Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 715
Filtrar
1.
Arthroscopy ; 36(6): 1702-1705, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503779

RESUMO

We are united as an orthopaedic community in trying to improve the outcomes of anterior cruciate ligament (ACL) reconstruction. Graft rupture rates of 10% to 28% are reported in high-risk populations, reoperation for non-graft rupture-related indications are reported in 18% to 26%, and only 50% to 65% of recreational athletes return to their preinjury level of sports. Numerous groups across the world have published studies providing evidence demonstrating significant clinical efficacy of lateral extra-articular tenodesis in improving the outcomes of ACL surgery. Finally, the reductions in ACL graft rupture rates augmented with anterolateral ligament or a modified Lemaire reconstruction appear to be broadly comparable. In our hands, anterolateral ligament may result in fewer adverse events.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Tenodese , Humanos , Articulação do Joelho/cirurgia , Ruptura
2.
Arthroscopy ; 36(5): 1261-1263, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370888

RESUMO

Clinical outcomes following shoulder subpectoral biceps tenodesis are generally favorable, with a very low complication rate (2%). One of the most devastating complications following this procedure is the occurrence of a proximal humerus fracture. Although all constructs have their unique advantages and disadvantages, creating a smaller bone hole while achieving good biomechanical outcomes is worth considering. This may be most advantageous in overhead-throwing athletes, tennis players, and/or volleyball athletes, who subject their shoulders to more torsional load due to the requirements of their sport. Thus, in addition to screws and buttons, smaller-diameter suture anchors could also be thoughtfully considered as a biceps tenodesis fixation option.


Assuntos
Tenodese , Fenômenos Biomecânicos , Parafusos Ósseos , Cadáver , Humanos , Úmero/cirurgia , Músculo Esquelético/cirurgia , Tendões/cirurgia
3.
Arthroscopy ; 36(5): 1374-1375, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370899

RESUMO

There is a vast amount of conflicting literature evaluating the anatomic, biomechanical, and clinical outcomes of combined anterior cruciate ligament (ACL) and anterolateral complex injury. This has become-and remains-one of the most controversial topics in the ACL-deficient knee literature, thus requiring further inquiry with clear and systematic approaches to biomechanical analysis, indications, graft selection, surgical technique, and clinical outcome evaluation. The considerable variety of procedures to address anterolateral rotatory instability in the setting of ACL deficiency described in the literature strongly suggests the lack of a reliable and reproducible technique. Anterolateral complex reconstruction may provide protection to the ACL-reconstructed knee without detrimental overconstraint.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular/cirurgia , Tenodese , Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
4.
Artigo em Russo | MEDLINE | ID: mdl-32207703

RESUMO

AIM: To determine the value of functional tenodesis (FT) of the hand as a predictor of the degree of disability in patients with cervical tetraplegia (CT) at different periods after a spinal injury. MATERIAL AND METHODS: We examined 190 patients (79% - men) with CT (92.5% of cases of traumatic origin) at the age of 27 [21.0; 36.0] years with a neurological level of CІІІ-DІ, and a share of complete motor damage (A - B according to AIS) 70%. The examination included determination of neurological, motor levels and completeness of spinal cord injury (according to ISNSCI), assessment of functional independence (FIM motor domain), FT of the hand, and the severity of contractures of the joints of the hand. Using logit-regression analysis, creation of contingency tables, ROC analysis, depending on the timing of spinal injury, 4 classification models were studied: Disease duration less than 6 months, assessment of the functional outcome 6 months after spinal injury (model A); disease duration less than 6 months, assessment after 12 months (model B); disease duration less than 12 months, assessment after 12 months (model C); disease duration more than 12 months, evaluation after more than 12 months (model D, primary one). RESULTS: FT developed in the first 6 months after spinal injury in 12 (24%) patients, in 6-12 months - in 15 patients (20%), in more than 12 months - in 1 (less than 1%) patient. The incidence of joint contractures of the hand in group A (20%) and C (24%) did not have a statistical difference (χ2=0.22; p=0.64). Hand contractures in the first 6 months were observed in 20% of patients, in the first 12 months - in 24%, more than 12 months after spinal injury - in 28% of patients. In model A, the FT sensitivity was 80%, specificity was 64%, AUC - 0.65; in model B - 85%, 36%, 0.36, respectively; in model C (log-regression χ2=19.1; p was not determined) - 69%, 100%, 0.59, respectively; in model D (log-regression χ2=55.3; p was not determined) - 65%, 100%, 0.71, respectively. CONCLUSION: FT and contracture of the joints of the hand form during the first year after the debut of CT. As a predictor of a pronounced limitation of self-care, the sensitivity of FT in the first 6 months after spinal injury was 80-85%, in the later period, the specificity of FT was 100%, and sensitivity was 65-69%; in general, the predictive power of FT was low (AUC 0.36-0.71) and increased with the assessment of the functional outcome in the period of more than 12 months after the injury.


