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1.
Acta Chir Orthop Traumatol Cech ; 87(5): 356-359, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-33146605

RESUMO

The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Artroscopia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1376-1381, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191693

RESUMO

Objective: To evaluate the performance, safety, and precision of the Yuanhua robotic-assisted total knee arthroplasty system (YUANHUA-TKA) through animal experiments, which will provide reference data for human clinical trials. Methods: Six 18-month-old goats, weighing 30-35 kg, were used in this study. The experimental study was divided into two parts: the preoperative planning and intraoperative bone resection. CT scans of the goats' lower extremities were firstly performed before the experiments. Then the CT scans were segmented to generate the femoral and tibial three-dimensional (3D) models in the YUANHUA-TKA system. The volumes and angles of each resection plane on the femur and tibia were planned. The bone resection was finally implemented under the assistance of the YUANHUA-TKA system. After completing all bone resections, the lower extremities of each goat were taken to have CT scans. By comparing the femoral and tibial 3D models before and after the experiments, the actual bone resection volumes and angles were calculated and compared with the preoperative values. Results: During the experiments, no abnormal bleeding was found; the YUANHUA-TKA system ran smoothly and stably and was able to stop moving and keep the osteotomy in the safe zone all the time. After the experiment, the resection planes were observed immediately and found to be quite flat. There was no significant difference between the planned and actual osteotomy thickness and osteotomy angle ( P>0.05); the error of the osteotomy thickness was less than 1 mm, and the error of the osteotomy angle was less than 2°. Conclusion: The YUANHUA-TKA system can assist the surgeons to perform osteotomy following the planned thickness and angle values. It is expected to assist surgeons to implement more accurate and efficient osteotomy in the future clinical applications.


Assuntos
Experimentação Animal , Artroplastia do Joelho , Osteoartrite do Joelho , Robótica , Cirurgia Assistida por Computador , Animais , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
3.
Medicine (Baltimore) ; 99(44): e22984, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126373

RESUMO

The objective of this study was to examine the relationship between cartilage degeneration early after partial medial meniscectomy and abnormal alignment in the lower extremity.The subjects were 34 patients (37 knees) with medial meniscal tear who underwent arthroscopic partial meniscectomy. MRI was performed before and 6 months after surgery. T2 mapping images in sagittal sections of medial femoral condyle were produced and 10 regions of interest were set at intervals of 10° in the articular cartilage in the femur. Subjects with an increase in T2 of ≥6% at a flexion angle of 30° were assigned to the degeneration group. Patient background, hip-knee-ankle (HKA) angle, and total resection of meniscal segments were compared between this group and the other patients to identify factors involved in degeneration of articular cartilage.T2 values 6 months after surgery in 3 ROIs at flexion angles of 30° to 50° were significantly longer than those before surgery. The preoperative HKA angle was significantly higher in the degeneration group. T2 values in articular cartilage of the femoral condyle increased earlier after meniscectomy with abnormal alignment in the lower extremity.Meniscectomy in cases with abnormal alignment may have a risk of early onset of osteoarthritis.Level of evidence: Level IV.


Assuntos
Cartilagem Articular/patologia , Articulação do Joelho/cirurgia , Meniscectomia/efeitos adversos , Lesões do Menisco Tibial/cirurgia , Cartilagem Articular/lesões , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4815-4818, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019068

RESUMO

Knee orthoses are designed to reestablish the normal kinematics of the knee joint. However, the data on the effectiveness of them on modifying the internal joint kinematics are scarce. The aim of this study was to develop a method to allow accurate comparison of the knee contact kinematics in osteoarthritic (OA) subjects with and without wearing a valgus knee orthosis using imaging techniques. Biplane x-ray images of a subject (68 yrs., female, 1.70 m, 89 kg, left knee) was recorded during a weight-bearing squat at five positions. The same squat trial was repeated while wearing the orthosis. The 3D models of the knee were reconstructed from the biplane x-rays and the joint kinematics as well as the tibiofemoral contact point locations and bone-to-bone distance were compared at each posture. This could be seen as a proof of concept for the use of contact point locations as a parameter for evaluating the effectiveness of knee orthoses.Clinical Relevance- Joint kinematics derived from the skin markers suffer from low accuracy. The real impact of the knee orthoses on the skeleton takes vigorous techniques, which allows detecting the subtle kinematics changes directly at the joint level.


