Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.199
Filtrar
1.
Orthop Clin North Am ; 51(3): 373-381, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498956

RESUMO

Arthroscopic Latarjet is a relatively new, but viable option for the treatment of anterior shoulder instability. Arthroscopic Latarjet has the advantage of faster recovery, reduced stiffness, identification of additional shoulder pathology, and improved cosmesis when compared with open Latarjet. By the majority of clinical and radiographic parameters, arthroscopic Latarjet produces equivalent outcomes compared with open Latarjet. A relatively substantial learning curve for arthroscopic Latarjet exists at about 25 cases; however, multiple studies have demonstrated comparable outcomes and surgical time after the learning curve.


Assuntos
Artroscopia/métodos , Transplante Ósseo/métodos , Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Artroscopia/reabilitação , Transplante Ósseo/reabilitação , Humanos , Instabilidade Articular/diagnóstico por imagem , Luxação do Ombro , Articulação do Ombro/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Bone Joint J ; 102-B(1): 102-107, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888364

RESUMO

AIMS: Trochlear dysplasia is a significant risk factor for patellofemoral instability. The Dejour classification is currently considered the standard for classifying trochlear dysplasia, but numerous studies have reported poor reliability on both plain radiography and MRI. The severity of trochlear dysplasia is important to establish in order to guide surgical management. We have developed an MRI-specific classification system to assess the severity of trochlear dysplasia, the Oswestry-Bristol Classification (OBC). This is a four-part classification system comprising normal, mild, moderate, and severe to represent a normal, shallow, flat, and convex trochlear, respectively. The purpose of this study was to assess the inter- and intraobserver reliability of the OBC and compare it with that of the Dejour classification. METHODS: Four observers (two senior and two junior orthopaedic surgeons) independently assessed 32 CT and axial MRI scans for trochlear dysplasia and classified each according to the OBC and the Dejour classification systems. Assessments were repeated following a four-week interval. The inter- and intraobserver agreement was determined by using Fleiss' generalization of Cohen's kappa statistic and S-statistic nominal and linear weights. RESULTS: The OBC showed fair-to-good interobserver agreement and good-to-excellent intraobserver agreement (mean kappa 0.68). The Dejour classification showed poor interobserver agreement and fair-to-good intraobserver agreement (mean kappa 0.52). CONCLUSION: The OBC can be used to assess the severity of trochlear dysplasia. It can be applied in clinical practice to simplify and standardize surgical decision-making in patients with recurrent patella instability. Cite this article: Bone Joint J 2020;102-B(1):102-107.


Assuntos
Instabilidade Articular/classificação , Luxação Patelar/classificação , Articulação Patelofemoral/lesões , Adolescente , Adulto , Criança , Feminino , Humanos , Escala de Gravidade do Ferimento , Instabilidade Articular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Luxação Patelar/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Adulto Jovem
3.
J Pediatr Orthop ; 40(2): 71-77, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923166

RESUMO

BACKGROUND: The majority of research on medial (MCL) and lateral (LCL) collateral ligament injuries has focused on adults and combined collateral/cruciate injuries. The purpose of this study was to determine characteristics associated with isolated collateral ligament injuries in adolescents, and assess timing for return to sports. METHODS: Electronic medical records were queried to identify patients aged below 17 years who sustained a magnetic resonance imaging-confirmed isolated MCL or LCL injury over an 8-year period. Retrospective review then documented patient and injury characteristics and clinical course. General linear modeling was used to analyze risk factors for prolonged return to sports, continued pain or reinjury. RESULTS: Fifty-one knees (33 in males, 65%), mean age 13.8 years (range, 5 to 17), were identified, of which 40 (78%) had MCL injuries. Over half (29, 57%) of knees had an open distal femoral physis including all 5 bony avulsion injuries. Eleven (22%) had LCL injuries of which 3 (6%) had concurrent posterolateral corner injuries. Forty-two (82%) knees had injuries that occurred during sports. Eleven knees (28%) with MCL tears had a simultaneous patellar instability episode. Knee injuries that occurred during sports had 37% shorter recovery time (P=0.02). Eight knees (16%) experienced a reinjury and 12 (24%) were followed over an extended period of time for various knee issues. Football injuries were more likely to be grade 3 (P=0.03), and football and soccer accounted for all grade III injuries. The mean return to sports was 2.2 months, with grade III cases returning at 2.4 months, and 95% of cases within 4 months. CONCLUSIONS: Isolated collateral ligament injuries are rare in adolescent athletes. MCL injuries, one-quarter of which occurred in conjunction with patellar instability events, were 4 times more common than LCL injuries, one quarter of which have other posterolateral corner structures involved. Grade III injuries represent 20% to 25% of collateral ligament injuries and occurred most commonly in football and soccer. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Assuntos
Instabilidade Articular/complicações , Traumatismos do Joelho/complicações , Ligamento Colateral Médio do Joelho/lesões , Articulação Patelofemoral/lesões , Volta ao Esporte , Adolescente , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Criança , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/terapia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/terapia , Imagem por Ressonância Magnética , Masculino , Ligamento Colateral Médio do Joelho/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/terapia , Fatores de Tempo
4.
World Neurosurg ; 136: e223-e233, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31899395

