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1.
Arthroscopy ; 36(11): 2820-2821, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33172581

RESUMO

Posteroinferior glenohumeral instability occurs in 10% of all instability cases but is observed increasingly more often. Arthroscopic posterior capsulolabral repair is the current standard for surgical management if nonoperative treatment fails. In contrast to the anterior inferior glenohumeral ligament (IGHL), the posterior IGHL inserts onto the glenoid surface rather than onto the labrum. This implies that suture anchors should be placed on the glenoid rim when repairing these defects. However, clinical studies demonstrate excellent clinical outcomes irrespective of the location of the suture anchor.


Assuntos
Instabilidade Articular , Articulação do Ombro , Artroscopia , Cadáver , Humanos , Instabilidade Articular/cirurgia , Escápula/cirurgia , Ombro , Articulação do Ombro/cirurgia
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1392-1398, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191696

RESUMO

Objective: To evaluate the short-term effectiveness of arthroscopically capsular vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity. Methods: A retrospective analysis was performed on 6 shoulder recurrent anterior dislocation patients combined with joint laxity treated with arthroscopically capsular vertical mattress suturing between January 2017 and December 2018. There were 5 males and 1 female with an average age of 20.8 years (range, 19-24 years). The number of shoulder dislocation was 3-18 times, with an average of 9.5 times. The disease duration ranged from 2 to 60 months, with an average of 25.3 months. The preoperative Beighton score was 4-7, with an average of 5.8; the Instability Severity Index Score (ISIS) was 2-5, with an average of 3.5. There were 5 cases of simple Bankart injury and 1 case of bony Bankart injury. The range of motion of shoulder joint (including active flexion and lifting, external rotation, abduction and external rotation, and internal ratation) was recorded before operation and at last follow-up; Oxford shoulder instability score, Rowe shoulder instability score, and Simple Shoulder Test (SST) score were used to evaluate shoulder joint function before operation, at 6 months after operation, and at last follow-up, and complications were recorded. Results: All patients were followed up 16-28 months (mean, 19.3 months). During the follow-up, all patients had satisfactory motor function, and no re-dislocation and postoperative neurovascular complications occurred. At last follow-up, the activities of active external rotation and abduction and external rotation were significantly improved when compared with those before operation ( P<0.05); the activities of active flexion and lifting and internal rotation were not limited before and after operation, and the difference was not significant ( P>0.05). The Oxford shoulder instability score, Rowe shoulder instability score, and SST score at 6 months after operation and at last follow-up were significantly improved when compared with those before operation ( P<0.05); there was no significant difference between at 6 months after operation and at last follow-up ( P>0.05). Conclusion: The treatment of shoulder recurrent anterior dislocation combined with joint laxity by arthroscopically vertical matress suturing can achieve good short-term effectiveness.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Adulto , Artroscopia , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Amplitude de Movimento Articular , Recidiva , Estudos Retrospectivos , Ombro , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Técnicas de Sutura , Resultado do Tratamento , Adulto Jovem
3.
Medicine (Baltimore) ; 99(43): e22756, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120779

RESUMO

OBJECTIVE: We conduct this research protocol for the assessment of the effect of phone-assisted care programs on functional outcomes in patients receiving shoulder instability surgery. METHODS: This is a randomized controlled, single center trial which will be implemented from October 2020 to December 2021. This trial is conducted according to the SPIRIT Checklist of randomized researches. It was authorized via the Ethics Committee of the First People's Hospital of Xiangyang city affiliated to Hubei Medical College (XY234-026). Ninety participants who undergo shoulder instability surgery are analyzed. Patients are randomly divided into control group (standard management group, with 45 patients) and study group (the phone program group, with 45 patients). In control group, the exercises at home are not monitored. Whereas in study group, patients are asked about their at-home activities, and the extra coaching sessions are provided to patients on self-care, exercise guidance, and the importance of exercise at home, and then answers to their questions. The primary outcome is the range of motion of the shoulder joint, and the pain arcs are determined through the range of motion. The extra assessments include the shoulder functional outcome, pain, and the quality of life. All the analysis needed in this study is implemented with SPSS (IBM, Chicago, USA) for Windows Version 19.0. RESULTS: The clinical outcome variables between groups are shown in Table. CONCLUSION: This investigation can offer a reliable basis for the effectiveness of phone assistance nursing program in patients after shoulder instability surgery. TRIAL REGISTRATION NUMBER: researchregistry6010.


