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1.
Acta Chir Orthop Traumatol Cech ; 87(5): 318-322, 2020.
Artigo em Eslovaco | MEDLINE | ID: mdl-33146598

RESUMO

Anterior cruciate ligament (ACL) rupture is one of the most common traumatic injuries of the knee joint. Acute knee injury is often characterized by pain and the typical accompanying rupture sound. The injured person often feels pain in the knee, with swelling, the movement is painful in the full range of motion. The most commonly used test procedures for rupture include Lachman test, pivot shift test, anterior drawer and lever sign test. This review includes a description of individual tests and the diagnostic value of examination after the ACL rupture. The sensitivity and specificity of the lever sign test was 0.92-1.00, the specificity was 0.94-1.00. The anterior drawer testing reported sensitivity values ranged from 0.18 to 0.92 and specificity values ranged from 0.78 to 0.98. The sensitivity and specificity of the pivot shift test ranged from 0.18 to 0.48 and the specificity from 0.90 to 0.99. The sensitivity and specificity of the Lachman test were 0.63-0.93 and the specificity was 0.55-0.99. The lever sign test, the pivot shift test, the anterior drawer test and the Lachman test are valid parts of the anterior cruciate ligament examination with respect to the prediction of anterior cruciate ligament rupture using Magnetic Resonance Imaging and arthroscopy. Key words: rupture ligamentum cruciatum anterius, test maneuvers, lever sign test, pivot shift test, anterior drawer, Lachman test.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho , Exame Físico , Ruptura
2.
Bone Joint J ; 102-B(11): 1535-1541, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135439

RESUMO

AIMS: Functional rehabilitation has become an increasingly popular treatment for Achilles tendon rupture (ATR), providing comparably low re-rupture rates to surgery, while avoiding risks of surgical complications. Limited evidence exists on whether gap size should affect patient selection for this treatment option. The aim of this study was to assess if size of gap between ruptured tendon ends affects patient-reported outcome following ATR treated with functional rehabilitation. METHODS: Analysis of prospectively collected data on all 131 patients diagnosed with ATR at Royal Berkshire Hospital, UK, from August 2016 to January 2019 and managed non-operatively was performed. Diagnosis was confirmed on all patients by dynamic ultrasound scanning and gap size measured with ankle in full plantarflexion. Functional rehabilitation using an established protocol was the preferred treatment. All non-operatively treated patients with completed Achilles Tendon Rupture Scores (ATRS) at a minimum of 12 months following injury were included. RESULTS: In all, 82 patients with completed ATRS were included in the analysis. Their mean age was 51 years (standard deviation (SD) 14). The mean ATRS was 76 (SD 19) at a mean follow-up of 20 months (SD 11) following injury. Gap inversely affected ATRS with a Pearson's correlation of -0.30 (p = 0.008). Mean ATRS was lower with gaps > 5 mm compared with ≤ 5 mm (73 (SD 21) vs 82 (SD 16); p = 0.031). Mean ATRS was lowest (70 (SD 23)) with gaps > 10 mm, with significant differences in perceived strength and pain. The overall re-rupture rate was two out of 131 (1.5%). CONCLUSION: Increasing gap size predicts lower patient-reported outcome, as measured by ATRS. Tendon gap > 5 mm may be a useful predictor in physically demanding individuals, and tendon gap > 10 mm for those with low physical demand. Further studies that control for gap size when comparing non-operative and operative treatment are required to assess if these patients may benefit from surgery, particularly when balanced against the surgical risks. Cite this article: Bone Joint J 2020;102-B(11):1535-1541.


