Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.124
Filtrar
1.
Clin Sports Med ; 41(1): 109-121, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782068

RESUMO

Management of the patient with multiple risk factors for recurrent patellar instability is complex. Surgeons must possess familiarity with the anatomic risk factors that are associated with first time and recurrent instability events and weigh them in the patient's individualized surgical "menu" options for surgical patellar stabilization. Addressing individual risk factors, pairing imaging findings with physical examination, and thoughts on prioritizing risk factors to determine which should be prioritized for surgical correction are discussed.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/epidemiologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Recidiva , Fatores de Risco
2.
Clin Sports Med ; 41(1): 137-155, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782070

RESUMO

Cartilage defects of the patellofemoral joint are commonly found in association with patellar instability owing to abnormal biomechanics. Strategies to address chondral defects of the patellofemoral joint secondary to instability should first address causes of recurrent instability. Most patellofemoral chondral defects associated with instability are less than 2 cm2 and do not generally require intervention beyond chondroplasty. Larger defects of the patella and/or the trochlea can be repaired with osteochondral or surface cartilage repair.


Assuntos
Doenças das Cartilagens , Instabilidade Articular , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Patela/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia
3.
Clin Sports Med ; 41(1): 15-26, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782071

RESUMO

Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has evolved to include uniplanar and multiplanar osteotomies, which allows patient-specific treatment. With a careful understanding of the complex pathoanatomy, including osseous, soft tissue, and dynamic muscular factors, an appropriately designed tibial tubercle osteotomy (TTO) is an invaluable tool for the orthopedic surgeon to improve joint biomechanics and off-load articular injuries. Current techniques have improved TTO surgery to limit complications and produce reliably good results.


Assuntos
Instabilidade Articular , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Osteotomia , Patela , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/cirurgia
4.
Clin Sports Med ; 41(1): 157-169, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782072

RESUMO

Patellar instability is one of the most prevalent knee disorders, with dislocations occurring in 5 to 43 cases per 10,000 annually. Traumatic patellar dislocation can result in significant morbidity and is associated with patellofemoral chondral injuries and fractures, medial soft tissue disruption, pain, and reduced function, and can lead to patellofemoral osteoarthritis. Chronic and recurrent instability can lead to deformation and incompetence of the medial soft tissue stabilizers. Despite recent gains in understanding the pathoanatomy of this disorder, the management of patients with this condition is complex and remains enigmatic.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho , Ligamentos Articulares/cirurgia , Luxação Patelar/epidemiologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
5.
Clin Sports Med ; 41(1): 171-183, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782073

RESUMO

The lateral patellofemoral complex is an important stabilizer to medial and lateral displacement of the patella. Soft tissue abnormalities can range from pathologic tightness to laxity, presenting with symptoms related to patellar instability, anterior knee pain, or arthritis. Clinical evaluation should be performed to confirm patellar dislocation, assess the integrity of the lateral and medial soft tissues, and explore other pathoanatomic factors that may need to be addressed. Lateral retinacular lengthening is recommended over lateral release owing to the potential of iatrogenic medial instability with release, and a lateral patellofemoral ligament reconstruction can be performed to effectively treat medial instability.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Patela , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
6.
Clin Sports Med ; 41(1): 27-46, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782074

RESUMO

Rotational deformity is a less common cause of patellar instability than trochlear dysplasia and patella alta. In some cases, rotational deformity is the primary bony factor producing the instability and should be corrected surgically. More research is needed on what are normal values for femoral version and tibial torsion, as well as when the axial plane alignment needs to be corrected. Many tools can be used to evaluate the axial plane and surgeons should be familiar with each of them. Understanding the advantages and disadvantages of each site for osteotomy will help the surgeon choose the most appropriate osteotomy.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur/cirurgia , Humanos , Instabilidade Articular/cirurgia , Patela , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/cirurgia
7.
Clin Sports Med ; 41(1): 47-63, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782075

RESUMO

Valgus malalignment is an important risk factor in recurrent patella instability. This article explores the role of corrective osteotomy and discusses the various described methods both on the femoral and tibial sides of the joint. A detailed operative technique of medial closing wedge distal femoral osteotomy is included.