Assuntos
Mãos/cirurgia , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Tenodese , Adulto , Feminino , Humanos , Masculino , Recuperação de Função Fisiológica , Adulto Jovem
6.
Arthroscopy ; 36(1): 33-35, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31864593

RESUMO

The contemporary management of biceps-labral pathology has increasingly transitioned toward primary treatment of the long head of the biceps tendon, largely in response to more consistent outcomes relative to SLAP repair and so-called benign neglect. Accordingly, there has been renewed interest in evaluating relevant differences between varying operative techniques and constructs for biceps tenodesis, including an array of subacromial, intra-articular, suprapectoral, and subpectoral methods. Among these, arthroscopic suprapectoral tenodesis and mini-open subpectoral tenodesis remain in contention for "best in show," albeit with distinctly different merits and risks. Important considerations with either technique include restoration of the native length-tension relation, avoidance of perioperative complications, surgical-site morbidity, and technical ease. Dogma aside, surgeons facile with both techniques can confidently counsel their patients on the comparable short-term results after suprapectoral or subpectoral biceps tenodesis.


Assuntos
Tenodese , Braço/cirurgia , Artroscopia , Humanos , Músculo Esquelético/cirurgia , Estudos Prospectivos , Tendões/cirurgia
7.
Bull Hosp Jt Dis (2013) ; 77(4): 238-243, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31785136

RESUMO

BACKGROUND: Open subpectoral biceps tenodesis (OSBT) with cortical button fixation can deliver acceptable results for long head of the biceps (LHB) pathology with the benefit of smaller bone tunnel diameter and a potential reduced risk of postoperative humeral shaft fracture. However, functional outcomes and complications of a button-only technique with a small diameter tunnel in the subpectoral region have not been studied sufficiently. PURPOSE: We sought to determine whether OSBT with cortical button fixation results in significant functional improvements from preoperative to final follow-up. The secondary purpose was to determine whether there is a lower risk of major postoperative complications. METHODS: A retrospective review of patients who underwent OSBT with cortical button fixation at one institution was conducted with objective measurements and clinical outcomes collected with a minimum of 2 years of follow-up. Surgical data was collected for analysis. Objective measures obtained at follow-up included physical exam, strength testing using a handheld dynamometer, and Long-Head of the Biceps score. Clinical outcomes were measured using the following validated questionnaires preoperatively and postoperatively: American Shoulder and Elbow Surgeons score (ASES), Disabilities of the Arm, Shoulder and Hand score (DASH), and Oxford Shoulder Score (OSS). RESULTS: Sixty-one patients with mean age of 53.1 ± 10.1 years at the time of surgery were enrolled in the study. Mean follow-up time was 42.4 ± 16.9 months (range: 24 to 64 months). The postoperative LHB score was 95.5 ± 6.1 (range: 77 to 100). All functional outcome measures (ASES, DASH, and OSS) demonstrated statistically significant improvements at final follow-up (p < 0.05 for each). At total of 92.5% of patients stated they would have the procedure again if necessary. Mean elbow flexion strength on the operative side measured 98.7% ± 15.9% (range: 74.1% to 142.3%) of the contralateral arm. The mean LHB tendon diameter was 5.7 ± 0.8 mm and mean tunnel diameter was 5.9 ± 0.7 mm. There were no cases of intraoperative or postoperative fracture, infection, or Popeye deformity noted during the follow-up period. CONCLUSION: Subpectoral biceps tenodesis with cortical button fixation is a safe and effective surgical treatment option to relieve pain and restore function.