RESUMO

OBJECTIVE: Assessment of transverse ligament (TL) competence in patients with suspected atlantoaxial instability is performed via indirect radiograph measurements or direct TL visualization on magnetic resonance imaging (MRI). Interpretation of these images can be limited by unique patient anatomy or imaging technique variability. We report a novel technique for evaluating TL competence using flexion-extension computed tomography (feCT) scan with 3-dimensional (3D) segmentation and quantitative analysis. METHODS: feCT scans of 11 patients were segmented to create 3D surface models. Six patients with atlantoaxial pathology were evaluated for possible instability based on clinical examination and imaging findings. The other 5 patients had no clinical or imaging evidence of atlantoaxial injury. Dynamic atlantodental interval (ADI) was calculated using point-to-point voxel changes between flexion and extension 3D models. Magnitude and direction of ADI changes were quantified and compared with available cervical spine flexion-extension radiograph and/or MRI findings. RESULTS: In the 5 patients without evidence of atlantoaxial injury, 94.3% of ADI vector changes were <3.0 mm. In the 3 patients with atlantoaxial pathology but TL competence, 92.4% of ADI vector changes were <3.0 mm. In the 3 patients with atlantoaxial pathology and TL incompetence, only 49.1% of ADI vector changes were <3.0 mm. In addition to the significant atlantoaxial subluxation in these 3 patients, there was significant rotational motion compared with the patients with an intact TL. CONCLUSIONS: 3D segmentation and quantitative analysis of feCT scan allow objective indirect assessment of TL integrity. Results are consistent with MRI findings and offer additional biomechanical information regarding the direction and distribution of atlantoaxial motion.


Assuntos
Articulação Atlantoaxial/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Instabilidade Articular/diagnóstico por imagem , Ligamentos/diagnóstico por imagem , Idoso , Articulação Atlantoaxial/patologia , Feminino , Humanos , Instabilidade Articular/patologia , Ligamentos/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
5.
World Neurosurg ; 134: 264-271, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31712115

RESUMO

BACKGROUND: The majority of the abnormalities and diseases that affect the craniovertebral junction (CVJ) have already been reported, and therefore it is exceedingly rare to identify new pathology that affects the CVJ. Immunoglobulin G4-related disease (IgG4-RD) is an immune mediated process treated with immunosuppressive medications. To our knowledge, this is the first reported case of IgG4-RD affecting the CVJ. CASE DESCRIPTION: The authors report the case of a woman aged 71 years with IgG4-RD of the CVJ. She presented with intractable left occipital pain and limited flexion, extension, and rotation of the neck. Computed tomography and magnetic resonance imaging revealed a lytic enhancing lesion of the left occipital condyle, left C1 lateral mass, and left C1 anterior arch resulting in cranial settling, basilar invagination, and CVJ instability. An open biopsy, subtotal resection, and occiput to C2 fusion was performed. Pathology revealed IgG4-RD. The patient was subsequently placed on rituximab immunotherapy with complete resolution of enhancement on magnetic resonance imaging and bone growth at the previous site of the lytic IgG4-RD lesion. CONCLUSIONS: To our knowledge, this case describes the first case of IgG4-RD affecting the CVJ, which mimicked a tumor-like process. When IgG4-RD affects the CVJ, stability must be accounted for, especially in the cases of osteolytic destruction. The combination of medical therapy to target the underlying inflammatory process and surgery to provide structural stability was successful.