Assuntos
Assistência ao Convalescente/métodos , Serviços de Assistência Domiciliar , Instabilidade Articular/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Autocuidado , Articulação do Ombro/cirurgia , Telefone , Humanos , Procedimentos Ortopédicos/enfermagem , Resultado do Tratamento
5.
Orthop Clin North Am ; 51(4): 481-491, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950217

RESUMO

Patellar instability and associated patellar dislocation can result in significant pain, disability, and associated injuries in young athletes. The patellofemoral joint is a complex articulation with stabilizing restraints, both medially and laterally, that help guide the patella into the corresponding trochlear groove as the knee cycles through an extension-to-flexion arc. In addition to soft tissue injuries, many osseous aberrancies can contribute to patellar instability in young athletes, including trochlear dysplasia, patella alta, and axial and coronal plane abnormalities. There is a role for nonoperative treatment in these young athletes; however, if recurrent or associated injuries are identified surgical intervention is warranted. Correct diagnosis of the underlying cause of the patellar instability is paramount to developing a surgical plan that will yield the most favorable outcome for these young athletes.


Assuntos
Instabilidade Articular/etiologia , Luxação Patelar/complicações , Adolescente , Criança , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia
6.
J Vet Sci ; 21(4): e67, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32735102

RESUMO

BACKGROUND: Tibial tuberosity transposition (TTT) causes caudalization of the patellar ligament insertion in canine medial patellar luxation, which can lead to increases in patellofemoral contact pressure. OBJECTIVES: The purpose of this study is to confirm the effect of patellofemoral contact mechanics after craniolateral and caudolateral transposition of tibial tuberosity in normal canine hindlimbs. METHODS: Craniolateral and caudolateral transposition of tibial tuberosity was performed in 5 specimens, respectively. The pressure was measured in the specimen before TTT, and then in the same specimen after TTT. In this process, data was obtained in 10 specimens. The measurement results were output as visualization data through the manufacturer's software and numerical data through spreadsheet. Based on these 2 data and the anatomical structure of the patellofemoral joint (PFJ) surface, whole measurement area was analysed by dividing into medial, lateral and central area. RESULTS: In craniolateralization of tibial tuberosity, total, medial, central contact pressure was decreased and lateral contact pressure was not statistically changed lateral contact pressure than normal PFJ. In caudolateralization of tibial tuberosity, total, lateral contact pressure was increased and medial contact pressure was not statistically changed than normal PFJ. Although not statistically significant changed, central contact pressure in caudolateralization of tibial tuberosity was increased in all 5 specimens. CONCLUSIONS: These results imply that traditional TTT, prone to caudal shift of patellar tendon, can increase retropatellar pressure may lead to various complications and diseases of the stifle joint.


Assuntos
Doenças do Cão/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/veterinária , Patela/cirurgia , Luxação Patelar/veterinária , Ligamento Patelar/cirurgia , Tíbia/cirurgia , Animais , Fenômenos Biomecânicos , Cães , Instabilidade Articular/fisiopatologia , Luxação Patelar/complicações , Luxação Patelar/cirurgia
7.
J Am Acad Orthop Surg ; 28(15): 607-616, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732652

RESUMO

Primary arthroscopic Bankart repair is a common procedure that is increasing in popularity; however, failure rates can approach up to 6% to 30%. Factors commonly attributed to failure include repeat trauma, poor or incomplete surgical technique, humeral and/or glenoid bone loss, hyperlaxity, or a failure to identify and address rare pathology such as a humeral avulsion of the glenohumeral ligament lesion. A thorough clinical and radiographic assessment may provide insight into the etiology, which can assist the clinician in making treatment recommendations. Surgical management of a failed primary arthroscopic Bankart repair without bone loss can include revision arthroscopic repair or open repair; however, in the setting of bone loss, the anterior-inferior glenoid can be reconstructed using a coracoid transfer, tricortical iliac crest, or structural allograft, whereas posterolateral humeral head bone loss (the Hill-Sachs defect) can be addressed with remplissage, structural allograft, or partial humeral head implant. In addition to the technical demands of revision stabilization surgery, patient and procedure selection to optimize outcomes can be challenging. This review will focus on the etiology, evaluation, and management of patients after a failed primary arthroscopic Bankart repair, including an evidence-based treatment algorithm.


