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1.
BMC Musculoskelet Disord ; 22(1): 916, 2021 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-34717593

RESUMO

BACKGROUND: Quantitative magnetic resonance imaging (MRI) methods such as T1rho and T2 mapping are sensitive to changes in tissue composition, however their use in cruciate ligament assessment has been limited to studies of asymptomatic populations or patients with posterior cruciate ligament tears only. The aim of this preliminary study was to compare T1rho and T2 relaxation times of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) between subjects with mild-to-moderate knee osteoarthritis (OA) and healthy controls. METHODS: A single knee of 15 patients with mild-to-moderate knee OA (Kellgren-Lawrence grades 2-3) and of 6 age-matched controls was imaged using a 3.0 T MRI. Three-dimensional (3D) fat-saturated spoiled gradient recalled-echo images were acquired for morphological assessment and T1ρ- and T2-prepared pseudo-steady-state 3D fast spin echo images for compositional assessment of the cruciate ligaments. Manual segmentation of whole ACL and PCL, as well as proximal / middle / distal thirds of both ligaments was carried out by two readers using ITK-SNAP and mean relaxation times were recorded. Variation between thirds of the ligament were assessed using repeated measures ANOVAs and differences in these variations between groups using a Kruskal-Wallis test. Inter- and intra-rater reliability were assessed using intraclass correlation coefficients (ICCs). RESULTS: In OA knees, both T1rho and T2 values were significantly higher in the distal ACL when compared to the rest of the ligament with the greatest differences in T1rho (e.g. distal mean = 54.5 ms, proximal = 47.0 ms, p < 0.001). The variation of T2 values within the PCL was lower in OA knees (OA: distal vs middle vs proximal mean = 28.5 ms vs 29.1 ms vs 28.7 ms, p = 0.748; Control: distal vs middle vs proximal mean = 26.4 ms vs 32.7 ms vs 33.3 ms, p = 0.009). ICCs were excellent for the majority of variables. CONCLUSION: T1rho and T2 mapping of the cruciate ligaments is feasible and reliable. Changes within ligaments associated with OA may not be homogeneous. This study is an important step forward in developing a non-invasive, radiological biomarker to assess the ligaments in diseased human populations in-vivo.


Assuntos
Lesões do Ligamento Cruzado Anterior , Cartilagem Articular , Ligamento Cruzado Posterior , Ligamento Cruzado Anterior , Estudos Transversais , Humanos , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Ligamento Cruzado Posterior/diagnóstico por imagem , Reprodutibilidade dos Testes
2.
Acta Ortop Mex ; 35(1): 69-74, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480443

RESUMO

INTRODUCTION: The two most commonly used types of prostheses are the total knee prosthesis with posterior cruciate ligament preservation and posterior cruciate ligament replacement. OBJECTIVE: To assess whether there is a difference in functionality between the two procedures. MATERIAL AND METHODS: Observational, retrospective and cross-sectional study with 134 patients divided into group A (N = 67) with ligament preservation and group B (N = 67) with posterior substituting. Using the American Association Scale for Knee Prosthetics with Insall modification to assess functionality. Statistical analysis: use of 2 with Yates correction. RESULTS: In group A the results: excellent (31%); good (24%); regular (22%) bad (22%). In group B the results: excellent (34%); good (31%); regular (16%) and bad (19%); without statistical difference between the two groups. CONCLUSIONS: No statistically significant difference was observed between age, gender, laterality of injury, or between number of patients with excellent results, good regular and bad according to the scale used. The high percentage of poor results in both groups of this series for the knee prosthesis is striking.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Ligamento Cruzado Posterior , Estudos Transversais , Humanos , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos
3.
Orthopedics ; 44(5): e691-e693, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34590955

RESUMO

In traditional endoscopic anterior cruciate ligament (ACL) reconstruction, inadequate visualization of the femoral footprint through a lateral portal frequently causes surgical errors. Although various portal locations have been reported, no study has identified ideal locations for specific portals in relation to ACL reconstruction. This article presents the new transtibial portal technique (ie, the use of an existing tibial tunnel). This technique provides excellent direct visualization of the femoral ACL footprint without the need to create additional portals. It allows dynamic visualization of the relationship of the future graft with posterior cruciate ligament and bone structures. [Orthopedics. 2021;44(5):e691-e693.].


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Posterior , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Artéria Femoral , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
4.
Knee ; 32: 121-130, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34461388

RESUMO

BACKGROUND: In conventional total knee arthroplasty (TKA), the anterior cruciate ligament (ACL) is resected. ACL dysfunction causes knee instability and is regarded as one factor in poor TKA outcomes. In bi-cruciate stabilized (BCS) TKA, the implant reproduces ACL function and provides anterior stability. The objective of this study was to evaluate preoperative and postoperative X-rays and accelerometer gait measurements in patients who underwent BCS TKA and posterior-stabilized (PS) TKA to assess the postoperative acceleration changes of knees after these procedures and to compare them in terms of joint range of motion (ROM) and the New Knee Society Score (New KSS). METHODS: The subjects were 60 patients, 30 of whom underwent BCS TKA and 30 PS TKA. Joint ROM, New KSS, lateral X-rays of the standing extended knee, and accelerometer data were evaluated 12 months postoperatively. RESULTS: There was no significant difference in joint ROM between the groups. Both had good New KSS results, but the functional activity score was significantly higher after BCS TKA than after PS TKA. X-rays showed a lower posterior offset ratio after BCS TKA than after PS TKA, with anteroposterior positioning closer to that of the normal knee. Accelerometer data showed that postoperative anteroposterior acceleration on the femoral side in the stance phase and swing phase was lower after BCS TKA than after PS TKA. CONCLUSION: Compared with PS TKA, BCS TKA resulted in a higher functional activity score, closer positioning to that of the normal knee on lateral X-ray, and lower anteroposterior acceleration on the femoral side.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Ligamento Cruzado Posterior , Acelerometria , Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular
5.
Unfallchirurg ; 124(10): 856-861, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34255102

RESUMO

OBJECTIVE: Stepwise reconstruction of knee stability and physiological kinematics in acute knee dislocation. INDICATIONS: The operative technique is demonstrated in a case of multiligamentous injury of the knee with involvement of both cruciate ligaments and additional medial and lateral peripheral injuries (type IV according to Schenck classification). CONTRAINDICATIONS: Critical soft tissue conditions, infections, old age, obesity, lack of compliance. SURGICAL TECHNIQUE: Time-limited arthroscopy in order to primarily identify and treat posterior horn/root injuries of the meniscus and concomitant intra-articular injuries. Anatomical placement of anterior cruciate ligament (ACL) drill wires for later ACL tunnel drilling is arthroscopically guided. Subsequent conversion to an anteromedial arthrotomy and ligament bracing of the posterior cruciate ligament. The ACL is reconstructed using the ipsilateral semitendinosus tendon. Medial and lateral peripheral injures are anatomically reconstructed followed by a posterolateral augmentation in a technique described by Arciero. FOLLOW-UP: Limited weight bearing for 6 weeks and stepwise increase of flexion using a standard knee brace and close clinical monitoring. EVIDENCE: Ligament bracing of both cruciate ligaments is an established treatment technique in acute knee dislocations and has been proven to achieve good to excellent clinical results. In an ongoing clinical study primary ACL reconstruction as a modified treatment approach indicated superior stability in a 12-month follow-up in patients with acute knee dislocations.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Luxação do Joelho , Ligamento Cruzado Posterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Humanos , Luxação do Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Resultado do Tratamento
6.
J Arthroplasty ; 36(11): 3765-3772.e4, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34330602