Assuntos
Geno Valgo , Instabilidade Articular , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Geno Valgo/diagnóstico por imagem , Geno Valgo/cirurgia , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteotomia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
8.
Clin Sports Med ; 41(1): 65-76, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782076

RESUMO

Patella alta is described as abnormally high-riding patella in relation to the femur, the trochlear groove, or the tibia with decreased bony stability. Patella alta represents an important predisposing factor for patellofemoral instability. Different measurement methods are used to define patella alta. Despite the clinical importance of patella alta, there is only limited consensus on cutoff values, indications for treatment, and ideal correction. In addition, the impact of patella alta on other risk factors for lateral patellar instability is significant. This must be considered when assessing clinical complaints and choosing the best individual treatment. Combined surgical interventions may be necessary.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Patela/diagnóstico por imagem , Patela/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Fatores de Risco
9.
Clin Sports Med ; 41(1): 77-88, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782077

RESUMO

When? Only patients with high-grade trochlear dysplasia types B and D, in which the prominence of the trochlea (supratrochlear spur) is over 5 mm, recurrent patellar dislocation, and maltracking. How? Sulcus deepening trochleoplasty: modifies the trochlear shape with a central groove and oblique medial and lateral facets; decreases the patellofemoral joint reaction force by reducing the trochlear prominence (spur); and reduces the tibial tubercle and the trochlear groove value by a proximal realignment. Pros: This procedure is highly effective in restoring patellofemoral stability and satisfying the patients. Cons: The patients must be aware of the risk of continuing residual pain and range-ofmotion limitation and that the development of patellofemoral osteoarthritis is not predictable.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Instabilidade Articular/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
10.
Clin Sports Med ; 41(1): 89-96, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782078

RESUMO

Medial patellofemoral ligament reconstruction is used increasingly to treat patellar instability. A number of different techniques have been described to perform this procedure. In this article, we review common pearls and pitfalls to medial patellofemoral ligament reconstruction, as well as tips for troubleshooting the procedure. A special emphasis is placed on femoral tunnel position and intraoperative adjustments that can be made to improve outcomes.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho , Ligamentos Articulares/cirurgia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
11.
Arthroscopy ; 37(11): 3253-3254, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34740404

RESUMO

Traditionally, most orthopaedic surgeons use glenoid bone loss of >15% to 20% glenoid width as the cut off for arthroscopic Bankart repairs. More than that amount of bone loss suggests the need to augment the glenoid with bone-most often performed with a Latarjet coracoid transfer. Primary Latarjet procedures are more widely used in Europe compared with the United States for the treatment of shoulder instability-even with less bone loss than 15%. Better results regarding stability are found using primary Latarjet compared with those in revision Latarjet procedures performed after an arthroscopic Bankart procedure has failed. Perhaps this should lead us to doing primary Latarjet procedures, with a lower threshold of bone loss.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia , Humanos , Instabilidade Articular/cirurgia , Recidiva , Estudos Retrospectivos , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia
12.
Zhongguo Gu Shang ; 34(10): 940-6, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34726023

