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1.
Acta Vet Scand ; 61(1): 44, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578143

RESUMO

BACKGROUND: Cranial cruciate ligament (CCL) rupture is one of the most common causes of limb lameness in dogs. Surgical techniques based on tibial osteotomies such as tibial plateau leveling osteotomy and tibial tuberosity advancement are used to eliminate dynamic thrust. Tibial tuberosity advancement (TTA) uses an osteotomy fixated by cage, plates, forks and screws to change the relationship of the patellar tendon and tibial plateau angle. Tension band wiring technique is one of the most common surgical methods used to treat a tension fracture and remains the gold standard for the treatment of tibial tuberosity fractures. In this study, we compared experimentally the biomechanical effect of application of tension band wiring compared to other techniques for the fixation of the TTA osteotomy. The techniques compared to are standard commercially available systems for TTA fixation. RESULTS: Tension band wiring (TBW) presented the higher resistance to failure compared to all the other surgical procedures, with the highest values found in the TBW group with 1.47 ± 0.07 N and the lowest in the TTA cage (0.82 ± 0.08) and TTA-2 (0.85 ± 0.06) groups with statistically significant differences in all cases (P < 0.001). TTA rapid and TTA plate groups exhibited a similar strength, and same happened between TTA-2 and TTA cage groups. All the other comparisons by pair were significantly different with P < 0.001. CONCLUSIONS: Results suggest that fixating the osteotomy with tension band wiring increases the strength of the fixation and decrease the risk of implant failure. Further clinical studies are needed to demonstrate in vivo reliability and to test different variables such as size and weight of dogs. These results could have important clinical implications in the treatment of CCL ruptures.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Ligamento Cruzado Anterior/cirurgia , Tíbia/cirurgia , Animais , Ligamento Cruzado Anterior/patologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Modelos Anatômicos , Osteotomia/veterinária , Resistência à Tração
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1060-1063, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512443

RESUMO

Objective: To review the advances in double-bundle anterior cruciate ligament (ACL) reconstruction in adolescents at home and abroad. Methods: Recent literature about double-bundle ACL reconstruction in adolescents at home and abroad was extensively consulted, and the relationship between bone canal and epiphyseal plate, clinical verification of surgical safety, and clinical effectiveness of double-bundle ACL reconstruction in adolescents were summarized and analyzed. Results: Double-bundle ACL reconstruction has certain advantages in clinical stability and re-rupture rate when compared with single-bundle ACL reconstruction in adolescents, and there is no significant difference in safety between them. Conclusion: Double-bundle ACL reconstruction in adolescents can achieve lower re-rupture rate and better stability when compared with single-bundle reconstruction. However, the sample size of clinical research is too small, and the follow-up time is too short, so the effectiveness needs to be continuously observed.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Pesquisa/tendências , Ruptura , Resultado do Tratamento
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1071-1076, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512445

RESUMO

Objective: To summarize the mid-term effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction combined with meniscus allograft transplantation. Methods: A clinical data of 21 patients treated with arthroscopic ACL reconstruction and meniscus allograft transplantation and followed up more than 5 years between February 2007 and December 2014 was retrospectively analyzed. There were 12 males and 9 females, aged from 18 to 45 years, with an average age of 23.5 years. The cause of injury was sport sprain in 15 cases, falling in 4 cases, and traffic accident in 2 cases. The time from injury to operation ranged from 2 to 36 months, with an average of 12 months. Among them, 15 patients underwent previous meniscectomy, with an average interval of 1.6 years (range, 3 months to 6.5 years). All patients were primary ACL reconstruction. Preoperative anterior drawer test, Lachman test, and pivot shift test were positive. Lysholm score was 43.6±10.2. International Knee Documentation Committee (IKDC) score was 60.50±14.06. Of the 21 patients, 10 were gradeⅠ-Ⅱcartilage injuries and 11 were grade Ⅲ cartilage injuries according to MRI. Results: All patients were followed up 5.1-7.8 years, with an average of 5.5 years. There were 2 cases of numbness of lower extremity, 3 cases of slight exudation of incision, 2 cases of articular movement bounce, 5 cases of mild joint swelling and pain after exercise. At last follow-up, Lachman tests were negative in 18 cases and positive in 3 cases; anterior drawer tests were negative in 19 cases and positive in 2 cases; pivot shift tests were negative in all cases. Lysholm score was 84.5±16.5 and IKDC score was 85.25±4.60, which were significantly higher than those before operation ( P<0.01). The flexion and extension of the affected knee joint were (128±13) and (3±7)°, respectively, which were smaller than those of the healthy knee joint [(133±15), (0±5)°] ( P<0.01). The results of KT-1000 test showed that when knee flexion was 30 and 90°, tibial anterior displacement of affected side [(2.35±1.20), (1.60±1.15) mm] were not significantly different from those of healthy side [(1.20±1.10), (1.10±1.03) mm] ( P>0.01). MRI showed that the ACL graft was in normal position and meniscus survived well. Cartilage injuries were gradeⅠ-Ⅱ in 18 cases and grade Ⅲ in 3 cases. Conclusion: For patients with severe meniscus injury and ACL rupture, ACL reconstruction combined with meniscus allograft transplantation can restore the stability of the joint, recover the meniscus function which is conducive to the protection of articular cartilage and obtain satisfactory mid-term effectiveness.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Menisco , Adolescente , Adulto , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Feminino , Humanos , Articulação do Joelho , Masculino , Menisco/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1077-1082, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512446