Assuntos
Traumatismos do Braço/cirurgia , Lesões do Ombro/cirurgia , Traumatismos dos Tendões/cirurgia , Tenodese/métodos , Adulto , Traumatismos do Braço/diagnóstico , Traumatismos do Braço/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fraturas do Ombro/etiologia , Lesões do Ombro/diagnóstico , Lesões do Ombro/fisiopatologia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/fisiopatologia , Tenodese/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
8.
J Orthop Surg Res ; 14(1): 370, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31729995

RESUMO

BACKGROUND: The best treatment for lesions of the long head of the biceps tendon (LHBT) with concomitant reparable rotator cuff tears is still controversial. The purpose of the meta-analysis was to compare clinical outcomes of biceps tenotomy and tenodesis for LHBT lesions. METHODS: A literature retrieval was conducted in MEDLINE, Embase, and Cochrane Library from 1979 to March 2018. Comparative studies (level of evidence I or II) comparing tenotomy and tenodesis for LHBT lesions with concomitant reparable rotator cuff tears were included. Risk of bias for all included studies was assessed using the Cochrane Collaboration's risk of bias tool. Clinical outcomes compared were Popeye sign, Constant score, VAS pain score, cramping pain, elbow flexion and forearm supination strength, and re-tear of the rotator cuff. RESULTS: Two randomized controlled trials (RCTs) and five prospective cohort studies (PCS) with 288 biceps tenotomy patients and 303 biceps tenodesis patients were included in this review. Tenotomy resulted in significantly greater rates of Popeye sign (RR, 2.70 [95% CI, 1.80 to 4.04]; P < 0.01) and a less favorable Constant score (MD, - 1.09 [95% CI, - 1.90 to - 0.28]; P < 0.01) compared to tenodesis. No significant heterogeneity was found between the two groups across all parameters except forearm supination strength. CONCLUSIONS: The current evidence indicates that biceps tenodesis for LHBT lesions with concomitant reparable rotator cuff tears results in decreased rate of Popeye sign and improved Constant score compared to biceps tenotomy. TRIAL REGISTRATION: PROSPERO, CRD42018105504. Registered on 13 August 2018.


Assuntos
Lesões do Manguito Rotador/cirurgia , Tenodese/estatística & dados numéricos , Tenotomia/estatística & dados numéricos , Humanos
9.
BMC Musculoskelet Disord ; 20(1): 522, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31706308

RESUMO

BACKGROUND: Simple tenotomy and anchor tenodesis are commonly used in treatment of long biceps tendon (LHB) pathologies. The tenotomy can result in biceps distalization or cosmetic deformities. A novel loop Tenodesis Technique (LTD) could prevent a distalization of the biceps muscle without the risk of implant associated complications. The purpose of this study was to investigate the biomechanical aspects of the novel LTD compared to a standard tenotomy of the LHB. It has been hypothesized that the novel technique will show biomechanical superiority in terms of resistance and distalization. METHODS: Seven paired adult human cadaveric shoulder joints were assigned to one of the two study groups: Loop tenodesis (LTD); simple tenotomy (STT). In both groups load-to-failure testing was performed. The load-displacement curve was used to determine the maximum load (N), the degree of distalization of the LHB (mm) and the stiffness (N/mm). Additionally, the mode of failure was registered. RESULTS: The LTD group achieved a significantly higher ultimate load to failure (LTD: 50.5 ± 12.5 N vs. STT: 6.6 ± 3.9 N; p = 0.001). Significantly less distalization of the tendon could be detected for the LTD group (LTD: 8 ± 2.3 mm vs. STT: 22.4 ± 2.4 mm; p = 0.001). Stiffness was 7.4 ± 3.9 N/mm for the LTD group and 0.23 ± 0.16 N/mm for the STT group (p = 0.001). In all specimens of the LTD group a tendon rupture was found as mode of failure, while the STT group failed because of pulling out the LHB through the bicipital groove. CONCLUSION: The novel loop Tenodesis Technique shows biomechanically higher stability as well as less distalization compared to a simple tenotomy of the long biceps tendon.


Assuntos
Artroscopia/métodos , Músculo Esquelético/cirurgia , Tendinopatia/cirurgia , Tenodese/métodos , Tenotomia/métodos , Adulto , Artroscopia/instrumentação , Fenômenos Biomecânicos , Parafusos Ósseos , Cadáver , Humanos , Músculo Esquelético/patologia , Articulação do Ombro/lesões , Articulação do Ombro/cirurgia , Tendinopatia/patologia , Tendões/patologia , Tendões/cirurgia , Tenodese/instrumentação , Tenotomia/instrumentação
12.
BMC Musculoskelet Disord ; 20(1): 477, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653247

RESUMO

BACKGROUNDS: Repair of full-thickness rotator cuff (RC) tears is routinely performed using suture anchors, which produce secure and effective soft tissue fixation to bone. The aim of this prospective study is to compare the long-term outcomes of single row arthroscopic rotator cuff repair (RCR) performed using metal or biodegradable suture anchors. The null hypothesis is that there is no difference in shoulder function using metal or biodegradable suture anchors as evaluated by UCLA shoulder score, Wolfgang criteria, and Oxford shoulder score. METHODS: Arthroscopic RCR was performed in 110 patients included in this case control study. They were divided into 2 groups of 51 and 59 patients respectively. Metal suture anchors were used in group 1, and biodegradable suture anchors in group 2. Results were obtained at a mean follow up of 4.05 + 2 years. Clinical outcomes and functional outcomes were evaluated. RESULTS: The mean modified UCLA shoulder score was 26.9 + 7.1 in group 1, and 27.7 + 6.5 in group 2 (P = 0.5); the mean Wolfgang score was 13.3 + 3.3 in group 1, and 14 + 2.6 in group 2 (P = 0.3); the mean OSS was 23.7 + 11.4 in group 1, and 20.7 + 9.2 points in group 2 (P = 0.1). The mean active anterior elevation was 163.5° + 28.2° in group 1 and 163.6° + 26.9 in group 2 (P = 0.9); the mean active external rotation was 46° + 19.7° in group 1 and 44.6° + 16.3° in group 2 (P = 0.7). The mean strength in anterior elevation was 4.8.02 + 23.52 N in group 1, and 43.12 + 17.64 N in group 2 (P = 0.2); the mean strength in external rotation was 48.02 + 22.54 N in group 1 and 46.06 + 17.64 N in group 2 (P = 0.6); the mean strength in internal rotation was 67.62 + 29.4 N in group 1, and 68.6 + 25.48 N in group 2 (P = 0.9). CONCLUSIONS: There are no statistically significant differences at a mean follow-up of 4.05 + 2 years in clinical and functional outcomes of single row arthroscopic RCR using metallic or biodegradable suture anchors for RC < 5 cm.


Assuntos
Implantes Absorvíveis , Artroscopia/instrumentação , Metais , Lesões do Manguito Rotador/cirurgia , Âncoras de Sutura , Idoso , Artroscopia/métodos , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Manguito Rotador/fisiopatologia , Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Técnicas de Sutura/instrumentação , Tenodese/instrumentação , Tenodese/métodos , Tenotomia/instrumentação , Tenotomia/métodos , Resultado do Tratamento
13.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 4038-4048, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31535193

RESUMO

PURPOSE: This systematic review assesses evidence for improvements in outcome for all reported types of treatment modalities [physical therapy, tenotomy or tenodesis of the long head of the biceps, debridement, partial repair, subacromial spacer, deltoid flap, muscle transfer, rotator cuff advancement, graft interposition, superior capsular reconstruction (SCR), and reversed shoulder arthroplasty (RSA)] used for irreparable posterosuperior rotator cuff tears without glenohumeral osteoarthritis. The primary aim was to be able to inform patients about expectations of the amount of clinical improvement after these treatments. METHODS: A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane databases for studies on irreparable posterosuperior rotator cuff lesions without glenohumeral osteoarthritis, published from January 2007 until January 2019, with minimum 2-year follow-up. Studies with pre-operative and/or intra-operative determination of cuff tear irreparability were included. We defined the non-adjusted Constant Score as the primary outcome. RESULTS: Sixty studies (2000 patients) were included with a fair mean quality score, according to the Modified Coleman Methodology Score. The employed definitions of 'irreparable' were mainly based on MRI criteria and were highly variable among studies. The smallest weighted mean preoperative to post-operative improvements in Constant Score were reported for biceps tenotomy/tenodesis (10.7 points) and physical therapy (13.0). These were followed by debridement (21.8) and muscle transfer (27.8), whereas the largest increases were reported for partial repair (32.0), subacromial spacer (32.5), rotator cuff advancement (33.2), RSA (34.4), graft reconstruction (35.0), deltoid flap (39.8), and SCR (47.4). Treatment using deltoid flap showed highest mean weighted improvement in Constant Score among studies with available medium-term (4-5-year) follow-up. Treatments deltoid flap, muscle transfer, and debridement were the only treatments with available long-term (8-10-year) follow-up and showed similar improvements in Constant Score at this time point. CONCLUSION: The variability in patient characteristics, co-interventions, outcome reporting, and length of follow-up in studies on irreparable rotator cuff tears without osteoarthritis complicates sound comparison of treatments. Clinically important treatment effects were seen for all 11 different treatment modalities. LEVEL OF EVIDENCE: IV.


Assuntos
Lesões do Manguito Rotador/terapia , Artroplastia , Desbridamento , Humanos , Músculo Esquelético/cirurgia , Modalidades de Fisioterapia , Próteses e Implantes , Retalhos Cirúrgicos , Tenodese , Tenotomia
14.
Orthop Surg ; 11(5): 857-863, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31532924

RESUMO

OBJECTIVE: To compare the clinical and radiological outcomes of patients who underwent rotator cuff repair (RCR) concomitant with long head of the biceps tendon (LHBT) tenotomy or subpectoral mini-open tenodesis. METHODS: Prospectively collected data was reviewed on 154 patients, who underwent a LHBT procedure (tenotomy or tenodesis) concomitant with RCR between January 2010 and January 2017. The exclusion criteria were irreparable massive rotator cuff tear, rotator cuff partial tear, subscapular tendon tear, glenohumeral arthritis, and prior shoulder surgery. The two patient groups are as follows: RCR + Tenotomy (Group A) and RCR + Subpectoral mini-open tenodesis (Group B). The visual analog scale (VAS) for pain, Constant Score scale, American Shoulder and Elbow Surgeons (ASES) scores, and the Disabilities of the Arm, Shoulder and Hand (DASH) scores preoperatively and 1 month, 3 months, 6 months, 1 year postoperatively and the latest out-patient clinic were compared between the two groups. RESULTS: Ninety-two patients in Group A and 62 patients in Group B completed the follow-up, with a median follow-up time of 27 and 42 months respectively. At the final follow-up, the VAS, Constant, ASES, and DASH scores in Group A were 0.1 ± 0.2, 87.0 ± 12.8, 96.4 ± 4.3 and 6.6 ± 4.8 respectively, and the VAS, Constant, ASES, and DASH scores in Group B were 0.1 ± 0.3, 92.5 ± 3.9, 96.3 ± 3.6 and 2.9 ± 1.3 respectively. Clinical evaluation scales showed satisfactory results in both groups, and there were no statistically significant differences between the two groups at the same follow-up time. Popeye sign was detected in one case of Group A (1.1%) and in one case of Group B (1.6%, P > 0.05). CONCLUSION: Both tenotomy and subpectoral mini-open tenodesis are effective for concomitant lesions of the LHBT in patients with reparable rotator cuff tears, and subpectoral mini-open tenodesis of the LHBT does not provide any significant clinical or functional improvement than isolated tenotomy.


Assuntos
Músculo Esquelético/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões do Manguito Rotador/cirurgia , Traumatismos dos Tendões/cirurgia , Tenodese/métodos , Tenotomia/métodos , Idoso , Artroscopia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/lesões , Medição da Dor , Estudos Prospectivos
15.
Zhongguo Gu Shang ; 32(8): 701-706, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31533379

RESUMO

OBJECTIVE: To compare clinical efficacy of arthroscopic tenodesis and tenotomy in treating biceps long head tendinitis. METHODS: From January 2015 to January 2017, 40 patients with long head of the biceps tendinitis were randomly divided into tenotomy group (18 patients) and tenodesis group(22 patients). In tenotomy group, there were 6 males and 12 females with an average age of (62.2±6.1) yeas old, and the average course of disease was (8.5±2.2) months; while in tenodesis group, there were 8 males and 14 females with an average age of(60.5±6.3) years old, and the average course of disease was (8.1±2.3) months. Operative time and deformity of Popeye were compared between two groups, VAS score was used to evaluate degree of pain, and UCLA score was used to assess clinical effects before operation, 3, 6 and 12 months after operation. RESULTS: Forty patients were followed up for 12 to 17 months with an average of(14.3±2.1) months. Eight patients occurred Popeye deformity in tenotomy group, and nobody in tenodesis group. There was significant difference between tenotomy group(40.55±7.51) min and tenodesis group(75.33±9.45) min. VAS score after operation at 3, 6 and 12 months were decreased than that of before operation, and VAS score in tenotomy group was lower than that of in tenodesis group at 3 months after operation(P<0.05); while there were no difference in VAS score between two groups at 6 and 12 months after operation(P>0.05). UCLA score at at 3, 6 and 12 months after operation in tenodesis group were increased than that of before operation, and UCLA score in tenotomy group was lower than that of in tenodesis group at 3 months after operation(P<0.05); while there were no difference in UCLA score between two groups at 6 and 12 months after operation(P>0.05). According to UCLA score, 5 got excellent results, 10 moderate and 3 poor in tenotomy group, while 8 got excellent results, 12 moderate and 2 poor in tenodesis group, but without difference between two groups(χ² =0.057, P=0.81). CONCLUSIONS: Both of arthroscopic tenotomy and tenodesis in treating long head of the biceps tendinitis could receive good clinical effects, and early functional outcomes by arthroscopic tenotomy was better than that of tenodesis, but no difference in later period.


Assuntos
Lesões do Manguito Rotador , Tendinopatia , Tenodese , Idoso , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manguito Rotador
16.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 4032-4037, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31486915

RESUMO

PURPOSE:  Surgical management for long head of the biceps (LHB) tendinopathy with either biceps tenotomy or tenodesis is a reliable, but debated treatment option. The aim of this prospective, randomized, single-blinded study is to evaluate differences in pain relief and subjective outcomes between biceps tenotomy versus tenodesis for LHB tendinopathy. METHODS:  Subjects were randomized and blinded to biceps tenotomy versus arthroscopic tenodesis intra-operatively. Outcomes evaluated included subjective patient outcome scores, pain, and cosmetic deformity. Subjective outcomes scores and pain were analyzed using a two-way ANOVA, controlling for concomitant rotator cuff repair. Binary outcomes were compared using Chi-square tests. RESULTS:  Thirty-four subjects (31 male, 3 female) with a median age of 56 (range 30-77) were enrolled. Twenty subjects were randomized to tenotomy and 14 to tenodesis. Fifty-six percent had concomitant rotator cuff repairs. The mean VAS pain score at 3 months was lower with tenotomy versus tenodesis. 2-year follow-up demonstrated no statistically significant differences for VAS, ASES, or SANE. 15/20 (75%) subjects with biceps tenotomy reported no pain medication use at the 2-week postoperative visit versus 5/14 (33%) for biceps tenodesis. Popeye deformity was found in 5/20 (25%) of tenotomy subjects versus 1/14 (7%) in tenodesis subjects. CONCLUSION: Outcomes appear similar between biceps tenotomy versus tenodesis; however, the tenotomy group demonstrated greater incidence of cosmetic deformity but an earlier improvement in postoperative pain. LEVEL OF EVIDENCE: Treatment Studies, Level II.


Assuntos
Artroscopia , Articulação do Ombro/cirurgia , Dor de Ombro/cirurgia , Tendinopatia/cirurgia , Tenodese , Tenotomia , Adulto , Idoso , Estética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/etiologia , Método Simples-Cego , Tendinopatia/complicações , Escala Visual Analógica
17.
Knee ; 26(5): 1003-1009, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31427244

RESUMO

BACKGROUND: To compare the biomechanical behavior of an anterolateral ligament (ALL) anatomical reconstruction and a semianatomical lateral extra-articular tenodesis (LET) in the context of an anterior cruciate ligament (ACL) reconstruction combined with an anterolateral lesion. METHODS: Twelve cadaveric knees were studied using a testing machine to assess the internal tibial rotation and anterior tibial translation across six surgical states: intact knee, ACL lesion, ACL + ALL lesion, ACL isolated reconstruction, ACL + ALL anatomical reconstruction and ACL + LET procedure. ALL and LET grafts were fixed at full knee extension and neutral rotation. RESULTS: Presented with combined ACL and ALL lesions, isolated ACL reconstruction failed to restore the internal tibial rotation to intact-knee values (P > 0.05 for all angles). The addition of both an ALL reconstruction and LET procedure significantly reduced the internal rotation, restoring the rotation laxity to intact-knee values at 0° and 30° of flexion (P < 0.05) and with a certain level of overconstraint at 60° and 90° (mean 3°â€¯±â€¯2SD). A higher tendency to overconstraint was observed with the LET, but there was no significant difference when comparing the ALL reconstruction with the LET (P > 0.05 for all angles). CONCLUSIONS: Residual rotational laxity was found after isolated ACL reconstruction in the presence of an anterolateral lesion. The combination of ACL reconstruction with anatomical ALL reconstruction or the LET procedure resulted in restoration to intact-knee values but with a certain degree of overconstraint in higher flexion angles. Both techniques showed optimal biomechanical results with no data supporting the advantage of one over the other.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Tenodese/métodos , Idoso , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Ligamentos Articulares/lesões , Masculino , Amplitude de Movimento Articular , Rotação
18.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 3997-4004, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31377825

RESUMO

PURPOSE: The study aimed to compare modified arthroscopic subscapularis augmentation (MASA) with tenodesis of the upper third of the subscapularis tendon using a tendon combined with capsulolabral reconstruction (Group A) or Bankart repair (Group B) for recurrent anterior shoulder instability (RASI). METHODS: A retrospective series of 49 patients underwent primary surgery for RASI with glenoid bone loss (GBL) < 25%. Outcomes included the Oxford Shoulder Instability Score (OSIS), Visual Analogue Scale (VAS) score, Rowe score, and American Shoulder and Elbow Surgeons (ASES) functional outcome scale score. Recurrent instability, sports activity level, and range of motion (ROM) were also analysed. RESULTS: No significant differences were observed at baseline. Forty-six patients were available for more than 2 years of follow-up. At the last follow-up after surgery, the patients in both groups had experienced significant improvements in all outcome scores (P < 0.05 for all), and obvious decreases in forward flexion and external rotation were noted in both groups (P < 0.05 for all). Group A had superior ASES scores, VAS scores, and OSISs (P < 0.05) but did not experience significant differences in either the Rowe score or ROM compared to Group B. Group A had lower rates of recurrent instability and superior outcomes for the return to sports activities. One patient in Group A had subluxation, and 4 patients in Group B had dislocation or subluxation. No patients in either group experienced neurovascular injury, joint stiffness, or surgical wound infection. CONCLUSION: For RASI with GBL < 25%, MASA with tenodesis of the upper third of the subscapularis tendon using a tendon combined with capsulolabral reconstruction was a safe technique that produced better outcomes in terms of ASES scores, VAS scores, OSISs, the return to sports, and postoperative recurrent instability and did not decrease the ROM compared to that achieved by arthroscopic Bankart repair. LEVEL OF EVIDENCE: III.