RESUMO

The incidence of posterior instability of shoulder joint was significantly lower than that of anterior instability, but the clinical diagnosis and treatment was difficult, and the misdiagnosis and missed diagnosis rate were high. Its etiology, clinical manifestation and treatment strategy are totally different from the anterior instability. Therefore, the deep understanding of the anatomical structure around the shoulder joint, the mastery of the examination method, and the classification of the shoulder instability based on the anatomy and injury mode are of great importance to improve the accuracy of diagnosis. CT three-dimensional reconstruction is helpful to evaluate the defect of humeral head and glenoid bone, and MRA is helpful for the accurate diagnosis of posterior glenoid lip and joint capsule. The treatment was divided into conservative treatment and surgical treatment. Conservative treatment is recommended for muscular instability. Surgical treatment is recommended for traumatic and dysplastic instability. Different operative methods should be performed according to the injury of glenoid side or humeral head side. According to the condition of bone defect, soft tissue operation, bone grafting or osteotomy were performed to reconstruct the posterior stable structure of the glenoid injury; according to the area of the anterior bone defect, bone grafting or subscapular muscle packing were performed to the head of humerus defect. The former has the advantages of short learning curve and firm fixation, while the latter has the advantages of minimally invasive operation and the ability to observe the lesions from multiple angles and accurately control the location of bone masses. This paper summarizes the above problems.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Humanos , Cabeça do Úmero , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Escápula , Ombro , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia
13.
Jt Dis Relat Surg ; 32(3): 744-751, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34842108

RESUMO

OBJECTIVES: This study aims to examine the clinical outcomes and complications of lateral ligament reconstruction performed using soft anchors according to the arthroscopic modified Broström technique (MBT) for the treatment of chronic ankle instability (CAI) and to evaluate the frequency of return to sports. PATIENTS AND METHODS: A total of 14 patients with CAI (9 males, 5 females; mean age: 30.1±4.6 years; range, 22 to 38 years) who underwent the MBT with soft anchors between January 2015 and December 2019 were retrospectively analyzed. Ankle function was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Karlsson Ankle Function Score (Karlsson/Peterson, K/D score), while pain was evaluated using the Visual Analog Scale (VAS) after a minimum follow-up of 12 months. RESULTS: The mean follow-up was 23.6±7.7 months. The mean overall AOFAS score was 74.0±2.6 preoperatively, which improved to 96.2±1.9 in the postoperative period (p=0.001). The mean pre- and postoperative K/P scores were 72.4±3.1 (range, 68 to 78) and 95.3±2.2 (range, 92 to 98), respectively (p=0.001). The mean preoperative VAS score was 2.4±0.9 (range, 1 to 4) and showed a significant improvement to 0.6±0.5 (range, 0 to 1) in the postoperative period (p=0.001). Nine (64.3%) patients returned to sports activities after surgery at a mean period of 9±2.1 months. CONCLUSION: In the treatment of CAI, arthroscopic MBT performed with soft anchors provides successful outcomes in short-term follow-up. In addition to being a minimally invasive technique, MBT is a reliable and safe approach with low complication rates and significant functional improvement. However, the low ratio of return to sports should be considered as a failure of this technique.


Assuntos
Tornozelo , Instabilidade Articular , Adulto , Artroscopia , Feminino , Seguimentos , Humanos , Instabilidade Articular/cirurgia , Masculino , Estudos Retrospectivos , Adulto Jovem
14.
BMC Musculoskelet Disord ; 22(1): 845, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600519

RESUMO

BACKGROUND: Anterior shoulder dislocation remains a clinical challenge. This study aimed to assess the graft position and clinical outcomes of the arthroscopic Latarjet procedure and capsular repair for the treatment of recurrent anterior shoulder dislocation with significant glenoid bone loss in 37 patients. METHODS: Between 2017 and 2017, 37 patients underwent arthroscopic Latarjet plus capsular repair procedure for recurrent anterior shoulder dislocation combined with significant glenoid bone loss. In follow-up examinations, Walch-Duplay scores, subjective shoulder value (SSV) scores, Rowe scores, and active range of motion (AROM) were assessed. Three-dimensional computed tomography (CT) was used to evaluate coracoid graft position and bone resorption. A new method of evaluating the position of the coracoid bone block after Latarjet (H-Z method) was developed. RESULTS: Thirty-seven patients were included in this study. Follow-up ranged from 6 to 36 months postoperatively (with an average of 13 months). No recurrent dislocation occurred at the final follow-up, and there was no significant effect on the AROM (all p > 0.05). Rowe (from 42.2 ± 5.6 to 91.1 ± 3.3), Walch-Duplay (from 31.5 ± 8.0 to 92.6 ± 3.7), and SSV (from 63.9 ± 6.1 to 79.3% ± 5.0%) scores were improved significantly after surgery (all p < 0.001). CT showed that the 29 patients had varying degrees of bone resorption, and 23 recovered to the preinjury level of motional function within 6-12 months after surgery. CONCLUSIONS: In active patients with recurrent anterior shoulder dislocations and significant glenoid bone loss, the arthroscopic Latarjet procedure plus capsular repair could restore shoulder stability satisfactory.