Assuntos
Articulação do Joelho , Joelho , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Aparelhos Ortopédicos , Raios X
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3799-3802, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018828

RESUMO

Ultrasound (US) imaging of muscle has been introduced as a promising sensing modality for assistive device control. Ten able-bodied subjects completed level, incline and decline walking on a treadmill in a motion capture laboratory while wearing reflective markers on upper- and lower-body. A wearable US transducer was affixed to subjects' anterior thigh, and time-intensity features were extracted from transverse US images of the knee extensor muscles. These features were used to train and test Gaussian process regression models for continuous estimation of knee flexion/extension angular velocity. Four regression models were evaluated: (1) subject-dependent/task-specific, (2) subject-dependent/pooled-tasks, (3) subject-independent/task-specific, and (4) subject-independent/pooled-tasks. Subject-independent models were "tuned" with up to six strides of the test subject's data to boost performance. A two-factor analysis of variance test was used to assess the effect of each approach on root mean square error (RMSE) of estimated knee angular velocity (α=0.05). Statistical parametric mapping (SPM) was completed to compare actual vs. estimated knee angular velocity as a function of the gait cycle (α=0.05). For incline and level walking, the subject-dependent/pooled-tasks model resulted in the lowest error while the subject-dependent/task-specific model resulted in the lowest error for decline walk. Impressively, the two-factor test revealed no difference between task-specific and pooled-task models. Furthermore, despite capturing many important features of knee velocity across individuals there were, as expected, significant differences between subject-dependent and subject-independent models. Collectively, these results are promising for potential assistive device control with error rates <10% for all regression models that were tested.Clinical Relevance-This work is the first study to demonstrate the feasibility of using ultrasound-based sensing for estimation of knee angular velocity during multiple modes of ambulation.


Assuntos
Joelho , Caminhada , Marcha , Humanos , Joelho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Ultrassonografia
6.
Acta Chir Orthop Traumatol Cech ; 87(4): 251-258, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32940220

RESUMO

PURPOSE OF THE STUDY This study is a component part of the project focused on cartilage imaging after the treatment of a defect. It aims to compare the evaluation of postoperative status performed by two radiologists with the use of 2D MOCART scoring system and to determine whether this method is a reliable tool for the evaluation of postoperative changes. MATERIAL AND METHODS The study evaluated 78 MRI examinations from 25 patients (one patient had two defects treated), each of whom underwent 3 MRI examinations at 6, 12 and 18 months after surgery. The MRI examinations were performed on Philips Ingenia 3T scanner with 8-channel knee coil, in line with the routine protocol (coronal, sagittal and transversal PD SPAIR, coronal T1, sagittal PD HR, sagittal bFFE). The MRI examinations were evaluated independently by two radiologists using the 2D MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS The raters agreed in a total of 592 of 702 evaluations, therefore the inter-rater reliability is high, namely 84.3%. The highest inter-rater agreement was in assessing subchondral lamina and subchondral bone. Whereas the lowest inter-rater agreement was achieved in assessing effusion. The total score showed a very strong and statistically significant correlation (r = 0.893). In eight out of nine questions there was no statistically significant difference between the raters. A significant difference was seen only in the assessment of repair tissue structure. Excellent reliability of the total score was also confirmed by the intraclass correlation coefficient. DISCUSSION The high degree of agreement in assessing the signal intensity of repair tissue was considered very positive as it is generally viewed as the major pitfall in evaluations. On the contrary, subjective perception was confirmed in the evaluation of tissue homogeneity, especially when comparing homogeneity with the adjacent tissue in close vicinity that could have changed already. Surprisingly, the lowest inter-rater concordance was reported in the evaluation of effusion, where in some cases, its volume was underestimated, when traced back retrospectively. CONCLUSIONS The results of this study confirm that despite certain doubts regarding subjective perception of some of the evaluation criteria the 2D MOCART scoring system is a very good and objective tool to evaluate the effects of surgery. Key words: magnetic resonance imaging , hyaline cartilage, classification.


Assuntos
Cartilagem Articular , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Reprodutibilidade dos Testes , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 99(35): e21437, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871866

RESUMO

RATIONALE: Osteochondritis dissecans (OCD) lesions involve disruption of the osteochondral unit along articular surfaces, with significant potential for joint deterioration if not managed appropriately. PATIENT CONCERNS: A 15-year-old male presented with persistent and insidious right knee pain, which had worsened following a collision with another player during a basketball game, resulting in episodes of locking. DIAGNOSES: Magnetic resonance imaging revealed a lateral trochlear OCD extending into the anterior lateral femoral condyle. INTERVENTIONS: Chondral fraying was observed along the margins of the OCD. Retrograde drilling ensued with use of a 0.045-inch Kirschner wire throughout the lesion to a depth that would allow for penetration of healthy underlying subchondral bone to create an influx of healing factors. Three resorbable pegs were arthroscopically placed through an accessory portal overlying the lesion to stabilize the fracture and compress the gapped cartilage mantle to reduce flow of synovial fluid behind the lesion. Bipolar radiofrequency coblation was used to stabilize the chondral fraying and seal the gap along the periphery of the lesion. OUTCOMES: The patient was put on a nonweight bearing protocol for 6 weeks, after which crutches and brace were discontinued, but therapy persisted. Repeat imaging at 3 months demonstrated excellent interval healing. The patient was released to slowly engage impact activities. Although he returned at approximately 8 months postoperatively with a contralateral anterior cruciate ligament tear, he reported the operative knee with the OCD was doing extremely well. LESSONS: Radiofrequency coblation appears to be a viable strategy as an adjunct to management for OCD in children.