Assuntos
Artroscopia/métodos , Lesões de Bankart/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Falha de Tratamento , Lesões de Bankart/diagnóstico por imagem , Lesões de Bankart/etiologia , Lesões de Bankart/patologia , Medicina Baseada em Evidências , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Reoperação , Escápula/cirurgia , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X
8.
J Am Acad Orthop Surg ; 28(15): 628-637, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732654

RESUMO

Posterior glenohumeral instability in overhead athletes presents a unique set of challenges for both diagnosis and treatment. Although a great deal of attention has been focused on the management of injuries to the biceps-labrum complex and rotator cuff in throwers, comparatively less has been written about posterior glenohumeral instability within this unique cohort. Historically, posterior instability has been observed secondary to either acute trauma or repetitive microtrauma, usually among collision athletes, weight lifters, and rowers. However, posterior glenohumeral instability resulting from pathology of the posterior capsulolabral tissues in throwers is a different entity, and the clinical assessment begins with an accurate differentiation between adaptive capsular laxity and labral injury with pathologic instability. Some posterior capsule labrum tears confirmed on arthroscopy will require nothing more than débridement. However, for more extensive lesions, surgical treatment must balance the necessity to repair torn capsulolabral tissues with the tendency to over constrain the shoulder. The literature provides mixed results regarding the likelihood of overhead athletes with posterior glenohumeral instability and labral injury treated surgically returning to their preinjury level of sport performance.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/cirurgia , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Lesões do Manguito Rotador/diagnóstico , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Humanos , Recuperação de Função Fisiológica , Lesões do Manguito Rotador/etiologia , Resultado do Tratamento
9.
Sports Health ; 12(6): 598-602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32609577

RESUMO

BACKGROUND: The management of the adolescent athlete after initial shoulder instability remains controversial. HYPOTHESIS: Individual risk factors in athletes with shoulder instability who are managed nonoperatively can be integrated into a scoring system that can predict successful return to sport. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 57 scholastic athletes with primary anterior shoulder instability who were managed nonoperatively were reviewed. Success was defined as a return to index sport at the same level and playing at least 1 subsequent season without missed time as a result of the shoulder. Patient-specific risk factors were individually evaluated, and odds ratios were calculated. A 10-point Nonoperative Injury Severity Index Score (NISIS) incorporated the risk factors for failure. This score was then retrospectively applied with regression analysis and a chi-square analysis to determine the overall optimal score that predicted failure of nonoperative management. RESULTS: In total, 6 risk factors for failure were included in the NISIS: age (>15 years), bone loss, type of instability, type of sport (contact vs noncontact), male sex, and arm dominance. Overall, 79% of patients treated nonoperatively were able to successfully return to sport. Nearly all (97%) low-risk patients (NISIS <7) successfully returned to sport, while only 59% of high-risk patients returned to sport, a relative risk of 12.2 (P = 0.001). High-risk patients with unipolar bone loss successfully returned (100%), but 67% of high-risk patients with bipolar bone loss failed. CONCLUSION: The NISIS is a simple and effective clinical tool to determine successful nonoperative management following anterior shoulder instability and may be helpful in guiding decision making when presented with the unstable shoulder in the scholastic athlete.


Assuntos
Instabilidade Articular/terapia , Luxação do Ombro/terapia , Articulação do Ombro/lesões , Índices de Gravidade do Trauma , Esportes Juvenis/lesões , Adolescente , Tomada de Decisão Clínica , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Recidiva , Estudos Retrospectivos , Volta ao Esporte , Medição de Risco , Fatores de Risco , Luxação do Ombro/diagnóstico , Luxação do Ombro/cirurgia , Falha de Tratamento
10.
Am J Sports Med ; 48(10): 2525-2533, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692952

