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1.
Arthroscopy ; 38(5): 1568-1570, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35501021

RESUMO

Medial patellofemoral ligament (MPFL) reconstruction has proven to be a reliable procedure to reduce patellar instability events in patients with recurrent patellar instability. As our reconstruction techniques have evolved to address pathology in a diverse patient population, there continues to be an obsessive focus on the precise anatomy of the MPFL origin on the medial knee, due in large part to concerns that improper femoral tunnel position may result in excessive graft anisometry and failure. However, recurrent patellar instability involves many complexities and should not be simply reduced to a single point on the medial knee.


Assuntos
Instabilidade Articular , Articulação Patelofemoral , Fêmur/cirurgia , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho , Ligamentos Articulares/cirurgia , Articulação Patelofemoral/cirurgia
2.
Am J Sports Med ; 50(6): 1627-1634, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35438591

RESUMO

BACKGROUND: Previous research supports that distal translation of the tibial tubercle osteotomy (dTTO) for patients with recurrent lateral patellar dislocation (R-LPD) and patella alta is effective for surgical patellar stabilization. HYPOTHESIS/PURPOSE: The main purpose of this article is to evaluate (1) the results of modifying the surgical threshold and postoperative goal of patellar height measurements for surgical stabilization originated in the "menu à la carte" approach to patellar surgical stabilization and (2) the relationship between the distance distalized in millimeters and postoperative complications. Our hypothesis was that dTTO with medial patellofemoral ligament reconstruction (MPFL-R) will successfully stabilize the patella with improvement in outcome scores and few complications, using a modification of the original menu à la carte as our surgical algorithm. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 68 consecutive patients with R-LPD underwent dTTO and MPFL-R for surgical patellar stabilization by a single surgeon between May 2009 and September 2015. Surgical indications were R-LPD combined with patella alta. The surgical threshold for dTTO was Caton-Deschamps index (CDI) or Insall-Salvati ratio ≥1.4 and/or a patellar trochlear index <0.15. The postoperative surgical goal for patellar height was a CDI of 1.1 to 1.2. Length of the distalization was computed by using the CDI measurement as the primary intraoperative guide and measured intraoperatively with a ruler. Clinical, radiographic, and patient outcome measures were reviewed. RESULTS: The mean CDI preoperatively was 1.40 and postoperatively it was 1.09. The mean distalization was 9.9 mm (range, 4-15 mm). Three patients (4.4%) had frank R-LPD postoperatively. Ten patients had residual patella alta (CDI >1.2), with 1 redislocation. Mean postoperative CDI in the recurrent dislocation group was 1.13 (range, 1.06-1.25) as compared with 1.09 (range, 0.92-1.35) in the nonrecurrent group (P = 0.65). Complications included 3 tibial fractures (4.4%) and postoperative knee arthrofibrosis in 6 patients (8.8%), with mean distalization greater in the arthrofibrosis group (P = .04). Knee injury and Osteoarthritis Outcome Score (KOOS) values improved in all domains, including a 31-point increase in Quality of Life. CONCLUSION: dTTO with MPFL-R for patients with patella alta leads to a high rate of normalization of patellar height measurements (87%) and patellar stabilization (95.6%). Residual patella alta is not associated with an increased risk of recurrence. The length of dTTO up to 15 mm is not associated with an increase in postoperative complications, except for an increased prevalence of arthrofibrosis (8.8%).


Assuntos
Luxações Articulares , Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Progressão da Doença , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Patela/cirurgia , Luxação Patelar/complicações , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Complicações Pós-Operatórias , Qualidade de Vida , Tíbia/cirurgia
3.
Handchir Mikrochir Plast Chir ; 54(2): 126-130, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35419783

RESUMO

PURPOSE: Post-operative pain in the palm and scar area is the most common complication after carpal tunnel release and injury to the terminal branches of the palmar cutaneous nerve is generally considered one of the causes for this complication. The Authors performed an intraoperative study preserving the terminal branches of the palmar cutaneous branch of the median nerve and verifying the frequency, location and direction of the branches that cross an interthenar incision. METHOD AND MATERIAL: Eighty-five consecutive patients (57 F - 28 M, mean age 66 y) underwent carpal tunnel release between February and June 2021. The cutaneous branches crossing the incision were identified and preserved by careful dissection. Subsequently they were counted and classified by their direction and distance from the proximal border of the transverse carpal ligament. RESULTS: Sensory branches were found in 40 % of cases (34/85) and their origin was observed at an average of 1.05 cm (0-1.8 cm) distal from the proximal border of the carpal tunnel. A total of 44 branches were observed of which 23 branches crossed the incision with a transverse course and 21 with an oblique, generally proximal-distal radio-ulnar course. The subcutaneous layer overlying the distal third of the transverse carpal ligament was found to be devoid of sensory branches, therefore it can be considered a relatively safe area. CONCLUSION: Isolation and protection of palmar sensory branches is important for improving carpal tunnel release results. This goal can be more easily achieved by locating the skin incision on the distal third of the transverse carpal ligament, where the sensory branches have a lower frequency, possibly associated with a second proximal incision (biportal technique) to better visualize the proximal portion of the ligament and antebrachial fascia.


