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1.
Zhonghua Yi Xue Za Zhi ; 100(3): 187-191, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008284

RESUMO

Objective: To compare the clinical outcome of posterior cruciate ligament (PCL) retention type and PCL substituting type using Advance(®) Medial Pivot (AMP) inner-axis knee prosthesis. Methods: A retrospective analysis was conducted on the cases of total knee arthroplasty (TKA) with AMP prosthesis in the Affiliated Hospital of Qingdao University from January 2011 to September 2016. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), American Knee Society Knee Score (KSS) clinical scores, KSS functional scores and knee-joint range of motion (ROM) before and after TKA, and Forgotten Joint Scores (FJS) after TKA were collected. The matching group was obtained by 1∶1 propensity score matching (PSM). Results: Complete scoring data were obtained in 47 knees of CR group and 1 059 knees of CS group, there were statistical differences in age, sex, body mass index, preoperative WOMAC score, preoperative KSS function score and ROM between the two groups (all P<0.05), except preoperative KSS clinical score (25±4 and 24±7, respectively, t=0.82, P=0.41). With the PSM matching, 37 knees in CR group and 37 knees in CS group were obtained. No significant differences in preoperative indexes were found between the matching groups (all P>0.05). The WOMAC, KSS clinical scores, KSS functional scores and ROM after TKA in each matching group were all much better than those before TKA (all P<0.05); no statistical differences existed in WOMAC, KSS clinical scores, KSS functional scores, ROM and FJS after TKA between the matching groups (all P>0.05). One PCL injury was found in CR matching group after TKA. Incidence of complications in the CR matching group (8.1%) was higher than that in the CS matching group (2.7%), but there was no statistical difference (χ(2)=1.04, P=0.31). Conclusions: When using AMP prosthesis, both CR insert and CS insert can obtain good clinical results in TKA. The potential risk of PCL injury and other complications after CR TKA makes it necessary for surgeons to carefully select an appropriate type of prosthesis.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Desenho de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
2.
J Surg Oncol ; 121(3): 570-577, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31902136

RESUMO

BACKGROUND: Joint-preserving intercalary tumor resection can result in better proprioception and a more normal joint function after reconstruction. However, most reported reconstruction techniques are usually associated with frequent complications. Therefore, the approach of reconstruction following joint-preserving tumor resection warrants further study. METHODS: Between September 2016 and October 2018, 12 patients with metaphyseal malignant bone tumors around the knee joint were treated by joint-preserving intercalary resections with the aid of three-dimensional (3D)-printed osteotomy guide plates and reconstructions using 3D-printed intercalary prostheses. We assessed the accuracy of the resection by comparing the cross sections at the resection plane with 3D-printed matching surface of the prostheses. The functional outcomes, complications and oncological status were also evaluated. RESULTS: All patients were observed for 7 to 32 months with an average follow-up of 22.5 months. The achieved resection was accurate, with accurate matching between the residual bone and prosthesis. The mean MSTS score was 28 (range, 26-30). Superficial infection occurred in two patients. Local recurrence was observed in one patient, while pulmonary metastasis was identified in one patient. CONCLUSIONS: The personalized osteotomy guide plate and prosthesis based on 3D printing technique facilitate joint-preserving tumor resection and functional reconstruction. However, longer follow-up and larger sample size are required to clarify its long-term outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Doenças Ósseas/cirurgia , Neoplasias Ósseas/cirurgia , Articulação do Joelho/cirurgia , Tratamentos com Preservação do Órgão/métodos , Impressão Tridimensional/instrumentação , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Neoplasias Ósseas/patologia , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Prognóstico , Desenho de Prótese , Estudos Retrospectivos
3.
Orthop Clin North Am ; 51(1): 27-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739877

RESUMO

Distal femoral replacement (DFR) is a reasonable treatment option when used for select indications. In the setting of comminuted intra-articular distal femoral fractures, distal femoral arthroplasty should be considered in low-demand patients with poor bone quality. This article summarizes the existing literature plus the authors' personal experience with DFR use for distal femoral fractures of the native knee.