Assuntos
Atlas Cervical/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Osso Occipital/diagnóstico por imagem , Osteólise/diagnóstico por imagem , Idoso , Articulação Atlantoccipital/fisiopatologia , Vértebra Cervical Áxis/cirurgia , Atlas Cervical/patologia , Atlas Cervical/cirurgia , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/patologia , Doença Relacionada a Imunoglobulina G4/terapia , Fatores Imunológicos/uso terapêutico , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Cervicalgia/etiologia , Osso Occipital/patologia , Osso Occipital/cirurgia , Osteólise/etiologia , Osteólise/patologia , Rituximab/uso terapêutico , Fusão Vertebral , Tomografia Computadorizada por Raios X
6.
World Neurosurg ; 134: e512-e523, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669688

RESUMO

OBJECTIVE: The aim of this study was to report an experience with 190 cases of os odontoideum over 20 years. The management outcome following atlantoaxial fixation was analyzed. METHODS: From January 2000 to September 2018, 190 patients with os odontoideum were surgically treated. There were 113 male patients and 77 female patients; average age was 24 years (range, 2-68 years).The patients were divided into 3 groups depending on the nature of atlantoaxial dislocation (group 1, mobile and partially or completely reducible atlantoaxial dislocation; group 2, fixed or irreducible atlantoaxial dislocation; group 3, presence of basilar invagination). There were 65 pediatric patients (<18 years old). All patients underwent atlantoaxial joint manipulation and lateral mass plate and screw fixation. The goal of surgery was segmental atlantoaxial arthrodesis. No transoral or posterior foramen magnum bone decompression was done. Occipital bone was not included in the fixation construct. RESULTS: On direct bone handling and observation, atlantoaxial joint pathologic hyperactivity related instability was identified in all patients. Atlantoaxial segmental stabilization resulted in clinical symptomatic and neurologic improvement in 100% of patients. CONCLUSIONS: Os odontoideum signifies chronic or long-standing atlantoaxial instability. Segmental atlantoaxial fixation is a reliable form of surgical treatment. Bone decompression is not necessary. Inclusion of occipital bone and subaxial vertebrae in the fixation construct is not necessary.


Assuntos
Vértebra Cervical Áxis/cirurgia , Adolescente , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebra Cervical Áxis/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Fusão Vertebral , Resultado do Tratamento , Adulto Jovem
7.
Spine (Phila Pa 1976) ; 45(1): 48-54, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415456

RESUMO

STUDY DESIGN: A retrospective cohort study of consecutive patients. OBJECTIVE: To investigate whether adequate flexion-extension was acquired in standard functional radiographs in lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA: In lumbar spondylolisthesis, flexion-extension radiographs taken in the standing position are most commonly used to evaluate spinal instability. However, these functional radiographs occasionally depend on the patient's effort and cooperation, they can provide different results. METHODS: This study included 92 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis. We analyzed the flexion-extension radiographs taken with the patient being led by the hand (LH) and those taken without LH (NLH). Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), and lumbar lordosis (LL) were measured on functional radiographs taken in both tests. Then, ST, SA, PO, detection rate of instability, and LL observed in LH were compared with those observed in NLH. Furthermore, the correlation of the difference was evaluated between ST, lumbar angulation, and LL. RESULTS: A relative value of ST was 9.5% ±â€Š4.3% in LH and 5.6% ±â€Š3.3% in NLH, which differed significantly (P < 0.001). SA and PO were also significantly greater in LH than in NLH. The detection rate of instability was 71.7% in LH and 30.4% in NLH (P < 0.001). LL measurement on flexion showed 17.6°â€Š±â€Š13.5° in LH and 28.2°â€Š±â€Š12.2° in NLH, which differed significantly (P < 0.001). However, no significant difference was found in LL on extension between LH and NLH. There was a moderate correlation between the difference of ST, SA, PO, and LL on flexion. CONCLUSION: Flexion with physical assistance was useful for the detection of abnormal lumbar mobility. Taking radiation exposure into consideration, physical assistance such as using a table in front of a patient could lead the similar evaluation of the segmental instability. LEVEL OF EVIDENCE: 2.


Assuntos
Instabilidade Articular/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Espondilolistese/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Lordose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Espondilolistese/cirurgia , Traduções
9.
Acta Orthop ; 91(1): 115-120, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31762353

RESUMO

Background and purpose - Insufficient initial fixation or early micromotion of an implant is associated with a thin layer of fibrous tissue at the peri-implant interface. It is unknown if bone loss is induced by the fibrous tissue interface acting as an active biological membrane, or as a membrane that will produce supraphysiologic fluid flow conditions during gait, which activates the mechanosensitive osteocytes to mediate osteoclast differentiation. We investigated whether mechanically induced osteolysis is dependent on the fibrous tissue interface as a biologically active scaffold, or if it merely acts as a conduit for fluid flow, affecting the mechanosensitive osteocytes in the peri-prosthetic bone.Methods - Using a rat model of mechanically instability-induced aseptic loosening, we assessed whether the induction of osteoclast differentiation was dependent on the presence of a peri-implant fibrous interface. We analyzed the amount of osteoclast differentiation, osteocyte apoptosis, pro-resorptive cytokine expression and bone loss using immunohistochemistry, mRNA expression and micro-CT.Results - Osteoclast differentiation and bone loss were induced by mechanical instability but were not affected by the presence of the fibrous tissue membrane or associated with osteocyte apoptosis. There was no increased mRNA expression of any of the cytokines in the fibrous tissue membrane compared with the peri-implant bone.Interpretation - Our data show that the fibrous tissue membrane in the interface plays a minor role in inducing bone loss. This indicates that the peri-implant bone adjacent to loose bone implants might play an important role for osteoclast differentiation.


Assuntos
Apoptose , Diferenciação Celular , Citocinas/metabolismo , Instabilidade Articular/metabolismo , Osteoclastos/metabolismo , Osteócitos/metabolismo , Falha de Prótese , Tíbia/metabolismo , Animais , Reabsorção Óssea/diagnóstico por imagem , Reabsorção Óssea/genética , Reabsorção Óssea/metabolismo , Interface Osso-Implante/diagnóstico por imagem , Citocinas/genética , Modelos Animais de Doenças , Imuno-Histoquímica , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/genética , Osteoclastos/citologia , Osteócitos/citologia , RNA Mensageiro/metabolismo , Ratos , Tíbia/diagnóstico por imagem , Microtomografia por Raio-X
10.
J Knee Surg ; 33(1): 89-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30544273

RESUMO

Patellar dislocation is a relatively common knee injury and can be challenging to diagnose. We describe an arthroscopic finding we noted in recurrent patellar dislocation. Arthroscopic photos were evaluated from 50 knees with a history patellar dislocation and 100 control patients. We quantified the amount of patellar subluxation seen on a single arthroscopic view and coined it Empty Sunrise Sign if the patella did not overlap the trochlea. Empty Sunrise Sign was found in 82% of 50 cases with recurrent patellar dislocation and none of the 100 control cases. The finding was 100% specific for identifying a recurrent patellar dislocator. High interobserver agreement was noted. Empty Sunrise Sign suggests significant capsular laxity. This may need to be considered in the surgical treatment of recurrent patellar dislocation.


Assuntos
Artroscopia/métodos , Instabilidade Articular/diagnóstico , Luxação Patelar/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Fotografação , Recidiva , Sensibilidade e Especificidade , Adulto Jovem
11.
J Shoulder Elbow Surg ; 29(1): 68-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31378683

RESUMO

BACKGROUND: Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI. METHODS: In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared. RESULTS: Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed. CONCLUSION: FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.


Assuntos
Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Ombro/diagnóstico por imagem , Adolescente , Adulto , Feminino , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Masculino , Músculo Esquelético/fisiopatologia , Postura , Estudos Prospectivos , Ombro/fisiopatologia , Adulto Jovem
12.
J Shoulder Elbow Surg ; 29(1): 132-138, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521526

RESUMO

BACKGROUND: The aim of this study was to determine the lateral ulnar collateral ligament (LUCL) injury associated with isolated radial head fracture (RHF) and the relationship of the ligament injury with the displacement of the fragment-loss of contact-in unstable displaced partial articular RHF in individuals without any history of ulnohumeral dislocation. METHODS: We retrospectively identified 131 consecutive patients who underwent open reduction and internal fixation of isolated closed Mason type II RHF performed at our institution. We identified 3 subsets by the pattern of RHF and the position of the unstable fragment (anterior or posterior) relative to the capitulum humeri: displaced stable (group I), displaced anterior unstable (group II), and displaced posterior unstable (group III). Standard radiographs were obtained preoperatively and postoperatively. The pattern of lateral collateral ligament avulsion and its distribution were inferred from intraoperative records. RESULTS: Preoperative radiographs of the 131 patients showed 101 nonseparated fractures (77%, group I) and 30 unstable fractures (23%). Anterior displacement of the fragment was found in 18 elbows (14%, group II) and posterior displacement in 12 (9%, group III). LUCL avulsion was found in 18 of 30 unstable RHFs (60%) and in 1 of 60 stable RHFs (1.6%). CONCLUSION: RHF is a complex fracture often associated with soft tissue lesions. It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability. The RHF pattern and classification as stable or unstable can help the surgeon in the identification and treatment of LUCL lesions.


Assuntos
Ligamento Colateral Ulnar/diagnóstico por imagem , Ligamento Colateral Ulnar/lesões , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Adulto , Idoso , Ligamento Colateral Ulnar/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Epífises/lesões , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas Intra-Articulares/complicações , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Masculino , Pessoa de Meia-Idade , Redução Aberta , Período Pré-Operatório , Radiografia , Fraturas do Rádio/complicações , Estudos Retrospectivos , Ruptura/complicações , Ruptura/cirurgia , Adulto Jovem
13.
Knee ; 27(1): 221-228, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31875838

RESUMO

BACKGROUND: Stress radiography is used in the valuation of soft tissue laxity following total knee arthroplasty (TKA). However, reliability and agreement is largely unknown. METHODS: In this prospective reliability study, we included 15 participants with prior TKA. Standardized coronal stress radiographs were obtained in both extension and flexion and with both varus and valgus stress. All radiographs were repeated (test-retest). In extension the Telos stress device was used, and flexion radiographs were obtained using the epicondylar-view. Three independent raters measured angulation between femoral and tibial component from all radiographs. Reliability was assessed by intra-class correlation coefficient (ICC) and agreement visualized with Bland-Altman plots and by mean difference and limits of agreement (LOA). RESULTS: Stress radiography in extension showed excellent reliability with ICC = 0.96 (0.95-0.98) and LOA of ±1.2°. Stress radiography at 80-90° of flexion showed good to excellent reliability when measuring medial laxity with ICC = 0.94 (0.89-0.97) and LOA of ±1.7°; however, when measuring lateral laxity the reliability was only moderate to good with ICC = 0.70 (0.51-0.84) and LOA of ±6.3°. CONCLUSION: Stress radiography is clinically applicable and the methods described in this study provide excellent reliability for measurement of laxity in extension. The reliability of measurements in flexion is good to excellent when measuring medial laxity but only moderate to good when measuring lateral laxity.


Assuntos
Artroplastia do Joelho , Fêmur/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Joelho/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Feminino , Fêmur/cirurgia , Humanos , Instabilidade Articular/cirurgia , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Tíbia/cirurgia
14.
Biomed Res Int ; 2019: 7623562, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31828128

RESUMO

As the initial part in the development of osteoarthritis (OA), subchondral bone sclerosis has been considered to be initiated by excess mechanical loading and proven to be correlated to other pathological changes. Sclerostin, which is an essential mechanical stress response protein, is encoded by the SOST gene. It is expressed in osteocytes and mature chondrocytes and has been proven to be closely correlated to OA. However, the relationship and mechanism between the SOST gene and the development of OA remain unclear. The aim of the present study was to investigate the role of the SOST gene in OA pathogenesis in the subchondral bone. A knee anterior cruciate ligament transection (ACLT) mouse osteoarthritis (OA) model on SOST-knockout (SOST KO) and wild-type (WT) mice was established. The pathogenic and phenotypic changes in the subchondral bone were investigated by histology, micro-CT, immunohistochemistry, TRAP staining, Masson staining, and Toluidine blue staining. It was found that sclerostin expression decreased in both the calcified cartilage and mineralized subchondral structures during the development of OA. Joint instability induced a severe cartilage degradation phenotype, with higher OARSI scores in SOST KO mice, when compared to WT mice. SOST KO mice with OA exhibited a higher BMD and BV/TV ratio, as well as a higher rate of bone remodeling and TRAP-positive cell number, when compared to the WT counterparts, but the difference was not significant between the sham-operation groups. It was concluded that loss of sclerostin aggravates knee OA in mice by promoting subchondral bone sclerosis and increasing catabolic activity of cartilage.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Hiperostose/genética , Osteoartrite/genética , Esclerose/genética , Sindactilia/genética , Animais , Densidade Óssea/genética , Remodelação Óssea/genética , Osso e Ossos/metabolismo , Osso e Ossos/fisiopatologia , Condrócitos/metabolismo , Condrócitos/patologia , Modelos Animais de Doenças , Fêmur/diagnóstico por imagem , Fêmur/metabolismo , Fêmur/fisiopatologia , Expressão Gênica/genética , Humanos , Hiperostose/diagnóstico por imagem , Hiperostose/fisiopatologia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Camundongos , Camundongos Knockout , Osteoartrite/diagnóstico por imagem , Osteoartrite/fisiopatologia , Osteócitos/metabolismo , Osteócitos/patologia , Esclerose/diagnóstico por imagem , Esclerose/fisiopatologia , Sindactilia/diagnóstico por imagem , Sindactilia/fisiopatologia
15.
Orthop Surg ; 11(6): 932-942, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31797563

RESUMO

Patellofemoral instability (PFI) is one of the most disabling conditions in the knee, often affecting young individuals. Despite its not uncommon presentation, the underlying biomechanical features leading to this entity are not entirely understood. The suitability of classic physical examination manoeuvres and imaging tests is a matter of discussion among treating surgeons, and so are the findings provided by these means. A potential cause for this lack of consensus is the fact that, classically, the diagnostic approach for PFI has relied on statically obtained data. Many authors advocate for the study of this entity in a dynamic scenario, closer to the actual situation in which the instability episodes occur. In this literature review, we have compiled the available data from the last decades regarding dynamic evaluation methods for PFI and related conditions. Several categories are presented, grouping the related techniques and devices: physical examination, imaging modalities (ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and combined methods), arthroscopic evaluation, and others. In conclusion, although a vast number of quality studies are presented, in which comprehensive data about the biomechanics of the patellofemoral joint (PFJ) are described, this evidence has not yet reached clinical practice universally. Most of the data still stays in the research field and is seldom employed to assist a better understanding of the PFI cases and their ideal treatment targets.


Assuntos
Instabilidade Articular/fisiopatologia , Luxação Patelar/fisiopatologia , Articulação Patelofemoral/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico por imagem , Luxação Patelar/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Exame Físico
16.
Bone Joint J ; 101-B(12): 1578-1584, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31787002

RESUMO

AIMS: A borderline dysplastic hip can behave as either stable or unstable and this makes surgical decision making challenging. While an unstable hip may be best treated by acetabular reorientation, stable hips can be treated arthroscopically. Several imaging parameters can help to identify the appropriate treatment, including the Femoro-Epiphyseal Acetabular Roof (FEAR) index, measured on plain radiographs. The aim of this study was to assess the reliability and the sensitivity of FEAR index on MRI compared with its radiological measurement. PATIENTS AND METHODS: The technique of measuring the FEAR index on MRI was defined and its reliability validated. A retrospective study assessed three groups of 20 patients: an unstable group of 'borderline dysplastic hips' with lateral centre edge angle (LCEA) less than 25° treated successfully by periacetabular osteotomy; a stable group of 'borderline dysplastic hips' with LCEA less than 25° treated successfully by impingement surgery; and an asymptomatic control group with LCEA between 25° and 35°. The following measurements were performed on both standardized radiographs and on MRI: LCEA, acetabular index, femoral anteversion, and FEAR index. RESULTS: The FEAR index showed excellent intraobserver and interobserver reliability on both MRI and radiographs. The FEAR index was more reliable on radiographs than on MRI. The FEAR index on MRI was lower in the stable borderline group (mean -4.2° (sd 9.1°)) compared with the unstable borderline group (mean 7.9° (sd 6.8°)). With a FEAR index cut-off value of 2°, 90% of patients were correctly identified as stable or unstable using the radiological FEAR index, compared with 82.5% using the FEAR index on MRI. The FEAR index was a better predictor of instability on plain radiographs than on MRI. CONCLUSION: The FEAR index measured on MRI is less reliable and less sensitive than the FEAR index measured on radiographs. The cut-off value of 2° for radiological FEAR index predicted hip stability with 90% probability. Cite this article: Bone Joint J 2019;101-B:1578-1584.


Assuntos
Acetábulo/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Imagem por Ressonância Magnética , Acetábulo/fisiopatologia , Acetábulo/cirurgia , Adolescente , Adulto , Regras de Decisão Clínica , Epífises/diagnóstico por imagem , Epífises/fisiopatologia , Epífises/cirurgia , Feminino , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Seguimentos , Luxação do Quadril/fisiopatologia , Luxação do Quadril/cirurgia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
17.
J Orthop Surg Res ; 14(1): 347, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703693

RESUMO

BACKGROUND: The objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation. METHODS: Thirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS: The median follow-up was 37.3 months (range, 15-53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up. CONCLUSIONS: Radial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.


Assuntos
Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Articulação do Cotovelo/lesões , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
18.
Knee ; 26(6): 1204-1209, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31703848

RESUMO

BACKGROUND: Tibial tuberosity trochlear groove distance (TT-TG) is an important radiological measurement in patellofemoral instability (PFI). Where instability is recurrent, a value ≥20 mm is considered an indication for tubercle medialisation. Trochlear dysplasia commonly accompanies PFI. It can make identification of the deepest part of the trochlea difficult, which makes the TT-TG difficult or impossible to assess. To address this, we propose a new method of identifying the deepest part of trochlea based on the femoral epicondyles. It is named the tibial tuberosity mid inter-epicondyle trochlea intersection distance (TT-MIELTI). METHODS: The TT-TG and TT-MIELTI of 30 consecutive non-dysplastic knee MRIs were compared, excluding 96 knees with dysplasia, sulcus angles ≥135°, a tibial tuberosity anterior cortex which was not fully demonstrated, artefact, fracture, or Osgood Schlatter's disease. To assess inter-observer reliability three blinded researchers measured the TT-TG and the TT-MIELTI of all 30 knees. To assess intra-observer repeatability one researcher repeated the measurements after six weeks. RESULTS: The intraclass correlation coefficient (ICC) test demonstrated good to excellent values for all measurements (TT-TG and TT-MIELTI correlation ICC 0.94-0.97; TT-TG inter-observer reliability ICC = 0.85, intra-observer repeatability ICC = 0.90; TT-MIELTI inter-observer reliability ICC = 0.86, intra-observer repeatability ICC = 0.89. All p values < .001.) CONCLUSIONS: In non-dysplastic knees the mid inter-epicondyle trochlea intersection (MIELTI) accurately identifies the deepest part of the trochlea, and TT-MIELTI is a reliable alternative to the TT-TG. Re-assessment in dysplastic knees would be of benefit to establish its usefulness in the clinical setting.


Assuntos
Instabilidade Articular/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Fêmur/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Reprodutibilidade dos Testes , Tíbia/diagnóstico por imagem , Adulto Jovem
19.
Spine Deform ; 7(6): 950-956, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31732007

RESUMO

STUDY DESIGN: Retrospective evaluation of cervical spine images from 2006-2012 for the purposes of "screening" children with Down syndrome for instability. OBJECTIVE: To determine whether a full series of cervical spine images including flexion/extension lateral (FEL) radiographs was needed to avoid missing upper cervical instability. SUMMARY OF BACKGROUND DATA: The best algorithm, measurements, and criteria for screening children with Down syndrome for upper cervical instability are controversial. Many authors have recommended obtaining flexion and extension views. We noted that patients who require surgical stabilization due to myelopathy or cord compression typically have grossly abnormal radiographic measurements on the neutral upright lateral (NUL) cervical spine radiograph. METHODS: The atlanto-dental interval, space available for cord, and basion axial interval were measured on all films. The Weisel-Rothman measurement was made in the FEL series. Clinical outcome of those with abnormal measurements were reviewed. Sensitivity, specificity, and positive and negative predictive values of NUL and FEL radiographs for identifying clinically significant cervical spine instability were calculated. RESULTS: A total of 240 cervical spine series in 213 patients with Down syndrome between the ages of 4 months and 25 years were reviewed. One hundred seventy-two children had an NUL view, and 88 of these patients also had FEL views. Only one of 88 patients was found to have an abnormal atlanto-dental interval (≥6 mm), space available for cord at C1 (≤14 mm), or basion axial interval (>12 mm) on an FEL series that did not have an abnormal measurement on the NUL radiograph. This patient had no evidence of cord compression or myelopathy. CONCLUSIONS: Obtaining a single NUL radiograph is an efficient method for radiographic screening of cervical spine instability. Further evaluation may be required if abnormal measurements are identified on the NUL radiograph. We also propose new "normal" values for the common radiographic measurements used in assessing risk of cervical spine instability in patients with Down syndrome. LEVEL OF EVIDENCE: Level IV.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Síndrome de Down/complicações , Instabilidade Articular/diagnóstico por imagem , Radiografia/métodos , Adolescente , Algoritmos , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/fisiopatologia , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Criança , Pré-Escolar , Síndrome de Down/diagnóstico , Síndrome de Down/patologia , Feminino , Humanos , Lactente , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Masculino , Programas de Rastreamento/métodos , Valor Preditivo dos Testes , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Adulto Jovem
20.
Knee ; 26(6): 1278-1285, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31668910

RESUMO

BACKGROUND: Our objective was to describe a measurement to assess sagittal tibial tuberosity (TT)-trochlear groove (TG) distance and to compare this between asymptomatic (control) patients and patients with symptomatic patellar instability. METHODS: We compared static CT images of 22 fully extended knees of patients with symptomatic patellar instability with images of 22 asymptomatic knees. TT-TG distance was measured to quantify lateralization of the TT, and anteroposterior TT-TG distance was used to quantify the sagittal distance between these two points. Lateral trochlear inclination, sulcus angle, and trochlear depth were measured. Groups were compared using paired t tests (alpha = 0.05). Correlations of anteroposterior TT-TG distance with lateral trochlear inclination, sulcus angle, and trochlear depth were assessed using linear and multivariate regression. RESULTS: Mean TT-TG distances were 19.9 ±â€¯4.4 mm (symptomatic) and 16.8 ±â€¯5.5 mm (control) (mean ±â€¯std deviation) (P = 0.002). Mean anteroposterior TT-TG distances were 8.3 ±â€¯7.8 mm (symptomatic) and -0.5 ±â€¯4.6 mm (control) (P < 0.0001). The symptomatic group had greater measurements of trochlear dysplasia, with lower lateral trochlear inclination, greater sulcus angle, and lower trochlear depth (all P < 0.0001). Anteroposterior TT-TG distance and trochlear depth were strongly negatively correlated (r = 0.62, R2 = 0.39, P < 0.0001). CONCLUSIONS: In asymptomatic patients, the anteroposterior TT-TG distance was -0.5 mm, indicating that the TG and TT were nearly in the same coronal plane. In patients with symptomatic patellar instability, the TG was almost nine millimeters anterior, and this distance correlated with measurements of trochlear dysplasia. LEVEL OF EVIDENCE: III, case control study.


Assuntos
Fêmur/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Luxação Patelar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA