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1.
Zhonghua Yi Xue Za Zhi ; 104(17): 1445-1452, 2024 May 07.
Artigo em Chinês | MEDLINE | ID: mdl-38706049

RESUMO

The prevalence of articular cartilage injuries and osteoarthritis (OA) is high, affecting a wide range of individuals. The self-repair ability of cartilage tissue is poor, and once damaged, it will irreversibly progress to OA. Mesenchymal stem cells (MSCs) play an important role in the field of regenerative medicine and are considered one of the most promising seed cells for cartilage repair and regeneration. In this article, based on the latest clinical research findings from both domestic and international sources, the theoretical basis, treatment goals, significance, sources, characteristics, clinical implementation plans, and efficacy of using MSCs for the treatment of cartilage injuries or osteoarthritis are reviewed. The article also discusses the challenges faced and future directions that need to be addressed in the clinical application of MSCs.


Assuntos
Cartilagem Articular , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Humanos , Cartilagem Articular/lesões , Células-Tronco Mesenquimais/citologia , Traumatismos do Joelho/terapia , Osteoartrite do Joelho/terapia , Osteoartrite/terapia
2.
BMC Musculoskelet Disord ; 25(1): 382, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38745166

RESUMO

BACKGROUND: An isokinetic moment curve (IMC) pattern-damaged structure prediction model may be of considerable value in assisting the diagnosis of knee injuries in clinical scenarios. This study aimed to explore the association between irregular IMC patterns and specific structural damages in the knee, including anterior cruciate ligament (ACL) rupture, meniscus (MS) injury, and patellofemoral joint (PFJ) lesions, and to develop an IMC pattern-damaged structure prediction model. METHODS: A total of 94 subjects were enrolled in this study and underwent isokinetic testing of the knee joint (5 consecutive flexion-extension movements within the range of motion of 90°-10°, 60°/s). Qualitative analysis of the IMCs for all subjects was completed by two blinded examiners. A multinomial logistic regression analysis was used to investigate whether a specific abnormal curve pattern was associated with specific knee structural injuries and to test the predictive effectiveness of IMC patterns for specific structural damage in the knee. RESULTS: The results of the multinomial logistic regression revealed a significant association between the irregular IMC patterns of the knee extensors and specific structural damages ("Valley" - ACL, PFJ, and ACL + MS, "Drop" - ACL, and ACL + MS, "Shaking" - ACL, MS, PFJ, and ACL + MS). The accuracy and Macro-averaged F1 score of the predicting model were 56.1% and 0.426, respectively. CONCLUSION: The associations between irregular IMC patterns and specific knee structural injuries were identified. However, the accuracy and Macro-averaged F1 score of the established predictive model indicated its relatively low predictive efficacy. For the development of a more accurate predictive model, it may be essential to incorporate angle-specific and/or speed-specific analyses of qualitative and quantitative data in isokinetic testing. Furthermore, the utilization of artificial intelligence image recognition technology may prove beneficial for analyzing large datasets in the future.


Assuntos
Lesões do Ligamento Cruzado Anterior , Articulação do Joelho , Amplitude de Movimento Articular , Humanos , Masculino , Feminino , Adulto , Amplitude de Movimento Articular/fisiologia , Articulação do Joelho/fisiopatologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Adulto Jovem , Fenômenos Biomecânicos/fisiologia , Traumatismos do Joelho/fisiopatologia , Valor Preditivo dos Testes , Lesões do Menisco Tibial/fisiopatologia , Articulação Patelofemoral/fisiopatologia , Articulação Patelofemoral/lesões , Pessoa de Meia-Idade
3.
JBJS Case Connect ; 14(2)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38704648

RESUMO

CASE: This report describes a new pattern of meniscal tear in an 18-year-old man after a knee sprain; he had undergone anterior cruciate ligament revision (ACL-R) 3 years earlier. He was diagnosed with an anterior cruciate ligament (ACL) graft rupture, a ramp lesion (Thaunat type 4), and a posterior root avulsion fracture of the medial meniscus (MM) (LaPrade type 5). He was treated successfully with an all-inside repair of the ramp lesion, a transtibial pull-out repair of the root tear, and ACL graft revision and anterolateral stabilization. CONCLUSION: This specific meniscal injury pattern should be recognized and documented, potentially warranting consideration as a new addition to Thaunat and LaPrade classifications as type 6.