Assuntos
Articulação do Joelho/patologia , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/terapia , Dor/etiologia , Terapia por Radiofrequência/métodos , Adolescente , Assistência ao Convalescente , Artroscopia/métodos , Cartilagem Articular/patologia , Terapia Combinada , Humanos , Traumatismos do Joelho/complicações , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Resultado do Tratamento
8.
Artigo em Inglês | MEDLINE | ID: mdl-32824529

RESUMO

The impact of ultramarathons (UM) on the organs, especially in professional athletes, is poorly understood. We tested a 36-year-old UM male runner before and after winning a 24-h marathon. The primary goal of the study was cardiovascular assessment. The athlete experienced right knee pain for the first time after 12 h of running (approximately 130 km), which intensified, affecting his performance. The competitors ran on a 1984 m rectangle-loop (950 × 42 m) in an atypical clockwise fashion. The winner completed 516 rectangular corners. Right knee Magnetic Resonance Imaging (MRI) one day after the run showed general overload in addition to degenerative as well as specific features associated with "turning to the right". Re-examination after three years revealed none of these findings. Different kinds of overloading of the right lower limb, including right knee pain, were indicated in 6 of 10 competitors from the top 20, including a woman who set the world record. The affected competitors suggested as cause for discomfort the shape of the loop and running direction. They believed that changing the direction of the run during the competition and an athletics stadium loop shape on a 2000-2500 m length is better for 24-h UM runners. In the absence of technical alternatives, the "necessary evil" is a counterclockwise run (also Association of Athletics Federations IAAF recommendation). Results suggest that a one-way, clockwise, 24-h UM run had an adverse effect on the athlete's right knee, as a result of unsymmetrical load. Organizers of 24-h UM runs should consider the shape of the competition loop and apply the principle of uniform load on the musculoskeletal system (alternate directions run). In case of technical impossibility, it would be better to run counterclockwise, which is more common, preferred by runners, and recommended by the IAAF.


Assuntos
Articulação do Joelho , Corrida , Adulto , Atletas , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiologia , Extremidade Inferior , Imagem por Ressonância Magnética , Masculino
9.
Acta Chir Orthop Traumatol Cech ; 87(3): 167-174, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32773017

RESUMO

PURPOSE OF THE STUDY Damage to hyaline cartilage represents a serious problem due to its limited capacity of regeneration. Currently, there are several treatment options available. The purpose of this study is to evaluate the success rate of treatment of chondral and osteochondral defects of the knee joint using the modified AMIC (Autologous Matrix-Induced Chondrogenesis) technique, combining microfractures of the base and the implantation of the type I collagen-based cell-free implant over a two-year period. MATERIAL AND METHODS The prospective study of the success rate of treatment by the modified AMIC technique included 15 patients (13 men and 2 women) with a defect confirmed by MRI and appropriate indication criteria. The mean age at the time of implantation was 33.4 years (range 19-47 years). The mean size of a treated defect was 3.66 ± 1.71 cm2 (range 2.00-7.05 cm2). The clinical outcomes were monitored through the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and the Tegner activity scale preoperatively and subsequently at 6, 12 and 24 months postoperatively. Control MRI was conducted at 6, 12 and 18 months postoperatively. The MRI finding was evaluated using the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. RESULTS The total KOOS score was 44.69 ± 7.71 preoperatively, while postoperatively it gradually increased up to 80.45 ± 8.97 (p < 0.001) at 24 months. The Lysholm score significantly rise from 43.47 ± 11.87 preoperatively to the mean value of 81.60 ± 13.07 (p < 0.001) at 24 months postoperatively. The preoperative Tegner score was 3.53 ± 1.41. At 24 months, there was a statistically significant increase to 5.40 ± 1.70 (p = 0.003). The mean MOCART score at 18 months postoperatively was 74.67 ± 14.08. At the end of the monitored period, a complete filling of the defect site by tissue was achieved in 73.33% patients. A complete integration with adjacent cartilage was seen in 66.67% patients and homogenous structure of newly formed tissue was reported in 80% of patients. DISCUSSION In recent years, cell-free implants (the so-called scaffolds or carriers) have been used ever more frequently in treating localised cartilage defects. Their main effect should consist in helping the cells penetrate the defect site and support new cartilage tissue formation. In order to improve the efficacy of cell-free implants, a new therapeutic technique was developed, combining the microfractures of the base with the use of cell-free scaffold AMIC (Autologous Matrix-Induced Chondrogenesis). Our modification of the original AMIC technique consists in the use of a type I collagen-based scaffold instead of the original collagen membrane constituted by collagen type I and III. Based on the statistical processing of results, the modified AMIC technique has shown a statistically significant improvement compared to the preoperative values of the KOOS questionnaire and all its sub-groups, the Lysholm core and the Tegner activity scale. These good clinical outcomes correlate with the results obtained by other authors using both the original method and the modified AMIC technique. CONCLUSIONS The modified AMIC technique using the cell-free type I collagen-based implant appears to be a safe, accessible and onestage technique to treat localised chondral and osteochondral defects of the knee joint up to the size of 8 cm2. Key words: hyaline cartilage, chondral defect, AMIC, scaffold, knee.


