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1.
J Rehabil Med ; 56: jrm12296, 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38385715

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) rupture is the most common knee injury among athletes, and can result in long-term complications and career-ending conditions for sportspeople. There is no consensus in the literature on the effectiveness of rehabilitation after ACL reconstruction, or the best protocol to follow for functional outcome improvement. OBJECTIVE: To determine the impact of an accelerated rehabilitation protocol on knee functional outcomes in amateur athletes with anterior cruciate ligament reconstruction (ACLR). DESIGN: Two-arm, parallel-group randomized comparative design. PATIENTS: A total of 100 amateur male athletes (mean age 22.01 ± 1.79 years) with ACLR were randomly divided into experimental and control groups (n = 50/group). METHODS: An accelerated rehabilitation protocol and a conventional rehabilitation protocol were used for the experimental group. In contrast, only the conventional rehabilitation protocol was used for the control group. The rehabilitation was delivered in 5 weekly sessions for 22 weeks. The primary outcome measure, knee pain, was measured using a visual analogue scale (VAS). Extensive test batteries, for hop tests, Knee Injury and Osteoarthritis Outcome Score (KOOS), and knee effusion, were measured, aiming to add more objective criteria to determine functional performance. RESULTS: Both groups (n = 50/group) were well-matched (p = 0.816), with insignificant differences in their demographic characteristics (p > 0.05). A multivariate analysis of variance (MANOVA) test showed no significant difference between the 2 groups (p = 0.781) at baseline. A 2-way MANOVA (2 × 2 MANOVA) of within- and between-group variations indicated overall significant treatment, time, and treatment × time interaction effects (p < 0.001) in favour of the accelerated rehabilitation group. CONCLUSION: The accelerated rehabilitation protocol was more effective in improving functional outcomes than a conventional rehabilitation protocol in amateur athletes with ACLR.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Humanos , Masculino , Adulto Jovem , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Atletas , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/reabilitação , Articulação do Joelho
2.
Knee Surg Sports Traumatol Arthrosc ; 32(1): 167-180, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38226729

RESUMO

PURPOSE: To determine bony knee morphological factors associated with primary posterior cruciate ligament (PCL) rupture or PCL graft failure after PCL reconstruction. METHODS: Three databases, namely MEDLINE, PubMed and EMBASE, were searched on 30th May 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data such as receiver operating characteristic curve parameters, as well as p-values for comparisons of values between patients with PCL pathology and control patients, were recorded. RESULTS: Nine studies comprising 1054 patients were included. Four studies reported that patients with PCL injury had flatter medial posterior tibial slopes (MTS) than controls, with mean values of 4.3 (range: 3.0-7.0) and 6.5 (range: 5.0-9.2) degrees, respectively. Two studies reported an MTS cutoff value ranging below 3.90-3.93° being a significant risk factor for primary PCL rupture or PCL graft failure. Two studies reported that shallow medial tibial depths were associated with primary PCL rupture, with mean values of 2.1 (range: 2.0-2.2) and 2.6 (range: 2.4-2.7) mm in PCL injury and control groups, respectively. Stenotic intercondylar notches and femoral condylar width were not consistently associated with PCL injuries. CONCLUSION: Decreased MTS is associated with primary PCL rupture and graft failure after PCL reconstruction with values below 3.93° being considered as a significant risk factor. Less common risk factors include shallow medial tibial depth, while femoral condylar width and parameters with regards to the intercondylar notch, such as notch width, notch width index and intercondylar notch volume, demonstrated conflicting associations with primary or secondary PCL injuries. LEVEL OF EVIDENCE: Level III.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Lesões dos Tecidos Moles , Entorses e Distensões , Humanos , Ligamento Cruzado Posterior/cirurgia , Ligamento Cruzado Posterior/lesões , Reconstrução do Ligamento Cruzado Posterior/efeitos adversos , Estudos de Casos e Controles , Articulação do Joelho/cirurgia , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/complicações , Tíbia/anatomia & histologia , Entorses e Distensões/cirurgia , Lesões dos Tecidos Moles/cirurgia , Fatores de Risco , Lesões do Ligamento Cruzado Anterior/cirurgia
3.
Am J Sports Med ; 52(1): 77-86, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38164668

