between the groups, the re-revision group showed more laxity at the 2-year follow-up. LEVEL OF EVIDENCE: Cohort study; IV.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Ligamento Cruzado Anterior/cirurgia , Articulação do Joelho/cirurgia , Reoperação/efeitos adversos , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Menisco/cirurgia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Patela/cirurgia , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
20.
Arthroscopy ; 35(11): 3099-3106, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31699263

RESUMO

PURPOSE: To investigate (1) the correlation between lateral posterior tibial slope (PTS) and clinical outcomes of lateral meniscus allograft transplantation (MAT) and (2) the difference of lateral PTS between the extrusion and nonextrusion groups or between the failure and nonfailure groups in lateral MAT. METHODS: Between January 2001 and February 2016, we retrospectively evaluated 61 patients (mean age, 29.1 ± 12.2 years) who underwent postoperative magnetic resonance imaging (MRI) and were followed for a minimum of 2 years after primary lateral MAT. The lateral PTS and graft extrusion in the coronal and sagittal planes were assessed by using MRI performed at 1 year postoperatively. Clinical scores and graft failure were evaluated at the last follow-up visit. The correlation between lateral PTS and clinical outcomes (clinical scores, graft extrusion) was analyzed. Lateral PTS was compared between the extrusion and nonextrusion groups and between the failure and nonfailure groups. RESULTS: Mean lateral PTS on MRI was 6.6° ± 3.1° (range, 0.8° to 15.7°). A significant correlation was not identified between lateral PTS and clinical outcomes (clinical scores, graft extrusion in the coronal and sagittal planes). A significant difference in lateral PTS was not identified between the extrusion and nonextrusion groups in the coronal (6.2° ± 2.5° vs 7.0° ± 3.4°, P = .400) and sagittal (anterior horn, 6.5° ± 2.3° vs 6.7° ± 3.7°, P = .988; posterior horn, 6.8° ± 3.5° vs 6.5° ± 2.7°, P = .771) planes. Moreover, a significant difference was not identified between the failure and nonfailure groups (7.5° ± 3.3° vs 6.4° ± 3.0°, P = .388). CONCLUSIONS: A significant correlation between lateral PTS and clinical or radiologic outcomes of lateral MAT was not identified. LEVEL OF EVIDENCE: Level IV, therapeutic case series with subgroup analysis.


Assuntos
Traumatismos do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Meniscos Tibiais/transplante , Procedimentos Ortopédicos/métodos , Adolescente , Adulto , Aloenxertos , Feminino , Humanos , Traumatismos do Joelho/diagnóstico , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...