Assuntos
Luxações Articulares , Instabilidade Articular , Articulação do Ombro , Artroscopia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Ombro , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia
15.
Arthroscopy ; 37(10): 3198-3199, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602157

RESUMO

Medial patellofemoral ligament (MPFL) reconstruction is the "workhorse" for surgical stabilization of recurrent patella instability. Complications of patella fixation (i.e., patella fracture) are rare but potentially catastrophic. Modifications to traditional MPFL reconstruction that avoid patella fixation are promising. These alternatives may be favored in high-risk scenarios such as revision, smaller pediatric cases, and patellofemoral arthroplasty with concomitant instability. Large-scale prospective and/or randomized studies are needed to differentiate between MPFL reconstruction techniques.


Assuntos
Instabilidade Articular , Articulação Patelofemoral , Criança , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho , Ligamentos Articulares/cirurgia , Patela/cirurgia , Articulação Patelofemoral/cirurgia , Estudos Prospectivos
16.
J Orthop Surg (Hong Kong) ; 29(3): 23094990211052095, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34647495

RESUMO

Purpose: Residual functional ankle instability regardless of the restoration of mechanical stability after the lateral ligament repair or reconstruction can cause recurrent sprain. The purpose of this study was to identify the sequential changes of joint-position sense, peroneal strength, postural control, and functional performance ability after the modified Broström procedure (MBP) for chronic ankle instability. Methods: A total of 46 patients (46 ankles) who underwent the MBP for chronic ankle instability were eligible for this study and were followed up for 1 year postoperatively. The changes of joint-position sense and peroneal strength were periodically evaluated with an isokinetic dynamometer. Postural control ability was evaluated using a one-leg stance test with eyes closed. The functional performance ability examination comprised a one-leg hop test, a six-meter hop test, and a cross three-meter hop test. Results: The error in joint-position sense significantly improved from a mean 4.3° to 2.8° (p < 0.001). Peak torque for eversion significantly improved from a mean 18.2 Nm to 21.2 Nm (p = 0.024). Balance retention time significantly improved from a mean 4.7 s to 6.4 s (p < 0.001). Among the functional performance tests, only the one-leg hop test showed a significant improvement postoperatively (p = 0.031). At 1 year postoperatively, the recovery ratios compared to the unaffected ankle were 67.9% in joint-position sense (p < 0.001), 86.9% in peroneal strength (p = 0.012), and 74.4% in postural control (p < 0.001), with significant side-to-side differences. Conclusion: Although joint-position sense, peroneal strength, postural control, and functional performance ability were significantly improved after the MBP, recovery ratios compared to the unaffected ankle were insufficient up to 1 year postoperatively. Level of Evidence: Level IV (prospective case series).


Assuntos
Tornozelo , Instabilidade Articular , Articulação do Tornozelo/cirurgia , Humanos , Instabilidade Articular/cirurgia , Força Muscular , Desempenho Físico Funcional , Equilíbrio Postural
17.
Pan Afr Med J ; 40: 7, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34650657

RESUMO

Traumatic dislocations of the shoulder joint are generally described as an antero-inferior dislocations. Anterior-superior dislocations are extremely rare. We report a rare case of traumatic dislocation of the anterior-superior shoulder in a 45-year-old patient whose physical examination showed an anterior-superior subcutaneous protrusion of the head filling the subacromial space. The diagnosis was radiologically confirmed. MRI showed total rupture of the supraspinatus and subscapularis tendons. Shoulder instability occurred after reduction of the dislocation. Temporary glenohumeral arthrodesis was subsequently performed with good functional results.