Assuntos
Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Fraturas Cominutivas/cirurgia , Articulação do Joelho/cirurgia , Idoso , Humanos , Fraturas Intra-Articulares/cirurgia , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Implantação de Prótese/métodos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Reimplante/métodos , Reimplante/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
4.
Orthop Clin North Am ; 51(1): 97-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739884

RESUMO

Osteochondritis dissecans (OCD) of the capitellum is a relatively rare condition, with a higher incidence in adolescents who participate in repetitive overhead sports. The surgical treatment approach for this uncommon problem has varied from microfracture, loose body removal, abrasion chrondroplasty, lesion fixation, osteochondral allograft transplantation surgery, and osteochondral autologous transplantation surgery. The purpose of this study is to present the authors' preferred surgical technique for the treatment of unstable OCD lesions of the capitellum with osteochondral autologous transplantation surgery using autograft from the ipsilateral knee.


Assuntos
Cartilagem Articular/cirurgia , Articulação do Cotovelo/cirurgia , Úmero/cirurgia , Osteocondrite Dissecante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/patologia , Feminino , Fraturas de Estresse , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Úmero/transplante , Incidência , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/epidemiologia , Osteocondrite Dissecante/patologia , Radiografia , Esportes , Transplante Autólogo/métodos , Resultado do Tratamento
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1521-1526, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823551

RESUMO

Objective: To investigate the effectiveness of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children. Methods: A retrospective analysis was made on 12 children (12 knees) with severe knee pathological flexion contracture deformity who were treated with internal and external lysis and Ilizarov external fixation between August 2012 and January 2017. There were 9 boys and 3 girls with an age of 3-12 years (mean, 8.4 years). There were 8 cases of tuberculosis, 3 cases of haemophilia A, and 1 case of residual deformity after extensive hemangioma drug injection. The disease duration ranged from 5 months to 4 years, with an average of 20.3 months. The degree of knee contracture was (67.42±23.30)°, and the range of motion of knee was (38.33±14.98)°. The preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score was 78.42±15.57. The complication was observed after operation, and the degree of knee contracture, range of motion, and WOMAC score at 3 months and 1 year after operation were recorded and compared with those before operation. Results: The operations completed successfully in all children. All the 12 cases were followed up 9-24 months (mean, 14.5 months). All incisions healed by first intention after operation. The knee function of all children improved significantly and the weight-bearing walking function of the lower limbs restored. The degree of knee contracture, range of motion, and WOMAC score were significantly improved at 3 months and 1 year after operation (P<0.05), but there was no significant difference between 3 months and 1 year after operation (P>0.05). Conclusion: For severe knee pathological flexion contracture deformity in children, application of internal and external lysis combined with Ilizarov external fixation has advantages, such as small trauma, rapid recovery, and early postoperative knee function training, and good effectiveness.


Assuntos
Fixadores Externos , Articulação do Joelho , Criança , Contratura , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(50): e18356, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852139

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is accompanied by moderate to severe postoperative pain. Multimodal analgesia, such as femoral nerve block, periarticular infiltration analgesia (PIA), and patient-controlled intravenous analgesia, have been used for postoperative analgesia. Recently, randomized controlled trials have compared the efficacy of the adductor canal block (ACB) and the PIA in patients undergoing TKA. However, there is no definite answer as to the efficacy and safety of the ACB compared with the PIA. METHOD: Randomized controlled trials about relevant studies were searched from PubMed (1996 to May 2019), Embase (1980 to May 2019), and Cochrane Library (CENTRAL, May 2019). Five studies which compared the ACB with the PIA methods were included in our meta-analysis. RESULTS: Five studies containing 413 patients met the inclusion criteria. There were no significant differences between the ACB and the PIA group in visual analog scale (VAS) score at rest (P = .14) and movement (P = .18), quadriceps muscle strength (P = .95), complications (P = .78), length of stay (LOS) (P = .54), and time up and go (TUG) test (P = .09), While patients in the ACB group had less equivalent morphine consumption (P < .05) compared with the PIA group. CONCLUSIONS: Our pooled data indicated the ACB group reduced the equivalent morphine consumption compared with the PIA group, with no statistically significant differences in the VAS score, quadriceps muscle strength, TUG test, complications, and LOS.