RESUMO

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


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/métodos , Humanos , Articulação do Joelho/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1083-1087, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512447

RESUMO

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


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Tíbia , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1088-1094, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512448

RESUMO

Objective: To investigate the effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament (ACL) reconstruction, and summarize the relevant rules to guide the clinic. Methods: Between August 2016 and December 2016, forty patients underwent arthroscopic ACL reconstruction using hamstring tendon were randomly divided into isokinetic group and control group ( n=20). The two groups of patients underwent staged rehabilitation treatment. The isokinetic group replaced the traditional intervention with the corresponding isokinetic strength training from 3 to 6 months after operation, and the traditional rehabilitation intervention was used in the control group. Finally, 12 cases of isokinetic group and 12 cases of control group with complete follow-up were enrolled in study. There was no significant difference in gender, age, body mass index, side of injury, the interval between injury and operation, and preoperative International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The peak torque (PT) of knee extension and flexion and hamstring quadriceps ratio (H/Q) were measured at 3 months, 6 months, 12 months, and the second-look arthroscopy. The MRI examination was performed at the same time to evaluate graft remodeling. The shape, tension, and degree of vascularization of grafts were observed under arthroscopy. The grafts were harvested and observed by HE staining. Results: The invertal between ACL reconstruction and the second-look arthroscopy was (23.57±3.23) months in isokinetic group and (23.22±3.56) months in control group, showing no significant difference between the two groups ( P>0.05). At the second-look arthroscopy, the IKDC score was 90.45±4.73 in isokinetic group and 89.32±4.54 in control group, showing significant differences when compared with preoperative scores in the two groups ( P<0.05). But there was no significant difference between the two groups ( t=0.868, P=0.404). At 3 months after operation, there was no significant difference in the PT of knee extension and flexion between the two groups ( P>0.05). At 6 months, 12 months, and the second-look arthroscopy, the PT of knee extension and flexion in isokinetic group were higher than those in control group ( P<0.05). The H/Q at 6 months and 12 months were higher in isokinetic group than in control group, and the differences were significant ( P<0.05). There was no significant difference in MRI score between the two groups at 3 months, 6 months, and the second-look arthroscopy ( P>0.05). The MRI score at 12 months was significantly higher in isokinetic group than in control group ( P<0.05). At the second-look arthroscopy, there was no significant difference in the arthroscopic score between the two groups ( P>0.05), and the histological score of the isokinetic group was superior to the control group ( P<0.05). Conclusion: On the basis of regular rehabilitation training, using the isokinetic training system to develop a suitable post-surgical isokinetic rehabilitation training program is helpful in early muscle strength recovery, early graft remodeling, and even long-term histological results after ACL reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Exercício , Músculo Esquelético , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Artroscopia , Feminino , Humanos , Masculino , Músculo Esquelético/crescimento & desenvolvimento , Coxa da Perna/crescimento & desenvolvimento , Resultado do Tratamento
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1095-1101, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512449