RESUMO

BACKGROUND: Little is known regarding anterior-posterior stability after anterior cruciate ligament-preserving partial (PKA) and combined partial knee arthroplasty (CPKA) compared to standard posterior cruciate-retaining total knee arthroplasty (TKA). METHODS: The anterior-posterior tibial translation of twenty-four cadaveric knees was measured, with optical tracking, while under 90N drawer with the knee flexed 0-90°. Knees were tested before and after PKA, CPKA (medial and lateral bicompartmental and bi-unicondylar), and then posterior cruciate-retaining TKA. The anterior-posterior tibial translations of the arthroplasty states, at each flexion angle, were compared to the native knee and each other with repeated measures analyses of variance and post-hoc t-tests. RESULTS: Unicompartmental and bicompartmental arthroplasty states had similar laxities to the native knee and to each other, with ≤1-mm differences throughout the flexion range (P ≥ .199). Bi-unicondylar arthroplasty resulted in 6- to 8-mm increase of anterior tibial translation at high flexion angles compared to the native knee (P ≤ .023 at 80-90°). Meanwhile, TKA exhibited increased laxity across all flexion angles, with increased anterior tibial translation of up to 18 ± 6 mm (P < .001) and increased posterior translation of up to 4 ± 2 mm (P < .001). CONCLUSIONS: In a cadaveric study, anterior-posterior tibial translation did not differ from native laxity after PKA and CPKA. Posterior cruciate ligament-preserving TKA demonstrated increased laxity, particularly in anterior tibial translation.


Assuntos
Artroplastia do Joelho , Ligamento Cruzado Posterior , Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia
7.
Surg Radiol Anat ; 43(10): 1667-1672, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34259889

RESUMO

PURPOSE: The present study aims to report a symptomatic rare anatomical variation of the posterior cruciate ligament (PCL) that was encountered during arthroscopy. CASE PRESENTATION: A 34-year-old female suffered from dull anterior pain in the right knee, along with stiffness and the presence of an audible click and occasionally locking during deep knee flexion. Physical examination revealed only slight pain during single-leg squatting and mild knee effusion with painful limitation of the last degrees of flexion. Following unsuccessful conservative treatment, knee arthroscopy was performed in which the PCL was found to be hypertrophic, having a broad femoral insertion that almost completely occupied the intercondylar notch and impinged the anterior cruciate ligament. Moreover, the PCL presented a large medial synovial fold that formed a plica inserting to the medial meniscus's posterior horn. Ligamentoplasty was performed by excising one-third of the PCL lateral portion. The PCL medial synovial fold and the plica attaching to the medial meniscus were resected. The patient was allowed to return to full activity when her symptoms resolved, and the knee function was restored, at 5 weeks post-operatively. CONCLUSION: The current study presented a rare and complex anatomical variation of the PCL that was symptomatic and recalcitrant to conservative treatment. Magnetic resonance imaging (MRI) can reveal the variant morphology of the PCL, and arthroscopy provides the definite treatment. This case report may be useful for orthopaedic surgeons and radiologists to consider anatomical PCL variations during differential diagnosis in patients with non-specific clinical presentation and findings.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia/métodos , Tratamento Conservador/métodos , Ligamento Cruzado Posterior/anormalidades , Adulto , Feminino , Humanos , Resultado do Tratamento
8.
Orthopedics ; 44(4): 235-240, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34292810