Assuntos
Analgesia/métodos , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Anestesia por Condução/métodos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Força Muscular/efeitos dos fármacos , Dor Pós-Operatória/etiologia , Músculo Quadríceps/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Coxa da Perna , Resultado do Tratamento
7.
Rev Port Cir Cardiotorac Vasc ; 26(3): 235-238, 2019.
Artigo em Português | MEDLINE | ID: mdl-31734979

RESUMO

Synovial hemangioma is a rare nonneoplastic vascular malformation of the synovial membrane described by Bouchut in 1856. Fewer than 200 cases have been described in the literature, corresponding to 1% of all hemangiomas. The presenting symptoms are often non-specific, which often leads to a delay in diagnosis of many years and can result in arthropathy if left undetected. The early diagnosis of a synovial haemangioma is important as recurrent haemarthrosis may lead to irreversible joint damage and chronic inflammatory synovitis. In practice, there is no consensus on the best treatment of synovial hemangiomas in children. Total resection of the tumor can be performed by arthroscopy in localized forms and for small lesions. Open resection associated with synovectomy is necessary when the hemangioma occupies most of synovial membrane.


Assuntos
Hemangioma/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Membrana Sinovial/diagnóstico por imagem , Criança , Hemangioma/cirurgia , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Sinovectomia
8.
Medicine (Baltimore) ; 98(40): e17133, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577705

RESUMO

BACKGROUND: This study aimed to investigate the efficacy and safety between early preoperative administration and postoperative administration of oral meloxicam in patients underwent arthroscopic knee surgery (AKS). METHODS: Totally 296 patients with the intention to undergo AKS were recruited and randomly allocated as 1:1 ratio into early preoperative analgesia (EPA) group and postoperative analgesia (POA) group. Pain visual analog scale (VAS) score and severity (at rest and at flexion), patient global assessment (PGA) score, the consumption of rescue analgesia (pethidine), and adverse events were evaluated during the perioperation. And knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were assessed at baseline and at 3 months after AKS. RESULTS: Both pain VAS score and severity (at rest and at flexion) were decreased at 4, 8, and 12 hours, but similar at -24, -2, 24, 36, and 48 hours after AKS in EPA group compared with POA group. Besides, PGA score was lower at 4, 8, 12, and 24 hours, but similar at -24, -2, 36, and 48 hours after AKS in EPA group compared with POA group. As to the consumption of pethidine in perioperative period, it was decreased in EPA group compared with POA group. No difference was observed in knee ROM, IKDC score, Lysholm score, and adverse effects between EPA group and POA group. CONCLUSION: Early preoperative administration of meloxicam was a superior approach in pain control compared with postoperative administration in treating patients underwent AKS.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artroscopia/efeitos adversos , Articulação do Joelho/cirurgia , Meloxicam/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Humanos , Masculino , Meloxicam/administração & dosagem , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Período Pré-Operatório , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Tempo
9.
Chirurgia (Bucur) ; 114(4): 437-442, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511129

RESUMO

Total knee arthroplasty (TKA) is a key surgical procedure for the treatment of severe knee osteoarthritis. Although TKA has very good clinical results, revision knee arthroplasty can sometimes be necessary due to prosthetic components malalignment which leads to early polyethylene wear, instability and aseptic loosening. Currently, the revision risk of TKA at ten years is 5%. The finite element method (FEM) is a numerical technique which allows the modelling of complex geometry and system of loads. This method is a necessity in the field of orthopedics to simulate or predict the conditions that could lead to complications or failure and react to increase the longevity of TKA. The aim of this literature review is to highlight the relevance of using FEM along with TKA. Specialty literature research shows that the use of finite element analysis is widely spread in total knee arthroplasty. It is used to compare insert materials in order to obtain the most effective method and thus decrease the wear rate. Using simulated angles, forces and stress, FEM tests different malalignment conditions in order to apply these results in the pre-operative planning and avoid a possible TKA failure. The finite element analysis has a great potential of further refining TKA alignment outcome and is very important for the analysis of knee biomechanics under different loads. FEM is used to reduce the incidence of TKA revision and to improve patients satisfaction after TKA.