RESUMO

BACKGROUND: There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients. HYPOTHESIS: There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL). RESULTS: Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014). CONCLUSION: These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Adolescente , Adulto Jovem , Humanos , Feminino , Criança , Adulto , Masculino , Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Prevalência , Estudos Transversais , Atenção Terciária à Saúde , Estudos Retrospectivos , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Meniscos Tibiais/cirurgia , Hospitais
4.
Am J Sports Med ; 52(2): 330-337, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38205511

RESUMO

BACKGROUND: Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses. PURPOSE: To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model. RESULTS: MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001). CONCLUSION: Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Lesões do Menisco Tibial , Humanos , Masculino , Estudos Retrospectivos , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Incidência , Lesões do Menisco Tibial/epidemiologia , Lesões do Menisco Tibial/cirurgia , Lesões do Menisco Tibial/etiologia , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Fatores de Risco
5.
J Sport Rehabil ; 33(2): 88-98, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38176405

RESUMO

OBJECTIVE: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. METHODS: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. RESULTS: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." CONCLUSIONS: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Osteoartrite , Adulto , Feminino , Humanos , Estudos de Coortes , Estudos Prospectivos , Recuperação de Função Fisiológica , Músculo Quadríceps , Lesões do Ligamento Cruzado Anterior/cirurgia , Volta ao Esporte , Traumatismos do Joelho/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Osteoartrite/cirurgia
6.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38241429

RESUMO

CASE: A 29-year-old man sustained a bilateral acute patellar tendon rupture (PTR) while jumping on a trampoline. He was initially treated with bilateral transosseous patellar tendon repairs. Bilateral rerupture occurred during a fall 10 weeks after. He subsequently underwent staged bilateral patellar tendon reconstructions using an Achilles tendon allograft. At 3-year follow-up, he has maintained full range of motion and leg strength without rerupture or other complications. CONCLUSION: The use of Achilles tendon allograft in the presence of inadequate and poor-quality tendon tissue for reconstruction of the patellar tendon in the revision setting is a viable and effective treatment option.


Assuntos
Traumatismos do Joelho , Ligamento Patelar , Procedimentos de Cirurgia Plástica , Masculino , Humanos , Adulto , Ligamento Patelar/cirurgia , Traumatismos do Joelho/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento , Ruptura/cirurgia , Ruptura/etiologia
7.
Knee Surg Sports Traumatol Arthrosc ; 32(2): 361-370, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38294966

RESUMO

PURPOSE: The hypothesis of the present study assumed that a history of focal cartilage lesions would not affect Knee Injury and Osteoarthritis Outcome scores (KOOSs) following knee arthroplasty compared to a matched national cohort of knee arthroplasty patients. METHODS: Fifty-eight knee arthroplasty patients with previous surgery for focal cartilage lesions (cartilage cohort) were compared to a matched cohort of 116 knee arthroplasty patients from the Norwegian Arthroplasty Register (control group). Age, sex, primary or revision arthroplasty, type of arthroplasty (total, unicondylar or patellofemoral), year of arthroplasty surgery and arthroplasty brand were used as matching criteria. Demographic data and KOOS were obtained through questionnaires. Regression models were employed to adjust for confounding factors. RESULTS: Mean follow-up post knee arthroplasty surgery was 7.6 years (range 1.2-20.3) in the cartilage cohort and 8.1 (range 1.0-20.9) in the control group. The responding patients were at the time of surgery 54.3 versus 59.0 years in the cartilage and control group, respectively. At follow-up the control group demonstrated higher adjusted Knee Injury and Osteoarthritis Outcome subscores than the previous focal cartilage patients with a mean adjusted difference (95% confidence interval in parentheses): Symptoms 8.4 (0.3, 16.4), Pain 11.8 (2.2, 21.4), Activities of daily living (ADL) 9.3 (-1.2, 18.6), Sport and recreation 8.9 (-1.6, 19.4) and Quality of Life (QoL) 10.6 (0.2, 21.1). The control group also demonstrated higher odds of reaching the patient-acceptable symptom state threshold for the Knee Injury and Osteoarthritis Outcome subscores with odds ratio: Symptoms 2.7 (1.2, 6.4), Pain 3.0 (1.3, 7.0), ADL 2.1 (0.9, 4.6) and QoL 2.4 (1.0, 5.5). CONCLUSION: Previous cartilage surgery was associated with inferior patient-reported outcomes after knee arthroplasty. These patients also exhibited significantly lower odds of reaching the patient-acceptable symptom state threshold for the Knee Injury and Osteoarthritis Outcome subscores. LEVEL OF EVIDENCE: Level III.