Assuntos
Cartilagem Articular , Adulto , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Condrogênese , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
10.
Medicine (Baltimore) ; 99(27): e21047, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629730

RESUMO

Repair of medial meniscus posterior root tear (MMPRT) is considered as an effective early intervention strategy for osteoarthritis. We aimed at evaluating whether or not single-photon emission computed tomography/computed tomography (SPECT/CT) could predict the treatment outcome.Eleven patients with MMPRT who underwent preoperative SPECT/CT were retrospectively enrolled. Clinical symptoms were evaluated based on the knee injury and osteoarthritis outcome score (KOOS) and visual analogue scale (VAS) for pain. The uptake pattern of the medial tibial plateau (MTP) on SPECT/CT was visually assessed. Additionally, the maximum lesion-to-cortical counts ratio (LCRmax) for the anterior and posterior aspects of MTP and anterior-posterior MTP ratio (APR) were quantitatively assessed. Spearman correlation analyses were performed between the change in clinical symptom scores and preoperative SPECT/CT patterns.All patients showed increased radiotracer uptake in MTP. Among them, 8 (73%) showed dominant uptake in the anterior aspect of MTP. The rest 3 (27%) showed posterior-dominant uptake. Patients with anterior-dominant patterns tended to show better outcomes in terms of the postoperative KOOS score (P = .07). Anterior MTP LCRmax showed a negative correlation with the change in VAS (ρ = -0.664, P < .03). APR showed a correlation with the change in the KOOS score (ρ = 0.655, P < .03).Patients with MMPRT with relatively higher uptake in the anterior aspect of MTP could have better clinical outcomes after the repair. The preoperative SPECT/CT pattern may have a predictive value in selecting patients with good postoperative outcomes.


Assuntos
Meniscos Tibiais/patologia , Osteoartrite/cirurgia , Ruptura/cirurgia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Idoso , Osso e Ossos/diagnóstico por imagem , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Meniscectomia/métodos , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
11.
Adv Clin Exp Med ; 29(6): 701-706, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32608581

RESUMO

BACKGROUND: Osteoarthritis represents a kind of chronic and degenerative joint disease characterized by articular cartilage injury and osteoproliferation. Osteoarthritis especially poses a serious threat to the elderly patients. At present, the diagnosis of osteoarthritis mainly consists of clinical examination, X-ray examination, magnetic resonance imaging (MRI), and arthroscopy. However, limitations and misdiagnosis are found within the single method. OBJECTIVES: This article intends to investigate the feasibility of assessing the condition of knee osteoarthritis through quantitative analysis of cartilage using nuclear magnetic resonance 3D fast-spin spoiled gradient-recalled echo (NMR 3D-FS-SPGR) imaging and γ-glutamic acid carboxylase (GGCX) detection in synovial fluid. MATERIAL AND METHODS: A total of 60 patients with primary knee osteoarthritis were enrolled. All the patients were staged and received 3D-FS-SPGR sequence MRI scan for grading based on scan results and cartilage injury. Cartilage tissues were collected for immunohistochemistry (IHC). The GGCX in cartilage was detected using western blotting to analyze the correlation with arthritis. RESULTS: The condition of articular cartilage injury in arthritis patients was clearly observed using 3D-FS-SPGR sequence. The expression of GGCX was decreased in 46 patients (p < 0.05). The expression of GGCX in synovial fluid was significantly reduced following upstaging (p < 0.05). The sensitivity measured using combined 3D-FS-SPGR imaging and synovial fluid GGCX detection for the evaluation of arthritis condition was significantly higher than that of the single detection method (p < 0.05). CONCLUSIONS: Our data showed that the sensitivity of combined detection was obviously higher than single detection for the evaluation of arthritis. The 3D-FS-SPGR combined with synovial fluid GGCX detection could be treated as a promising strategy for arthritis evaluation.


Assuntos
Carboxiliases , Cartilagem Articular , Osteoartrite do Joelho , Líquido Sinovial , Idoso , Carboxiliases/análise , Cartilagem Articular/diagnóstico por imagem , Ácido Glutâmico , Humanos , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Osteoartrite do Joelho/diagnóstico por imagem , Líquido Sinovial/química
12.
Artigo em Inglês | MEDLINE | ID: mdl-32605170

RESUMO

The purpose of this study was to compare the inter-limb joint kinematics, joint moments, muscle forces, and joint reaction forces in patients after an Achilles tendon rupture (ATR) via subject-specific musculoskeletal modeling. Six patients recovering from a surgically repaired unilateral ATR were included in this study. The bilateral Achilles tendon (AT) lengths were evaluated using ultrasound imaging. The three-dimensional marker trajectories, ground reaction forces, and surface electromyography (sEMG) were collected on both sides during self-selected speed during walking, jogging and running. Subject-specific musculoskeletal models were developed to compute joint kinematics, joint moments, muscle forces and joint reaction forces. AT lengths were significantly longer in the involved side. The side-to-side triceps surae muscle strength deficits were combined with decreased plantarflexion angles and moments in the injured leg during walking, jogging and running. However, the increased knee extensor femur muscle forces were associated with greater knee extension degrees and moments in the involved limb during all tasks. Greater knee joint moments and joint reaction forces versus decreased ankle joint moments and joint reaction forces in the involved side indicate elevated knee joint loads compared with reduced ankle joint loads that are present during normal activities after an ATR. In the frontal plane, increased subtalar eversion angles and eversion moments in the involved side were demonstrated only during jogging and running, which were regarded as an indicator for greater medial knee joint loading. It seems after an ATR, the elongated AT accompanied by decreased plantarflexion degrees and calf muscle strength deficits indicates ankle joint function impairment in the injured leg. In addition, increased knee extensor muscle strength and knee joint loads may be a possible compensatory mechanism for decreased ankle function. These data suggest patients after an ATR may suffer from increased knee overuse injury risk.


Assuntos
Tendão do Calcâneo , Anormalidades Musculoesqueléticas , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/fisiopatologia , Articulação do Tornozelo , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/diagnóstico por imagem , Músculo Esquelético , Projetos Piloto , Ruptura
13.
Am J Sports Med ; 48(9): 2205-2212, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32667272

RESUMO

BACKGROUND: Several anatomic features of the knee have been shown to affect joint and anterior cruciate ligament (ACL) loading and the risk of subsequent injuries. While several studies have highlighted sex differences between these anatomic features, little is known on how these differences develop during skeletal growth and maturation. HYPOTHESES: (A) Anatomic features linked to an ACL injury will significantly change during skeletal growth and maturation. (B) The age-related changes in anatomic features linked to an ACL injury are different between male and female patients. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: After institutional review board approval, magnetic resonance imaging data from 269 unique knees (patient age 3-18 years; 51% female), free from any injuries, were used to measure femoral notch width, posterior slope of the lateral tibial plateau (lateral tibial slope), medial tibial depth, tibial spine height, and posterior lateral meniscal bone angle. Linear regression was used to test the associations between age and quantified anatomic indices. Patients were then divided into 4 age groups: preschool (3-6 years), prepubertal (7-10 years), early adolescent (11-14 years), and late adolescent (15-18 years). Also, 2-way analysis of variance with the Holm-Sidak post hoc test was used to compare morphology between male and female patients in each age group. RESULTS: The femoral notch width, medial tibial depth, and tibial spine height significantly increased with age (P < .001). The lateral tibial slope decreased with age only in male patients (P < .001). Except for the posterior lateral meniscal bone angle, the age-related changes in anatomy were different between male and female patients (P < .05). On average, early and late adolescent female patients had smaller femoral notches, steeper lateral tibial slopes, flatter medial tibial plateaus, and shorter tibial spines compared with age-matched male patients (P < .01). CONCLUSION: Overall, the findings supported our hypotheses, showing sex-specific changes in anatomic features linked to an ACL injury during skeletal growth and maturation. These observations help to better explain the reported age and sex differences in the prevalence of ACL injuries. The fact that most of these anatomic features undergo substantial changes during skeletal growth and maturation introduces the hypothesis that prophylactic interventions (ie, activity modification) would have the potential to reshape a maturing knee in a manner that lowers the risk of noncontact ACL injuries.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Articulação do Joelho/anatomia & histologia , Caracteres Sexuais , Tíbia/anatomia & histologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Fatores de Risco
14.
Zhonghua Wai Ke Za Zhi ; 58(6): 435-440, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498482

RESUMO

Objective: To investigate the sagittal and torsional changes in the tibia after a medial open wedge high tibial osteotomy (OWHTO) and their correlation with the corrective angle of proximal tibial coronal plane. Methods: A prospective analysis was conducted on patients who underwent OWHTO at Department of Orthopaedic Surgery, Beijing Chaoyang Emergency Medical Center from March 2019 to July 2019.The operation were performed by the same surgeon. X-ray and CT were performed before and 3 days after the operation. The mechanical axis angle (mFTA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and tibial torsion angle (TTA) were measured and compared by paired t-test. Pearson correlation coefficient was used to analyze the correlation between the changes of PTS and TTA and the correction angle of MPTA. Results: A total of 13 patients (19 knees) were recruited. There were 9 males (13 knees) and 4 females (6 knees), aged (39.4±14.4) years (range:20 to 60 years). The mFTA improved from (8.1±2.8) degrees preoperatively to (-1.4±1.6) degrees postoperatively (t=14.819, P=0.000). The MPTA was changed from (81.1±2.4) degrees pre-operatively to (90.4±3.4) degrees postoperatively (t=-15.579, P=0.000). The PTS decreased from (79.6±3.2) degrees to (76.8±3.1) degrees (t=9.709, P=0.000). The differences of mFTA, MPTA and PTS were statistically significant. There was no significant difference in TTA between before and after operation ((28.2±1.5) ° vs. (27.3±6.3) °,t=1.925, P=0.070). There was no correlation between the correction angle of MPTA and the change of PTS and TTA (r=0.384, P=0.105; r=0.321, P=0.181). Conclusions: Even if the intra-operative measures were used to control tibial slope, the PTS still increased significantly after OWHTO, while the TTA has no significant change. No correlation was seen between the change of sagittal and torsional and the corrective angle of proximal tibial coronal plane.


Assuntos
Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Osteotomia/métodos , Tíbia/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Adulto , Feminino , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Período Pós-Operatório , Estudos Prospectivos , Tíbia/cirurgia , Anormalidade Torcional/etiologia , Adulto Jovem
15.
Am J Sports Med ; 48(8): 1893-1899, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32515986

RESUMO

BACKGROUND: Some cadaveric studies have indicated that the anterior cruciate ligament (ACL) consists of anteromedial and posterolateral bundles that display reciprocal function with regard to knee flexion. However, several in vivo imaging studies have suggested that these bundles elongate in parallel with regard to flexion. Furthermore, the most appropriate description of the functional anatomy of the ACL is still debated, with the ACL being described as consisting of 2 or 3 bundles or as a continuum of fibers. HYPOTHESIS: As long as their origination and termination locations are defined within the ACL attachment site footprints, ACL bundles elongate in parallel with knee extension during gait. STUDY DESIGN: Descriptive laboratory study. METHODS: High-speed biplanar radiographs of the right knee joint were obtained during gait in 6 healthy male participants (mean ± SD: body mass index, 25.5 ± 1.2 kg/m2; age, 29.2 ± 3.8 years) with no history of lower extremity injury or surgery. Three-dimensional models of the right femur, tibia, and ACL attachment sites were created from magnetic resonance images. The bone models were registered to the biplanar radiographs, thereby reproducing the in vivo positions of the knee joint. For each knee position, the distances between the centroids of the ACL attachment sites were used to represent ACL length. The lengths of 1000 virtual bundles were measured for each participant by randomly sampling locations on the attachment site surfaces and measuring the distances between each pair of locations. Spearman rho rank correlations were performed between the virtual bundle lengths and ACL length. RESULTS: The virtual bundle lengths were highly correlated with the length of the ACL, defined as the distance between the centroids of the attachment sites (rho = 0.91 ± 0.1, across participants; P < 5 × 10-5). The lengths of the bundles that originated and terminated in the anterior and medial aspects of the ACL were positively correlated (rho = 0.81 ± 0.1; P < 5 × 10-5) with the lengths of the bundles that originated and terminated in the posterior and lateral aspects of the ACL. CONCLUSION: As long as their origination and termination points are specified within the footprint of the attachment sites, ACL bundles elongate in parallel as the knee is extended. CLINICAL RELEVANCE: These data elucidate ACL functional anatomy and may help guide ACL reconstruction techniques.


Assuntos
Ligamento Cruzado Anterior/diagnóstico por imagem , Marcha , Articulação do Joelho/diagnóstico por imagem , Adulto , Ligamento Cruzado Anterior/anatomia & histologia , Fenômenos Biomecânicos , Fêmur/anatomia & histologia , Fêmur/diagnóstico por imagem , Humanos , Articulação do Joelho/anatomia & histologia , Masculino , Amplitude de Movimento Articular , Tíbia/anatomia & histologia , Tíbia/diagnóstico por imagem
16.
J Pediatr Orthop ; 40(6): 271-276, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501906