RESUMO

Objective: To evaluate the correlation between the Mohawk (MKX) expression level and the collagen fiber diameter of autologous hamstring tendon graft during the stable graft remodeling phase after anterior cruciate ligament (ACL) reconstruction. Methods: Between January 2018 and August 2018, patients who underwent arth-roscopic single-bundle anatomical ACL reconstruction with autologous hamstring tendons for at least 48 months and also underwent second-look arthroscopy were enrolled in study. During the second-look arthroscopic procedures, ACL graft biopsies were performed from the surface of central part of the ligament. MKX expressions of ACL grafts were analysed by real-time fluorescent quantitative PCR (qRT-PCR). The ultrastructure of collagen fibers of grafts were evaluated by transmission electron microscopy, which included average diameter of collagen fibers (D c), average diameter of large-diameter collagen fibers (D L), average diameter of small-diameter collagen fibers (D S), and large-small collagen fibers ratio (R L/S). The correlation between MKX expression level and graft collagen fiber diameter was calculated. Results: Twenty-six patients met the selection criteria and their ACL graft specimens were enrolled in the study. The interval between ACL reconstruction and second-look arthroscopy was 52-128 months, with an average of 78.6 months. Arthroscopic graft remodeling score was 3-6 (mean, 4.8). There were 17 cases of excellent remodeling and 9 cases of fair remodeling. All ACL grafts showed typical bimodal distributions of both large-diameter collagen fibers and small-diameter collagen fibers, but the ultrastructural characteristics of the graft collagen fibers were different according to different remodeling status under arthroscopy. The D C, D L, D S, and R L/S of the graft specimens were (65.2±9.3) nm, (91.6±10.5) nm, (45.7±8.6) nm, and 0.73±0.12, respectively. The relative expression level of MKX was 1.42±0.11, which was positively linearly correlated with D C, D L, and R L/S, and the correlation coefficient was statistically significant ( r=0.809, P=0.000; r=0.861, P=0.000; r=0.942, P=0.000), while there was no significant correlation between D S and relative expression level of MKX ( r=0.147, P=0.238). Regression analysis showed that the relative expression level of MKX could predict the D C, D L, and R L/S results of the ACL graft specimens ( P<0.05). Conclusion: After autologous hamstring tendon grafts stepped into stabilized remodeling phase, MKX expression level could predict the diameter measurement results of collagen fibers and be used as an important evaluation basis for graft collagen anabolic metabolism.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Colágeno , Regulação da Expressão Gênica no Desenvolvimento , Tendões dos Músculos Isquiotibiais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/patologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Colágeno/metabolismo , Colágeno/ultraestrutura , Correlação de Dados , Tendões dos Músculos Isquiotibiais/citologia , Tendões dos Músculos Isquiotibiais/metabolismo , Tendões dos Músculos Isquiotibiais/cirurgia , Proteínas de Homeodomínio/genética , Humanos , Transplante Autólogo
8.
Acta Cir Bras ; 34(6): e201900604, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31432995

RESUMO

PURPOSE: In view of the principal role of Toll-like receptor 4 (TLR4) in mediating sterile inflammatory response contributing to osteoarthritis (OA) pathogenesis, we used lipopolysaccharide (LPS), a known TLR4 activator, to clarify whether modulation of TLR4 contributed to the protective actions of intra-articular administration of curcumin in a classical rat OA model surgically induced by anterior cruciate ligament transection (ACLT). METHODS: The rats underwent ACLT and received 50µl of curcumin at the concentration of 1 mg mL-1 and 10 µg LPS by intra-articular injection once a week for 8 weeks. Morphological changes of the cartilage and synovial tissues were observed. Apoptotic chondrocytes were detected using TUNEL assay. The concentrations of IL-1ß and TNF-ɑ in synovial fluid were determined using ELISA kits. The mRNA and protein expression levels of TLR4 and NF-κB p65 were detected by real-time PCR and Western blotting, respectively. RESULTS: Intra-articular administration of curcumin significantly improved articular cartilage injury, suppressed synovial inflammation and down-regulated the overexpression of TLR4 and its downstream NF-κB caused by LPS-induced TLR4 activation in rat osteoarthritic knees. CONCLUSION: The data suggested that the inhibition of TLR4 signal might be an important mechanism underlying a protective effect of local curcumin administration on OA.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Curcumina/farmacologia , Osteoartrite/prevenção & controle , Receptor 4 Toll-Like/metabolismo , Animais , Ligamento Cruzado Anterior/patologia , Western Blotting , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Injeções Intra-Articulares , Interleucina-1beta/metabolismo , Lipopolissacarídeos , Masculino , NF-kappa B/metabolismo , Osteoartrite/induzido quimicamente , Osteoartrite/metabolismo , Reação em Cadeia da Polimerase , Ratos , Receptor 4 Toll-Like/efeitos dos fármacos , Fator de Necrose Tumoral alfa/metabolismo
9.
Am J Vet Res ; 80(8): 779-786, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339759

RESUMO

OBJECTIVE: To evaluate a novel prosthesis technique for extracapsular stabilization of cranial cruciate ligament (CCL)-deficient stifle joints in adult cattle. SAMPLE: 13 cadaveric bovine stifle joint specimens. PROCEDURES: In the first of 3 study phases, the most isometric points on the distal aspect of the femur (distal femur) and proximal aspect of the tibia (proximal tibia) were determined from measurements obtained from lateromedial radiographs of a stifle joint specimen maintained at angles of 135°, 90°, 65°, and 35°. During phase 2, 800-lb-test monofilament nylon leader line was cut into 73-cm-long segments. Each segment was secured in a loop by use of 2, 3, or 4 crimping sleeves such that there were 12 replicates for each construct. Each loop was distracted to failure at a constant rate of 1 mm/s. Mean force at failure and elongation and mode of failure were compared among the 3 constructs. During phase 3, bone tunnels were created in the distal femur and proximal tibia at the isometric points identified during phase 1 in each of 12 CCL-deficient stifle joint specimens. The 3-sleeve construct was applied to each specimen. Specimens were distracted to failure at a constant rate of 1 mm/s. RESULTS: Among the 3 constructs evaluated, the 3-sleeve construct was considered optimal in terms of strength and amount of foreign material. In phase 3, all replicates failed because of suture slippage. CONCLUSIONS AND CLINICAL RELEVANCE: Use of 800-lb-test monofilament nylon leader line as a prosthesis might be a viable alternative for extracapsular stabilization of CCL-deficient stifle joints in adult cattle. Further in vivo studies are necessary.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Bovinos/cirurgia , Próteses e Implantes/veterinária , Joelho de Quadrúpedes/cirurgia , Animais , Cadáver , Fêmur , Nylons , Radiografia/veterinária , Suturas/veterinária , Tíbia
10.
Medicine (Baltimore) ; 98(26): e16081, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261520

RESUMO

The purpose of the present study was to investigate the characteristics of growth disturbances in patients with remaining growth after transphyseal anterior cruciate ligament (ACL) reconstruction who were confirmed to have no definite postoperative physeal abnormalities on magnetic resonance imaging (MRI).Forty adolescents (mean age 15.6 ±â€Š1.0 years [range 12.2-16.8], mean follow-up 2.7 ±â€Š0.7 years [range 2.0-5.5 years]), who underwent transphyseal ACL reconstruction and were confirmed to have no focal physeal disruptions on follow-up MRIs 6 to 12 months after the operation, were retrospectively evaluated. The patients were grouped according to the leg-length growth of the uninjured side, measured on scanograms, obtained before surgery, and at the final follow-up.Leg-length discrepancies (LLD) at the last follow-up were greater in patients with leg growth ≥4 cm than in those with leg growth <4 cm (5.3 ±â€Š9.0 mm vs -0.3 ±â€Š4.2 mm, P = .033); however, no significant difference was observed between subgroup patients with leg growth of 4 to 6 cm or ≥6 cm (5.6 ±â€Š10.4 mm vs 4.8 ±â€Š7.0 mm, P = .958). On multivariate analysis, leg growth was a significant predictive factor for the final LLD (P = .030).Adolescents with additional leg-length growth after transphyseal ACL reconstructions presented with greater LLDs (as shown in the <4 cm vs ≥4 cm groups), but they also presented a ceiling effect (as shown in the 4-6 cm vs ≥6 cm subgroups). Transphyseal ACL reconstructions appeared to cause temporary growth arrest/disturbances in patients with substantial remaining growth which then resumed resulting in clinically insignificant LLDs.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Desigualdade de Membros Inferiores/etiologia , Complicações Pós-Operatórias , Adolescente , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Criança , Feminino , Seguimentos , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/crescimento & desenvolvimento , Perna (Membro)/cirurgia , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/patologia , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos
11.
Bone Joint J ; 101-B(7_Supple_C): 77-83, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256640