Assuntos
Artroplastia do Joelho , Traumatismos do Joelho , Osteoartrite do Joelho , Osteoartrite , Humanos , Qualidade de Vida , Atividades Cotidianas , Traumatismos do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Cartilagem/cirurgia , Dor/cirurgia , Osteoartrite/cirurgia , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/complicações , Resultado do Tratamento , Articulação do Joelho/cirurgia
8.
Instr Course Lect ; 73: 879-900, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38090946

RESUMO

Tibial plateau fractures encompass a broad array of injuries. The mechanism of injury ranges from low to high energy. Devastating complications and associated injuries can occur in both low-energy and high-energy mechanisms; therefore, a careful and detailed physical examination and review of imaging must be performed. Furthermore, a mechanistic approach to fracture classification and morphology enhances the surgeon's understanding of the injury and the ability to predict associated injuries and develop effective strategies for management.


Assuntos
Traumatismos do Joelho , Fraturas da Tíbia , Fraturas do Planalto Tibial , Humanos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Tomografia Computadorizada por Raios X , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Traumatismos do Joelho/cirurgia
9.
Free Radic Biol Med ; 212: 191-198, 2024 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-38154571

RESUMO

Oxidative stress has been implicated in the etiology of skeletal muscle weakness following joint injury. We investigated longitudinal patient muscle samples following knee injury (anterior cruciate ligament tear). Following injury, transcriptomic analysis revealed downregulation of mitochondrial metabolism-related gene networks, which were supported by reduced mitochondrial respiratory flux rates. Additionally, enrichment of reactive oxygen species (ROS)-related pathways were upregulated in muscle following knee injury, and further investigation unveiled marked oxidative damage in a progressive manner following injury and surgical reconstruction. We then investigated whether antioxidant protection is effective in preventing muscle atrophy and weakness after knee injury in mice that overexpress Mn-superoxide dismutase (MnSOD+/-). MnSOD+/- mice showed attenuated oxidative damage, atrophy, and muscle weakness compared to wild type littermate controls following ACL transection surgery. Taken together, our results indicate that ROS-related damage is a causative mechanism of muscle dysfunction after knee injury, and that mitochondrial antioxidant protection may hold promise as a therapeutic target to prevent weakness and development of disability.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Humanos , Camundongos , Animais , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/genética , Lesões do Ligamento Cruzado Anterior/cirurgia , Antioxidantes/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Atrofia Muscular/genética , Atrofia Muscular/prevenção & controle , Debilidade Muscular/genética , Debilidade Muscular/complicações , Traumatismos do Joelho/complicações , Traumatismos do Joelho/cirurgia , Estresse Oxidativo/fisiologia , Superóxido Dismutase/genética , Superóxido Dismutase/metabolismo
10.
BMC Musculoskelet Disord ; 24(1): 936, 2023 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-38042790