RESUMO

BACKGROUND: Persistent posterior instability of the acromioclavicular (AC) joint is a reported complication after isolated coracoclavicular (CC) reconstruction. Thus, multiple techniques have been proposed attempting to restore biomechanics of the AC ligament complex (ACLC). PURPOSE/HYPOTHESIS: The purpose was to evaluate the posterior translational and rotational stability of an ACLC reconstruction with a dermal allograft (ACLC patch) as compared with 3 suture brace constructs. It was hypothesized that the ACLC patch would better restore AC joint posterior stability. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 28 cadaveric shoulders (mean ± SD age, 57.6 ± 8.3 years) were randomly assigned to 1 of 4 surgical techniques: ACLC patch, oblique brace, anterior brace, and x-frame brace. The force and torque to achieve 10 mm of posterior translation and 20° of posterior rotation of the AC joint were recorded in the following conditions: intact, transected ACLC, ACLC patch/brace repair, ACLC patch/brace repair with dissected CC ligaments, and ACLC patch/brace repair with CC ligament repair. RESULTS: For posterior translation, transection of the ACLC reduced resistance to 16.7% of the native. With the native CC ligaments intact, the ACLC patch (59.1%), oblique brace (54.1%), and anterior brace (60.7%) provided significantly greater stability than the x-frame brace (33.2%; P < .001, P = .008, P < .001, respectively). ACLC patch, oblique brace, and anterior brace continued to have significantly higher posterior translational resistance than the x-frame (35.1%; P < .001, P = .003, P < .001) after transection and subsequent CC ligament repair. For posterior rotation, transection of the ACLC decreased the resistance to 5.4% of the intact state. With the CC ligaments intact, the ACLC patch (77.1%) better restored posterior rotational stability than the oblique (35.3%), anterior (48.5%), and x-frame (23.0%) brace repairs (P < .001, P = .002, P < .001). CC ligament transection and subsequent repair demonstrated the ACLC patch (41.0%) to have improved stability when compared with the oblique (16.0%), anterior (14.0%), and x-frame (12.7%) repairs (P = .006, P = .003, P = .002). CONCLUSION: ACLC reconstruction with a dermal allograft better restored native posterior rotational stability than other brace constructs, with translational stability similar to the oblique and anterior brace technique at the time of surgery. CLINICAL RELEVANCE: Horizontal stability of the AC joint is primarily controlled by the ACLC. Inability to restore AC joint biomechanics can result in persistent posterior instability and lead to functional impairment.


Assuntos
Articulação Acromioclavicular , Instabilidade Articular , Procedimentos Cirúrgicos Reconstrutivos/métodos , Articulação Acromioclavicular/cirurgia , Idoso , Fenômenos Biomecânicos , Cadáver , Humanos , Cápsula Articular , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Pessoa de Meia-Idade , Rotação
11.
J Am Acad Orthop Surg ; 28(14): e595-e603, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692095

RESUMO

Weight-bearing CT (WBCT) scans of the foot and ankle have improved the understanding of deformities that are not easily identified on radiographs and are increasingly being used by orthopaedic surgeons for diagnostic and preoperative planning purposes. In contrast to standard CT scans, WBCT scans better demonstrate the true orientation of the bones and joints during loading. They have been especially useful in investigating the alignment of complex pathologies such as adult-acquired flatfoot deformity in which patients have been found to have a more valgus subtalar joint alignment than in a normal cohort and high rates of subfibular impingement. Studies using WBCT scans have also provided new insight into more common lower extremity conditions such as hallux valgus, ankle fractures, and lateral ankle instability. WBCT scans have allowed researchers to investigate pronation of the first metatarsal in patients with hallux valgus compared with normal feet, and patients with lateral ankle instability have been found to have more heel varus than healthy control subjects. Understanding the application of WBCT scans to clinical practice is becoming more important as surgeons strive for improved outcomes in the treatment of complicated foot and ankle disorders.


Assuntos
Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Pé/diagnóstico por imagem , Pé/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Suporte de Carga , Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Pé Chato/cirurgia , Pé/cirurgia , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/fisiopatologia , Hallux Valgus/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Planejamento de Assistência ao Paciente
12.
Sports Health ; 12(5): 425-430, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716726

RESUMO

CONTEXT: Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed. OBJECTIVE: To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature. DATA SOURCES: An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE). STUDY SELECTION: Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar). RESULTS: A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured "tracking" without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely <15% of glenoid width in recent studies. Recommendations regarding humeral head loss were more variable (many authors providing only qualitative descriptions) with increasing attention on glenohumeral tracking. CONCLUSION: It is essential that a standardized method of glenoid and humeral head bone loss measurements be performed preoperatively to assess which patients will have successful stabilization after arthroscopic Bankart repair. Glenoid bone loss should be <15%, and humeral head lesions should be "on track" if an arthroscopic-only Bankart is planned. If there is greater bone loss, adjunct or open procedures should be performed.