Assuntos
Síndrome do Túnel Carpal , Nervo Mediano , Idoso , Síndrome do Túnel Carpal/cirurgia , Mãos/cirurgia , Humanos , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Nervo Mediano/cirurgia , Articulação do Punho
4.
Am J Sports Med ; 50(4): 984-993, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35373608

RESUMO

BACKGROUND: The lateral patellofemoral complex (LPFC) is an important stabilizer of the patella composed of the lateral retinacular structures including the lateral patellofemoral ligament (LPFL), the lateral patellomeniscal ligament (LPML), and the lateral patellotibial ligament (LPTL). While the isolated anatomy of the LPFL has been previously described, no previous study has investigated the entirety of the LPFC structure, length changes, and radiographic landmarks. An understanding of LPFC anatomy is important in the setting of LPFL injury or previous lateral release resulting in iatrogenic medial instability requiring LPFC reconstruction. PURPOSE: To both qualitatively and quantitatively describe the anatomy and length changes of the LPFC on gross anatomic dissections and standard radiographic views. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten nonpaired cadaveric specimens were utilized in this study. Specimens were dissected to identify distinct attachments of the LPFL, LPML, and LPTL. Ligament lengths, footprints, and centers of each attachment were described with respect to osseous landmarks using a 3-dimensional coordinate measuring device. Ligament length changes were also assessed from 0° to 90° of flexion. Radiopaque markers were subsequently utilized to describe attachments on standard anteroposterior and lateral radiographic views. RESULTS: The individual elements of the LPFC were identified in all specimens. The LPFL patellar attachment had an average total length of 22.5 mm (range, 18.3-27.5 mm), involving a mean of 59% (range, 50%-75%) of the sagittal patella. Based on the average patellar size, a mean of 63% of the LPFL attached to the patella, and the remainder (11.1 ± 1.4 mm) inserted into the patellar tendon. The femoral attachment of the LPFL had a mean maximum length of 24.4 ± 4.3 mm. The center of the LPFL femoral attachment was a mean distance of 13.5 ± 3.2 mm anterior and distal to the lateral epicondyle. The LPFL demonstrated significant shortening, especially in the first 45° of flexion (7.5 ± 5.1 mm). In contrast, the LPTL (5.5 ± 3.0 mm) and LPML (10.0 ± 3.3 mm) demonstrated significant shortening from 45° to 90°. On lateral radiographs, the center of the femoral attachment of the LPFL was a mean total distance of 19.2 ± 7.2 mm from the lateral epicondyle. CONCLUSION: The most important findings of this study were the correlative anatomy of 3 distinct lateral patellar ligaments (LPFL, LPML, and LPTL) and their anisometry through flexion. All 3 components demonstrated significant shortening during flexion. The quantitative and radiographic measurements detailed the LPFL osseous attachment on the patella; soft tissue attachment on the patellar tendon; and finally, the osseous insertion on the femur distal and anterior to the lateral epicondyle. Similarly, the authors documented the meniscal insertion of the LPML and defined a patellar insertion of the LPTL and LPML as a single attachment. These data allow for reproducible landmarks to aid in the understanding and reconstruction of the lateral patellar restraints. CLINICAL RELEVANCE: The data produced from this investigation provide a comprehensive description of these 3 lateral patellar stabilizers (LPFL, LPML, LPTL). These data can be used intraoperatively to facilitate anatomic reconstructions of the lateral patellar stabilizers.


Assuntos
Patela , Ligamento Patelar , Fêmur/diagnóstico por imagem , Humanos , Articulação do Joelho/cirurgia , Ligamentos Articulares/anatomia & histologia , Ligamentos Articulares/diagnóstico por imagem , Patela/anatomia & histologia , Patela/diagnóstico por imagem , Ligamento Patelar/diagnóstico por imagem , Ligamento Patelar/cirurgia
5.
ScientificWorldJournal ; 2022: 2864485, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35431665

RESUMO

A diagnosis of carpal tunnel syndrome (CTS) in a human often contains more than one test. Calcification of the traverse carpal ligament (TCL) is the common reason why patients seek CTS surgery. However, the determination of calcium (Ca) concentration in the TCL has not been studied. The results of environmental toxicity studies assessing the relationship between Ca and elemental deposition in the TCL are inconsistent. The purpose of this paper was to verify this hypothesis by conducting a chemical analysis of a portion of the released TCL to assess whether there is a relationship between CTS and Ca, measured as the total concentration of Ca, and to measure the precipitation of elements; the most closely related elements associated with Ca are cadmium and lead, which are also toxic. Surgical release of TCL was performed on forty patients. Total concentrations of Ca, Cd, and Pb in the extracted portion of TCL were digested and determined using inductively coupled plasma mass spectrometry (ICP-MS) and the possibility of using X-ray spectroscopy (XRF) for direct elemental analysis. Ca mineralisation was revealed in some TCLs. In assessing patients' environmental pollution, it was observed that the Cd and Pb concentrations were significant with a higher Ca concentration, and XRF was useful for direct detection of the elements in samples of the human body. These results indicate that TCL mineralisation by Ca does not characterise CTS, which has important concerns in improving patients' therapeutic strategies, and Cd and Pb concentrations varied due to different factors.