RESUMO

BACKGROUND: We have applied primarily multiple locking compression miniplates in treating multifragmentary, comminuted patellar fracture in combination with conventional fixation methods. METHODS: Medical and radiologic data were retrospectively reviewed for the patients surgically fixated with locking compression miniplates in patellar fracture of AO/OTA 34-C3. The primary outcome was bone union at the final follow-up, and the secondary outcomes were functional outcomes and postoperative complications associated with the procedure. For the functional assessment, the Lysholm score, Tegner scores, and the knee range of motion was compared. RESULTS: A total of twenty patients with AO/OTA 34-C3 patellar fracture were included in the study with an average follow-up period of 15 months (range:11 ~ 18 months) between June 2018 and November 2021. Eleven male and nine female patients presented an average age of 57.15 years. The primary fracture union was seen in all twenty patients, and the average time to the union was 15.6 weeks on serial radiograph follow-up. All patients did not show any postoperative complications, such as fixation failure, infection, or revision operations. Postoperatively, all patients achieved an average range of motion of 130 degrees, and the Lysholm and Tegners scores showed an average of 90.4 and 5.0 at the final follow-up, retrospectively. CONCLUSION: Fixations with miniplates in comminuted patellar fractures can be a useful option for effective osteosynthesis due to their versatile, efficient, and low-profile nature.


Assuntos
Fraturas Ósseas , Fraturas Cominutivas , Traumatismos do Joelho , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Patela/diagnóstico por imagem , Patela/cirurgia , Fraturas Ósseas/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Complicações Pós-Operatórias
11.
Medicine (Baltimore) ; 102(51): e36764, 2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38134064

RESUMO

BACKGROUND: This systematic review and meta-analysis aims to compare the effectiveness of home-based tele-rehabilitation programs with hospital-based rehabilitation programs in improving pain and function at various time points (≤6 weeks, ≤14 weeks, and ≤ 52 weeks) following the initial total knee arthroplasty. METHODS: This study used PRISMA and AMSTAR reporting guidelines. We systematically searched 5 databases (PubMed, Embase, Web of Science, Cochrane Library, and Medline) to identify randomized controlled trials published from January 1, 2019, to January 1, 2023. The primary outcomes were pain, knee injury and osteoarthritis outcome score, and mobility (knee range of motion). RESULTS: We included 9 studies involving 1944 patients. Low-quality evidence showed hospital-based rehabilitation was better than home-based tele-rehabilitation in knee injury and osteoarthritis outcome score (mean difference [MD], -2.62; 95% confidence interval [CI], -4.65 to -0.58; P = .01) at ≤ 14 weeks after total knee arthroplasty. Based on low-quality evidence, home-based tele-rehabilitation was better than hospital-based rehabilitation in knee range of motion (MD, 2.00; 95% CI, 0.60 to 3.40; P = .005). There was no significant difference between hospital-based rehabilitation and home-based tele-rehabilitation in knee pain at ≤ 6 weeks (MD, 0.18; 95% CI, -0.07 to 0.42; P = .16), 14 weeks (MD, 0.12; 95% CI, -0.26 to 0.49; P = .54), and ≤ 52 weeks (MD, 0.16; 95% CI, -0.11 to 0.43; P = .24). CONCLUSION: Home-based tele-rehabilitation and hospital-based rehabilitation programs showed comparable long-term outcomes in pain, mobility, physical function, and patient-reported health status after primary total knee arthroplasty. Considering the economic costs, home-based tele-rehabilitation programs are recommended as a viable alternative to hospital-based rehabilitation programs.


Assuntos
Artroplastia do Joelho , Traumatismos do Joelho , Osteoartrite do Joelho , Telerreabilitação , Humanos , Artroplastia do Joelho/reabilitação , Osteoartrite do Joelho/cirurgia , Pacientes Ambulatoriais , Dor/cirurgia , Traumatismos do Joelho/cirurgia , Hospitais
12.
BMJ Open ; 13(12): e065254, 2023 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-38114287

RESUMO

INTRODUCTION: Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries in sports, and the gold standard for treating ACL rupture is tendon graft reconstruction. Internal brace technology is being used nowadays for ligament repair; however, more relevant in vivo clinical evidence is required for using internal brace technology in ACL reconstruction (ACLR). We conducted a randomised controlled trial to investigate the clinical efficacy of internal brace technology in ACLR. METHODS AND ANALYSIS: This randomised, parallel-controlled trial included patients with ACL rupture who underwent inpatient surgery at the Department of Orthopaedics, Xiangya Hospital, Central South University. Random number table method was used to assign the participants to either the test or the control group. The test group underwent ACLR using the internal brace technique, whereas the control group underwent standard ACLR. Uniform postoperative rehabilitation protocol was used for both the groups. Patient-reported outcomes included preoperative baseline and postoperative recovery at 1, 3, 6, 12 and 24 months. The primary outcome was International Knee Documentation Committee function from baseline (ACL rupture) to 6 months postoperatively. Secondary outcomes included (1) other patient outcome reporting metrics, Lysholm knee score, Knee Injury and Osteoarthritis Outcome Score and Visual Analog Scale; (2) the use of Kneelax3 knee stabiliser to assess knee stability; (3) occurrence of adverse events, such as graft refraction or symptomatic instability, postoperative infection and contralateral injury and (4) magnetic resonance images at 12 and 24 months after ACLR. ETHICS AND DISSEMINATION: This trial was approved by the Medical Ethics Committee of the Xiangya Hospital of Central South University on 26 October 2021. Data will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: ChiCTR2200057526.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Humanos , Articulação do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Resultado do Tratamento , Traumatismos do Joelho/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Zhongguo Gu Shang ; 36(12): 1159-64, 2023 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-38130225

RESUMO

OBJECTIVE: To explore application value and effectiveness of virtual reality technology combined with isokinetic muscle strength training in the rehabilitation of patients after anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Forty patients who underwent ACL reconstruction surgery from December 2021 to January 2023 were selected and divided into control group and observation group according to treatment methods, 20 patients in each group. Control group was received routine rehabilitation training combined with isokinetic muscle strength training, including 15 males and 5 females, aged from 17 to 44 years old, with an average of (29.10±8.60) years old. Observation group was performed virtual reality technology combined with isokinetic muscle strength training, including 16 males and 4 females, aged from 17 to 45 years old with an average of (30.95±9.11) years old. Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque between two groups at 12 (before training) and 16 weeks (after training) after surgery were compared. RESULTS: All patients were followed up for 1 to 6 months with an average of (3.30±1.42) months. There were no statistically significant difference in Lysholm knee joint score, peak knee extension peak torque, and peak knee flexion peak torque between two groups (P>0.05) before training. After training, Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque of both groups were improved compared to before training (P<0.05);there were significant difference in Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque between two groups(P<0.05). CONCLUSION: The application of virtual reality technology combined with isokinetic muscle strength training could promote recovery of knee joint function and enhance muscle strength in patients after ACL reconstruction surgery in further.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Treinamento de Força , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Lesões do Ligamento Cruzado Anterior/cirurgia , Articulação do Joelho/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Traumatismos do Joelho/cirurgia , Força Muscular/fisiologia
14.
J Orthop Surg Res ; 18(1): 835, 2023 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-37926844

RESUMO

BACKGROUND: Tension band wiring (TBW) has conventionally been used for the open reduction and internal fixation of the patella. However, it suffers from distinct disadvantages such as large incision, implant irritation, and need for subsequent implant removal. Here, we propose a novel technique using closed reduction and percutaneous fixation with three cannulated screws (TCS), which may be an alternative to this established conventional technique. Although some researchers have proposed alternative methods including closed reduction and cannulated screw fixation, with or without additional wires through the screws, and arthroscopic-assisted reduction and fixation, there are few studies that focus on the biomechanical stability of percutaneous fixation using only cannulated screws. Thus, the purpose of this study was to evaluate TCS versus TBW for simple transverse patellar fractures in cadaveric and patients' level, aiming to determine whether TCS show superiority over TBW in terms of biomechanical stability in a cadaveric study with benign clinical feasibility and outcomes in patients. METHODS: We conducted a cadaveric study with 15 knee specimens that had simple transverse patellar fractures. We used two fixation techniques: TBW (group A, n = 6) and TCS (group B, n = 9). We applied sinusoidal forces (25 N-125 N) at 1/5 Hz and 90° knee flexion to simulate knee movement. We compared the displacements at the fracture site between the two groups. We also used the same technique in a total of 23 patients and followed up them for at least 1 year. RESULTS: TCS demonstrated favourable biomechanical stability in the cadaveric study. The technique also performed excellently in terms of postoperative pain, knee function recovery, and complication rates during the follow-up period. CONCLUSIONS: The technique provides a surgical treatment option with small incisions, minimal soft tissue irritation, and possibly lower removal rate of bothersome material.


Assuntos
Fraturas Ósseas , Traumatismos do Joelho , Humanos , Fraturas Ósseas/cirurgia , Fixação Interna de Fraturas/métodos , Parafusos Ósseos , Fios Ortopédicos , Patela/cirurgia , Traumatismos do Joelho/cirurgia , Cadáver
15.
BMC Musculoskelet Disord ; 24(1): 871, 2023 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-37946171

RESUMO

BACKGROUND: Patellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management. METHODS: In a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines. RESULTS: A total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p < 0.043). The incidence of posttraumatic infection was significantly higher following the hybrid fixation technique with cannulated screws and tension wire than following the other analysed techniques (p = 0.024). No postoperative wound infection was observed after screw fixation or locking plate fixation. Symptomatic hardware was most frequently seen after tension-band fixation. Onset of posttraumatic osteoarthritis was most often found after the hybrid fixation technique (55%). CONCLUSION: Surgical management of patellar fractures remains crucial but fracture fixation using plating systems or small fragment screws is least associated with postoperative complications. TRIAL REGISTRATION: Trial registration number (DRKS):00027894.


Assuntos
Fraturas Ósseas , Traumatismos do Joelho , Osteoartrite , Humanos , Estudos Retrospectivos , Incidência , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fios Ortopédicos , Patela/diagnóstico por imagem , Patela/cirurgia , Patela/lesões , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
16.
Ortop Traumatol Rehabil ; 25(4): 219-227, 2023 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-37947146

RESUMO

The incidence of anterior cruciate ligament (ACL) injuries in children and adolescents has been growing recently. This problem is a challenge for the treating orthopedic surgeon, especially when the patient is in the prepubertal period with a high growth potential. Since reconstructive procedures require interventions close to active growth plates, they are associated with the risk of postoperative limb length discrepancies and limb deformities. Postponing ACL reconstruction until the end of growth is not a solution, as persistent knee instability increases the risk of secondary intra-articular damage. The key to success is not only knowledge of the anatomy and biomechanics of the pediatric knee but also the ability to predict the remaining growth potential and familiarity with a wide range of reconstructive surgical procedures available for patients at different ages.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Adolescente , Humanos , Criança , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Articulação do Joelho/cirurgia , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/epidemiologia , Reconstrução do Ligamento Cruzado Anterior/métodos
17.
Injury ; 54(12): 111133, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37922834

RESUMO

INTRODUCTION: Posterolateral corner (PLC) injuries constitute 16 % of all knee ligament injuries and are often seen with other ligamentous injuries. PLC injuries can be overlooked. If left untreated, other ligamentous reconstructions are at risk, residual laxity may occur, and early osteoarthritis may result. MATERIALS AND METHODS: Patients diagnosed with PLC injury and who underwent surgical treatment between November 2018 and November 2022 were retrospectively analyzed. Two groups were formed 44 PLC patients with a concomitant ligament injury and 50 patients with an isolated ACL injury (control group). Preoperative MRI findings and arthroscopic surgery findings of the patients were evaluated. Medial femoral condyle notching sign (MFNS) and lateral femoral condyle notching sign (LFNS) data were obtained from preoperative MRI sections. If the lesion depth was less than 1.5 mm, it was not considered a notching sign. RESULTS: In group 1, there were 44 patients with PLC injuries accompanied by other ligamentous injuries. In group 2, there were 50 patients with isolated ACL injuries not accompanied by other ligamentous injuries. Medial femoral notching sign (MFNS) was higher in Group 1 (p < 0.00001). The lateral femoral notching sign (LFNS) was higher in Group 2 (p:0.023). CONCLUSION: PLC injuries are difficult to diagnose. MFNS is a finding that may facilitate diagnosis in PLC injuries.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Humanos , Estudos Retrospectivos , Articulação do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/patologia , Fêmur/patologia
18.
Am J Sports Med ; 51(14): 3706-3713, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37924211