Assuntos
Lesões do Menisco Tibial , Humanos , Masculino , Adolescente , Lesões do Menisco Tibial/cirurgia , Lesões do Menisco Tibial/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Meniscos Tibiais/diagnóstico por imagem , Reconstrução do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem
5.
Semin Musculoskelet Radiol ; 28(3): 318-326, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38768596

RESUMO

The posteromedial corner (PMC) of the knee is an anatomical region formed by ligamentous structures (medial collateral ligament, posterior oblique ligament, oblique popliteal ligament), the semimembranosus tendon and its expansions, the posteromedial joint capsule, and the posterior horn of the medial meniscus. Injuries to the structures of the PMC frequently occur in acute knee trauma in association with other ligamentous or meniscal tears. The correct assessment of PMC injuries is crucial because the deficiency of these supporting structures can lead to anteromedial rotation instability or the failure of cruciate ligaments grafts. This article reviews the anatomy and biomechanics of the PMC to aid radiologists in identifying injuries potentially involving PMC components.


Assuntos
Traumatismos do Joelho , Ligamentos Articulares , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Imageamento por Ressonância Magnética/métodos , Articulação do Joelho/diagnóstico por imagem , Fenômenos Biomecânicos
6.
Semin Musculoskelet Radiol ; 28(3): 305-317, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38768595

RESUMO

The posterolateral corner (PLC) of the knee is a complex anatomical-functional unit that includes ligamentous and tendinous structures that are crucial for joint stability. This review discusses the intricate anatomy, biomechanics, and imaging modalities, as well as the current challenges in diagnosing PLC injuries, with an emphasis on magnetic resonance imaging (MRI). Recognizing the normal MRI anatomy is critical in identifying abnormalities and guiding effective treatment strategies. Identification of the smaller structures of the PLC, traditionally difficult to depict on imaging, may not be necessary to diagnose a clinically significant PLC injury. Injuries to the PLC, often associated with cruciate ligament tears, should be promptly identified because failure to recognize them may result in persistent instability, secondary osteoarthritis, and cruciate graft failure.


Assuntos
Traumatismos do Joelho , Articulação do Joelho , Imageamento por Ressonância Magnética , Humanos , Articulação do Joelho/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Fenômenos Biomecânicos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Instabilidade Articular/diagnóstico por imagem
7.
Semin Musculoskelet Radiol ; 28(3): 327-336, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38768597

RESUMO

Knee pain is one of the most common indications for radiography in the evaluation of musculoskeletal disorders in children and adolescents. According to international guidelines, knee radiographs should be obtained when there is the suspicion of an effusion, limited motion, pain to palpation, inability to bear weight, mechanical symptoms (such as "locking"), and persistent knee pain after therapy. When indicated, radiographs can provide crucial information for the clinical decision-making process. Because of the developmental changes occurring in the knee during growth, the assessment of knee radiographs can be challenging in children and adolescents. Radiologists unfamiliar with the appearance of the knee on radiographs during skeletal maturation risk overcalling or overlooking bone lesions. Image acquisition techniques and parameters should be adapted to children. This article describes the most common challenges in distinguishing pathology from the normal appearance of knee radiographs in the pediatric population, offering some pearls and pitfalls that can be useful in clinical practice.


Assuntos
Articulação do Joelho , Humanos , Criança , Articulação do Joelho/diagnóstico por imagem , Adolescente , Radiografia/métodos , Artropatias/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Diagnóstico Diferencial
8.
Eur J Radiol ; 175: 111460, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38608501