Assuntos
Artroscopia/métodos , Instabilidade Articular/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Tenodese , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Cápsula Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Estudos Retrospectivos , Tendões/transplante , Escala Visual Analógica
19.
Am J Sports Med ; 47(11): 2572-2576, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31381359

RESUMO

BACKGROUND: Lateral extra-articular tenodesis (LET) is being increasingly performed as an additional procedure in both primary and revision anterior cruciate ligament reconstruction in patients with excessive anterolateral rotatory instability. Consistent guidelines for femoral tunnel placement would aid in intraoperative reproducible graft placement and postoperative evaluation of LET procedures. PURPOSE: To determine radiographic landmarks of a recently described isometric femoral attachment area in LET procedures with reference to consistent radiographic reference lines. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten fresh-frozen cadaveric knees were dissected. The footprints of the lateral femoral epicondyle (LFE) apex and the deep aspects of the iliotibial tract, with its Kaplan fiber attachments (KFAs) on the distal femur, were marked with a 2.5-mm steel ball. True lateral radiographic images were taken. Mean absolute LFE and KFA distances were measured from the posterior cortex line (anterior-posterior direction) and from the perpendicular line intersecting the contact of the posterior femoral condyle (proximal-distal direction), respectively. Furthermore, positions were measured relative to the femur width. Finally, radiographic descriptions of an isometric femoral attachment area were developed. RESULTS: The mean LFE and KFA positions were found to be 4 ± 4 mm posterior and 4 ± 3 mm anterior to the posterior cortex line, and 6 ± 4 mm distal and 20 ± 5 mm proximal to the perpendicular line intersecting the posterior femoral condyle, respectively. The mean LFE and KFA locations, relative to the femur width, were found at -12% and 11% (anterior-posterior) and -17% and 59% (proximal-distal), respectively. Femoral tunnel placement on or posterior to the femoral cortex line and proximal to the posterior femoral condyle within a 10-mm distance ensures that the tunnel remains safely located in the isometric zone. CONCLUSION: Radiographic landmarks for an isometric femoral tunnel placement in LET procedures were described. CLINICAL RELEVANCE: These findings may help to intraoperatively guide surgeons for an accurate, reproducible femoral tunnel placement and to reduce the potential risk of tunnel misplacement, as well as to aid in the postoperative evaluation of LET procedures in patients with residual complaints.


Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Reconstrução do Ligamento Cruzado Anterior/métodos , Fêmur/cirurgia , Reoperação/métodos , Tenodese/métodos , Idoso , Cadáver , Humanos , Pessoa de Meia-Idade , Radiografia
20.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 4005-4013, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410527

RESUMO

PURPOSE: This study aimed to compare the clinical outcomes between single on-lay and double on-lay subpectoral biceps tenodesis (SPBT) using all-suture type anchor in patients with concomitant long head of the biceps tendon (LHBT) lesions and rotator cuff tears. METHODS: The study included 130 patients who underwent SPBT using all-suture type anchor and arthroscopic rotator cuff repair. Single and double anchor on-lay fixations were performed in 69 patients (group A) and 61 patients (group B), respectively. In 16 patients of group A and 36 patients of group B, a metallic wire was embedded at tenodesis site and difference of wire location pre-and postoperatively was measured using simple radiography. RESULTS: In both groups, the mean visual analogue scale (VAS) score during motion, the mean UCLA and constant scores significantly improved at the last follow-up (all p < 0.001). These scores were not significantly different between two groups. However, postoperatively, a significant difference was observed in the incidence of cosmetic deformity between two groups (p = 0.019). The cosmetic deformity was noted in 9 (13.0%) patients (Popeye deformity 7.2% and biceps softening 5.8%) in group A and 1 (1.6%) patient (Popeye deformity) in group B. In the subgroup analysis on biceps migration after the surgery, the mean migration distance of metal wire was 2.5 ± 3.0 mm in group A and 1.9 ± 2.6 mm in group B (n.s.). No patient had migration of > 10 mm. CONCLUSIONS: SPBT using all-suture type anchor was a favorable treatment option for lesions of the LHBT with rotator cuff tear. The clinical relevance of this study is the finding that double on-lay fixation with all-suture type anchor would result less cosmetic deformity than the single on-lay fixation for those who need subpectoral biceps tenodesis. LEVEL OF EVIDENCE: III.


Assuntos
Âncoras de Sutura , Tenodese/métodos , Adulto , Idoso , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Manguito Rotador/cirurgia , Traumatismos dos Tendões/cirurgia , Escala Visual Analógica
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA