Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.572
Filtrar
1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
10.
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
11.
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
12.
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
13.
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
14.
J Med Case Rep ; 15(1): 284, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34078448

RESUMO

BACKGROUND: To the best of our knowledge, arthroscopic treatment for symptomatic mucoid degeneration of the posterior cruciate ligament in young athletes has not been reported before. CASE PRESENTATION: An 18-year-old Asian male college soccer player presented with a 3-month history of right knee pain without episodes of trauma. Despite conservative treatment over the preceding 3 months, his symptoms persisted. Physical examination of the right knee revealed full range of motion, though posterior knee pain was induced when the knee approached full flexion. On ligament examination, posterior sagging and Lachman test were negative, and no clinical finding indicative of ligament insufficiency was noted. Magnetic resonance imaging showed a diffusely thickened posterior cruciate ligament with increased signal intensity on the T2-weighted sequence. A few intact fibers were observed with continuous margin from origin to insertion. Based on the patient's history and the magnetic resonance imaging findings, we suspected mucoid degeneration of the posterior cruciate ligament as the cause of the patient's symptoms. Since conservative treatment had failed to relieve the symptoms, arthroscopic treatment was indicated. Arthroscopic examination revealed yellowish crumbly tissues along the thickened posterior cruciate ligament. Tension and bulk of the posterior cruciate ligament were well preserved. Curettage of degenerative tissue and decompression of the posterior cruciate ligament resulted in symptom relief without instability of the knee joint. The patient returned to play at 3 months. At 12 months, postoperative magnetic resonance imaging showed no evidence of recurrence and indicated that the remaining posterior cruciate ligament was thicker than before the surgery. At 2 years follow-up, the patient remained asymptomatic and could play soccer at the same level as before the onset of pain. CONCLUSIONS: Arthroscopic decompression of the posterior cruciate ligament may relieve knee pain and facilitate early return to play with good functional results.


Assuntos
Ligamento Cruzado Posterior , Futebol , Adolescente , Artroscopia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Masculino , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular
16.
J Orthop Surg Res ; 16(1): 299, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962632

RESUMO

OBJECTIVE: To analyze the effect of sacrificing the posterior cruciate ligament (PCL) on the early postoperative outcome of cruciate retaining (CR) highly congruent rotating platform TKA. METHODS: From May 2018 to September 2019, 105 cases of total knee arthroplasty (TKA) with CR highly congruent rotating platform prosthesis were retrospectively analyzed. According to the tension of posterior cruciate ligament, they were divided into sacrifice group (29 cases, 27.6%) and retention group (76 cases, 72.4%). Preoperative and postoperative The Hospital for Special Surgery (HSS) score, range of motion (ROM) were compared between the two groups. In addition, postoperative infection, prosthesis loosening, bearing dislocation, and other complications were also compared. RESULTS: All patients were followed up for 11~24 months (mean 18.14 ± 3.52) months. There was no significant difference in general data, preoperative HSS score, and ROM between the two groups (P > 0.05). At the last follow-up, HSS score and ROM of the two groups were better than those before operation (P < 0.05). However, there was no significant difference between the two groups (P > 0.05). Moreover, there were no complications such as infection, loosening of prosthesis, and bearing dislocation in all cases. CONCLUSION: In CR, highly congruent rotating platform TKA with or without tension of the PCL can achieve satisfactory outcomes. Tension-free PCL do not cause joint instability.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Desenho de Prótese , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
17.
Injury ; 52(7): 1934-1938, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33934882

RESUMO

OBJECTIVE: To compare the clinical effects of an inverted L-shaped postero-medial approach with a homemade hook plate and arthroscopic fixation with Endobutton for tibial avulsion fractures of the posterior cruciate ligament. METHODS: The clinical data of 36 patients with PCL tibial avulsion fractures from January 2012 to December 2019 were analyzed retrospectively. The fractures were classified into Meyers-McKeever types II and III. Among them, 20 cases were treated with a homemade hook plate through an inverted L-shaped postero-medial approach (incision group), and 16 cases were treated with Endobutton under arthroscopy (arthroscopic group). The operative time, fracture union time, operative complications and range of motion of the knee joint were compared between the two groups. The stability of the knee joint was tested by the posterior drawer test, the functional recovery of the knee joint was evaluated by the Lysholm score, and the gastrocnemius muscle strength of the incision group was tested by performing heel raises with a single leg stance. RESULTS: There were no adverse events, such as fracture nonunion, infection, deep-vein thrombosis, abnormal hematoma or joint stiffness, in either group. The operative time was shorter in the incision group, and the difference was statistically significant (P < 0.05). There was no significant difference in fracture union time between the two groups (P > 0.05). At the last follow-up, there was no significant difference in range of motion or the Lysholm score between the two groups. There was no decrease in gastrocnemius muscle strength in the incision group. CONCLUSIONS: The fixation of PCL tibial avulsion fractures with a homemade hook plate through an inverted L-shaped postero-medial approach is safe and effective. It showed almost the same satisfactory outcomes as arthroscopic Endobutton fixation.