Assuntos
Instabilidade Articular/cirurgia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Artrodese/métodos , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/etiologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/lesões , Resultado do Tratamento
18.
Am J Sports Med ; 49(13): 3620-3627, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34523379

RESUMO

BACKGROUND: The Latarjet is a successful procedure but can be associated with significant complications, including failure. Iliac crest bone grafting (ICBG) is one of the salvage options for such failure. PURPOSE: To analyze factors associated with failure or success to restore shoulder stability with ICBG after Latarjet failure. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty consecutive patients with recurrence of instability after a Latarjet procedure underwent revision using ICBG. Sixteen patients (80%) with a mean age of 35.0 years (range, 25-55) could be personally reexamined clinically and radiographically (including computed tomography scan) after a mean follow-up of 4.5 years (range, 2-8). Twelve patients had redislocation and 4 had recurrent subluxation after the Latarjet. RESULTS: Salvage ICBG failed in 7 patients because of recurrent dislocations, with 5 necessitating reoperations: 2 arthrodeses, 1 reverse total shoulder arthroplasty, 1 repeat ICBG, and 1 Hill-Sachs allograft reconstruction and Bankart repair. Factors associated with ICBG failure were multidirectional instability (n = 2), subscapularis insufficiency (n = 1), uncontrolled seizures (n = 1), static inferior glenohumeral subluxation (n = 1), total graft resorption (n = 1), and voluntary dislocation attributed to schizoaffective disorder (n = 1). The initial Latarjet graft was malpositioned (too medial) in 3 of these patients. In patients without recurrent instability (n = 9), reasons for Latarjet failure were graft related: 6 graft avulsions, 2 graft resorptions, and 1 medial graft malpositioning. The mean absolute Constant score (62 to 87 points, P = .012) and relative Constant score (66% to 91%, P = .012), pain (10 to 15 points, P < .001), and Subjective Shoulder Value (31% to 85%, P = .011) in the group with a successful procedure were significantly improved over the preoperative state, and the total Western Ontario Shoulder Instability Index averaged 64% at final follow-up. Except in 1 case of major resorption, mild graft resorption or none was observed in successful procedures. Axial and sagittal graft positioning was good in all 9 patients. CONCLUSIONS: Salvage ICBG for failed Latarjet procedures failed in 7 of 16 patients. It was successful in patients with clearly graft-related factors of the initial Latarjet procedure. However, patients with unclear instability symptoms, subscapularis insufficiency, inferior subluxation, uncontrolled seizures, or psychological disorders were poor candidates for salvage ICBG, underlining the importance of careful patient selection for the initial Latarjet procedure and for salvage ICBG.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Adulto , Artroscopia , Humanos , Ílio/cirurgia , Instabilidade Articular/cirurgia , Recidiva , Estudos Retrospectivos , Ombro
19.
Am J Sports Med ; 49(13): 3569-3574, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34524034

RESUMO

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is an established operative procedure to restore medial restraining force in patients with patellar instability. In the setting of a shallow sulcus, it is unclear whether an isolated MPFL reconstruction is sufficient to restore patellofemoral stability. HYPOTHESIS: Progressively increasing the sulcus angle would have an adverse effect on the ability of an MPFL reconstruction to restrain lateral patellar motion. STUDY DESIGN: Controlled laboratory study. METHODS: Seven fresh-frozen human cadaveric knees were harvested and prepared for experimentation. Each specimen was run through the following test conditions: native, lateral retinacular release, lateral retinacular repair, MPFL release, MPFL reconstruction, and MPFL reconstruction with trochlear flattening. Four 3-dimensional printed wedges (10°, 20°, 30°, and 40°) were created to insert beneath the native trochlea to raise the sulcus angle incrementally and simulate progressive trochlear flattening. For each test condition, the knee was positioned at 0°, 15°, 30°, and 45° of flexion, and the force required to displace the patella 1 cm laterally at 10 mm/s was measured. Group comparisons were made with repeated measures analysis of variance. RESULTS: In the setting of an MPFL reconstruction, as the trochlear groove was incrementally flattened, the force required to laterally displace the patella progressively decreased. A 10° increase in the sulcus angle significantly reduced the force at 15° (P = .01) and 30° (P = .03) of knee flexion. The force required to laterally displace the patella was also significantly lower at all knee flexion angles after the addition of the 20°, 30°, and 40° wedges (P≤ .05). Specifically, a 20° increase in the sulcus angle reduced the force by 29% to 36%; a 30° increase, by 35% to 43%; and a 40° increase, by 40% to 47%. CONCLUSION: Despite an MPFL reconstruction, the force required to laterally displace the patella decreased as the sulcus angle was increased in our cadaveric model. CLINICAL RELEVANCE: An isolated MPFL reconstruction may not be sufficient to restore patellar stability in the setting of a shallow or flat trochlea. Patients with an abnormal sulcus angle may have recurrent instability postoperatively if treated with an isolated MPFL reconstruction.


Assuntos
Instabilidade Articular , Luxação Patelar , Ligamento Patelar , Articulação Patelofemoral , Fenômenos Biomecânicos , Cadáver , Fêmur , Humanos , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Patela , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Tendões
20.
Am J Sports Med ; 49(13): 3528-3533, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34524037

RESUMO

BACKGROUND: A lateral meniscal (LM) disorder is one factor that causes rotational laxity after anterior cruciate ligament (ACL) reconstruction (ACLR). There are different types of irreparable meniscal disorders, one of which is a massive meniscal defect. HYPOTHESIS/PURPOSE: The purpose of this study was to evaluate the kinematic effects of arthroscopic centralization on an irreparable LM defect. The hypothesis was that arthroscopic centralization for an irreparable LM defect with concomitant ACLR would improve knee rotational stability. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 14 fresh-frozen human cadaveric knees were tested in 4 states: (1) intact ACL and intact lateral meniscus, (2) reconstructed ACL and intact lateral meniscus, (3) reconstructed ACL and lateral meniscus defect, and (4) reconstructed ACL and centralized lateral meniscus. Anatomic ACLR was performed using an 8 mm-diameter hamstring tendon graft. An LM defect (20% of the anteroposterior length) was created arthroscopically, and arthroscopic centralization was performed. Kinematics were analyzed using a 6 degrees of freedom robotic system under 4 knee loads: (1) an 89.0-N anterior tibial load, (2) a 5.0-N·m external rotation tibial torque, (3) a 5.0-N·m internal rotation tibial torque, and (4) a simulated pivot-shift load with a combined 7.0-N·m valgus and 5.0-N·m internal rotation tibial torque. RESULTS: LM centralization reduced anterior tibial translation similar to that of the ACLR intact LM state under anterior tibial loading (~2 mm at 30° of flexion) and showed 40% to 100% of tibial displacement in the 4 knee states under simulated pivot-shift loading. The procedure overconstrained the knee under internal rotation tibial torque and simulated pivot-shift loading. CONCLUSION: Arthroscopic centralization reduced knee laxity after ACLR for a massive LM defect in a cadaveric model. CLINICAL RELEVANCE: In cases involving irreparable LM injuries during ACLR, consideration should be given to arthroscopic centralization for reducing knee laxity. However, the procedure may overconstrain the knee in certain motions.


Assuntos
Lesões do Ligamento Cruzado Anterior , Instabilidade Articular , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Meniscos Tibiais , Amplitude de Movimento Articular
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...