Assuntos
Artroscopia/métodos , Lesões de Bankart/cirurgia , Instabilidade Articular/cirurgia , Ombro/cirurgia , Lesões de Bankart/patologia , Tomada de Decisão Clínica , Cavidade Glenoide/patologia , Humanos , Cabeça do Úmero/patologia , Instabilidade Articular/patologia , Ombro/patologia
13.
Arthroscopy ; 36(7): 1951-1952, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624128

RESUMO

Over the past several years, there has been a resurgence of interest in the anterolateral side of the anterior cruciate ligament-injured knee. The 2 most commonly techniques on the anterolateral side for surgically controlling residual rotational instability are anterolateral ligament reconstruction and modified Lemaire lateral extra-articular tenodesis. Several biomechanical studies have shown no or only subtle differences between the 2 procedures. It is time to advance from the biomechanical analyses and direct future work to clinical studies focusing on improving patient selection, surgical morbidity, and longer-term outcomes.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular/cirurgia , Tenodese , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/cirurgia
14.
Yonsei Med J ; 61(7): 635-639, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608208

RESUMO

Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its correction is controversial. The current study aimed to evaluate clinical and radiographic outcomes of a modified Broström procedure (MBP) with additional procedures for CLAI with subtle cavovarus deformity and a positive peek-a-boo heel sign. We reviewed the records of 15 patients who underwent MBP with additional procedures for CLAI with a positive peek-a-boo heel sign between August 2009 and April 2015. Consecutive physical and radiographic examinations were performed. The visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Karlsson-Peterson (KP) ankle score were applied to assess clinical outcomes. Weight bearing radiographs, hindfoot alignment view, and ankle stress radiographs were also examined. The mean follow-up period was 58.5 months. Calcaneal lateral closing wedge osteotomy was performed in seven patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy was performed in 11 patients to correct plantarflexion of the first ray. Three patients underwent both procedures. Mean VAS, AOFAS, and KP ankle scores improved significantly (p=0.001), and instability did not recur. Radiographically, all stress parameters improved significantly (p=0.007). Simultaneous correction of a positive peek-a-boo heel sign and cavovarus deformity with MBP for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for subtle cavovarus deformity should be followed when treating patients with CLAI. This trial is registered on Clinical Research Information Service (CRiS, KCT0003287).


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/métodos , Adulto , Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , , Calcanhar/diagnóstico por imagem , Calcanhar/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/diagnóstico por imagem , Masculino , Ossos do Metatarso , Metatarso/diagnóstico por imagem , Metatarso/cirurgia , Pessoa de Meia-Idade , Radiografia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Pé Cavo/diagnóstico por imagem , Pé Cavo/cirurgia , Resultado do Tratamento , Escala Visual Analógica
15.
Am J Sports Med ; 48(9): 2105-2114, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32667269