RESUMO

The goal of this study was to evaluate the stiffness and resistance to elongation of an internal bracing (IB) construct in posterior cruciate ligament reconstruction (PCLR). The authors hypothesized that augmentation with an internal brace would increase construct stiffness and decrease posterior tibial translation during cyclic loading in a fresh frozen cadaveric model. Ten cadaver knees underwent PCL reconstruction with (PCLR+IB) and without (PCLR) augmentation with an internal brace and were compared with an intact PCL state. Knees were subjected to cyclic posterior drawer loading at 45 N, 90 N, and 134 N. The PCLR+IB showed significantly less tibial translation with posterior drawer loading compared with the PCLR. Posterior tibial translation measured 8.83 mm for the PCLR vs 6.59 mm for the PCLR+IB (P=.05) at 45 N posterior load. This difference remained significant at higher loads, with posterior translation of 10.84 mm and 8.44 mm for PCLR and PCLR+IB, respectively, at 90 N (P=.035) and posterior translation of 12.80 mm and 10.23 mm for PCLR and PCLR+IB, respectively, at 134 N (P=.023). No significant differences were found in overall construct stiffness between groups. These data suggest a checkrein mechanism of action for the internal brace in this construct, rather than a load-sharing mechanism. Importantly, the PCLR+IB technique did not constrain posterior translation more than the intact, physiologic state. Clinical studies are warranted to determine whether these ex vivo biomechanical benefits will translate to improved outcomes. [Orthopedics. 2021;44(4):235-240.].


Assuntos
Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Fenômenos Biomecânicos , Cadáver , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Tíbia/cirurgia
9.
Arthroscopy ; 37(7): 2029-2030, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34225996

RESUMO

Improved understanding of the biomechanical significance and clinical repercussions of tibial slope on cruciate ligament function has sparked a newfound clinical interest in this morphological feature. Using either magnetic resonance imaging or lateral tibia radiographs, the anterior-posterior angulation of the tibial plateau relative to the tibial shaft can be measured. Clinical and biomechanical studies have reported that increased posterior tibial slope (PTS) places significantly increased tension on the native and reconstructed anterior cruciate ligament (ACL), leading to an increased risk of failure. It has also been suggested that increased PTS of the lateral tibial plateau has a greater impact on ACL forces and anterior tibial translation than PTS of the medial tibial plateau. Conversely, a decreased PTS has been shown to be a risk factor for recurvatum deformity, posterior cruciate ligament (PCL) injury, and posterior tibial translation and has been linked to single bundle PCL reconstruction failure. In the setting of ACL insufficiency with a PTS greater than 12°, anterior closing wedge osteotomy has been shown to be protective for ACL reconstructions. Alternatively, some surgeons have advocated for the addition of lateral extraarticular stabilization procedures in the setting of increased PTS. Further, in the setting of PCL insufficiency with an anteriorly directed, or flat, PTS, anterior opening wedge osteotomy has shown encouraging results. In addition, double bundle PCL reconstructions should be strongly considered in the setting of anteriorly directed, or flat, tibial slope.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Posterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(7): 823-828, 2021 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-34308588

RESUMO

Objective: To investigate the effectiveness of the posterior-posterior triangulation technique for arthroscopic posterior cruciate ligament (PCL) reconstruction by comparing with the anteroposterior approach. Methods: Retrospective analysis was performed on 40 patients who underwent arthroscopic PCL reconstruction between February 2016 and February 2020. The PCLs were reconstructed via anteroposterior approach in 20 patients (anteroposterior approach group) and posterior-posterior triangulation technique in 20 patients (posterior-posterior triangulation technique group). There was no significant difference in gender, age, cause of injury, injury side, disease duration, preoperative International Knee Documentary Committee (IKDC) score, and Lysholm score between the two groups ( P>0.05). The operation time, surgical complications, and postoperative posterior drawer test, Lysholm score, and IKDC score were recorded and compared between the two groups. Results: The operation time was (65.25±10.05) minutes in the anteroposterior approach group and (56.15±8.15) minutes in the posterior-posterior triangulation technique group, and the difference was significant ( t=3.145, P=0.003). All incisions healed by first intention, and there was no complication such as vascular and nerve injuries or infection. Patients were followed up (27.05±11.95) months in the anteroposterior approach group and (21.40±7.82) months in the posterior-posterior triangulation technique group, with no significant difference ( t=1.770, P=0.085). At last follow-up, the posterior drawer tests were positive in 4 cases (3 cases of stageⅠand 1 case of stage Ⅱ) of the anteroposterior approach group and in 1 case (stageⅠ) of the posterior-posterior triangulation technique group, showing no significant difference between the two groups ( P=0.342). At last follow-up, Lysholm score and IKDC score in both groups were significantly higher than those before operation ( P<0.05). The above functional scores in the posterior-posterior triangulation technique group were significantly higher than those in the anteroposterior approach group ( P<0.05). Imaging reexamination showed that the position, shape, and tension of the grafts were well in both groups, and the grafts were covered with the synovium in the posterior-posterior triangulation technique group, the meniscofemoral ligaments were well preserved. There was no re-rupture of the reconstructed ligament during follow-up. Conclusion: Compared to the anteroposterior approach, the posterior-posterior triangulation technique provides a clearer view under arthroscopy, no blind spot, sufficient operating space, and relative safety. Moreover, it is easier to retain the remnant and the meniscofemoral ligaments, and can obtain good short-term effectiveness.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Humanos , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
J Orthop Trauma ; 35(Suppl 2): S36-S37, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34227604