RESUMO

AIMS: Anterior cruciate ligament (ACL) and multiligament knee (MLK) injuries increase the risk of development of knee osteoarthritis and eventual need for total knee arthroplasty (TKA). There are limited data regarding implant use and outcomes in these patients. The aim of this study was to compare the use of constrained implants and outcomes among patients undergoing TKA with a history of prior knee ligament reconstruction (PKLR) versus a matched cohort of patients undergoing TKA with no history of PKLR. PATIENTS AND METHODS: Patients with a history of ACL or MLK reconstruction who underwent TKA between 2007 and 2017 were identified in a single-institution registry. There were 223 patients who met inclusion criteria (188 ACL reconstruction patients, 35 MLK reconstruction patients). A matched cohort, also of 223 patients, was identified based on patient age, body mass index (BMI), sex, and year of surgery. There were 144 male patients and 79 female patients in both cohorts. Mean age at the time of TKA was 57.2 years (31 to 88). Mean BMI was 29.7 kg/m2 (19.5 to 55.7). RESULTS: There was a significantly higher use of constrained implants among patients with PKLR (76 of 223, 34.1%) compared with the control group (40 of 223, 17.9%; p < 0.001). Subgroup analysis showed a higher use of constrained implants among patients with prior MLK reconstruction (21 of 35, 60.0%) compared with ACL reconstruction (55 of 188, 29.3%; p < 0.001). Removal of hardware was performed in 69.5% of patients with PKLR. Mean operative time (p < 0.001) and tourniquet time (p < 0.001) were longer in patients with PKLR compared with controls. There were no significant differences in rates of deep vein thrombosis, pulmonary embolism, infection, transfusion, postoperative knee range of movement (ROM), or need for revision surgery. There was no significant difference in preoperative or postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) scores between groups. CONCLUSION: Results of this study suggest a history of PKLR results in increased use of constrained implants but no difference in postoperative knee ROM, patient-reported outcomes, or incidence of revision surgery. Cite this article: Bone Joint J 2019;101-B(7 Supple C):77-83.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Ligamento Cruzado Anterior/cirurgia , Artroplastia do Joelho/estatística & dados numéricos , Osteoartrite do Joelho/etiologia , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões do Ligamento Cruzado Anterior/complicações , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroplastia do Joelho/métodos , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Qualidade de Vida , Reoperação , Estudos Retrospectivos
12.
Bone Joint J ; 101-B(7): 824-831, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256666

RESUMO

AIM: Mesenchymal stem cells (MSCs) have several properties that may support their use as an early treatment option for osteoarthritis (OA). This study investigated the role of multiple injections of allogeneic bone marrow-derived stem cells (BMSCs) to alleviate the progression of osteoarthritic changes in the various structures of the mature rabbit knee in an anterior cruciate ligament (ACL)-deficient OA model. MATERIALS AND METHODS: Two months after bilateral section of the ACL of Japanese white rabbits aged nine months or more, either phosphate buffered saline (PBS) or 1 x 106 MSCs were injected into the knee joint in single or three consecutive doses. After two months, the articular cartilage and meniscus were assessed macroscopically, histologically, and immunohistochemically using collagen I and II. RESULTS: Within the PBS injection (control group), typical progressive degenerative changes were revealed in the various knee structures. In the single MSC injection (single group), osteoarthritic changes were attenuated, but still appeared, especially in the medial compartments involving fibrillation of the articular cartilage, osteophyte formation in the medial plateau, and longitudinal tear of the meniscus. In the multiple-injections group, the smoothness and texture of the articular cartilage and meniscus were improved. Histologically, absence or reduction in matrix staining and cellularity were noticeable in the control and single-injection groups, respectively, in contrast to the multiple-injections group, which showed good intensity of matrix staining and chondrocyte distribution in the various cartilage zones. Osteoarthritis Research Society International (OARSI) scoring showed significantly better results in the multiple-injections group than in the other groups. Immunohistochemically, collagen I existed superficially in the medial femoral condyle in the single group, while collagen II was more evident in the multiple-injections group than the single-injection group. CONCLUSION: A single injection of MSCs was not enough to restore the condition of osteoarthritic joints. This is in contrast to multiple injections of MSCs, which had the ability to replace lost cells, as well as reducing inflammation. Cite this article: Bone Joint J 2019;101-B:824-831.


Assuntos
Transplante de Células-Tronco Mesenquimais/métodos , Osteoartrite do Joelho/terapia , Animais , Ligamento Cruzado Anterior/cirurgia , Injeções Intra-Articulares , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/patologia , Coelhos , Transplante Homólogo , Resultado do Tratamento
13.
Orthopade ; 48(10): 858-861, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31289891

RESUMO

BACKGROUND: Lateral extra-articular procedures in association with anterior cruciate ligament (ACL) reconstruction can act as a protection against undesired loads occurring in the early postoperative phase. The purpose of the present study was to retrospectively review the clinical outcome of contralateral hamstring tendon autografts with extra-articular tenodesis for ACL revision surgery in skeletally mature patients under 25 years of age, specifically with respect to patient satisfaction, return to preinjury activity level and postoperative functional outcome. METHODS: In this study 9 patients (<25 years old at surgery) who underwent ACL revision surgery using contralateral hamstring tendon autografts and extra-articular tenodesis were contacted and retrospectively reviewed at an average follow-up of 3.6 years (range 2-7 years). The Tegner activity scale, Lysholm knee score and International Knee Documentation Committee (IKDC) questionnaire were used. Objective evaluation included range of motion, Lachmann test, pivot-shift test and KT-1000 instrumented laxity testing. RESULTS: No cases of re-rupture were observed. The Lysholm knee score as well as the IKDC score improved at follow-up reaching a mean value of 87.9 and 85.6, respectively, with a statistically significant improvement compared to preoperative status (p < 0.001). In terms of knee stability anterior tibial translation has changed from a preoperative mean value of 5.4 mm to a postoperative value of 2.9 mm, which was statistically significant (p < 0.001). No subjective loss of motion or strength of the contralateral knee, rotational injuries following tendon harvesting or significant morbidity at follow-up were reported. CONCLUSION: Revision ACL reconstruction with contralateral hamstrings and associated extra-articular tenodesis provides satisfying subjective outcomes and restores knee stability in skeletally mature patients under 25 years of age. LEVEL OF EVIDENCE:  IV.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Tenodese , Feminino , Seguimentos , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(6): 685-688, 2019 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-31197994

RESUMO

Objective: To investigate the effectiveness of arthroscopic GraftLink technique reconstruction combined with suture anchor fixation in treatment of anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) grade Ⅲ injury. Methods: Between June 2015 and February 2018, 28 patients with ACL rupture and MCL grade Ⅲ injury were treated. Arthroscopic GraftLink technique was used to reconstruct ACL with autologous peroneus longus tendon (PLT), and suture anchor fixation was used to repair MCL. There were 22 males and 6 females, aged 21-47 years, with an average age of 30.4 years. The cause of injury included traffic accident in 18 cases, falling from height in 7 cases, and sports injury in 3 cases. The time from injury to admission was 1-2 weeks, with an average of 1.3 weeks. The preoperative Lysholm score of knee joint was 46.8±3.0 and the International Knee Documentation Commission (IKDC) score was 49.2±2.7. The American Orthopaedic Foot and Ankle Society (AOFAS) score of ankle joint was 98.29±0.72. Both Lachman test and valgus stress test were positive. There were 8 cases of meniscus injury and 2 cases of cartilage injury. Results: The operation time ranged from 55 to 90 minutes, with an average of 72.5 minutes. All incisions healed by first intention after operation, and no complications related to operation occurred. All patients were followed up 6-38 months, with an average of 20.7 months. At 3 months after operation, the range of motion of the knee joint was 116- 132°, with an average of 122°. Lachman test showed that the anterior translation more than 5 mm in 2 cases, and the others were negative; while the valgus stress test showed that all patients were positive. At 6 months after operation, the Lysholm score and IKDC score of knee joint were 90.2±1.8 and 93.5±2.3, respectively, which were significantly higher than preoperative scores ( t=31.60, P=0.00; t=29.91, P=0.01); AOFAS score of ankle joint was 97.86±0.68, with no significant difference compared with preoperative score ( t=2.89, P=0.08). KT-1000 test showed that the difference of anterior relaxation between bilateral knee joints was less than 2 mm in 25 cases and 3 to 5 mm in 3 cases. Conclusion: The method of ACL reconstruction via arthroscopic GraftLink technique with PLT and MCL repair via suture anchor fixation has the advantages of less knee injury and faster recovery, and there is no significant impact on ankle function after tendon removal.