Assuntos
Artroplastia do Joelho , Análise de Elementos Finitos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Falha de Prótese , Reoperação
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1077-1082, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512446

RESUMO

Objective: To investigate the effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction via transtibial (TT) and transportal (TP) techniques after 10 years follow-up. Methods: A clinical data of 103 patients who underwent arthroscopic ACL reconstruction with a single bundle of autologous hamstring tendon between March 2006 and March 2009 was retrospectively analyzed, among which 57 patients were reconstructed with TT technique (TT group) and 46 patients were reconstructed with TP technique (TP group). There was no significant difference in gender, age, cause of injury, interval between injury and operation, preoperative pivot shift test, preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, and KT-2000 side-to-side difference (SSD) between the two groups ( P>0.05). At 10 years after operation, Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee; KT-2000 SSD was used to measure tibial anterior displacement; IKDC score and Lysholm score were used to evaluate knee function; MRI examination was performed to observe graft healing and measure coronal inclination angles of the tibia and femoral tunnels. The rate of return to sports was also calculated. Results: The incisions healed by first intention in the two groups, and no early complication occurred after operation. All patients were followed up 10-13 years, with an average of 11.5 years. During the follow-up period, there was no limitation of knee extension and flexion, no discomfort of donor site or graft failure in either group. MRI examination showed that the graft healed well. The IKDC score, Lysholm score, and KT-2000 SSD in the two groups were significantly improved after 10 years ( P<0.05), and there was no significant difference between the two groups at 10 years after operation ( P>0.05). There were significant differences in coronal inclination angles of femoral tunnel and tibial tunnel between the two groups ( P<0.05). There was no significant difference in Lachman test and pivot shift test between the two groups ( P>0.05). The rate of return to sports of patients was 61.40% (35/57) in TT group and 63.04% (29/46) in TP group, showing no significant difference between the two groups ( χ 2=0.29, P=0.87). Conclusion: TT and TP techniques can both achieve good effectiveness in ACL reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/métodos , Humanos , Articulação do Joelho/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1083-1087, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512447

RESUMO

Objective: To evaluate the effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction via tibial tunnel made by three-portal technique. Methods: Between July 2015 and December 2016, 45 patients with ACL ruptures were treated. There were 29 males and 16 females with an average age of 27.5 years (range, 18-42 years). There were 18 cases in the left side and 27 cases in the right side. There were 28 cases of sports injuries, 13 cases of traffic accidents, and 4 cases of other injuries. The average time from injury to operation was 21.6 days (range, 5-36 days). There were 25 cases of simple ACL injury and 20 cases of ACL complicated with medial collateral ligament, medial meniscus or lateral meniscus injuries. The Lachman tests of all patients were positive. The pivot shift tests of all patients were positive with grade Ⅰ in 27 cases, grade Ⅱ in 13 cases, and grade Ⅲ in 5 cases. The preoperative International Knee Documentation Committee (IKDC) score was 70.28±6.12, and the Lysholm score was 63.27±7.62. All patients underwent arthroscopic single-bundle ACL reconstruction, and the tibial tunnel was created through the anterolateral, high anteromedial, and additional low anteromedial approaches. Results: All incisions healed by the first intention. All patients were followed up 18.7 months on average (range, 14-32 months). The three-dimensional CT at 3 days after operation showed that the tibial tunnel positions were accurate and the middle points were located in the 36.81%-43.35% of tibial plateau on sagittal plane. The medial borders of the tibial tunnel on coronal plane were located at the lateral to the medial eminence of the tibia. There were 3 cases of thrombosis of intermuscular vein of lower limbs, 2 cases of joint swelling and pain, and 3 cases of stiffness of knee joint. At last follow-up, the Lachman tests of all patients were negative and the pivot shift test were negative in 42 patients and positive in 3 patients (grade Ⅰ). The IKDC score (92.59±4.36) and Lysholm score (93.15±5.53) were significantly higher than preoperative scores ( t=11.35, P=0.00; t=12.27, P=0.00). Conclusion: Arthroscopic ACL reconstruction via tibial tunnel made by three-portal technique, which was simple and accurate, can obtain the satisfactory function of the knee in the early stage after operation.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Tíbia , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1121-1126, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512453