RESUMO

BACKGROUND: Since the description of the arthroscopic Latarjet technique, discussion about the superiority of the open or arthroscopic procedure has arisen. The appropriate placement of the coracoid graft (CG) on the anterior glenoid neck is reported to be the most important step of the Latarjet procedure. PURPOSE: To verify if there are differences in the parameters that may affect the final position and fixation of CG obtained from the open and arthroscopic Latarjet techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty fresh-frozen human paired cadaveric shoulder specimens were randomly distributed in 2 surgery groups (open group [OG] and arthroscopic group [AG]) with 10 specimens in each. Two surgeons, each with experience performing open and arthroscopic Latarjet techniques, executed these procedures: one surgeon performed all open techniques, and the other performed all arthroscopic techniques, respectively. After surgery, a computerized tomography scan was performed. The surgical time, the position of each CG, a series of variables that might affect the CG fixation, and the level of the subscapularis muscle split were evaluated. RESULTS: The mean surgical time was significantly longer in the AG (mean, 26 minutes for OG and 57 minutes for AG). Three intraoperative complications (30%) were identified in the AG, consisting of graft fractures. The CG was determined to be in an optimal cranial-caudal position in 90% of specimens of the OG and 44% of the AG (Fisher, P = .057). In both groups, the CG was placed in an optimal medial-lateral position in all specimens. In the OG, the degree of parallelism between the major axes of the glenoid surface and CG was significantly greater than in the AG (mean, 3.8º for OG and 15.1º for AG). No significant differences were observed in superior and inferior screw orientation between the groups. In the longitudinal and transverse directions, significant differences were found in the centering of the superior screw, being closer to the ideal point in the OG than in the AG. The location where the longitudinal subscapularis muscle split was performed was significantly higher in the AG. CONCLUSION: The open Latarjet technique required less surgical time; presented a lower number of intraoperative complications; and allowed more adequate placement of the CG, better centering of the screws, and a subscapularis muscle split closer to the ideal position. CLINICAL RELEVANCE: The reported benefits of the arthroscopic Latarjet technique seem less clear if we take into account the added surgery time and complications.


Assuntos
Artroscopia/métodos , Transplante Ósseo/métodos , Instabilidade Articular , Músculo Esquelético/transplante , Articulação do Ombro , Cadáver , Humanos , Instabilidade Articular/cirurgia , Escápula/cirurgia , Articulação do Ombro/cirurgia
16.
Bone Joint J ; 102-B(7_Supple_B): 27-32, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600197

RESUMO

AIMS: Dual mobility (DM) bearings are an attractive treatment option to obtain hip stability during challenging primary and revision total hip arthroplasty (THA) cases. The purpose of this study was to analyze data submitted to the American Joint Replacement Registry (AJRR) to characterize utilization trends of DM bearings in the USA. METHODS: All primary and revision THA procedures reported to AJRR from 2012 to 2018 were analyzed. Patients of all ages were included and subdivided into DM and traditional bearing surface cohorts. Patient demographics, geographical region, hospital size, and teaching affiliation were assessed. Associations were determined by chi-squared analysis and logistic regression was performed to assess outcome variables. RESULTS: A total of 406,900 primary and 34,745 revision THAs were identified, of which 35,455 (8.7%) and 8,031 (23.1%) received DM implants respectively. For primary THA, DM usage increased from 6.7% in 2012 to 12.0% in 2018. Among revision THA, DM use increased from 19.5% in 2012 to 30.6% in 2018. Patients < 50 years of age had the highest rates of DM implantation in every year examined. For each year of increase in age, there was a 0.4% decrease in the rate of DM utilization (odds ratio (OR) 0.996 (95% confidence interval (CI) 0.995 to 0.997); p < 0.001). Females were more likely to receive a DM implant compared to males (OR 1.077 (95% CI 1.054 to 1.100); p < 0.001). Major teaching institutions and smaller hospitals were associated with higher rates of utilization. DM articulations were used more commonly for dysplasia compared with osteoarthritis (OR 2.448 (95% CI 2.032 to 2.949); p < 0.001) during primary THA and for instability (OR 3.130 (95% CI 2.751 to 3.562) vs poly-wear; p < 0.001) in the revision setting. CONCLUSION: DM articulations showed a marked increase in utilization during the period examined. Younger patient age, female sex, and hospital characteristics such as teaching status, smaller size, and geographical location were associated with increased utilization. DM articulations were used more frequently for primary THA in patients with dysplasia and for revision THA in patients being treated for instability. Cite this article: Bone Joint J 2020;102-B(7 Supple B):27-32.


Assuntos
Artroplastia de Quadril/tendências , Prótese de Quadril , Desenho de Prótese , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Luxação do Quadril/cirurgia , Número de Leitos em Hospital , Hospitais de Ensino/estatística & dados numéricos , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Sistema de Registros , Reoperação/estatística & dados numéricos , Distribuição por Sexo , Estados Unidos/epidemiologia
17.
Bone Joint J ; 102-B(7_Supple_B): 105-111, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600211

RESUMO

AIMS: The purpose of this study is to examine six types of bearing surfaces implanted at a single institution over three decades to determine whether the reasons for revision vary among the groups and how long it takes to identify differences in survival. METHODS: We considered six cohorts that included a total of 1,707 primary hips done between 1982 and 2010. These included 223 conventional polyethylene sterilized with γ irradiation in air (CPE-GA), 114 conventional polyethylene sterilized with gas plasma (CPE-GP), 116 crosslinked polyethylene (XLPE), 1,083 metal-on-metal (MOM), 90 ceramic-on-ceramic (COC), and 81 surface arthroplasties (SAs). With the exception of the COC, all other groups used cobalt-chromium (CoCr) femoral heads. The mean follow-up was 10 (0.008 to 35) years. Descriptive statistics with revisions per 100 component years (re/100 yr) and survival analysis with revision for any reason as the endpoint were used to compare bearing surfaces. RESULTS: XLPE liners demonstrated a lower cumulative incidence of revision at 15 years compared to the CPE-GA and CPE-GP groups owing to the absence of wear-related revisions (4% for XLPE vs 18%, p = 0.02, and 15%, p = 0.003, respectively). Revisions for adverse local tissue reactions occurred exclusively among the MOM (0.8 re/100 year) and SA groups (0.1 re/100 year). The revision rate for instability was lower among hips with 36 mm and larger head sizes compared to smaller head sizes (0.2% vs 2%, p < 0.001). CONCLUSION: The introduction of XLPE has eliminated wear-related revisions through 15-year follow-up compared to CPE-GP and CPE-GA. Dislocation incidence has been reduced with the introduction of larger diameter heads but remains a persistent concern. The potential for adverse local tissue reactions with MOM requires continued follow-up. Cite this article: Bone Joint J 2020;102-B(7 Supple B):105-111.


Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril , Desenho de Prótese , Falha de Prótese/tendências , Adulto , Idoso , Cerâmica , Ligas de Cromo , Estudos de Coortes , Seguimentos , Humanos , Instabilidade Articular/cirurgia , Masculino , Próteses Articulares Metal-Metal , Pessoa de Meia-Idade , Polietileno , Reoperação/estatística & dados numéricos , Virginia
18.
Jt Dis Relat Surg ; 31(2): 223-229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584718

RESUMO

OBJECTIVES: This study aims to compare the clinical results of patients with traumatic isolated Bankart lesions and type V superior labrum anterior to posterior (SLAP) lesions after arthroscopic repair. PATIENTS AND METHODS: Patients who underwent arthroscopic repair for traumatic anterior glenohumeral instability were evaluated retrospectively between December 2014 and January 2019. Fifty-one patients (49 males, 2 females; mean age 25 years; range, 18 to 36 years) without bone defects affecting >20% of the glenoid fossa, off-track engaging Hills-Sachs lesions, multidirectional instability, or ligamentous laxity were included in the study. Group 1 had 31 patients with isolated Bankart lesions and group 2 had 20 patients with type V SLAP lesions. There were only two female patients in group 1 and all patients were male in group 2. The mean age was 25 years (range, 18 to 36 years) in group 1 and 25 years (range, 19 to 35 years) in group 2. Rowe, Constant, and Western Ontario Shoulder Instability (WOSI) scoring systems were used to evaluate the clinical outcomes of the patients preoperatively and at the last follow-up. RESULTS: The mean follow-up time was 32 months (range, 12 to 48 months) in group 1 and 28.5 months (range, 12 to 42 months) in group 2. There were no statistically significant differences between the two groups in terms of the number of shoulder dislocations before the surgery, mean age at the time of surgery, and the mean time from the first dislocation to surgical treatment. When the Rowe, Constant, and WOSI scores were evaluated preoperatively and at the last follow-up, there were statistically significant changes within, but not between, the two groups. CONCLUSION: In type V SLAP lesions, the affected and repaired labrum surface area is larger than isolated Bankart lesions. However, as a result of appropriate surgical treatment, the affected surface area does not have a negative effect on clinical outcomes, and similar clinical results can be obtained in patients with type V SLAP lesions compared to patients with isolated Bankart lesions.


Assuntos
Lesões de Bankart/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Instabilidade Articular/cirurgia , Luxação do Ombro/cirurgia , Adolescente , Adulto , Artroscopia , Lesões de Bankart/etiologia , Lesões de Bankart/fisiopatologia , Feminino , Seguimentos , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Índice de Gravidade de Doença , Luxação do Ombro/complicações , Luxação do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Adulto Jovem
19.
Am J Sports Med ; 48(9): 2260-2267, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32551826

RESUMO

BACKGROUND: Increased external tibial torsion and tibial tuberosity-trochlear groove distance (TTTG) affect patellofemoral instability and can be corrected by tibial rotational osteotomy and tibial tuberosity transfer. Thus far, less attention has been paid to the combined correction of tibial torsion and TTTG by supratuberositary osteotomy. PURPOSE: To quantify the effect of a supratuberositary torsional osteotomy on TTTG. STUDY DESIGN: Descriptive laboratory study. METHODS: Seven patients who underwent supratuberositary osteotomy to treat patellofemoral instability and an additional 13 patients with increased TTTG were included (N = 20). With 3-dimensional (3D) surface models, supratuberositary rotational osteotomies were simulated with predefined degrees of rotation. Concomitant 3D TTTG was measured by a novel and validated measurement method. In addition, all operated patients underwent 2-dimensional (2D) radiographic evaluation with pre- and postoperative computed tomography data. Absolute differences among simulated, predicted, and achieved postoperative corrections were compared. RESULTS: A total of 500 supratuberositary osteotomies were simulated. The linear regression estimate yielded a change of -0.68 mm (95% CI, -0.72 to -0.63; P < .0001) in 3D TTTG per degree of tibial rotation, and 2D and 3D TTTG measurements in the operated patients were comparable in pre- and postoperative measurements (preoperative, 19.8 ± 2.5 mm and 20.0 ± 2.4 mm; postoperative, 13.6 ± 3.8 mm and 14.6 ± 3.4 mm, respectively). Postoperative 2D TTTG deviated in absolute terms from predicted (regression) and simulated TTTG by 1.4 ± 1.0 mm and 1.5 ± 0.6 mm. Inter- and intrarater reliability (intraclass correlation coefficient) for radiological and simulated measurements ranged between 0.883 and 0.996 and were almost perfect. CONCLUSION: In supratuberositary osteotomy, TTTG changes by -0.68 mm per degree of internal tibial rotation. The absolute mean difference between postoperative predicted TTTG and 2D TTTG was only 1.4 mm. Thus, TTTG correction can be successfully predicted by the degree of tibial rotation. CLINICAL RELEVANCE: TTTG correction can be successfully predicted by the degree of tibial rotation. Therefore, in selected cases, tibial torsional deformity and TTTG can be corrected by 1 osteotomy. However, isolated rotations have been performed, and unintended translational movements during tibial rotation may alter the postoperative results.


Assuntos
Instabilidade Articular/cirurgia , Osteotomia , Articulação Patelofemoral/cirurgia , Tíbia , Anormalidade Torcional/cirurgia , Humanos , Articulação Patelofemoral/fisiopatologia , Radiografia , Reprodutibilidade dos Testes , Tíbia/cirurgia , Tomografia Computadorizada por Raios X
20.
Acta Orthop Belg ; 86(1): 69-76, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32490776

RESUMO

The goal of this study was to present the results of an anatomical superficial medial collateral ligament (sMCL) reconstruction combined with reefing of the posteromedial capsule in a series of 10 patients with symptomatic valgus instability complaints in combined injuries of the knee. All patients under- went an sMCL reconstruction with reefing of the posteromedial capsule. If cruciate ligament insuf- ficiency was present, this was reconstructed as well. Pre- and postoperatively, multiple subjective knee outcome scores were obtained, and valgus stress radiographs objectively evaluated laxity. Median valgus laxity of the injured knee on valgus stress radiographs improved significantly. There was no statistically significant difference between post- operative valgus laxity of the injured knee and valgus laxity of the uninjured knee. All subjective knee outcome scores improved significantly compared with the preoperative situation. The described procedure restores valgus laxity to a level comparable to the uninjured knee.


Assuntos
Cápsula Articular/cirurgia , Instabilidade Articular/cirurgia , Ligamento Colateral Médio do Joelho/lesões , Ligamento Colateral Médio do Joelho/cirurgia , Adolescente , Adulto , Humanos , Cápsula Articular/fisiopatologia , Instabilidade Articular/fisiopatologia , Ligamento Colateral Médio do Joelho/fisiopatologia , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Adulto Jovem
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