Assuntos
Fratura Avulsão , Ligamento Cruzado Posterior , Fraturas da Tíbia , Artroscopia , Fixação Interna de Fraturas , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/cirurgia , Humanos , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia , Estudos Retrospectivos , Técnicas de Sutura , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
18.
Knee ; 30: 322-336, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34029853

RESUMO

PURPOSE: To evaluate the efficacy and safety of the Ligament Augmentation and Reconstruction System (LARS) in posterior cruciate ligament (PCL) reconstruction in isolated PCL injuries and multiligament knee injuries, analysing clinical, radiographic, and patient reported outcome measures (PROMs). METHODS: A systematic review according to PRISMA guidelines was performed through Embase via Ovid, PubMed, and the Cochrane Library to identify studies reviewing LARS use for PCL reconstruction. The methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS: From 225 results screened, 13 studies were included published between 2004 and 2020, analysing LARS use for PCL reconstruction. Mean follow-up was 21 months to 11.9 years, however only four studies had follow-up of over five years. Results in isolated PCL reconstruction utilising LARS demonstrated scores that were consistent with good function and minimal limitation in daily or sporting activities, in addition to a significant improvement in knee laxity and low complication rates. Symptomatic rupture and synovitis rates were both 1.7% in this group. LARS use in complex multiligament injuries demonstrated satisfactory PROMs, although there was concern regarding residual laxity on stress radiography. CONCLUSIONS: LARS demonstrates good outcomes in PCL injury reconstruction in the short to mid-term, particularly in isolated PCL injuries, achieving equivocal or improved results compared to autograft reconstruction using hamstring tendon in the three comparative studies included. LARS has a quicker recovery time and no donor-site morbidity, however long-term data is lacking. Utilising LARS for reconstruction of the PCL in multiligament injuries revealed more variable results.


Assuntos
Traumatismos do Joelho/cirurgia , Reconstrução do Ligamento Cruzado Posterior/métodos , Tendões dos Músculos Isquiotibiais/cirurgia , Tendões dos Músculos Isquiotibiais/transplante , Humanos , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/cirurgia , Reconstrução do Ligamento Cruzado Posterior/instrumentação , Reconstrução do Ligamento Cruzado Posterior/reabilitação , Volta ao Esporte , Ruptura/cirurgia , Sinovite/etiologia , Sinovite/cirurgia , Transplante Autólogo , Resultado do Tratamento
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(5): 556-561, 2021 May 15.
Artigo em Chinês | MEDLINE | ID: mdl-33998207

RESUMO

Objective: To investigate the short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament (PCL) injuries. Methods: A clinical data of 30 patients with PCL injury, who were admitted between December 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. All patients were treated with arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon and TightRope technique. Among them, 19 were male and 11 were female, aged 17-48 years (mean, 28.2 years). The PCL injury was caused by traffic accident in 8 cases, sport in 14 cases, falling and bruising by a heavy objective in 5 cases, and other injuries in 3 cases. The interval between injury and operation was 10-90 days (mean, 39.3 days). The PCL injury was rated as grade Ⅱ in 6 cases and grade Ⅲ in 24 cases. The posterior drawer test was positive in 26 cases and the inverse Lachman test was positive in 24 cases. The International Knee Documentation Committee (IKDC) score was 61.37±8.49, and the objective IKDC ligament grading was near normal in 2 cases, abnormal in 8 cases, and significantly abnormal in 20 cases. The modified Lysholm knee score was 62.20±5.67. The knee range of motion (ROM) was (101.83±8.15) °. Results: The operative time ranged from 70 to 110 minutes (mean, 79.7 minutes). All incisions healed by first intetion. All patients were followed up 12-24 months (mean, 19.0 months). There were 3 cases of deep vein thrombosis in the lower extremity after operation, and 1 case of approximately 10° limitation of knee extension. At last follow-up, the posterior drawer test was positive in 2 cases and the inverse Lachman test was positive in 1 case, with significant differences compared with the preoperative period ( χ 2=38.571, P=0.000; χ 2=36.274, P=0.000). The IKDC score was 84.67±3.67, and the objective IKDC ligament grading was normal in 16 cases, nearly normal in 10 cases, abnormal in 3 cases, and significantly abnormal in 1 case; the modified Lysholm knee score was 90.37±4.49; all of the above indexes were significantly better than preoperative ones, and the differences were significant ( t=-12.387, P=0.000; Z=-2.810, P=0.005; t=-22.865, P=0.000). Knee ROM was (88.33±9.86)° at 1 month after operation and reached (113.33±13.48)° at last follow-up, showing significant differences between pre- and post-operation ( P<0.05). MRI re-examination showed that the form and position of reconstructed PCL were satisfactory. Conclusion: It can obtain good short-term effectiveness for PCL injuries by arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon, which has the advantages of reliable surgical approach, safe operation, and precise effectiveness.