RESUMO

Objective: To compare the effectiveness of the intermittent suture and the cosmetic suture in total knee arthroplasty (TKA). Methods: A clinical data of 48 patients with knee osteoarthritis, who underwent initial TKA between January 2017 and April 2018, was retrospectively analyzed. Among them, 23 patients underwent intermittent suture (group A) and 25 patients underwent cosmetic suture (group B). There was no significant difference in gender, age, body mass index, disease duration, degrees of varus and valgus deformities, knee society score (KSS), visual analogue scale (VAS) score, and levels of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in serum before operation between the two groups ( P>0.05). KSS scores at 1 and 6 months after operation were used to assess the knee function. VAS scores at 1, 3, and 5 days after operation were used to assess the pain degree of knee. Levels of IL-6, PCT, CRP, and ESR in serum at 1 day and 1 month after operation were recorded to evaluate the risk of periprosthetic infection. Likert score at 6 months after operation was used to evaluate the satisfaction of incision. The hospitalization time after operation was also recorded. Results: All patients were followed up 7- 17 months (mean, 11.3 months). There was no significant difference in hospitalization time after operation between two groups ( t=-1.907, P=0.063). The Likert score in group A was significantly lower than that in group B ( t=-2.196, P=0.033). The VAS score, KSS clinical score and KSS functional score at different time points after operation were significantly better than those before operation in two groups ( P<0.05). The VAS score at 5 days after operation was better than that at 1 day after operation in two groups, and the KSS clinical score and KSS functional score at 6 months after operation were better than those at 1 month after operation in two groups, all showing significant differences ( P<0.05). The VAS scores at 3 and 5 days after operation were significantly lower in group B than in group A ( P<0.05), and there was no significant difference in VAS score and KSS scores between two groups at other time points after operation ( P>0.05). There was no significant difference in the levels of IL-6, PCT, CRP, and ESR between the two groups at different time points after operation ( P>0.05). Conclusion: Cosmetic suture is superior to intermittent suture in incision appearance and pain management, but there is no significant difference in short-term joint function and risk of periprosthetic infection after TKA.


Assuntos
Artroplastia do Joelho , Articulação do Joelho , Osteoartrite do Joelho , Suturas , Artroplastia do Joelho/métodos , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Suturas/normas , Resultado do Tratamento
13.
Clin Orthop Surg ; 11(3): 282-290, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475048

RESUMO

Background: Although microfracture is widely accepted as an effective treatment option for knee chondral lesions, little is known about the deterioration of clinical outcomes and radiological progression in middle-aged patients. Therefore, this study was conducted to evaluate the clinical and radiological changes after microfracture of knee chondral lesions in middle-aged Asian patients. Methods: A total of 71 patients were included in the study. They were between the ages of 40 and 60 years and underwent arthroscopic microfracture for localized full-thickness cartilage defects of the knee from January 2000 to September 2015. The recovery status of chondral lesions was assessed by using the magnetic resonance observation of cartilage repair tissue (MOCART) score in postoperative magnetic resonance imaging (MRI). Clinical and radiological results were reviewed, and survival rate with conversion to arthroplasty or osteotomy as an end point was evaluated. Results: The mean age of the patients at surgery was 51.3 ± 4.7 years (range, 40 to 60 years), and the mean follow-up period was 7.2 ± 2.6 years (range, 1.0 to 17.4 years). The MOCART scores of 32 patients at mean postoperative 2.1 years showed three cases (9%) of full recovery, two cases (7%) of hyperplastic recovery, 23 cases (70%) with more than 50% filling, and four cases (14%) with less than 50% filling. Clinical scores improved significantly at 1 year after surgery (p < 0.05); however, the scores deteriorated over time after postoperative 1 year, and the mean values reached preoperative levels at postoperative 10 years. Significant radiological progression of arthritis (Kellgren-Lawrence grade) was observed at 5 years after surgery. Four patients underwent total knee arthroplasty during follow-up. Conclusions: Most patients showed more than 50% of defect filling at 2 years after surgery on MRI. Clinical results of microfracture of knee chondral lesion showed the best improvement at postoperative 1 year but gradually worsened thereafter until postoperative 10 years. Radiological progression of arthritis was observed from 5 years after surgery.


Assuntos
Artroplastia Subcondral , Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Adulto , Grupo com Ancestrais do Continente Asiático , Doenças das Cartilagens/diagnóstico , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/etnologia , Cartilagem Articular/diagnóstico por imagem , Progressão da Doença , Humanos , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem
14.
J Pediatr Orthop ; 39(9): e668-e673, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503222

RESUMO

BACKGROUND: Anterior tibial spine fractures (ATSF) in the skeletally immature parallel anterior cruciate ligament (ACL) tears in adult patients, yet these injuries are generally regarded as mutually exclusive. Biomechanical analysis suggests that intrinsic ACL damage occurs during ATSF, and long-term clinical studies demonstrate residual anteroposterior knee laxity following ATSF. We aim to describe prevalence, demographics, and characteristics of pediatric patients who sustained ATSF with concomitant ACL injury. METHODS: We included 129 patients with ATSF over a 16-year period. Age, sex, injury mechanism, ATSF type, magnetic resonance imaging (MRI) evaluation, treatment modality, ACL injury, and concomitant meniscal/chondral injuries were analyzed. Concurrent ACL injury was confirmed either from MRI or intraoperatively. RESULTS: Nineteen percent (n=25) of ATSF patients had concomitant ACL injury, with ACL injury significantly more likely in type II or type III ATSF compared with type I ATSF (P=0.03). Patients with combined ATSF/ACL injury were significantly older (P=0.02) and more likely to be male (P=0.01). Mechanism of ATSF injury was not associated with ACL injury (P=0.83). Preoperative MRI had low sensitivity (0.09) for recognizing ACL injury at the time of ATSF relative to intraoperative assessment. Half of ATSF/ACL-injured patients had additional meniscal or chondral injury, with meniscal repair or debridement required in 37.5% of the type II ATSF/ACL injury. CONCLUSIONS: There are demographic characteristics, such as age (older) and sex (male), associated with a higher risk of concomitant ACL injury at the time of ATSF. Type II and type III ATSF patterns had a higher prevalence of ACL injury. MRI failed to correctly identify ACL injury at the time of ATSF. Concomitant ACL injury at the time of ATSF is highly prevalent in the skeletally immature, occurring in 19.4% of patients with ATSF. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Fraturas da Tíbia/complicações , Adolescente , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Criança , Estudos de Coortes , Colorado/epidemiologia , Desbridamento , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Prevalência , Estudos Retrospectivos , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/epidemiologia , Lesões do Menisco Tibial/complicações
15.
Bone Joint J ; 101-B(9): 1071-1080, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474146

RESUMO

AIMS: The aim of this study was to determine the long-term risk of undergoing knee arthroplasty in a cohort of patients with meniscal tears who had undergone arthroscopic partial meniscectomy (APM). PATIENTS AND METHODS: A retrospective national cohort of patients with a history of isolated APM was identified over a 20-year period. Patients with prior surgery to the same knee were excluded. The primary outcome was knee arthroplasty. Hazard ratios (HRs) were adjusted by patient age, sex, year of APM, Charlson comorbidity index, regional deprivation, rurality, and ethnicity. Risk of arthroplasty in the index knee was compared with the patient's contralateral knee (with vs without a history of APM). A total of 834 393 patients were included (mean age 50 years; 37% female). RESULTS: Of those with at least 15 years of follow-up, 13.49% (16 256/120 493; 95% confidence interval (CI) 13.30 to 13.69) underwent subsequent arthroplasty within this time. In women, 22.07% (95% CI 21.64 to 22.51) underwent arthroplasty within 15 years compared with 9.91% of men (95% CI 9.71 to 10.12), corresponding to a risk ratio (RR) of 2.23 (95% CI 2.16 to 2.29). Relative to the general population, patients with a history of APM were over ten times more likely (RR 10.27; 95% CI 10.07 to 10.47) to undergo arthroplasty rising to almost 40 times more likely (RR 39.62; 95% CI 27.68 to 56.70) at a younger age (30 to 39 years). In patients with a history of APM in only one knee, the risk of arthroplasty in that knee was greatly elevated in comparison with the contralateral knee (no APM; HR 2.99; 95% CI 2.95 to 3.02). CONCLUSION: Patients developing a meniscal tear undergoing APM are at greater risk of knee arthroplasty than the general population. This risk is three-times greater in the patient's affected knee than in the contralateral knee. Women in the cohort were at double the risk of progressing to knee arthroplasty compared with men. These important new reference data will inform shared decision making and enhance approaches to treatment, prevention, and clinical surveillance. Cite this article: Bone Joint J 2019;101-B:1071-1080.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Osteoartrite do Joelho/epidemiologia , Lesões do Menisco Tibial/epidemiologia , Adulto , Fatores Etários , Idoso , Progressão da Doença , Inglaterra/epidemiologia , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Risco , Fatores de Risco , Fatores Sexuais , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/cirurgia
16.
Bone Joint J ; 101-B(9): 1138-1143, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474148