RESUMO

SUMMARY: This video depicts the materials and steps for the repair of a Schenck classification knee dislocation IV multiligamentous injury and peroneal nerve palsy. The patient had bilateral injuries after a car pinned him to a garage in his cabinet. The video demonstrates primary repair of the avulsions of the right knee with acute repair of anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and posterior lateral corner in the patient.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamentos Colaterais , Luxação do Joelho , Traumatismos do Joelho , Ligamento Cruzado Posterior , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Luxação do Joelho/diagnóstico por imagem , Luxação do Joelho/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Masculino , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(7): 829-835, 2021 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-34308589

RESUMO

Objective: To compare the early effectiveness of arthroscopic suture bridge technique and conventional double tunnel suture technique in the treatment of avulsion fracture of posterior cruciate ligament (PCL) insertion. Methods: Between June 2013 and December 2018, 62 patients with tibial avulsion fracture of PCL insertion that met the criteria were selected and randomly divided into trial group (using arthroscopic suture bridge technique) and control group (using conventional double tunnel suture technique), 31 cases in each group. There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, Meyers & McKeever classification, Kellgren-Lawrence classification, and preoperative knee range of motion, difference of posterior relaxation of bilateral knee joints, International Knee Documentation Committee (IKDC) score, and Lysholm score between the two groups ( P>0.05). The operation time and IKDC score, Lysholm score, knee range of motion, the difference of posterior relaxation of bilateral knee joints (measured by KT-2000 under knee flexion of 90° and 30 lbs) were recorded and compared between the two groups before operation and at 3 and 12 months after operation. Results: Both groups successfully completed the operation, and the operation time of the trial group and the control group were (61.81±6.83) minutes and (80.42±4.22) minutes respectively, showing significant difference between the two groups ( t=12.911, P=0.000). All the incisions healed by first intention, and there was no wound infection and other early postoperative related complications. All patients were followed up 13-18 months (mean, 14.6 months). The fractures in both groups healed at 3 months after operation. No knee pain, limited movement, or other complications occurred. At 3 and 12 months after operation, the IKDC score, Lysholm score, knee range of motion, and the difference of posterior relaxation of bilateral knee joints in both groups were significantly improved when compared with preoperative ones, and further improved at 12 months after operation when compared with at 3 months after operation ( P<0.05). At each time point after operation, the above indexes and the grade of the difference of posterior relaxation of bilateral knee joints in the trial group were significantly better than those in the control group ( P<0.05). Conclusion: Arthroscopic suture bridge technique in the treatment avulsion fracture of PCL insertion is simple and reliable, which can significantly improve the function and stability of the knee joint and obtain satisfactory early effectiveness.


Assuntos
Fratura Avulsão , Ligamento Cruzado Posterior , Fraturas da Tíbia , Artroscopia , Humanos , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Técnicas de Sutura , Suturas , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
14.
Oper Orthop Traumatol ; 33(5): 445-455, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34081174

RESUMO

OBJECTIVE: Description of a reproducible surgical technique for single-bundle anterolateral reconstruction of the posterior cruciate ligament (PCL) based on a septum-sparing approach. This technique is less traumatic than the trans-septum approach. The article illustrates surgical steps to simplify the technical aspects of the procedure. INDICATIONS: A complete grade III symptomatic tear of the PCL associated with instability and often discomfort (deceleration, stairs) or subsequent gonalgia arising from the medial compartment or patellofemoral joint. Injury of the peripheral joint stabilizers alongside the PCL including the posterolateral corner or a complete medial knee injury. The procedure is indicated in chronic cases, but also in acute cases of posterior instability > 10 mm, if it is an intraligamentous tear with dislocated PCL stumps. CONTRAINDICATIONS: Bony avulsions of the PCL suitable for refixation, soft tissue compromise, infection, advanced osteoarthritic disease. SURGICAL TECHNIQUE: After diagnostic arthroscopy of the knee, the ipsilateral semitendinosus and gracilis tendons are harvested and prepared as a 6-strand graft for PCL reconstruction. One high anterolateral viewing portal, one low anterolateral portal, one anteromedial portal, and a posteromedial portal are used for single-bundle reconstruction via one femoral and one tibial bone tunnel and hybrid graft fixation. POSTOPERATIVE MANAGEMENT: Weight bearing is restricted to 20 kg for 6 weeks. PCL brace with tibial support for a period of 12 weeks. Flexion is limited to 30° in the first 2 postoperative weeks, then 60° for 2 weeks, and 90° for 2 further weeks. Passive flexion in prone position is performed. Active focused muscle strengthening exercise is begun after 6 weeks postoperatively and participation in competitive sports is not recommended before full muscle strength and coordination is re-established, at the earliest 9-12 months postoperatively. RESULTS: Two isolated and 19 combined PCL injuries were treated. Mean patient age was 27.4 years, and the minimal follow-up was 12 months. On average, we found good clinical outcome with slight degree of posterior laxity (4.1 mm) after PCL reconstruction in comparison with the contralateral knee. No patient showed signs of effusion at follow-up. Range of motion was fully restored in 19 of 21 patients. One patient suffered failure due to persistent posterior instability and persistence of symptoms.


Assuntos
Traumatismos do Joelho , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Adulto , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia , Resultado do Tratamento
15.
Arthroscopy ; 37(6): 1881-1882, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34090571

RESUMO

Isolated tibial posterior cruciate ligament avulsion fractures, although rare, are becoming increasingly common in regions of the world with frequent 2-wheel motor vehicle accidents. Arthroscopic-assisted suture fixation has become a popular fixation method for these injuries. Suspensory metal button fixation of tibial posterior cruciate ligament avulsion fractures, although commonly used for other applications, has until recently been limited to isolated reports of a few patients.


Assuntos
Ligamento Cruzado Posterior , Fraturas da Tíbia , Artroscopia , Humanos , Ligamento Cruzado Posterior/cirurgia , Técnicas de Sutura , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia
16.
Am J Sports Med ; 49(9): 2416-2425, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34115543

RESUMO

BACKGROUND: It remains unclear how posterior cruciate ligament (PCL) reconstruction influences long-term lower extremity joint biomechanics. PURPOSE: To determine whether patients who underwent PCL reconstruction exhibited long-term alterations in lower limb gait mechanics. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 26 patients underwent gait analyses at 8.2 ± 2.6 years after primary unilateral PCL reconstruction. Sex- and age-matched healthy controls were analyzed for comparison. Gait data were collected using motion capture and force plates. Hip, knee, and ankle angles and moments were compared during initial contact, early stance, and late stance for the reconstructed and uninjured contralateral limbs of patients who underwent PCL reconstruction (PCL group) as well as the limbs of healthy control participants (CON group). RESULTS: No side-to-side kinematic differences were noted between the reconstructed and contralateral limbs of the PCL group; some trivial differences were noted in knee and hip moments. However, major differences between the PCL and CON groups occurred at the knee. Reconstructed and contralateral limbs of the PCL group exhibited larger knee flexion angles during initial contact (Δ = 7.0° [P < .001] and Δ = 6.9° [P < .001], respectively), early stance (Δ = 5.8° [P = .003] and Δ = 6.7° [P < .001], respectively), and late stance (Δ = 7.9° [P < .001] and Δ = 8.0° [P < .001], respectively) compared with the CON group. During early stance, contralateral limbs of the PCL group displayed larger knee flexion moments (Δ = 0.20 N·m/kg; P = .014) compared with the CON group, and both reconstructed (Δ = 0.05 N·m/kg; P = .027) and contralateral (Δ = 0.07 N·m/kg; P = .001) limbs of the PCL group exhibited larger knee external rotation moments compared with the CON group. During late stance, reconstructed and contralateral limbs of the PCL group exhibited smaller knee extension moments (Δ = 0.24 N·m/kg [P < .001] and Δ = 0.26 N·m/kg [P < .001], respectively) and knee internal rotation moments (Δ = 0.06 N·m/kg [P < .001] and Δ = 0.06 N·m/kg [P < .001], respectively) compared with the CON group. No discrepancies were observed at the hip; minimal differences were noted in sagittal-plane ankle mechanics. CONCLUSION: Patients who underwent PCL reconstruction generally exhibited bilateral gait symmetry at 8 years after surgery. However, they exhibited important biomechanical deviations in both knees compared with healthy controls. These modifications likely reflect adaptive gait strategies to protect the PCL after reconstruction. CLINICAL RELEVANCE: Long-term follow-up analyses of patients who underwent PCL reconstruction should not use the uninjured contralateral limb as a "healthy" reference, as it also exhibits mechanical differences compared with controls. Results could inform the development of neuromuscular and strength training programs targeting the restoration of knee biomechanics similar to healthy controls to prevent early-onset degeneration that is frequently associated with altered biomechanics.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Posterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Marcha , Humanos , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia
19.
J Orthop Surg Res ; 16(1): 383, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130707

RESUMO

PURPOSE: Increased tibial tubercle-trochlear groove distance (TT-TG) was proposed as one of the main risk factors for patellofemoral instability (PFI). The increased TT-TG distance indicated externalization of the tibial tubercle with the reference of the trochlear groove. However, in the case of severe trochlear dysplasia, the reference point on the trochlear groove was indistinct, and the accuracy of TT-TG was controversial. The purpose of this study was to evaluate the accuracy of TT-TG and TT-PCL in consideration of the mild and severe trochlear dysplasia. METHODS: From 2015 to 2020, MRI findings of consecutive knee joints with PFI symptoms diagnosed in our hospital were retrospectively analyzed. All knees with trochlear dysplasia were diagnosed by longitudinal MRI scan and lateral radiograph. The knees were classified according to the four-type classification system described by Dejour et al. Twenty cases of type A (mild trochlear dysplasia); 20 cases of type B, C, and D (severe trochlear dysplasia); and 20 cases of normal type were selected and divided into normal group (normal trochlea), mild group (type A), and severe group (type B, type C, type D). Tibial tubercle-trochlear groove distance (TT-TG), tibial tubercle-posterior cruciate ligament distance (TT-PCL), and the Dejour classification of trochlear dysplasia were assessed by 2 experienced orthopedics. The reliability of TT-TG distance and TT-PCL distance was tested by intraclass correlation coefficients (ICCs). RESULTS: Comparing the differences between TT-TG and TT-PCL in the normal, mild, and severe groups, the TT-TG and TT-PCL in the mild and severe groups show different meanings (normal, 8.83 ± 3.62 mm vs. 8.44 ± 4.57 mm, P > 0.05; mild, 17.30 ± 4.81 mm vs. 20.09 ± 5.05 mm, P < 0.05; severe, 10.79 ± 4.24 mm vs. 12.31 ± 5.43 mm, P > 0.05). The Pearson correlation coefficient of TT-TG and TT-PCL measurements of trochlear dysplasia were r = 0.480 (mild group, P = 0.032) and r = 0.585 (severe group, P < 0.001). The intra-observer ICCs of TT-TG were r = 0.814 (mild group) and r = 0.739 (severe group). The inter-observer ICCs of TT-TG were r = 0.810 (mild group) and r = 0.713 (severe group). In the normal knee, the Pearson correlation coefficient of TT-TG and TT-PCL was r = 0.787(P < 0.001), the intra-observer ICC of TT-TG was r = 0.989, and the inter-observer ICC of TT-TG was r = 0.978. CONCLUSION: Compared with the mild trochlear dysplasia, the inter-observer and intra-observer correlations of TT-TG measurements decreased in the group of severe dysplastic trochlea (inter-observer ICC, 0.810 vs. 0.713; intra-observer ICC, 0.814 vs. 0.739). In the present study, the determination of TT-TG and TT-PCL distance are of great significance for patients with low-grade trochlear dysplasia. And TT-PCL, without referring to the abnormal trochlear groove, is an effective indicator to measure the lateralization of tibial tuberosity in patients with severe dysplastic trochlea.


Assuntos
Instabilidade Articular/etiologia , Articulação Patelofemoral , Ligamento Cruzado Posterior/patologia , Tíbia/patologia , Adolescente , Adulto , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Articulação Patelofemoral/diagnóstico por imagem , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
20.
Jt Dis Relat Surg ; 32(2): 371-376, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145813

RESUMO

OBJECTIVES: This study aims to investigate the correlation between posterior cruciate ligament (PCL) buckling phenomena and the presence or absence of the anterior meniscofemoral ligament (aMFL). PATIENTS AND METHODS: Between January 2012 and January 2019, magnetic resonance imaging of a total of knee joints of 199 patients (163 males, 16 females; mean age: 31.5±5.3 years; range, 18 to 40 years) were reviewed retrospectively. The patients were divided into four groups. The first group included 32 patients with a ruptured anterior cruciate ligament (ACL) and absent aMFL. The second group included 67 patients with a ruptured ACL and apparent aMFL. The third group included 23 patients with an intact ACL and absent aMFL, and the fourth group included 77 patients with an intact ACL and apparent aMFL. The PCL angle was used to measure the buckling degree of the ligament, as calculated as the angle between two lines drawn through the tibial and femoral central portions of the PCL insertions. We assessed the buckling phenomena of the PCL in ACL-ruptured and ACL-intact knees and examined a possible correlation between the PCL buckling angle and the presence or absence of the aMFL of Humphrey. RESULTS: In the ruptured ACL groups (Groups 1 and 2), the mean PCL buckling angle values were 133.88±6.32 and 104.83±7.34 degrees, respectively. A significant difference was detected between both groups (p=0.026). In the intact ACL groups (Groups 3 and 4), the mean PCL buckling angle values were 143.47±5.96 and 116.77±8.38 degrees, respectively. A significant difference was detected between both groups (p=0.039). No statistically significant difference was observed between Groups 1 and 3 (p=0.13) and between Groups 2 and 4 (p=0.088). CONCLUSION: The PCL buckling sign is not specific for ACL ruptures, and can be seen frequently in normal knee joints which it is strongly associated with the presence of aMFL of Humphrey.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Articulação do Joelho/diagnóstico por imagem , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/fisiopatologia , Adolescente , Adulto , Variação Anatômica , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Feminino , Humanos , Ligamentos/anatomia & histologia , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Ruptura/diagnóstico por imagem , Adulto Jovem
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