RESUMO

BACKGROUND: Traumatic knee injuries are challenging to diagnose accurately through radiography and to a lesser extent, through CT, with fractures sometimes overlooked. Ancillary signs like joint effusion or lipo-hemarthrosis are indicative of fractures, suggesting the need for further imaging. Artificial Intelligence (AI) can automate image analysis, improving diagnostic accuracy and help prioritizing clinically important X-ray or CT studies. OBJECTIVE: To develop and evaluate an AI algorithm for detecting effusion of any kind in knee X-rays and selected CT images and distinguishing between simple effusion and lipo-hemarthrosis indicative of intra-articular fractures. METHODS: This retrospective study analyzed post traumatic knee imaging from January 2016 to February 2023, categorizing images into lipo-hemarthrosis, simple effusion, or normal. It utilized the FishNet-150 algorithm for image classification, with class activation maps highlighting decision-influential regions. The AI's diagnostic accuracy was validated against a gold standard, based on the evaluations made by a radiologist with at least four years of experience. RESULTS: Analysis included CT images from 515 patients and X-rays from 637 post traumatic patients, identifying lipo-hemarthrosis, simple effusion, and normal findings. The AI showed an AUC of 0.81 for detecting any effusion, 0.78 for simple effusion, and 0.83 for lipo-hemarthrosis in X-rays; and 0.89, 0.89, and 0.91, respectively, in CTs. CONCLUSION: The AI algorithm effectively detects knee effusion and differentiates between simple effusion and lipo-hemarthrosis in post-traumatic patients for both X-rays and selected CT images further studies are needed to validate these results.


Assuntos
Inteligência Artificial , Hemartrose , Traumatismos do Joelho , Tomografia Computadorizada por Raios X , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/complicações , Tomografia Computadorizada por Raios X/métodos , Feminino , Masculino , Estudos Retrospectivos , Hemartrose/diagnóstico por imagem , Hemartrose/etiologia , Pessoa de Meia-Idade , Adulto , Algoritmos , Idoso , Exsudatos e Transudatos/diagnóstico por imagem , Idoso de 80 Anos ou mais , Adulto Jovem , Adolescente , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Articulação do Joelho/diagnóstico por imagem , Sensibilidade e Especificidade
9.
Injury ; 55(6): 111546, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38599010

RESUMO

INTRODUCTION: Currently there is no consensus on the need for investigating knee ligamentous and meniscal injuries in a patient with a tibial plateau fracture. Consequently, many soft tissue injuries are likely undiagnosed and therefore untreated. The impact this has on long term knee outcomes is not well defined. We aimed to identify the impacts of various diagnostic methods on the management of meniscal injuries associated with tibial plateau fractures and evaluate the clinical outcomes. MATERIALS AND METHODS: We performed a systematic review using Pubmed, Medline, Embase, CINAHL and Cochrane following Cochrane guidelines. We included studies that operatively managed tibial plateau fractures and soft tissue injuries, which were diagnosed with either preoperative MRI, intra-operative arthroscopy or arthrotomy. RESULTS: 18 articles with 884 people, with a mean age of 46.4 years were included. Soft tissue injuries were detected on MRI (32-73%) and arthroscopy (12-70%), of which the most common were lateral meniscal injuries (7-64% of tibial plateau fractures). When identified by arthroscopy and arthrotomy, these injuries were almost always treated, either by repair or debridement. The clinical outcomes of these patients were poorly reported, with a heterogenous use of patient reported outcome measures, and follow up time points. There were no randomised trials or control groups for comparative analysis, however operative treatment yielded good to excellent outcomes. CONCLUSION: There is a high incidence of concomitant soft tissue injuries with tibial plateau fractures, particularly lateral meniscal injuries. There are 2 main approaches to meniscal injuries: surgeons who don't investigate, don't treat, whilst surgeons who do investigate often do surgically treat. Although studies that treated these injuries achieved good to excellent results, the currently available evidence doesn't confirm treatment superiority. As there is plausibility for better outcomes, randomised studies are needed to further investigate this clinical question.


Assuntos
Artroscopia , Imageamento por Ressonância Magnética , Lesões dos Tecidos Moles , Fraturas da Tíbia , Lesões do Menisco Tibial , Humanos , Fraturas da Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/complicações , Lesões dos Tecidos Moles/cirurgia , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Lesões do Menisco Tibial/diagnóstico por imagem , Artroscopia/métodos , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Desbridamento/métodos , Fraturas do Planalto Tibial
10.
BMJ Case Rep ; 17(4)2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38649242

RESUMO

We present a case of a fit man in his 50s, with simultaneous bilateral quadriceps tendon repair of injuries sustained 6 years apart. Spontaneous closed ruptures of the quadriceps tendon are uncommon. Clinical data of a single case of bilateral quadriceps tendon injury with simultaneous repair was gathered via the patient, notes and surgeon. Diagnosis was primarily based on history and clinical examination. Suggestive features on the plain radiographic imaging were also present. Confirmation was attempted using ultrasonography but yielded conflicting reports. The patient was screened for any associated predisposing conditions that would preclude surgical intervention or increase risk of recurrence. Repairs were accomplished by employing a combination of suture anchors and transpatellar cerclage reinforcement. Apposition of the tendon to the superior patellar pole was successful although with decreased passive flexion on the neglected side (approximately 30°) compared with the acute (approximately 90°). Follow-up continues with postoperative rehabilitation.


Assuntos
Músculo Quadríceps , Traumatismos dos Tendões , Humanos , Masculino , Traumatismos dos Tendões/cirurgia , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico , Músculo Quadríceps/lesões , Músculo Quadríceps/cirurgia , Músculo Quadríceps/diagnóstico por imagem , Pessoa de Meia-Idade , Ruptura/cirurgia , Âncoras de Sutura , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/diagnóstico por imagem
11.
Am J Sports Med ; 52(6): 1498-1504, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38619042

RESUMO

BACKGROUND: Recent adult studies have demonstrated that decreased posterior tibial slope angle (PTSA) may be a risk factor for posterior cruciate ligament (PCL) injury. However, there is no study investigating this phenomenon in a pediatric population. Understanding risk factors for PCL injuries among a pediatric population is important given the recent rise in athletic competition/specialization and sports-related injuries. HYPOTHESIS/PURPOSE: The purpose of this study was to compare PTSA between pediatric patients sustaining a primary PCL tear compared with age- and sex-matched controls. It was hypothesized that pediatric patients sustaining a PCL tear would have a decreased PTSA compared with controls, with decreased PTSA being associated with higher odds of PCL injury. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The records of all patients sustaining a PCL injury between 2006 and 2021 at a level 1 pediatric trauma center were reviewed. Patients aged ≤18 years with magnetic resonance imaging-confirmed PCL tear were included. Excluded were patients with concomitant anterior cruciate ligament tears, previous PCL reconstruction, or previous coronal plane realignment. A control cohort, with their ligament shown as intact on magnetic resonance imaging scans, was matched based on age and sex. PTSA was measured on lateral radiographs of the injured knee or tibia. The mean PTSA was compared between cohorts, and odds ratios were calculated based on the normal slope range (7°-10°) described in the literature, an upper range (>10°), and a lower range (<7°). Inter- and intrarater reliability were determined via calculation of an intraclass correlation coefficient. RESULTS: Of the 98 patients who sustained a PCL injury in this study period, 59 (60%) met inclusion criteria, and 59 healthy knee controls were matched. There were no differences between the cohorts for age (P = .90), sex (P > .99), or body mass index (P = .74). The PCL cohort had a lower mean ± SD PTSA compared with the control group (5.9°± 2.7° vs 7.3°± 4.3°; P = .03). PTSA <7° was associated with a 2.8 (95% CI, 1.3-6.0; P = .01) times risk of PCL tear. Conversely, PTSA >10° was associated with a 0.27 (95% CI, 0.09-0.81; P = .02) times risk of PCL tear. These PTSA measurements demonstrated acceptable intrarater and interrater reliability. CONCLUSION: PTSA <7° was associated with an increased odds of PCL injury, whereas a slope >10° was associated with a decreased odds of PCL injury in a pediatric population. These findings corroborate similar outcomes in adult studies; however, further studies are needed to elucidate PTSA as a risk factor for PCL injury.


Assuntos
Ligamento Cruzado Posterior , Tíbia , Humanos , Feminino , Masculino , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/diagnóstico por imagem , Adolescente , Criança , Tíbia/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Fatores de Risco , Estudos Retrospectivos , Estudos de Casos e Controles , Imageamento por Ressonância Magnética , Radiografia , Estudos de Coortes
12.
BMC Musculoskelet Disord ; 25(1): 292, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38622682

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) can diagnose meniscal lesions anatomically, while quantitative MRI can reflect the changes of meniscal histology and biochemical structure. Our study aims to explore the association between the measurement values obtained from synthetic magnetic resonance imaging (SyMRI) and Stoller grades. Additionally, we aim to assess the diagnostic accuracy of SyMRI in determining the extent of meniscus injury. This potential accuracy could contribute to minimizing unnecessary invasive examinations and providing guidance for clinical treatment. METHODS: Total of 60 (n=60) patients requiring knee arthroscopic surgery and 20 (n=20) healthy subjects were collected from July 2022 to November 2022. All subjects underwent conventional MRI and SyMRI. Manual measurements of the T1, T2 and proton density (PD) values were conducted for both normal menisci and the most severely affected position of injured menisci. These measurements corresponded to the Stoller grade of meniscus injuries observed in the conventional MRI. All patients and healthy subjects were divided into normal group, degeneration group and torn group according to the Stoller grade on conventional MRI. One-way analysis of variance (ANOVA) was employed to compare the T1, T2 and PD values of the meniscus among 3 groups. The accuracy of SyMRI in diagnosing meniscus injury was assessed by comparing the findings with arthroscopic observations. The diagnostic efficiency of meniscus degeneration and tear between conventional MRI and SyMRI were analyzed using McNemar test. Furthermore, a receiver operating characteristic curve (ROC curve) was constructed and the area under the curve (AUC) was utilized for evaluation. RESULTS: According to the measurements of SyMRI, there was no statistical difference of T1 value or PD value measured by SyMRI among the normal group, degeneration group and torn group, while the difference of T2 value was statistically significant among 3 groups (P=0.001). The arthroscopic findings showed that 11 patients were meniscal degeneration and 49 patients were meniscal tears. The arthroscopic findings were used as the gold standard, and the difference of T1 and PD values among the 3 groups was not statistically significant, while the difference of T2 values (32.81±2.51 of normal group, 44.85±3.98 of degeneration group and 54.42±3.82 of torn group) was statistically significant (P=0.001). When the threshold of T2 value was 51.67 (ms), the maximum Yoden index was 0.787 and the AUC value was 0.934. CONCLUSIONS: The measurement values derived from SyMRI could reflect the Stoller grade, illustrating that SyMRI has good consistency with conventional MRI. Moreover, the notable consistency observed between SyMRI and arthroscopy suggests a potential role for SyMRI in guiding clinical diagnoses.


Assuntos
Traumatismos do Joelho , Menisco , Lesões do Menisco Tibial , Humanos , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Lesões do Menisco Tibial/patologia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Curva ROC , Imageamento por Ressonância Magnética/métodos , Artroscopia/métodos , Meniscos Tibiais/cirurgia , Sensibilidade e Especificidade
13.
Artigo em Inglês | MEDLINE | ID: mdl-38569093

RESUMO

Patellar tendon ruptures can be debilitating injuries. When incomplete, partial tears can be managed nonsurgically with immobilization and progressive rehabilitation. Although complete ruptures remain a relatively uncommon injury, they portend a high level of morbidity. Ruptures typically result from an acute mechanical overload to the extensor mechanism, such as with forced quadriceps contraction and knee flexion. However, chronically degenerated tendons are also predisposed to failure from low-energy injuries. Diagnosis can often be made clinically with recognition of a palpable defect to the tendon, localized patellar tendon tenderness, and inability to actively extend the knee. Diagnosis and surgical planning can be established with radiograph, ultrasonography, or magnetic resonance imaging. Surgical repair is the mainstay of treatment, and there have been many recent advances in repair technique, optimal reconstruction strategies, and supplemental fixation. Time to surgery for complete tears remains the most important prognosticator for success. Direct primary repair can be completed with transosseous tunnels, suture anchor repair, or end-to-end repair. Tendon reconstruction can be achieved with or without mechanical or biologic augments. Rehabilitation programs vary in specifics, but return to sport can be expected by 6 months postoperatively.


Assuntos
Traumatismos do Joelho , Ligamento Patelar , Traumatismos dos Tendões , Humanos , Ligamento Patelar/diagnóstico por imagem , Ligamento Patelar/cirurgia , Ligamento Patelar/lesões , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Tendões/cirurgia , Ruptura/cirurgia
14.
Nat Rev Rheumatol ; 20(5): 272-289, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38605249

RESUMO

Up to 50% of individuals develop post-traumatic osteoarthritis (PTOA) within 10 years following knee-joint injuries such as anterior cruciate ligament rupture or acute meniscal tear. Lower-extremity PTOA prevalence is estimated to account for ≥12% of all symptomatic osteoarthritis (OA), or approximately 5.6 million cases in the USA. With knowledge of the inciting event, it might be possible to 'catch PTOA in the act' with sensitive imaging and soluble biomarkers and thereby prevent OA sequelae by early intervention. Existing biomarker data in the joint-injury literature can provide insights into the pathogenesis and early risk trajectory related to PTOA and can help to elucidate a research agenda for preventing or slowing the onset of PTOA. Non-traumatic OA and PTOA have many clinical, radiological and genetic similarities, and efforts to understand early risk trajectories in PTOA might therefore contribute to the identification and classification of early non-traumatic OA, which is the most prevalent form of OA.


Assuntos
Biomarcadores , Traumatismos do Joelho , Humanos , Biomarcadores/metabolismo , Traumatismos do Joelho/complicações , Traumatismos do Joelho/prevenção & controle , Osteoartrite do Joelho/prevenção & controle , Osteoartrite do Joelho/etiologia , Lesões do Ligamento Cruzado Anterior/complicações , Osteoartrite/prevenção & controle , Osteoartrite/etiologia
15.
Clin Orthop Surg ; 16(2): 322-325, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38562628

RESUMO

Background: Toe symphalangism is characterized by a fusion of the interphalangeal joint between the middle and distal phalanges. While typical lesser toe fractures heal well with conservative treatment, in our clinical experience, we encountered patients with symphalangeal toe fractures who experienced long-lasting pain and delayed radiographic union. Therefore, this study aimed to report radiographic outcomes following conservative treatment of symphalangeal fractures of the lesser toes. Methods: We retrospectively reviewed 14 patients with symphalangeal lesser toe fractures who were treated conservatively. We investigated the mechanism of injury and measured the time from the initial injury date to the complete radiographic union. The fracture gap distance was measured on an initial lateral radiograph. Results: Symphalangeal fractures involved the fourth toe in 4 patients (28.5%) and the fifth toe in 10 patients (71.4%). Regarding the mechanism of injury, 6 patients (42.9%) were injured by stubbing or bumping into the door, 5 patients (35.7%) were injured by tripping, 2 patients (14.3%) were injured by heavy objects falling directly on their toes, and 1 patient (2.3%) complained of pain after wearing pointed shoes for half a day. The mean time to complete union was 9.1 months, and the median period was 5.5 months (range, 0.8-29 months). The initial gap of the fracture was 0.60 mm (range, 0.30-1.04 mm). Conclusions: The results of our case series may help counsel patients in the outpatient clinic that prolonged healing time may be required for the union of symphalangeal toe fractures.


Assuntos
Traumatismos do Tornozelo , Fraturas Ósseas , Traumatismos do Joelho , Humanos , Tratamento Conservador , Estudos Retrospectivos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Dedos do Pé/lesões , Dor , Resultado do Tratamento
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(4): 432-437, 2024 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-38632062

RESUMO

Objective: To probe into the effectiveness of vertical compression of locking plate combined with hollow screws in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods: The clinical data of 128 patients with Sanders type Ⅱ and Ⅲ calcaneal fractures who were admitted between March 2019 and April 2022 and met the selection criteria were retrospectively analyzed. Among them, 65 patients were treated with locking plate combined with hollow screw vertical compression (study group), and 63 patients were treated with simple locking plate (control group). There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, fracture side and Sanders classification, cause of injury, time from injury to operation. The operation time, intraoperative blood loss, hospital stay, and fracture healing time were recorded and compared between the two groups. Before operation and at 12 months after operation, the American Orthopaedic Foot and Ankle Association (AOFAS) score (including total score, pain score, functional score, and alignment score) was used to evaluate the recovery of foot function, and imaging indicators such as calcaneal width, calcaneal height, calcaneal length, Böhler angle, and Gissane angle were measured on X-ray films. Results: All patients were followed up 12 months after operation. There was no significant difference in operation time, intraoperative blood loss, hospital stay, and fracture healing time between the two groups ( P>0.05). Poor wound healing occurred in 1 case in the study group and 2 cases in the control group. At 12 months after operation, there was no significant difference between the two groups in the pre- and post-operative difference of calcaneal length, calcaneal height, Gissane angle, and Böhler angle ( P>0.05). However, the pre- and post-operative difference in calcaneal width in the study group was significantly higher than that in the control group ( P<0.05). The pre- and post-operative difference of AOFAS total score in the study group was significantly higher than that in the control group ( P<0.05), and further analysis showed that the pre- and post-operative difference of pain and function scores in the study group were significantly higher than those in the control group ( P<0.05), while there was no significant difference in the pre- and post-operative difference of force score between the two groups ( P>0.05). Conclusion: Compared with simple locking plate treatment, the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures with vertical compression of locking plate combined with hollow screws can more effectively improve the width of the subtalar calcaneal articular surface, avoid peroneal longus and brevis impingement, reduce pain, and increase the range of motion of the subtalar joint, and the effectiveness is better.


Assuntos
Traumatismos do Tornozelo , Calcâneo , Traumatismos do Pé , Fraturas Ósseas , Traumatismos do Joelho , Humanos , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos , Perda Sanguínea Cirúrgica , Resultado do Tratamento , Fraturas Ósseas/cirurgia , Calcâneo/lesões , Dor
17.
Zhongguo Gu Shang ; 37(4): 368-73, 2024 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-38664207

RESUMO

OBJECTIVE: To investigate the effect of electroacupuncture therapy on postoperative rehabilitation training of patients with knee fractures. METHODS: Patients with knee fractures from July 2020 to July 2021 were randomly assigned to either the experimental group or a control group according to the double-blind principle. Both groups were given surgical treatment and postoperative conventional rehabilitation training. There were 40 cases in the control group, including 27 males and 13 females;the age ranged from 20 to 66 years old with an average of (36.46±6.29) years old, continuous passive motion (CPM) training was performed after operation. There were 40 patients in the experimental group, including 24 males and 16 females. The age ranged from 21 to 68 years old with an average of (37.62±7.08) years old, on the basis of the control group, electroacupuncture was given. After 4 weeks of intervention, the excellent rate of knee function score, visual analogue scale (VAS) before and after intervention, serum pain mediators, prostaglandin E (PGE), substance P (SP), bradykinin (BK), joint range of motion and quality of life were compared between the two groups. RESULTS: After 4 weeks of intervention, the Rasmussen score for knee function in the experimental group (24.15±1.36) scores was higher than that in the control group (21.25±2.20) scores (P<0.001). The VAS in the experimental group (2.04±0.51) scores was lower than that in the control group (2.78±0.60) after 4 weeks of intervention (P<0.05). Serum PGE (2.25±0.37) mg·L-1, SP (4.43±1.05) ng·ml-1, BK (2.67±0.68) ng·ml-1 in the experimental group were lower than those in the control group (3.91±0.44) mg·L-1, (6.12±1.37) ng·ml-1, (4.55±1.03) ng·ml-1 after 4 weeks of intervention(P<0.05);in the experimental group, the active knee flexion angle of the knee joint was (108.63±9.76)°, the active knee extension angle (-2.46±0.70)°, passive knee flexion angle (116.83±6.57)°, passive knee extension angle (1.44±0.38)° were better than control group (100.24±8.15)°, (-3.51±0.86)°, (111.04±8.22)°, (0.78±0.24)° (P<0.05);the experimental group's psychological score (73.12±5.08), physiological score (72.26±5.89), social function score (72.57±4.23), overall health score (75.12±5.16) were higher than that of the control group (68.49±4.13), (68.13±5.27), (69.04±3.42), and(70.88±3.97) respectvely(P<0.05). CONCLUSION: Electroacupuncture combined with CPM training after knee fracture surgery can significantly improve knee function and range of motion, reduce pain levels, and also improve quality of life and reduce the incidence of adverse events.


Assuntos
Eletroacupuntura , Humanos , Masculino , Eletroacupuntura/métodos , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Amplitude de Movimento Articular , Adulto Jovem , Qualidade de Vida , Período Pós-Operatório , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/reabilitação , Articulação do Joelho/cirurgia , Substância P/sangue , Método Duplo-Cego , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Fraturas do Joelho
18.
Stud Health Technol Inform ; 313: 7-8, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38682496

RESUMO

Knee injuries are a common concern in orthopedic and sports medicine, often requiring extensive rehabilitation to restore function and alleviate pain. The rehabilitation process can be long and challenging, necessitating innovative approaches to engage and motivate patients effectively. Serious games have emerged as a promising tool in rehabilitation, offering an interactive and enjoyable way to perform therapeutic exercises. In this context, a new serious game that leverages the Wii Fit Balance Board as an input device supported by a keyboard to aid knee rehabilitation was developed. To tailor the game to the specific needs of knee rehabilitation, qualitative content analysis and requirement extraction based on three interviews with therapists were conducted. These insights were then iteratively integrated into the game's development, ensuring that the final game was both clinically relevant and engaging. A therapist subsequently re-evaluated the completed game, confirming its potential to enhance the rehabilitation process. It was also shown that further research is needed to detect squat movements on the Balance Board. But this initial approach, combining the Wii Fit Balance Board with squat exercises, uniquely addresses the challenges of knee rehabilitation, offering a novel video and game solution.


Assuntos
Terapia por Exercício , Traumatismos do Joelho , Jogos de Vídeo , Humanos , Terapia por Exercício/métodos , Traumatismos do Joelho/reabilitação , Equilíbrio Postural/fisiologia
19.
BMJ Case Rep ; 17(3)2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38514157

RESUMO

Multiligamentous knee injuries (MLKIs) are rare and challenging to manage in many aspects. The injury requires prompt diagnosis, reconstruction of multiple ligaments, and management of associated neurovascular injuries. Another important aspect that surgeons should consider is resource availability. Successful management of a case of MLKI using the cost-effective 'modified confluent tunnel technique' is described in this case report. We used confluent tunnels for intra- and extra-articular ligament reconstructions at the femoral side. We incorporated the weave technique for medial collateral ligament (MCL) reconstruction, and Larson's technique for posterolateral corner (PLC) reconstruction in this construct, and augmented the anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction with the remaining PLC and MCL grafts, respectively. This was cost-effective and resulted in good functional outcomes. The technique also helped us to avoid tunnel convergence which is an expected complication in MLKI surgeries.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Procedimentos de Cirurgia Plástica , Ligamento Cruzado Posterior , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Anterior , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia
20.
BMC Musculoskelet Disord ; 25(1): 232, 2024 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-38521904

RESUMO

BACKGROUND: Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. METHODS: Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44-443) days and 502 (260-1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. RESULTS: Ninety patients were included. VAS pain scores were significantly (p < 0.01) lower after arthroscopic repair compared to conservative treatment (1.27±0.38vs.4±0.52) at the last follow-up visit with median (IQR) of 325 (180-1391) days. Increased meniscal extrusion (mm) was associated with higher odds of receiving non-surgical treatment (OR = 1.65, 95%CI 1.02-2.69, p = 0.04). The odds of having arthroscopic repair increased by 19% for every 1 mm increase in the distance of the tear from the root attachment (OR = 1.19, 95% CI: 1.05-1.36, p < 0.01). The odds of undergoing arthroscopic repair were reduced by 49% for every 1 mm increase in the extent of meniscal extrusion (OR = 0.51, 95% CI: 0.29-0.91, p = 0.02) as observed in the baseline MRI. CONCLUSIONS: Patients who underwent arthroscopic repair had lower pain scores than patients with conservative treatment in the follow-up. Distance of the torn meniscus to the root attachment and the extent of meniscal extrusion were significant predictors for arthroscopic repair in the next three weeks (time from the baseline MRI to the surgery date).


Assuntos
Traumatismos do Joelho , Meniscos Tibiais , Humanos , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Radiografia , Imageamento por Ressonância Magnética/métodos , Artroscopia/métodos , Ruptura , Dor , Estudos Retrospectivos
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