Assuntos
Lesões do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Ligamento Cruzado Posterior , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/cirurgia , Estudos Retrospectivos , Tendões/cirurgia , Resultado do Tratamento , Adulto Jovem
20.
Zhongguo Gu Shang ; 34(5): 417-24, 2021 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-34032042

RESUMO

OBJECTIVE: This study aimed to research whether anterior tibial crest is a reliable anatomical reference for rotational alignment of tibial component in TKA. METHODS: The study included 122 patients who underwent computed tomography angiography (CTA) examination for unilateral lower extremity trauma with normal contralateral lower extremities, including 89 males and 33 females, with an average age of(51.4±16.4) years old(ranged 18 to 81 years old). Picture archiving and communication system (PACS) was used to mark 11 lines including the surgical epicondylar axis (SEA) connecting the most prominent points of the lateral epicondyle and the deepest point of the sulcus on the medial epicondyle of the femur, axis of medial border of patellar tendon (MEPT)connecting the middle of the posterior cruciate ligament (PCL) and medial border of the patellar tendon at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, transverse axis of tibia (TAT) at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, Akagi line connecting the projected middle of the PCL and medial border of the patellar tendon at the tibial attachment, the axis of the medial 1/3 of patellar tendon(M1/3) connecting the projected middle of PCL and the medial 1/3 of the patellar tendon at the patellar tendon attachment level, Insall line connecting the projected middle of the PCL and the medial 1/3 of tibial tubercle, the axis of medial border of tibial tubercle (MBTT) connecting the projected middle of the PCL and medial border of tibial tubercle, as well as the axis of the proximal anterior tibial crest (PATC), axis 1 of the middle anterior tibial crest (MATC1), axis 2 of the middle anterior tibial crest (MATC2) and the axis of the distal anterior tibial crest (DATC) which were marked by connecting the 4 equidistant points on the sharp anterior tibial crest and the projected middle of the PCL. The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using One-Way ANOVA and paired t-test. RESULTS: The angles between the axes of MEPT, Akagi line, M1/3, Insall line, MBTT, PATC, MATC1, MATC2, DATC and the perpendicular to SEA were (-1.6 ±4.5)° , (1.4 ±5.0)° , (10.2±5.1)°, (11.9±5.4)°, (3.6±4.8)°, (12.0±6.9)°, (7.2±8.6)°, (7.1±10.4)°, (6.6±13.5)°, respectively. The angle between TAT and SEA was (4.1±5.3)°. MEPT was external rotation compared to SEA. M1/3, Insall line and PATC were significantly greater than Akagi line, MBTT, TAT (P<0.001). MATC1, MATC2 and DATC were also significantly greater than Akagi line, MBTT axis and TAT (P<0.001). However, MATC1, MATC2 and DATC were also significantly less than M1/3 axis, Insall line and PATC(P<0.01). There were no significant statistical differences between MATC1, MATC2 and DATC(P>0.05). CONCLUSION: The middle tibial anterior crest can be used as a reference for rotational alignment of tibial component in TKA, and its reliability is better than Insall line, but worse than Akagi line, TAT and MBTT.


Assuntos
Artroplastia do Joelho , Ligamento Cruzado Posterior , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/cirurgia , Reprodutibilidade dos Testes , Rotação , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...