Assuntos
Lesões do Ligamento Cruzado Anterior , Artroscopia , Ligamentos Colaterais , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia/métodos , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Âncoras de Sutura , Resultado do Tratamento , Adulto Jovem
16.
Oper Orthop Traumatol ; 31(3): 221-247, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31172213

RESUMO

OBJECTIVE: Restoration of knee stability after rerupture of an anterior cruciate ligament (ACL) graft. INDICATION: Acute and chronic functional instability with rerupture of an ACL graft with subjective instability with anatomical or non-anatomical bone tunnel without tunnel widening. CONTRAINDICATIONS: Partial anatomical bone tunnels of the previous operation, significant tunnel widening of anatomical bone tunnels, local infection of the knee joint, local soft tissue damage. SURGICAL TECHNIQUE: Graft choices are hamstring tendons (semitendinosus muscle, gracilis muscle), the quadriceps tendon, patellar tendon and a peroneus tendon split graft. In cases with anatomical tunnels, careful debridement is performed down to the tunnel wall. In non-anatomical tunnels, a new femoral tunnel is drilled over a deep anteromedial portal with the knee flexed more than 110° in the insertion area of the ACL. Using drills and dilators, a tunnel is prepared. At the tibia, the anterior horn of the lateral meniscus serves as a landmark in the absence of an ACL stump. The cortical tibial tunnel aperture is probed with a guide wire and the tunnel is drilled stepwise until the tunnel wall is reached, which is debrided with a spoon or synovial resector to remove graft residues and implants from the tunnel. The femoral fixation can either be done with a flip button, an interference screw or in the case of a bone block graft implant-free. At the tibial side, the graft is fixed with a resorbable interference screw and fixation button. POSTOPERATIVE MANAGEMENT: The rehabilitation program comprises 4-5 phases. Inflammatory phase (weeks 1-2): control of pain and swelling (cooling, isometric tension exercises, 20 kg partial load). Phase 2 (weeks 2-6): increasing load and range of motion with closed chain exercises (target: extension/flexion 0-0-120°). Phase 3 (from week 6): strength and coordination exercises. Phase 4: balance, strength and jump exercises. Return to competitive sport not before postoperative month 6-10. RESULTS: Included were 51 patients with recurrent instability after ACL surgery where primary ACL replacement was performed with ipsilateral bone quadriceps tendon graft or contralateral semitendinosus-gracilis graft. All patients had anatomical or non-anatomical tunnel locations without significant widening (>11 mm). After 2 years, the side-to-side difference for anterior tibial translation measured with the KT 1000 arthrometer was 2.0 ± 1.2 mm for the quadriceps group and 3.0 ± 2.9 mm for the semitendinosus-gracilis group (P = 0.461). No difference in the rate of positive pivot shift tests (P = 0.661); no significant difference in the individual Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores or in the frequency of anterior knee pain.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Tendões , Resultado do Tratamento
17.
Phys Sportsmed ; 47(3): 240-241, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31204881

RESUMO

A recent cross-sectional national USA registry of surgery to repair anterior cruciate ligament tears found that fewer adolescent women who reported using combined hormonal contraceptives (CHC) had the surgery. They reviewed a complex literature on ovarian steroidal relationships with connective tissues biology, physiology and clinical issues. They concluded, based on their data and that evidence shows the greatest gender imbalance for women's ACL injury during adolescence, that all adolescent athletic women should be treated with CHC to prevent ACL injury. We caution that this admonition is using association to imply causation, implies we understand the ovarian hormonal relationships with connective tissues while that remains unclear, the directive to use CHC in adolescent ignores the recent meta-analytic evidence that its use is associated with failure to achieve peak bone mass and that these authors have used erroneous inferential reasoning and ignored the other variables besides sex and age related to ACL injury and the convincing evidence that training strategies can prevent tears.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho/cirurgia , Adolescente , Ligamento Cruzado Anterior/cirurgia , Anticoncepcionais Orais , Estudos Transversais , Feminino , Humanos
18.
Vet Surg ; 48(5): 694-699, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31168843

RESUMO

OBJECTIVE: To report infection rate, implant removal rate, and postoperative antibiotic therapy after tibial tuberosity advancement (TTA) in dogs. STUDY DESIGN: Retrospective study. ANIMALS: One thousand seven hundred sixty-eight stifles in 1,732 dogs. METHODS: Medical records (January 2007-December 2011) of dogs treated with a TTA were reviewed. Cases were included if at least 1 year of postoperative follow-up was available and no additional procedures were performed on the stifle. Date of surgery, date of culture, culture and susceptibility results, postoperative antimicrobials used, and any implant removals were recorded. Use of postoperative antibiotics and implant removal were evaluated statistically for effect on infection occurrence and resolution. RESULTS: Postoperative infections were diagnosed in 82 of 1,768 (4.6%) stifles. Implants were removed from 32 (39%) stifles, with plate and screw removal only in 23 (71.9%) stifles. The rate of infection did not differ between dogs with or without postoperative antibiotic therapy. However, dogs receiving postoperative antibiotic therapy were at risk for developing an oxacillin-resistant infection (P = .001). Oxacillin-resistant infections were associated with a requirement for implant removal to achieve resolution compared with other types of bacterial infections (P < .05). CONCLUSION: No benefit was detected with the use of postoperative antibiotics after TTA in this population. Implant removal was infrequent, and the requirement for cage removal was not commonly required for infection resolution. CLINICAL SIGNIFICANCE: This study does not provide evidence to support postoperative antibiotic therapy after TTA. Postoperative infection can be treated in most dogs without removal of the TTA cage.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Antibacterianos/uso terapêutico , Remoção de Dispositivo/veterinária , Doenças do Cão/cirurgia , Complicações Pós-Operatórias/veterinária , Joelho de Quadrúpedes/cirurgia , Animais , Placas Ósseas/veterinária , Cães , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Retrospectivos , Tíbia/cirurgia
20.
Am J Vet Res ; 80(6): 607-612, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31140840

RESUMO

OBJECTIVE: To radiographically compare patellar ligament length (PLL) in dogs undergoing tibial plateau leveling osteotomy (TPLO) for unilateral cranial cruciate ligament rupture at preoperative, postoperative, and follow-up evaluations. ANIMALS: 105 dogs that underwent TPLO for unilateral cranial cruciate ligament rupture at a referral veterinary hospital from October 1, 2008, through November 30, 2017. PROCEDURES: Medical records were reviewed to obtain information on dog signalment, surgical procedure, and radiographically measured PLL at preoperative, postoperative, and follow-up evaluations. RESULTS: Dogs undergoing TPLO had a shorter PLL at the postoperative and follow-up evaluations, compared with the PLL at the preoperative evaluation. Mean ± SD overall unadjusted PLL decreased significantly by 2.3 ± 3.4% between the preoperative and postoperative evaluation and by 2.8 ± 3.9% between the preoperative and follow-up evaluation. The PLL did not differ significantly between the postoperative and follow-up evaluation; mean PLL decreased by 0.4 ± 3.8% between the postoperative and follow-up evaluation. CONCLUSIONS AND CLINICAL RELEVANCE: The PLL was shorter after TPLO in dogs, which was similar to changes observed for humans after high tibial osteotomy procedures. Further evaluation of clinical assessments, joint mobility, ultrasonographic assessments, and kinematic results are needed to determine the relevance of the PLL and whether a decrease in ligament length results in decreased mobility and persistent lameness in dogs, as has been reported for humans.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Ligamento Cruzado Anterior/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagem , Osteotomia/veterinária , Ligamento Patelar/diagnóstico por imagem , Joelho de Quadrúpedes/diagnóstico por imagem , Animais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Doenças do Cão/cirurgia , Cães , Feminino , Seguimentos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Joelho de Quadrúpedes/cirurgia , Tíbia , Ultrassonografia/veterinária
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