Assuntos
Cálcio , Síndrome do Túnel Carpal , Cádmio , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/cirurgia , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Chumbo , Ligamentos Articulares/cirurgia
6.
J Biomech Eng ; 144(5)2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35244145

RESUMO

The facet capsule ligament (FCL) is a structure in the lumbar spine that constrains motions of the vertebrae. Subfailure loads can produce microdamage resulting in increased laxity, decreased stiffness, and altered viscoelastic responses. Therefore, the purpose of this investigation was to determine the mechanical and viscoelastic properties of the FCL under various magnitudes of strain from control samples and samples that had been through an impact protocol. Two hundred FCL tissue samples were tested (20 control and 180 impacted). Impacted FCL tissue samples were obtained from functional spinal units that had been exposed to one of nine subfailure impact conditions. All specimens underwent the following loading protocol: preconditioning with five cycles of 5% strain, followed by a 30 s rest period, five cycles of 10% strain, and 1 cycle of 10% strain with a hold duration at 10% strain for 240 s (4 min). The same protocol was followed for 30% and 50% strain. Measures of stiffness, hysteresis, and force-relaxation were computed. No significant differences in stiffness were observed for impacted specimens in comparison to control. Impacted specimens from the 8 g flexed and 11 g flexed and neutral conditions exhibited greater hysteresis during the cyclic-30% and cyclic-50% portion of the protocol in comparison to controls. In addition, specimens from the 8 g and 11 g flexed conditions resulted in greater stress decay for the 50%-hold conditions. Results from this study demonstrate viscoelastic changes in FCL samples exposed to moderate and highspeed single impacts in a flexed posture.


Assuntos
Articulação Zigapofisária , Animais , Fenômenos Biomecânicos , Cápsula Articular , Ligamentos Articulares , Vértebras Lombares/fisiologia , Estresse Mecânico , Suínos , Articulação Zigapofisária/fisiologia
7.
Clin Biomech (Bristol, Avon) ; 94: 105630, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35334403

RESUMO

BACKGROUND: Patients with longstanding progressive collapsing foot deformity often develop osteoarthritis of the ankle, midfoot, or hindfoot joints, which can be symptomatic or lead to fixed deformities that complicate treatment. The development of deformity is likely caused by ligament degeneration and tears. However, the effect of individual ligament tears on changes in joint contact mechanics has not been investigated. METHODS: A validated finite element model of the foot was used to compare joint contact areas, forces, and pressures between the intact and collapsed foot, and to evaluate the effect of individual ligament tears on joint contact mechanics. FINDINGS: Collapsing the foot resulted in an increase in contact pressure in the subtalar, calcaneocuboid, tibiotalar, medial naviculocuneiform, and first tarsometatarsal joints but a decrease in contact pressure in the talonavicular joint. Rupture of the spring ligament was the main contributor to increased calcaneocuboid and subtalar joint contact pressures and decreased medial naviculocuneiform and first tarsometatarsal joint contact pressures, as well as talonavicular subluxation. Deltoid ligament rupture was the primary source of increased contact pressure in the medial naviculocuneiform, first tarsometatarsal, and tibiotalar joints. INTERPRETATION: Degenerative tearing of the ligaments in flatfoot deformity leads to increased joint contact pressures, primarily in the calcaneocuboid, subtalar, and tibiotalar joints, which has been implicated in the development of osteoarthritis in these joints. An improved understanding of the relationship between ligament tears and joint contact pressures could provide support for the use of ligament reconstructions to prevent the development of arthrosis.


Assuntos
Pé Chato , Doenças Musculares , Osteoartrite , Articulações Tarsianas , Análise de Elementos Finitos , Humanos , Ligamentos Articulares
8.
Clin Orthop Surg ; 14(1): 128-135, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35251550

RESUMO

BACKGROUND: The purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group. METHODS: This retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score. RESULTS: The mean follow-up period was 17.5 months (range, 11-38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (all p < 0.05). Clavicular tunnel widening more than 100% was found in 5 patients, all belonging to the coracoid loop group. Clavicular tunnel fractures occurred in 3 patients (all in the coracoid loop group). Fracture was associated with severe tunnel widening (more than 100% increase). The mean value of the final clavicular tunnel diameter in patients with fractures was significantly larger than that in patients without (12.7 ± 3.3 mm vs. 8.4 ± 1.5 mm, p = 0.016). CONCLUSIONS: Clavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Luxação do Ombro , Articulação Acromioclavicular/cirurgia , Clavícula/cirurgia , Humanos , Luxações Articulares/cirurgia , Ligamentos Articulares/cirurgia , Estudos Retrospectivos , Luxação do Ombro/cirurgia
9.
Open Vet J ; 12(1): 1-4, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35342723

RESUMO

Background: Lateral patellar luxation (LPL) is commonly diagnosed in large or giant breed dogs. In the surgical outcome for canine LPL, approximately half of the patients had complications, including reoperation and relaxation. Medial patellofemoral ligament (MPFL) reconstruction has been widely used for human repetitive patellar luxation. This case report describes that modified MPFL reconstruction with other surgical techniques might be effective for severe canine LPL repair. Case Description: An 11-month-old intact male Siberian Husky was referred to us with the main complication reported as bilateral hind lameness and LPL, diagnosed by a family doctor. Physiological examination showed bilateral patellar luxation (grade 4). We performed general surgical techniques with modified MPFL. The patient showed good prognosis. Conclusion: This report suggests that modified MPFL with general surgical techniques for LPL might be an effective surgical technique in dogs.


Assuntos
Doenças do Cão , Luxação Patelar , Articulação Patelofemoral , Animais , Doenças do Cão/cirurgia , Cães , Humanos , Articulação do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Masculino , Luxação Patelar/congênito , Luxação Patelar/cirurgia , Luxação Patelar/veterinária , Articulação Patelofemoral/cirurgia
10.
Am J Sports Med ; 50(3): 778-787, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35289224

RESUMO

BACKGROUND: The deltoid ligament (DL) is an important stabilizer of the ankle. DL injury of varying severity can occur alone or with syndesmotic injury and fibular fracture. Limited diagnostic tools are available to assess DL injury quantitatively. PURPOSE: To establish an arthroscopic quantitative assessment of DL injury and to compare its performance with that of external rotation stress (ERS) and gravity stress (GS) radiography. STUDY DESIGN: Controlled laboratory study. METHODS: In total, 24 cadaveric lower extremities were divided into 4 groups: group 1 consisted of intact DL, group 2 of superficial DL disruption, group 3 of deep DL disruption, and group 4 of complete DL (superficial and deep) disruption. All specimens underwent sequential sectioning of syndesmotic ligaments, and medial clear space (MCS) was measured with ankle arthroscopy, ERS radiography, and GS radiography at different stages of syndesmotic sectioning. RESULTS: For noninjured deltoid (group 1) and injured deltoid (groups 2-4), area under the receiver operating characteristic curve (AUC) of measurement of MCS was 0.939 for arthroscopy, 0.932 for ERS radiography, and 0.874 for GS radiography, with a significant difference between arthroscopy and GS radiography (P = .014). For incomplete deltoid injury (groups 1-3) and complete deltoid injury (group 4), the AUC of MCS was 0.811 for arthroscopy, 0.656 for ERS radiography, and 0.721 for GS radiography, with a significant difference between arthroscopy and ERS radiography (P < .001) and between arthroscopy and GS radiography (P = .035). For all stages of syndesmotic sectioning, cutoff values of arthroscopic MCS with intact fibula were ≤2.5 mm for intact DL, between 2.5 and 3.5 mm for partial DL injury (superficial or deep), and ≥3.5 mm for complete DL injury. Arthroscopy was unable to detect a difference between superficial deltoid injury (group 2) and deep deltoid injury (group 3) in partial DL injury, with a measured MCS between 2.5 and 3.5 mm. The intraclass correlation coefficient of interrater reliability was 0.975 for arthroscopy, 0.917 for ERS radiography, and 0.811 for GS radiography. CONCLUSION: Arthroscopic MCS measurement can differentiate intact DL, partial DL injury, and complete DL injury. Compared with ERS and GS radiography, arthroscopic MCS measurement has greater accuracy with excellent interrater reliability. CLINICAL RELEVANCE: For patients with suspected DL injury, arthroscopic MCS is useful for determining deltoid lesion severity based on defined cutoff values for consideration in preoperative planning to improve surgical outcomes.


Assuntos
Fraturas do Tornozelo , Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Cadáver , Humanos , Ligamentos Articulares/lesões , Extremidade Inferior , Radiografia , Reprodutibilidade dos Testes
11.
J Biomech Eng ; 144(6)2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35237790

RESUMO

The lumbar facet capsular ligament, which surrounds and limits the motion of each facet joint in the lumbar spine, has been recognized as being mechanically significant and has been the subject of multiple mechanical characterization studies in the past. Those studies, however, were performed on isolated tissue samples and thus could not assess the mechanical state of the ligament in vivo, where the constraints of attachment to rigid bone and the force of the joint pressure lead to nonzero strain even when the spine is not loaded. In this work, we quantified these two effects using cadaveric lumbar spines (five spines, 20 total facet joints harvested from L2 to L5). The effect of joint pressure was measured by injecting saline into the joint space and tracking the 3D capsule surface motion via digital image correlation, and the prestrain due to attachment was measured by dissecting a large section of the tissue from the bone and by tracking the motion between the on-bone and free states. We measured joint pressures of roughly 15-40 kPa and local first principal strains of up to 25-50% when 0.3 mL of saline was injected into the joint space; the subsequent increase in pressure and strain were more modest for further increases in injection volume, possibly due to leakage of fluid from the joint. The largest stretches were in the bone-to-bone direction in the portions of the ligament spanning the joint space. When the ligament was released from the vertebrae, it shrank by an average of 4-5%, with local maximum (negative) principal strain values of up to 30%, on average. Based on these measurements and previous tests on isolated lumbar facet capsular ligaments, we conclude that the normal in vivo state of the facet capsular ligament is in tension, and that the collagen in the ligament is likely uncrimped even when the spine is not loaded.


Assuntos
Articulação Zigapofisária , Fenômenos Biomecânicos , Humanos , Ligamentos Articulares , Vértebras Lombares , Amplitude de Movimento Articular
12.
Sci Rep ; 12(1): 4238, 2022 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-35273287

RESUMO

The coracohumeral ligament (CHL) is an important structure of the biceps pulley which also merges with the rotator cuff. Which role it actually plays in the pathogenesis of rotator cuff degeneration (RCD) and rotator cuff tears (RCT) is still a point of discussion. The hypothesis of this study was, that macroscopic injury to the anterosuperior part of the rotator cuff also includes parts of or the whole CHL. Forty fresh-frozen shoulders were dissected and examined, the morphology of the rotator cuff and the coracohumeral ligament were evaluated and existing lesions documented. 27.5% of the shoulder joints showed an anterosuperior full-thickness RCT. 57.5% of all examined shoulder girdles showed at least a partial rupture of the CHL. A highly significant correlation (p < 0.001, rho = 0.529) between the presence of rotator cuff tears and ruptures of the CHL was found. Cartilage damage within the anterosuperior section of the humeral head was observed in 20% cases. In rotator cuff degeneration and atraumatic rotator cuff tears of the elderly population, the pathomechanism of full-thickness RCT is based on repetitive anterosuperior glenoid impingement. This is especially supported by the identification of a higher frequency of CHL lesions compared to RCT reported in this study. No intact CHL was identified in shoulders with damaged rotator cuff tendons.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Idoso , Humanos , Ligamentos Articulares , Manguito Rotador , Ombro
13.
BMC Musculoskelet Disord ; 23(1): 279, 2022 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-35321711

RESUMO

BACKGROUND: The acromioclavicular (AC) and coracoclavicular (CC) ligaments are important stabilizers of the AC joint. We hypothesized that AC and trapezoid ligament injuries induce AC joint instability and that the clavicle can override the acromion on cross-body adduction view even in the absence of conoid ligament injury. Accordingly, we investigated how sectioning the AC and CC ligaments contribute to AC joint instability in the cross-body adduction position. METHODS: Six fresh-frozen cadaveric shoulders were used in this study, comprising five male and one female specimen, with a mean age of 68.7 (range, 51-87) years. The left side of the trunk and upper limb, and the cervical and thoracic vertebrae and sternum were firmly fixed with an external fixator. The displacement of the distal end of the clavicle relative to the acromion was measured using an electromagnetic tracking device. We simulated AC joint dislocation by the sequential resection of the AC ligament, AC joint capsule, and CC ligaments in the following order of stages. Stage 0: Intact AC and CC ligaments and acromioclavicular joint capsule; stage 1: Completely sectioned AC ligament, capsule and joint disc; stage 2: Sectioned trapezoid ligament; and stage 3: Sectioned conoid ligament. The superior clavicle displacement related to the acromion was measured in the horizontal adduction position, and clavicle overriding on the acromion was assessed radiologically at each stage. Data were analyzed using a one-way analysis of variance and post-hoc tests. RESULTS: Superior displacement was 0.3 mm at stage 1, 6.5 mm at stage 2, and 10.7 mm at stage 3. On the cross-body adduction view, there was no distal clavicle overriding at stages 0 and 1, and distal clavicle overriding was observed in five cases (5/6: 83%) at stage 2 and in six cases (6/6: 100%) at stage 3. CONCLUSION: We found that AC and trapezoid ligament sectioning induced AC joint instability and that the clavicle could override the acromion on cross-body adduction view regardless of conoid ligament sectioning. The traumatic sections of the AC and trapezoid ligament may lead to high grade AC joint instability, and the distal clavicle may subsequently override the acromion.


Assuntos
Articulação Acromioclavicular , Instabilidade Articular , Articulação Acromioclavicular/lesões , Idoso , Cadáver , Clavícula/cirurgia , Feminino , Humanos , Ligamentos Articulares , Masculino
14.
BMC Musculoskelet Disord ; 23(1): 257, 2022 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-35296292

RESUMO

BACKGROUND: Several interventions are established for treating patellofemoral instability in adults. Fewer exist for pediatric patients without damaging the epiphysis. The Ali Krogius (AK) method is currently still being used. Most studies are not current and report varying results in small patient population. The aim of this study is to determine the long-term results of the AK method. METHODS: In this monocentric, retrospective study design, 33 knees in 33 patients who received the AK procedure for recurrent patellar dislocation were assessed. The average age was 20.8 years (range 6-40). The following functional scores were assessed: Kujala Score, Lysholm Score and Tegner Score. Subgroup analysis was done for patients ≤16 years of age. Available preoperative imaging was assessed for known risk factors. RESULTS: After an average follow-up of 7.8 years (Range 59-145 months), a total of 8 (24%) knees suffered a redislocation postoperatively. Seven of the eight dislocations occurred in patients ≤ 16 years of age. One knee (3%) was revised due to persistent pain. The median score was 86 points for the Kujala score and 90 for the Lysholm score. The median in the Tegner score was level 6. Clinically, the patellar glide was lateralized in 7 knees (21%) and an apprehension sign was triggered in 8 knees (24%). CONCLUSIONS: Including the present study, the existing literature indicates a redislocation rate between 24 and 41% following AK. It should thus be regarded as obsolete even though it protects the epiphysis. Surgical interventions such as medial patellofemoral ligament reconstruction with femoral drilling distal to the epiphysis should be preferred. TRIAL REGISTRATION: Retrospectively registered: S-302/2016. LEVEL OF EVIDENCE: III.


Assuntos
Luxação Patelar , Adolescente , Adulto , Criança , Humanos , Articulação do Joelho , Ligamentos Articulares/cirurgia , Patela/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Estudos Retrospectivos , Adulto Jovem
15.
BMC Musculoskelet Disord ; 23(1): 264, 2022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35303842

RESUMO

BACKGROUND: Transverse ligament and posterior inferior tibiofibular ligament injuries have not been investigated till date because these are difficult to evaluate using standard magnetic resonance imaging. This study aimed to investigate the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles using oblique axial magnetic resonance imaging. METHODS: The patients who were diagnosed with syndesmosis injury using magnetic resonance imaging (MRI) within 7 days of the trauma were included. Patients with concomitant fractures were excluded. A total of 34 patients (1 woman and 33 men) with an average age of 22 years (range, 14-64 years) were included. The anterior inferior tibiofibular, interosseous, transverse, and posterior inferior tibiofibular ligaments were classified as intact, partial tear, or complete tear using usual axial and oblique axial MRIs. RESULTS: There were 8 (23.5%) ankles with an intact, 21 (61.8%) ankles with a partially torn, and 5 (14.7%) ankles with a complete tear of transverse ligament. There were 20 (58.8%) ankles with an intact, 12 (35.3%) ankles with a partially torn, and 2 (5.9%) ankles with a complete tear of posterior inferior tibiofibular ligament. Overall, 50% of the transverse ligament injuries occurred without posterior inferior tibiofibular ligament involvement. CONCLUSIONS: The oblique axial magnetic resonance imaging scan revealed that the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles were 76.5 and 41.2%, respectively.


Assuntos
Ligamentos Laterais do Tornozelo , Adulto , Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Humanos , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Articulares/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Masculino , Prevalência , Estudos Retrospectivos , Adulto Jovem
16.
Am J Sports Med ; 50(2): 327-333, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35137638

RESUMO

BACKGROUND: Humeral avulsion glenohumeral ligament (HAGL) lesions are often underreported but have been shown to occur in up to 10% of cases of anterior shoulder instability. PURPOSE: To compare clinical outcomes and recurrence rates of patients with HAGL lesions undergoing open stabilization for anterior shoulder instability versus a pair-matched control. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective review of all patients who underwent both arthroscopic and open stabilization procedures with a minimum 24-month follow-up was performed. Patients with HAGL lesions were pair-matched in a 1:6 ratio for age, sex, sport, level of preoperative play, and follow-up length with those without HAGL lesions who underwent arthroscopic Bankart repair alone. Return to play (RTP), the level of return, and the timing of return were assessed. In addition, recurrence, visual analog scale for pain (VAS), Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether they would undergo the same surgery again were compared. RESULTS: A total of 15 patients with HAGL lesions who underwent shoulder stabilization procedures were included, with a mean age of 21.5 ± 4.1 years and mean follow-up of 53.5 ± 17.4 months, and were pair-matched to 90 patients without HAGL lesions. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SSV, satisfaction) used between the 2 groups (1.6 vs 1.7, P = .86; 83.4 vs 88.0, P = .06; 85.7 vs 87.2, P = .76; and 86.7% vs 94.5%, P = .26, respectively). In addition, there were no significant differences in terms of overall rates, levels, and timing of RTP between the 2 groups (93.3% vs 90.0%, P > .99; 80.0% vs 78.9%, P > .99; and 5.3 ± 2.2 vs 5.9 ± 2.9 months, P = .45, respectively). There was no significant difference in the rates of apprehension, subluxation, and recurrent instability between the HAGL and pair-matched control groups (26.7% vs 26.7%, P > .99; 6.7% vs 3.3%, P = .47; and 13.3% vs 6.7% months, P = .32, respectively). CONCLUSION: Patients with anterior shoulder instability undergoing surgical stabilization with open HAGL repair demonstrate excellent functional outcomes and high rates of RTP, with low rates of recurrence in the medium term compared with a control group without HAGL lesions who underwent arthroscopic Bankart repair alone.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Adolescente , Adulto , Artroscopia/métodos , Estudos de Coortes , Humanos , Úmero/cirurgia , Instabilidade Articular/patologia , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Recidiva , Estudos Retrospectivos , Ombro , Luxação do Ombro/patologia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Adulto Jovem
17.
Am J Sports Med ; 50(3): 674-680, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35144479

RESUMO

BACKGROUND: There are few reports on the return to sports after complex patellar-stabilizing surgery. PURPOSES: To evaluate patients' ability to return to sports and to investigate the extent to which the preoperative level of sports participation influences sports activity after deepening trochleoplasty (TP) and concomitant patellar-stabilizing procedures. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between April 2015 and April 2019, 144 patellar-stabilizing procedures, including deepening TP and medial patellofemoral ligament reconstruction or medial reefing with and without concomitant realignment procedures, were carried out in 142 patients. The Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) and the Tegner activity score were used to assess patients' quality of life and sports activity level. In addition, a numerical analog scale was used to evaluate patellofemoral pain intensity during rest and activity and subjective knee joint function. RESULTS: Outcomes were available for 111 patients (112 knees) (male/female, 77/34; mean age, 23.4 ± 7.8 years), yielding a 77.7% follow-up rate at a mean of 39.2 ± 9.9 months (range, 24-48 months). Two-thirds of the patients returned to their preoperative level of activity or higher, but their Tegner scores did not change significantly (4.5 ± 2.4 vs 4.7 ± 1.6; P = .365). Low-level athletes (preoperative Tegner score 0-4) participated at a higher level of sports activity (2.7 ± 1.4 to 4.1 ± 1.2; P < .0001), whereas higher-level athletes (preoperative Tegner score 5-10) participated at a lower level (6.8 ± 1.3 to 5.5 ± 1.7; P < .0001). The likelihood of returning to the preoperative activity level (Tegner score) was significantly higher in the low-level activity group than in the high-level activity group (P = .0001; 95% CI, 4.055-27.05; odds ratio, 10.47). All of the patient-reported outcome measures improved postoperatively, independent of the patients' age, sex, and body mass index. CONCLUSION: Patients undergoing deepening TP and medial soft tissue stabilization with or without concomitant realignment surgery for complex patellar instability can expect good clinical results and a high rate of return to sports participation, with two-thirds of patients returning to their preoperative Tegner-level of activity or higher. However, higher-level athletes should be informed that their likelihood of returning to sports at the preoperative level or full participation at a competitive level is reduced.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Masculino , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Qualidade de Vida , Volta ao Esporte , Adulto Jovem
18.
Medicine (Baltimore) ; 101(6): e28661, 2022 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-35147088

RESUMO

RATIONALE: Traumatic radial head dislocation (RHD) can occur due to hyperpronation injury with sequential disruption of the annular ligament, quadrate ligament, and the interosseous membrane. Although studies have shown that traumatic RHD is generally associated with Monteggia fracture-dislocation, traumatic RHD occurring with ipsilateral radial shaft fractures has rarely been reported. Delayed RHD secondary to the malunion of isolated radial shaft fractures is extremely rare. PATIENT CONCERNS: We report the case of a 12-year-old right-handed boy with progressive pain and limited range of motion in the right elbow. DIAGNOSIS: The patient was diagnosed with delayed RHD associated with radial shaft fracture malunion. INTERVENTIONS AND OUTCOMES: A corrective osteotomy was performed at the site of malunion with open reduction of the radial head using an extensile lateral approach. The annular ligament was disrupted. Forearm rotation causes radial head subluxation Therefore, the Bell Tawse procedure was additionally performed to reconstruct the annular ligament by turning down a strip of triceps tendon and anchoring it around the radial neck. LESSONS: Malunion of the radial shaft can cause delayed RHD with a limited elbow range of motion. Annular reconstruction using a strip of the triceps tendon and corrective osteotomy of the radial shaft with an extensile lateral approach may be useful for treating this rare entity or situation.


Assuntos
Articulação do Cotovelo/lesões , Fraturas Mal-Unidas/complicações , Luxações Articulares/cirurgia , Ligamentos Articulares/cirurgia , Fratura de Monteggia/cirurgia , Fraturas do Rádio/complicações , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Fraturas Mal-Unidas/cirurgia , Humanos , Luxações Articulares/complicações , Luxações Articulares/etiologia , Masculino , Procedimentos Ortopédicos/métodos , Rádio (Anatomia) , Fraturas do Rádio/cirurgia , Resultado do Tratamento
19.
Orthop Surg ; 14(3): 605-612, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35142045

RESUMO

OBJECTIVE: To report a new technique for anatomical acromioclavicular (AC) joint reconstruction. METHODS: In order to minimize such complications, the authors describe a new anatomical and biological AC joint repair. This technique aims to provide greater stability by using two anatomically placed clavicular tunnels and a combined construct with a double endobutton cortical fixation for primary stabilization, and to be biologically advantageous by using an autologous semitendinosus (ST) tendon graft. Additionally, the coracoclavicular ligament reconstruction is complemented with an AC joint cerclage and capsular reinforcement, which will protect the biological construction in its initial stage of healing. RESULTS: This technique provides adequate primary and secondary biomechanical stability by passing both a semitendinosus autogenous graft and a double endobutton device, through anatomically placed and small diameter clavicle holes, without the need for coracoid drilling. Our technique showed encouraging results regarding pain resolution, range of motion, and function. At final follow-up we experienced excellent results with average pain score of 1.6, and average ROM of 159° of forward flexion, 160° of abduction, 68° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 87 and a Subjective Shoulder Value of 89 points. This technique also achieved perfectly acceptable radiographic results, with an average coracoclavicular distance increase of 0.8 mm. Regarding complications, our sample showed one case of AC join subluxation, two cases of internal saphenous nerve injury, and two partial graft tears at the suture-button interface, with none of these requiring surgical revision. CONCLUSION: This technique is advantageous in treatment of acromioclavicular joint dislocation and can be performed in both the subacute and chronic setting.


Assuntos
Articulação Acromioclavicular , Artroplastia de Substituição , Músculos Isquiossurais , Luxações Articulares , Luxação do Ombro , Articulação Acromioclavicular/lesões , Articulação Acromioclavicular/cirurgia , Humanos , Luxações Articulares/cirurgia , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Luxação do Ombro/cirurgia
20.
J Am Acad Orthop Surg ; 30(10): e769-e778, 2022 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-35171859

RESUMO

INTRODUCTION: The purpose of this study was to arthroscopically evaluate syndesmotic stability after fixation with several combinations of suture buttons (SBs) and suture tape reinforcement in a completely unstable cadaver model. METHODS: Fifteen cadaver above-knee specimens underwent sequential ligament transection and fixation to create six experimental models: (1) intact model, (2) after complete disruption of the syndesmotic ligaments, and after repair with either suture tape reinforcement (3), suture tape reinforcement with a single SB (4), suture tape reinforcement with two diverging SBs (5), or two diverging SBs alone (6). Instability measurements included anterior and posterior tibiofibular spaces measured arthroscopically under 100 N coronal stress, tibiofibular anteroposterior and posteroanterior translation in sagittal plane measured arthroscopically under sagittal stress of 100 N, and anterior tibiofibular space measured directly with a caliper under external rotation torque of 7.5 N·m. Instability measurements taken after each fixation method were compared with the uninjured model and with the complete unstable model using the Wilcoxon signed-rank test. RESULTS: Fixation using a combination of one SB and singular suture tape reinforcement augmentation provided stability similar to the intact stage (coronal anterior space 1.24 versus 1.15, P = 0.887; coronal posterior space 1.63 versus 1.64, P = 0.8421; anteroposterior translation 0.91 versus 0.46, P = 0.003; posteroanterior translation 0.51 versus 0.57, P = 0.051; external rotation anterior tibiofibular space 1.08 versus 0.55, P = 0.069). Moreover, adding a second SB led to further gains in fixation stability. DISCUSSION: This study suggests that although a destabilizing syndesmotic injury that includes the anterior inferior tibiofibular ligament, interosseous ligament, and posterior inferior tibiofibular ligament is not adequately stabilized by either one or two SBs, the addition of a suture tape reinforcement to even one SB restores syndesmotic stability to the preinjury level.


Assuntos
Traumatismos do Tornozelo , Ligamentos Laterais do Tornozelo , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Cadáver , Humanos , Ligamentos Articulares/cirurgia , Técnicas de Sutura , Suturas
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