RESUMO

BACKGROUND: Missed posterolateral corner (PLC) injuries are a known cause of anterior cruciate ligament reconstruction (ACL) failure in the adult population. Failed ACL reconstruction causes significant morbidity in the skeletally immature pediatric population. There is little literature on the character and potential significance of PLC injuries in skeletally immature patients. METHODS: Magnetic resonance imaging studies of the knee at a tertiary care children's hospital for patients who underwent an ACL reconstruction without PLC surgery were retrospectively reviewed. Demographic variables were obtained through chart review, and magnetic resonance imaging studies were evaluated for PLC (popliteus, fibular collateral ligament, popliteofibular ligament, and arcuate ligament) injury, and ACL, medial collateral ligament (MCL), bone bruise, fracture, and meniscal pathology by an experienced pediatric musculoskeletal radiologist. RESULTS: A total of 50 patients with a mean age at 13.3 years at injury were analyzed. PLC injuries were found in 26 patients (52%), with 7 patients (14%) having a complete tear of a component of the PLC. There was no association between sex (P=0.35), Segond fracture (P=0.09), meniscus injury (P=0.92), or MCL injury (P=0.24) with the risk of PLC injury. There was an association between patient age and PLC injury (P=0.02). For each additional year of age, the odds of PLC injury increased by 1.8 times (odds ratio, 1.8; 95% confidence interval, 1.4-2.2). There was no association between PLC injury and ACL graft failure (P=0.19). CONCLUSIONS: Missed PLC injuries are a significant source of morbidity and poor clinical outcomes in the management of concomitant ACL injuries in adults. This study demonstrates the prevalence of PLC injuries in the setting of concomitant ACL injuries in the unique skeletally immature patient population. Incomplete PLC injuries are relatively common. Complete PLC injuries are relatively uncommon. PLC injury was more common in older patients. No other concomitant injury predicted the likelihood of PLC injury. Further research is needed regarding the risk of ACL reconstruction failure from associated PLC injury and the indications for PLC reconstruction in skeletally immature patients. LEVEL OF EVIDENCE: Level IV-diagnostic study.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico , Erros de Diagnóstico , Traumatismos do Joelho , Articulação do Joelho/diagnóstico por imagem , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Erros de Diagnóstico/efeitos adversos , Erros de Diagnóstico/prevenção & controle , Erros de Diagnóstico/estatística & dados numéricos , Feminino , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Prevalência , Estudos Retrospectivos
17.
J Pediatr Orthop ; 40(6): 314-321, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501930

RESUMO

BACKGROUND: Musculoskeletal infection is a major cause of morbidity in the pediatric population. Despite the canonical teaching that an irritable joint and signs of infection likely represent an infected joint space, recent evidence in the pediatric hip has demonstrated that alternative diagnoses are equally or more likely and that combinations of pathologies are common. The knee is the second most commonly infected joint in children, yet there remains a paucity of available data regarding the epidemiology and workup of the infected pediatric knee. The authors hypothesize that there is heterogeneity of pathologies, including combinations of pathologies, that presents as a potentially infected knee in a child. The authors aim to show the utility of magnetic resonance imaging and epidemiologic and laboratory markers in the workup of these patients. METHODS: A retrospective review of all consults made to the pediatric orthopaedic surgery team at a single tertiary care center from September 2009 through December 2015 regarding a concern for potential knee infection was performed. Excluded from the study were patients with penetrating trauma, postoperative infection, open fracture, no C-reactive protein (CRP) within 24 hours of admission, sickle cell disease, an immunocompromised state, or chronic osteomyelitis. RESULTS: A total of 120 patients were analyzed in this study. There was marked variability in pathologies. Patients with isolated osteomyelitis or osteomyelitis+septic arthritis were older, had an increased admission CRP, were more likely to be infected with Staphylococcus aureus, required an increased duration of antibiotics, and had an increased incidence of musculoskeletal complications than patients with isolated septic arthritis. CONCLUSIONS: When considering a child with an irritable knee, a heterogeneity of potential underlying pathologies and combinations of pathologies are possible. Importantly, the age of the patient and CRP can guide a clinician when considering further workup. Older patients with a higher admission CRP value warrant an immediate magnetic resonance imaging, as they are likely to have osteomyelitis, which was associated with worse outcomes when compared with patients with isolated septic arthritis. LEVEL OF EVIDENCE: Level III-retrospective research study.


Assuntos
Artrite Infecciosa , Articulação do Joelho/diagnóstico por imagem , Osteomielite , Staphylococcus aureus/isolamento & purificação , Adolescente , Fatores Etários , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Criança , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Imagem por Ressonância Magnética/métodos , Masculino , Osteomielite/diagnóstico , Osteomielite/microbiologia , Osteomielite/terapia , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Estados Unidos/epidemiologia
18.
Am J Sports Med ; 48(9): 2221-2229, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32584594

RESUMO

BACKGROUND: Imaging characteristics of osteochondritis dissecans (OCD) lesions quantified by magnetic resonance imaging (MRI) are often used to inform treatment and prognosis. However, the interrater reliability of clinician-driven MRI-based assessment of OCD lesions is not well documented. PURPOSE: To determine the interrater reliability of several historical and novel MRI-derived characteristics of OCD of the knee in children. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: A total of 42 OCD lesions were evaluated by 10 fellowship-trained orthopaedic surgeons using 31 different MRI characteristics, characterizing lesion size and location, condylar size, cartilage status, the interface between parent and progeny bone, and features of both the parent and the progeny bone. Interrater reliability was determined via intraclass correlation coefficients (ICCs) with 2-way random modeling, Fleiss kappa, or Krippendorff alpha as appropriate for each variable. RESULTS: Raters were reliable when the lesion was measured in the coronal plane (ICC, 0.77). Almost perfect agreement was achieved for condylar size (ICC, 0.93), substantial agreement for physeal patency (ICC, 0.79), and moderate agreement for joint effusion (ICC, 0.56) and cartilage status (ICC, 0.50). Overall, raters showed significant variability regarding interface characteristics (ICC, 0.25), progeny (ICC range, 0.03 to 0.62), and parent bone measurements and qualities (ICC range, -0.02 to 0.65), with reliability being moderate at best for these measurements. CONCLUSION: This multicenter study determined the interrater reliability of MRI characteristics of OCD lesions in children. Although several measurements provided acceptable reliability, many MRI features of OCD that inform treatment decisions were unreliable. Further work will be needed to refine the unreliable characteristics and to assess the ability of those reliable characteristics to predict clinical lesion instability and prognosis.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Osteocondrite Dissecante , Criança , Estudos de Coortes , Humanos , Imagem por Ressonância Magnética , Osteocondrite Dissecante/diagnóstico por imagem , Reprodutibilidade dos Testes
19.
Medicine (Baltimore) ; 99(24): e20475, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541469

RESUMO

RATIONALE: Several case reports about the diagnostic and therapeutic approaches of hemarthrosis after total knee arthroplasty using angiogram have been reported, owing to the probability of bleeding caused by vascular injuries. However, there were only few cases of spontaneous hemarthrosis of the knee joint in the elderly patient that have not undergone total knee arthroplasty that have been previously reported. PATIENTS CONCERNS: An 82-year-old male presented to our outpatient department with acute left knee pain. He had no history of trauma. The patient had under gone several times of therapeutic arthrocentesis for treatment of left knee joint effusion at a local clinic. DIAGNOSIS: Arthroscopic examination was performed at the local clinic and was not able to reveal any focus of intra-articular bleeding. We consulted this case with the department of radiology to angiographically find out abnormalities of the genicular arteries. Angiographs showed hyper vascularity of the superior and inferior lateral genicular artery, and superior medial genicular artery. INTERVENTION: One-step embolization using micro-catheter and 50 to 150 µm gelfoam particles was conducted. The hypervascular findings shown on angiogram were markedly subsided after embolization. OUTCOMES: Until 1 year after embolization, there were no signs of recurrence on outpatient follow-up sessions LESSONS:: Degenerative changes of the genicular arteries may be a cause of spontaneous knee joint hemarthrosis in the elderly patients. Angiographic diagnosis and treatment may be effective for such cases.


Assuntos
Embolização Terapêutica , Hemartrose/terapia , Articulação do Joelho/diagnóstico por imagem , Idoso de 80 Anos ou mais , Hemartrose/diagnóstico por imagem , Humanos , Masculino
20.
AJR Am J Roentgenol ; 215(2): 458-464, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32507014

RESUMO

OBJECTIVE. The purpose of this study is to assess the use of cross-sectional imaging to qualitatively and quantitatively categorize trochlear dysplasia as low grade (type A) or high grade (types B-D) according to the Dejour classification. MATERIALS AND METHODS. A retrospective review of CT and MRI knee examinations performed before patients underwent deepening trochleoplasty was independently conducted by two musculoskeletal radiologists. Each case of trochlear dysplasia was qualitatively assigned a Dejour type. Subsequently, quantitative measurements of the sulcus angle, distance from the tibial tubercle to the trochlear groove, trochlear depth, lateral trochlear inclination, trochlear facet asymmetry, and degree of patellar lateralization were performed. RESULTS. A total of 35 patients (29 female patients and six male patients; mean age, 21.1 years) with 39 affected knees (17 right knees and 22 left knees) were included. Readers had exact qualitative agreement using Dejour classification for 30 of 39 knees (77% [κ = 0.77; 95% CI, 0.62-0.91]) and agreement on classification of low-grade versus high-grade dysplasia for 36 of 39 knees (92%). For these 36 knees, the mean differences in measurements of low- versus high-grade dysplasia, respectively, were as follows: for sulcus angle, 153° versus 168° (p < 0.001); for trochlear depth, 4 versus 1 mm (p < 0.001); for lateral trochlear inclination, 12 versus 7 mm (p < 0.02); and for decreased trochlear facet asymmetry, 13% versus 92% (p < 0.001). Trochlear depth, lateral trochlear inclination, and trochlear facet asymmetry were also different in comparisons of knees with Dejour type B and C trochlear dysplasia versus those with Dejour types B and D (all p < 0.05). No quantitative measurement differentiated between trochlear dysplasia of Dejour types C and D. The distance from the tibial tubercle to the trochlear groove and the degree of patellar lateralization were not statistically different between low- and high-grade dysplasia. CONCLUSION. Qualitative use of the Dejour classification accurately categorizes trochlear dysplasia as low grade or high grade in 92% of cases, with exact agreement reached in 77% of cases. Furthermore, the trochlear depth, lateral trochlear inclination, trochlear facet asymmetry, and sulcus angle can differentiate between low-grade and high-grade dysplasia, with trochlear depth, lateral trochlear inclination, and trochlear facet asymmetry useful for differentiating between Dejour types B and C and Dejour types B and D.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Fêmur/diagnóstico por imagem , Fêmur/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imagem por Ressonância Magnética , Patela/diagnóstico por imagem , Patela/patologia , Tomografia Computadorizada por Raios X , Adolescente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
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