Assuntos
Tendão do Calcâneo/lesões , Traumatismos dos Tendões/reabilitação , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Modalidades de Fisioterapia , Estudos Prospectivos , Recuperação de Função Fisiológica , Ruptura , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento , Ultrassonografia
4.
J Vet Sci ; 21(5): e53, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33016013

RESUMO

BACKGROUND: The TightRope System is a device developed to provide extracapsular stabilization of the cranial cruciate ligament (CCL) rupture in canine stifles. I was then also employed for the extra-articular treatment of shoulder instability and for the intra-articular treatment of hip luxation in dogs and cats. OBJECTIVES: To evaluate the feasibility of the Mini-TightRope (mTR) System for the intra-articular treatment of CCL rupture in small breed dogs. METHODS: A cadaveric canine model was used to record the steps of the surgical procedure. Five client owned dogs weighing from 8 to 10 kg and from 2 to 12 years of age were enrolled in the prospective study in which the mTR device was implanted in the stifle joint to replace the ruptured CCL. The dogs were graded using the Bologna Healing Stifle Injury Index (BHSII) and radiographic osteoarthritis (OA) scores. RESULTS: The outcomes obtained at the time of the surgery (T0) and for the following 12 months (T12) showed an improvement in the functional parameters (BHSII from a median of 74.3 [range, 58.1-82.4] at T0 to 95.6 [range, 94.1-99.3] at T12]). The OA did not change in 3 dogs and increased by only 1 point in 2 dogs. CONCLUSIONS: In this preliminary study, the mTR was a successful and repeatable intra-articular surgical procedure for all dogs. Additional studies related to the clinical application of the technique in medium-large dogs should be encouraged.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Cães/cirurgia , Ruptura/veterinária , Joelho de Quadrúpedes/cirurgia , Animais , Lesões do Ligamento Cruzado Anterior/cirurgia , Cães/lesões , Feminino , Masculino , Estudos Prospectivos , Ruptura/cirurgia
5.
Int J Nanomedicine ; 15: 7155-7171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061373

RESUMO

Objective: Tissue engineering approaches seem to be an attractive therapy for tendon rupture. Novel injectable porous gelatin microcryogels (GMs) can promote cell attachment and proliferation, thus facilitating the repair potential for target tissue regeneration. The research objectives of this study were to assess the efficacy of tissue-like microunits constructed by multiple GMs laden with adipose-derived mesenchymal stem cells (ASCs) in accelerated tendon regeneration in a rat model. Methods: Through a series of experiments, such as isolation and identification of ASCs, scanning electron microscopy, mercury intrusion porosimetry (MIP), laser scanning confocal microscopy and the CCK-8 test, the biocompatibility of GMs was evaluated. In an in vivo study, 64 rat right transected Achilles tendons were randomly divided into four groups: the ASCs+GMs group (microunits aggregated by multiple ASC-laden GMs injected into the gap), the ASCs group (ASCs injected into the gap), the GMs group (GMs injected into the gap) and the blank defect group (non-treated). At 2 and 4 weeks postoperatively, the healing tissue was harvested to evaluate the gross observation and scoring, biomechanical testing, histological staining and quantitative scoring. Gait analysis was performed over time. The 64 rats were randomly assigned into 4 groups: (1) micro-unit group (ASCs+GMs) containing ASC (105)-loaded 120 GMs in 60 µL DMEM; (2) cell control group (ASCs) containing 106 ASCs in 60 µL DMEM; (3) GM control group (GMs) containing 120 blank GMs in 60 µL DMEM; (4) blank defect group (Defect) containing 60 µL DMEM, which were injected into the defect sites. All animals were sacrificed at 2 and 4 weeks postsurgery (Table 1). Results: In an in vitro study, GMs (from 126 µm to 348 µm) showed good porosities and a three-dimensional void structure with a good interpore connectivity of the micropores and exhibited excellent biocompatibility with ASCs. As the culture time elapsed, the extracellular matrix (ECM) secreted by ASCs encased the GMs, bound multiple microspheres together, and then formed active tendon tissue-engineering microunits. In animal experiments, the ASCs+GMs group and the ASCs group showed stimulatory effects on Achilles tendon healing. Moreover, the ASCs+GMs group was the best at improving the macroscopic appearance, histological morphology, Achilles functional index (AFI), and biomechanical properties of repair tissue without causing adverse immune reactions. Conclusion: Porous GMs were conducive to promoting cell proliferation and facilitating ECM secretion. The ASCs-GMs matrices showed an obvious therapeutic efficiency for Achilles tendon rupture in rats.