RESUMO

AIMS: The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches. PATIENTS AND METHODS: A total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test - Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain. RESULTS: A total of 53 patients were randomized to a suprapatellar approach and 42 to an infrapatellar approach. AWT-K results showed a greater mean proportion of weight transmitted through the injured leg compared with the uninjured leg when kneeling in the suprapatellar group compared with the infrapatellar group at all timepoints at all follow-up visits. This reached significance at four months for all timepoints except 30 seconds. It also reached significance at six months at 0 seconds, and for one year at 60 seconds. CONCLUSION: The suprapatellar surgical approach for antegrade tibial nailing is associated with less anterior knee pain postoperatively compared with the infrapatellar approach Cite this article: Bone Joint J 2019;101-B:1138-1143.


Assuntos
Artralgia/prevenção & controle , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Dor Pós-Operatória/prevenção & controle , Patela/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Artralgia/etiologia , Pinos Ortopédicos/efeitos adversos , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Medidas de Resultados Relatados pelo Paciente , Tíbia/lesões , Tíbia/cirurgia , Adulto Jovem
17.
Knee ; 26(5): 1010-1019, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31402095

RESUMO

BACKGROUND: Determine whether the tibiofemoral motion and electromyographic activity of the knee differs in patients with a medial pivot implant, compared to those with cruciate-retaining and posterior-stabilised designs, during knee extension after Total Knee Arthroplasty (TKA). METHODS: An observational study was conducted on a cohort of patients that had undergone TKA for a minimum of 12 months prior. Three matched groups (n = 18) were categorised based on implant type: medial-pivot (MP), posterior-stabilised (PS) and cruciate-retaining (CR). Kinematics, with motion analysis (Vicon, USA) and surface electromyography (Delsys, USA) were assessed during step-ascent and walking tasks. RESULTS: All groups displayed a similar amount of knee extension in both tasks. They also paradoxically produced an average mean internal rotation movement during knee extension in both the step-ascent and walking tasks. The only significant difference was found in the step-ascent task, in which the MP group produced a larger absolute amount of rotation than the CR implant group (P = 0.007), but neither group differed from the PS implant group. The groups did not differ in rotation during the walking task (P > 0.05). The MP group displayed significantly (P < 0.01) greater knee extensor activation during the step-ascent than the PS group. CONCLUSION: The MP design was only significantly different to another implant design for the step-ascent task. Patients with either knee implant types were not strictly limited to producing the traditional "screw-home" mechanism, defined by external rotation during extension. Furthermore, comparison with the non-implant contralateral limb suggested that rotation is not necessarily dictated by implant design.


Assuntos
Artroplastia do Joelho/instrumentação , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Feminino , Fêmur/fisiopatologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento , Desenho de Prótese , Amplitude de Movimento Articular , Rotação , Tíbia/fisiopatologia , Tíbia/cirurgia , Caminhada
18.
Arch Orthop Trauma Surg ; 139(10): 1455-1460, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31414170

RESUMO

BACKGROUND: Anteroposterior (AP) whole leg radiographs (WLR) in the standing position for assessment of the mechanical leg axis are generally performed preoperatively for the planning of total knee replacement (TKR) and postoperatively to assess the leg axis. The objective of the present study was to investigate whether, if preoperative WLR are available, postoperative AP standard knee radiographs in the standing position are sufficient for calculating the mechanical leg axis. METHODS: In the present prospective study, the mechanical and the anatomical leg axes were determined on the basis of WLR from 104 patients prior to implantation of a TKR and the difference was calculated. Twelve weeks postoperatively, standing long AP radiographs and WLR were prepared. In addition, the mechanical axis was calculated by adding the preoperative difference between the anatomical and mechanical axis to the anatomical axis from the postoperative AP radiographs. Accuracy, bias and level of agreement for calculated relative to measured mechanical alignment were determined. RESULTS: Mean accuracy of calculated mechanical alignment was 0.5° ± 0.4°, and mean bias was 0.0° ± 0.6° (p = 1.00). Bland-Altman analysis revealed a 95% upper and lower level of agreement of - 1.3° and 1.3°, respectively. CONCLUSION: A preoperative WLR and a postoperative long AP knee standard radiograph are sufficient to determine the mechanical leg axis after TKR. If these are available, it is possible to do without WLR after TKR, particularly since they involve higher radiation exposure, are time-consuming, and are also prone to errors in the first postoperative weeks. LEVEL OF EVIDENCE: II diagnostic study.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/diagnóstico por imagem , Ossos da Perna/diagnóstico por imagem , Radiografia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos
19.
Arch Orthop Trauma Surg ; 139(11): 1617-1624, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31372713

RESUMO

PURPOSE: To identify the efficacy of isolated trochleoplasty (TP) as an independent treatment for severe trochlear dysplasia compared with TP combined with medial patellofemoral ligament (MPFL) reconstruction. METHODS: Search of current literature using terms (trochleoplasty and medial patellofemoral ligament reconstruction) in the electronic search engines PubMed and Embase, and Medline databases was performed on February 25, 2018, and it yielded 515 abstracts for review. At the end of the search, six articles met specific inclusion criteria and were included in this review. Means were calculated for population size, age and follow-up time. The Kujala score was analyzed as the primary clinical outcome parameter in the meta-analysis. Pooled estimates were calculated for postoperative complications. RESULTS: Six studies with a total of 192 knees (168 patients) were included in this analysis. The isolated TP group comprised of 3 articles with a total of 111 knees, and the TP combined with MPFL group comprised of 3 articles with a total of 81 knees. At the final follow-up, the preoperative Kujala score increased significantly by 21.39 (95% CI 18.94, 23.84; P < 0.00001) points in the isolated TP group and by 24.91 (95% CI 15.47, 34.36; P < 0.00001) points in the TP combined with MPFL group. The rates of subjective patellar instability including subluxation and anterior knee pain were 1.03% and8.45% respectively. Meanwhile, the rate of objective patellar redislocation was 2.06% in isolated TP group and 0% in TP combined with MFPL group. A total of 8.24% returned to the operating room for additional procedures in the isolated TP group and 7.04% in the TP combined with MPFL group. CONCLUSION: Trochleoplasty is a useful and reliable surgical technique to improve patellofemoral instability in patients with a dysplastic trochlea. However, it as isolated treatment for patients has lower outcome and higher residual instability compared with combined MPFL and trochleoplasty.


Assuntos
Instabilidade Articular , Articulação do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Procedimentos Ortopédicos , Luxação Patelar/cirurgia , Humanos , Instabilidade Articular/epidemiologia , Instabilidade Articular/etiologia , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos
20.
Knee ; 26(5): 962-968, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31431338

RESUMO

BACKGROUND: To assess the risk of tunnel collision in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. METHODS: Three-dimensional (3D) CT reconstructions of 32 knees after transtibial (TT) (N = 16) or anteromedial portal (AMP) (N = 16) ACL reconstruction were used to simulate potential tunnel collision of the femoral ACL tunnel if combined with a virtual ALL reconstruction. The minimal distance between tunnels, the ALL tunnel length, and the lateral femoral condyle (LFC) width were measured. Moreover, the relationship between the ALL tunnel and the intercondylar notch, trochlear groove and posterior femoral cortex was determined. RESULTS: The highest rate of tunnel collision (81%) was observed when the ALL tunnel was aimed at 20° in the coronal plane and 0° in the axial plane. However, by aiming the ALL tunnel at 0° coronal and 40° axial angulation, collision was avoided in all patients and no violation of the trochlea was observed. Tunnel collision rate was significantly higher (P = 0.002) when the ACL tunnel was drilled by the AMP technique. CONCLUSIONS: Risk of tunnel collision was significantly increased when the tunnel was drilled at 0° in the axial plane. Tunnel collision was avoided by aiming the ALL tunnel 40° anteriorly and perpendicular to the anatomical axis of the femur. A more horizontal orientation of the ACL with the AMP technique is a risk factor for tunnel conflicts. CLINICAL RELEVANCE: ALL tunnel orientation needs to be adjusted to avoid tunnel conflicts in combined ACL-ALL reconstructions.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Fêmur/cirurgia , Ligamentos Articulares/cirurgia , Adulto , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroplastia/efeitos adversos , Artroplastia/métodos , Cadáver , Epífises , Feminino , Fêmur/diagnóstico por imagem , Humanos , Imagem Tridimensional , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamentos Articulares/lesões , Masculino , Orientação Espacial , Medição de Risco , Fatores de Risco , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
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