Assuntos
Tendão do Calcâneo/patologia , Tecido Adiposo/citologia , Criogéis/farmacologia , Células-Tronco Mesenquimais/citologia , Traumatismos dos Tendões/patologia , Traumatismos dos Tendões/terapia , Cicatrização/efeitos dos fármacos , Doença Aguda , Animais , Materiais Biocompatíveis/química , Fenômenos Biomecânicos , Diferenciação Celular , Modelos Animais de Doenças , Fluorescência , Gelatina/química , Masculino , Fenótipo , Porosidade , Ratos Sprague-Dawley , Ruptura , Engenharia Tecidual
6.
Klin Monbl Augenheilkd ; 237(9): 1070-1078, 2020 Sep.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-32967031

RESUMO

Due to their complexity, globe ruptures are highly compromising traumas for the patient. This is due on the one hand to the eye injury itself with the accompanying loss of vision and on the other hand due to the need for extended treatment with uncertain prognosis and the resulting psychological stress. Globe ruptures are among the prognostically most unfavorable injuries due to the force and peak pressure impacting the eye. Furthermore, contusional retinal necrosis may be of significance prognostically. In the present review, we discuss treatment of globe ruptures involving retinal surgery. We discuss the primary sugery, its chronological planning and extent as well as the necessity for follow-up interventions. We also discuss the origin of traumatic retinal detachment with differential diagnosis of giant retinal tear versus oradialysis as well as secondary sequelae of traumas such as formation of macular holes and their treatment. On this basis, the use of buckling surgery versus pars-plana vitrectomy is discussed. Further focus is set on the role of the iris lens diaphragm in surgery of globe ruptures.


Assuntos
Traumatismos Oculares/diagnóstico , Traumatismos Oculares/cirurgia , Traumatismos Oculares/terapia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Humanos , Estudos Retrospectivos , Ruptura/cirurgia , Vitrectomia
7.
Zhonghua Wai Ke Za Zhi ; 58(9): 718-722, 2020 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-32878420

RESUMO

Objective: To evaluate the clinical outcome of the reconstruction of Myerson type Ⅲ chronic Achilles tendon rupture by using the total arthroscopic technique combined with free semitendinosus tendon and gracilis tendon autograft. Methods: Clinical data of 32 patients(32 ankles) with Myerson type Ⅲ chronic Achilles tendon rupture who were treated by using the total arthroscopic technique combined with free semitendinosus tendon and gracilis tendon autograft at Department of Hand and Foot Microsurgery, Xuzhou Central Hospital from September 2013 to September 2018 were analyzed retrospectively.There were 28 males and 4 females, aged 45.5 years old(range: 22 to 69 years old), 12 cases in the right side and 20 in the left.All patients were treated by using the total arthroscopic technique combined with free semitendinosus tendon and gracilis tendon autograft for Myerson type Ⅲ chronic Achilles tendon rupture reconstruction.The functional recovery of the ankle was evaluated according to ankle-hindfood score of American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale, Achilles tendon total rupture score (ATRS), visual analogue scale (VAS).Arner-Lindholm score was used to evaluate the excellent and good rate.The quantitative data were compared using t-test or Wilcoxon test. Results: The 32 patients were followed up for 33 months (range: 15 to 72 months).No serious postoperative complications such as infection, sural nerve injury or tend re-rupture outcomes were reported.Three patients complained of mild pain when after a minimum sitting, walking or jogging, which were completely relieved by simple physical therapy or continuous stretching of Achilles tendon.At the last follow-up, the VAS decreased from 3 (5) (M (Q(R)) ) preoperative to 0 (3) (Z=1.357, P<0.01) and AOFAS ankle hindfoot scale improved from 58.6±13.5 preoperative to 95.5±4.0 (t=16.9, P=0.00), ATRS improved from 47.5±9.3 preoperative to 96.6±3.3 (t=25.661, P<0.01).According to the score of Arner-Lindholm, 20 cases were excellent, 12 cases were good, and the excellent and good rate was 100%. Conclusion: The reconstruction of Myerson type Ⅲ chronic Achilles tendon rupture by using the total arthroscopic technique combined with free semitendinosus tendon and gracilis tendon autograft has the advantages of safety, reliability, effectiveness and minor injury.


Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Traumatismos dos Tendões/cirurgia , Tendões/transplante , Adulto , Idoso , Artroscopia , Autoenxertos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ruptura , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
8.
Clin Imaging ; 67: 237-245, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32871428

RESUMO

OBJECTIVE: We present a series of 20 cases of a sleeve-type injury of the distal tibia characterized by traumatic periosteal stripping caused by a high ankle sprain. We characterize the magnetic resonance imaging findings associated with this injury and highlight its association with distal tibial osteonecrosis. MATERIALS AND METHODS: We collected 20 cases of high ankle sprains with periosteal stripping of the distal tibia through teaching files and a search through our PACS database. We recorded the presence and pattern of syndesmotic ligamentous injury and the presence or absence of syndesmotic widening in patients with periosteal stripping. The presence or absence of associated fractures and osteonecrosis was noted and characterized by location. RESULTS: The most commonly torn ligament was the anterior inferior tibiofibular ligament. 25% (5/20) of the patients in our series developed osteonecrosis. Osteonecrosis developed as early as 3-4 weeks following the initial injury. Of the patients with osteonecrosis, 40% (2/5) had fractures of the posterior malleolus. All patients with osteonecrosis had widening of the syndesmosis. Two of the five patients with osteonecrosis were in the pediatric age group. CONCLUSION: In contrast to conventional syndesmotic and interosseous ligamentous tearing, high ankle injuries with tibial periosteal stripping may result in avulsion of the extra-osseous vasculature supplied by the periosteum, leading to osteonecrosis. This pattern of injury has not been emphasized in the literature. Our findings underscore the importance of the integrity of the periosteum for maintaining adequate vascularity of the distal tibia.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Osteonecrose/diagnóstico por imagem , Adolescente , Traumatismos do Tornozelo/patologia , Feminino , Fraturas Ósseas , Humanos , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Ruptura , Ossos do Tarso , Tíbia/patologia
10.
Stroke ; 51(10): 2990-2996, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912090

RESUMO

BACKGROUND AND PURPOSE: Do children have an increased risk for brain arteriovenous malformation (AVM) recurrence compared with adults and does this risk vary depending on initial presentation with AVM rupture? METHODS: We retrospectively studied 115 patients initially presenting with brain AVM under age 25 years who underwent complete surgical resection of the AVM as documented by digital subtraction angiography (DSA) and had delayed follow-up DSA to evaluate for AVM recurrence after apparent initial cure. RESULTS: The mean time from baseline DSA to follow-up DSA was 2.3 years, ranging from 0 to 15 years. Twelve patients (10.4% of the 115 patient cohort and 16.7% of 72 patients with hemorrhage at initial presentation) demonstrated AVM recurrence on follow-up DSA. All patients with recurrence initially presented with intracranial hemorrhage, and intracranial hemorrhage was a significant predictor of recurrence (log rank P=0.037). Among patients with initial hemorrhage, the 5-year recurrence rate was 17.8% (95% CI, 8.3%-35.7%). All recurrences occurred in patients who were children at the time of their initial presentation; the oldest was 15 years of age at the time of initial AVM surgery. The 5-year recurrence rate for children (0-18 years of age) with an initial presentation of hemorrhage was 21.4% (95% CI, 10.1%-41.9%). Using Cox regression, we found the risk of AVM recurrence decreased by 14% per each year increase in age at the time of initial surgical resection (hazard ratio=0.86 [95% CI, 0.75-0.99]; P=0.031). CONCLUSIONS: There is a high rate of recurrence of apparently cured brain AVMs in children who initially present with AVM rupture. Imaging follow-up is warranted to prevent re-rupture.


Assuntos
Fístula Arteriovenosa/cirurgia , Encéfalo/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Adolescente , Angiografia Digital , Fístula Arteriovenosa/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Microcirurgia , Procedimentos Neurocirúrgicos , Recidiva , Estudos Retrospectivos , Ruptura/cirurgia , Resultado do Tratamento , Adulto Jovem
11.
Medicine (Baltimore) ; 99(35): e21001, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871860

RESUMO

BACKGROUND: Previous literature on epidural pneumatosis (pneumorrhachis, or air in epidural cavity) associated with forceful vomiting in a patient with diabetic ketoacidosis (DKA) has consisted of individual case reports without comprehensive syndrome characterization due to syndromic rarity, with the largest previous literature review comprising 6 cases. Presumed pathophysiology is air escaping from alveolar rupture from forceful vomiting via tissue planes to cause epidural pneumatosis. AIM: Systematically review literature to facilitate syndromic diagnosis, evaluation, and treatment. A new illustrative case is reported. METHODS: Systematic review of literature using 2 independent readers, 2 computerized databases, and the following medical terms/keywords: ["epidural pneumatosis" OR "pneumorrhachis"] AND ["diabetes" OR "diabetic ketoacidosis" or "DKA"]. Discrepancies between 2 readers were resolved by consensus using prospectively developed study inclusion criteria. Two readers independently abstracted case report. Prospective review protocol and patients, problems, intervene, comparison group, outcomes discussed in Methods section of paper. RESULTS-SYSTEMATIC-LITERATURE-REVIEW: Revealed 10 previously reported cases plus 1 new case (see below) that shows this syndrome presents rather stereotypically with the tentatively proposed following pentad (% of patients fulfilling individual criterion): 1-forceful vomiting (100%), 2-during DKA (100%), 3-pneumomediastinum from forceful alveolar rupture (100%), 4-epidural pneumatosis from air escape from pneumomediastinum (100%), and 5-no complications of Boerhaave syndrome or of focal neurological deficits (100%). Pentad is pathophysiologically reasonable because forceful vomiting can cause alveolar rupture, pneumomediastinum, and air entry into epidural space. RESULTS-ILLUSTRATIVE-CASE-REPORT: Epidural pneumatosis occurred in a 33-year-old-male with poorly controlled diabetes mellitus type 1 who presented with forceful vomiting while in DKA. Radiologic findings also included subcutaneous emphysema, pneumomediastinum, and small pneumothorax. The patient rapidly improved while receiving acute therapy for DKA, and was discharged after 2 hospital days. STUDY LIMITATIONS: Limited number of analyzed, retrospectively reported cases. Case reports subject to reporting bias. Specificity, positive predictive value, and negative predictive value not meaningfully analyzed in this homogeneous population. CONCLUSIONS: Based on systematic review, syndrome is tentatively proposed as a pentad with: 1-forceful vomiting, 2-during DKA, 3- pneumomediastinum, 4-epidural pneumatosis, and 5-no complications of Boerhaave syndrome or focal neurological deficits. Proposed pentad should be prospectively tested in a larger population including patients with this versus closely related syndromes.


Assuntos
Cetoacidose Diabética/complicações , Perfuração Esofágica/complicações , Doenças do Mediastino/complicações , Pneumorraque/diagnóstico , Radiografia Torácica/métodos , Vômito/complicações , Adolescente , Adulto , Tratamento Conservador/métodos , Feminino , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologia , Pneumorraque/fisiopatologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Alvéolos Pulmonares/patologia , Estudos Retrospectivos , Ruptura/complicações , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Síndrome , Resultado do Tratamento , Adulto Jovem
12.
Medicine (Baltimore) ; 99(31): e21434, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756153

RESUMO

RATIONALE: Intracranial aneurysm with the first manifestation of acute subdural hematoma (aSDH) is rare in the field of neurosurgery. Usually subarachnoid hemorrhage or intracranial hematoma happens after the rupture of an intracranial aneurysm, whereas trauma is the primary cause of aSDH. PATIENT CONCERNS: Here, we present the case of a 71-year-old woman who presented with spontaneous aSDH with progressive headache and vomiting. DIAGNOSIS: Urgent head computed tomography (CT) identified an aSHD, but the patient had no history of trauma. CT angiography (CTA) identified the cause of the aSDH as rupture of an intracranial aneurysm in the left middle cerebral artery. INTERVENTIONS: Emergent craniotomy with hematoma evacuation was performed. OUTCOMES: Due to prompt diagnosis and appropriate intervention, the patient recovered fully with no disability. LESSONS: This unique case demonstrates that aSDH caused by intracranial aneurysm rupture requires timely identification and appropriate action to prevent adverse outcomes. We performed a comprehensive systematic literature review to examine the etiology and pathogenesis of non-traumatic aSDH. Furthermore, digital subtraction angiography should be considered in patients diagnosed with an aSDH with no known cause.


Assuntos
Angiografia Digital/métodos , Hematoma Subdural Agudo/etiologia , Aneurisma Intracraniano/patologia , Artéria Cerebral Média/diagnóstico por imagem , Ruptura/complicações , Adulto , Idoso , Angiografia Digital/normas , Angiografia por Tomografia Computadorizada/métodos , Craniotomia/métodos , Feminino , Cefaleia/etiologia , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Agudo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/patologia , Resultado do Tratamento , Vômito/etiologia
13.
Arthroscopy ; 36(8): 2332-2333, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747070

RESUMO

A paucity of evidence exists by which to inform clinical decision-making in the management of repair of horizonal cleavage tears of the meniscus. Available data suggest reasonable outcomes and low failure rates; however, high-quality research is required to refine our understanding of optimal indications, techniques, and long-term outcomes with respect to function and joint preservation.


Assuntos
Doenças das Cartilagens , Traumatismos do Joelho , Lesões do Menisco Tibial , Humanos , Meniscos Tibiais , Ruptura
14.
Am J Sports Med ; 48(10): 2456-2464, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32736504

RESUMO

BACKGROUND: Nonoperative management of injuries to the distal musculotendinous T junction of the biceps femoris is associated with variable periods of rehabilitation and high risk of recurrence. To our knowledge, the efficacy of operative treatment in patients with these acute injuries has not been previously reported. HYPOTHESIS: Surgical repair of injuries to the distal musculotendinous T junction of the biceps femoris would enable return to preinjury level of sport with low risk of recurrence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This prospective single-surgeon study included 34 professional athletes (mean age, 26.4 ± 3.1 years; 31 male [91.2%]; 3 female [8.8%]; body mass index, 25 ± 2.0 kg/m2) undergoing primary surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris. All study patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes relating to time for return to sporting activity, patient satisfaction, range of motion, hamstring muscle strength, passive range of motion, functional progress, and complications were recorded at regular intervals after surgery. Mean follow-up time was 28.4 months (range, 24.0-36.3 months) from date of surgery. RESULTS: All study patients returned to their preinjury level of sporting activity. Mean time from surgical repair to full sporting activity was 11.7 ± 3.6 weeks. No patients had recurrence of the primary injury. At 1-year follow-up, 18 patients (52.9%) were very satisfied and 16 patients (47.1%) were satisfied with the outcomes of their surgery. At 3 months after surgery, patients had improved mean passive straight leg raise (69.7° ± 11.7° vs 24.1° ± 7.4°; P < .001); increased mean isometric hamstring muscle strength at 0° (93.1% ± 5.4% vs 63.1% ± 7.7%; P < .001), 45° (76.8% ± 9.7% vs 24.8% ± 8.3%; P < .001), and 90° (96.4% ± 3.9% vs 85.6% ± 5.9%; P < .001); higher mean lower extremity functional scores (64.5 ± 4.5 vs 27.2 ± 5.4; P < .001); and improved mean Marx Activity Rating Scale scores (10.7 ± 2.7 vs 2.2 ± 2.1; P < .001) compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery. CONCLUSION: Surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.


Assuntos
Músculos Isquiossurais , Traumatismos dos Tendões/cirurgia , Adulto , Feminino , Músculos Isquiossurais/lesões , Músculos Isquiossurais/cirurgia , Humanos , Masculino , Força Muscular , Satisfação do Paciente , Estudos Prospectivos , Amplitude de Movimento Articular , Ruptura , Tendões/cirurgia , Adulto Jovem
15.
Medicine (Baltimore) ; 99(27): e21047, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629730

RESUMO

Repair of medial meniscus posterior root tear (MMPRT) is considered as an effective early intervention strategy for osteoarthritis. We aimed at evaluating whether or not single-photon emission computed tomography/computed tomography (SPECT/CT) could predict the treatment outcome.Eleven patients with MMPRT who underwent preoperative SPECT/CT were retrospectively enrolled. Clinical symptoms were evaluated based on the knee injury and osteoarthritis outcome score (KOOS) and visual analogue scale (VAS) for pain. The uptake pattern of the medial tibial plateau (MTP) on SPECT/CT was visually assessed. Additionally, the maximum lesion-to-cortical counts ratio (LCRmax) for the anterior and posterior aspects of MTP and anterior-posterior MTP ratio (APR) were quantitatively assessed. Spearman correlation analyses were performed between the change in clinical symptom scores and preoperative SPECT/CT patterns.All patients showed increased radiotracer uptake in MTP. Among them, 8 (73%) showed dominant uptake in the anterior aspect of MTP. The rest 3 (27%) showed posterior-dominant uptake. Patients with anterior-dominant patterns tended to show better outcomes in terms of the postoperative KOOS score (P = .07). Anterior MTP LCRmax showed a negative correlation with the change in VAS (ρ = -0.664, P < .03). APR showed a correlation with the change in the KOOS score (ρ = 0.655, P < .03).Patients with MMPRT with relatively higher uptake in the anterior aspect of MTP could have better clinical outcomes after the repair. The preoperative SPECT/CT pattern may have a predictive value in selecting patients with good postoperative outcomes.


Assuntos
Meniscos Tibiais/patologia , Osteoartrite/cirurgia , Ruptura/cirurgia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Idoso , Osso e Ossos/diagnóstico por imagem , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Meniscectomia/métodos , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
16.
Medicine (Baltimore) ; 99(27): e21134, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629748

RESUMO

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before.


Assuntos
Implantes de Mama/efeitos adversos , Comportamento de Escolha/fisiologia , Mastectomia/efeitos adversos , Cirurgia Plástica/efeitos adversos , Feminino , Hospitalização , Humanos , Responsabilidade Legal/economia , Imagem por Ressonância Magnética/métodos , Imperícia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Ruptura/complicações , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Cirurgiões/psicologia , Ultrassonografia/métodos
17.
Medicine (Baltimore) ; 99(27): e21139, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629749

RESUMO

INTRODUCTION: Most symptomatic large-to-massive rotator cuff tears (RCTs) should be operated, but the surgical reparability depended on the degree of rotator cuff muscle atrophy or fatty infiltration. The orthopedic surgeons will decide whether the teared stump is reparable during the surgery, but preoperative evaluation can be done by some assessment tools. Magnetic resonance imaging (MRI) was used in recent studies to predict the reparability of large-to-massive RCTs, but the clinical availability was not as good as ultrasound. We hypothesize that the ultrasound elastography can predict the reparability of large-to-massive RCTs. METHODS: This is a prospective observational study and participants with large-to-massive RCTs who are going to have surgeries will be included. Out investigators will evaluate the shoulder passive range of motion (ROM) and strength of all participants. Participants' degree of shoulder pain and activities of daily living (ADLs) will be assessed by American Shoulder and Elbow Surgeons (ASES) score. The ultrasound elastography will be used to evaluate the tissue quality of supraspinatus muscle and infraspinatus muscle. To test the reliability of the ultrasound elastography, two physicians will perform the ultrasound elastography independently and twenty participants will be selected for the reliability test. Besides, MRI will be used to evaluate the size of tear, the degree of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, the orthopedic surgeons will perform surgeries and decide whether the teared stump can be completely repaired intraoperatively. The primary analysis is the predictive validity of ultrasound elastography for the reparability of large-to-massive RCTs. Before the predictive validity of ultrasound elastography is measured, our investigators will assess the reliability of ultrasound elastography when administered to cases with large-to-massive RCTs, and we will check the correlations between the findings of ultrasound elastography and MRI. DISCUSSION: The outcome will provide the evidence of ultrasound elastography for preoperative evaluation of large-to-massive RCTs. The relationships between the findings of ultrasound elastography and MRI will also be examined for further analysis. TRIAL REGISTRATION: Clinicaltrials.gov NCT03682679. Date of Registration: 25 September 2018, https://clinicaltrials.gov/ct2/show/NCT03682679?cond=rotator+cuff&cntry=TW&draw=2&rank=1.


Assuntos
Lesões do Manguito Rotador/diagnóstico por imagem , Ruptura/cirurgia , Ombro/fisiopatologia , Atividades Cotidianas , Tecido Adiposo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Atrofia Muscular/patologia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia
18.
Bone Joint J ; 102-B(7): 933-940, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600149

RESUMO

AIMS: The aim was to compare long-term patient-reported outcome measures (PROMs) after operative and nonoperative treatment of acute Achilles tendon rupture in the context of a randomized controlled trial. METHODS: PROMs including the Short Musculoskeletal Function Assessment (SMFA), Achilles Tendon Total Rupture Score (ATRS), EuroQol five-dimension (EQ-5D), satisfaction, net promoter score and data regarding re-rupture, and venous thromboembolic rates were collected for patients randomized to receive either operative or nonoperative treatment for acute Achilles tendon rupture in a previous study. Of the 80 patients originally randomized, 64 (33 treated surgically, 31 nonoperatively) patients were followed up at a mean of 15.7 years (13.4 to 17.7). RESULTS: There was no statistically significant difference between operatively and nonoperatively treated patients, in SMFA Dysfunction Index (median 1.56 (interquartile range (IQR) 0 to 5.51) vs 1.47 (IQR 0 to 5.15); p = 0.289), SMFA Bother Index (2.08 (IQR 0 to 12.50) vs 0.00 (IQR 0 to 6.25); p = 0.074), ATRS (94 (IQR 86 to 100) vs 95 (IQR 81 to 100); p = 0.313), EQ-5D-5L (1 (IQR 0.75 to 1) vs 1 (IQR 0.84 to 1); p = 0.137) or EQ-5D health today visual analogue score (85 (IQR 72.5 to 95) vs 85 (IQR 8 to 95); p = 0.367). There was no statistically significant difference between operative and nonoperative groups in terms of satisfaction (84% vs 100%; p = 0.119) or willingness to recommend treatment to friends or family (79% vs 87%; p = 0.255). Four nonoperative patients and two in the operative group sustained a re-rupture (p = 0.306). CONCLUSION: Both patient groups reported good results at long-term follow-up. The findings give no evidence of superior long-term patient reported outcomes (as measured by the SMFA) for surgical treatment over nonoperative treatment. There was no demonstrable difference in other patient reported outcome measures, satisfaction, or re-rupture rates at long-term follow-up. Cite this article: Bone Joint J 2020;102-B(7):933-940.


Assuntos
Tendão do Calcâneo/lesões , Medidas de Resultados Relatados pelo Paciente , Traumatismos dos Tendões/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Ruptura , Traumatismos dos Tendões/cirurgia
19.
Chirurg ; 91(10): 895-902, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32699912

RESUMO

Flexor tendon injuries of the hand are relatively rare but pose significant challenges to both physician and patient. A thorough clinical evaluation enables flexor tendon lacerations to be identified and classified. The flexor tendons of the hand are divided into five anatomic zones (from distal to proximal). Diagnostics, treatment and prognosis may differ depending on which zone is affected. Early, careful and proficient management is needed to ensure good functional outcomes. Various factors influence the outcome, including location, mechanism of injury, presence of concomitant injuries, time of surgery, quality of tendon repair and the rehabilitation protocol. It is important to inform the patient about the importance of thorough rehabilitation and possible complications. Postoperative scarring and adhesions, infections and secondary tendon ruptures due to insufficient primary repairs are especially challenging and potentially necessitate a lengthy and strenuous secondary repair and rehabilitation process.


Assuntos
Traumatismos dos Dedos , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/cirurgia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia , Humanos , Ruptura , Tendões
20.
Orthopade ; 49(8): 737-748, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32710138

RESUMO

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.


Assuntos
Artralgia/etiologia , Artroplastia de Quadril/métodos , Artroplastia de Quadril/psicologia , Nádegas/lesões , Músculo Esquelético/lesões , Músculo Esquelético/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos dos Tendões/etiologia , Artralgia/diagnóstico , Artralgia/cirurgia , Nádegas/cirurgia , Endoscopia , Humanos , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/epidemiologia , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Reoperação , Ruptura , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/epidemiologia , Traumatismos dos Tendões/terapia , Resultado do Tratamento
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