RESUMO

BACKGROUND: Meniscal injuries are extremely common. Several anatomic features of the knee, including the tibial plateau morphology, have been shown to influence knee biomechanics and the risk of ligamentous injuries. Little is known, however, how these morphological features influence the risk of isolated meniscal injuries in the anterior cruciate ligament (ACL)-intact knee. HYPOTHESIS: There are differences in the slopes and concavity of the tibial plateau between patients with isolated meniscal tears and matched uninjured controls. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: In total, 89 patients with first-instance isolated medial (n = 37) or lateral (n = 52) meniscal injuries requiring surgical treatment (mean age, 16 ± 1 years; 35% female) were matched to 89 controls with uninjured knees and no previous injuries (mean age, 16 ± 2 years; 35% female) based on age and sex. Magnetic resonance imaging scans (preoperative for injured group) were used to measure the coronal slope of the tibial plateau, posterior slope of the medial and lateral tibial plateaus, and maximum depth of the medial tibial plateau. General linear models were used to evaluate the differences in tibial plateau morphology between the knees with and without meniscal injuries, with and without adjustment for age and sex. RESULTS: Compared with matched controls, patients with surgically treated isolated meniscal tears had a smaller lateral tibial slope (by 2.2° [medial meniscal injury] and 1.6° [lateral meniscal injury]; P < .02), a smaller medial tibial slope (by 2.3° [medial meniscal injury] and 2.4° [lateral meniscal injury]; P < .001) and a larger medial tibial depth (by 0.8 mm [medial meniscal injury] and 0.9 mm [lateral meniscal injury]; P < .001). There were no differences in coronal tibial slope between the injured and uninjured groups. There were no differences in quantified anatomic features between the isolated medial and lateral meniscal injury groups. The same trends were observed after adjusting for age and sex. CONCLUSION: This study suggests that patients with an isolated meniscal tear requiring surgery have a smaller posterior tibial slope and a larger medial tibial depth (more concave medial tibial plateau) than matched uninjured controls. This is contrary to what is known for ACL tears, in which a steeper posterior tibial slope and a shallower medial tibial depth have been associated with an increased risk of ACL tear.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Humanos , Feminino , Adolescente , Masculino , Estudos de Coortes , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Tíbia/anatomia & histologia , Ligamento Cruzado Anterior/cirurgia , Articulação do Joelho/cirurgia , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Imageamento por Ressonância Magnética , Estudos Retrospectivos
19.
J Pak Med Assoc ; 73(11): 2257-2259, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38013541

RESUMO

The majority of meniscal tears in bucket handles are associated with anterior cruciate ligament (ACL) impairment. Its a rare condition which is rarely encountered when the meniscus has a bucket handle on both sides of the compartment. Here we present the case of a 28-year- old male cricket player with a total ACL rupture, a double Posterior Cruciate ligament (PCL) sign on MRI (Magnetic Resonance Imaging), an uncommon occurrence of a complex bucket handle rupture of the medial meniscus with a double PCL sign. It was a complete ACL tear and displaced bucket handle medial meniscus that was also visible on the magnetic resonance imaging. In this report, double PCL sign was shown on MRI and that was confirmed during the arthroscopic procedure.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Lesões do Menisco Tibial , Humanos , Masculino , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Artroscopia/métodos , Ligamento Cruzado Anterior/cirurgia , Meniscos Tibiais/patologia , Meniscos Tibiais/cirurgia , Traumatismos do Joelho/cirurgia , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Lesões do Menisco Tibial/complicações , Imageamento por Ressonância Magnética/métodos , Estudos Retrospectivos
20.
Arthroscopy ; 39(12): 2499-2501, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37981390

RESUMO

With the improved recognition of meniscal root tears over the past decade, it has become clear that root repairs are necessary in most patients indicated for a repair to prevent the further progression of osteoarthritis. Root repairs are cost beneficial to and prevent the early need for a total knee arthroplasty. As further postoperative follow-up occurs for root repairs, we have found that most patients have significantly improved patient-reported outcomes, while it is still clear that further clinical outcome study as well as further refinement of surgical technique is necessary. The next thing that we have to investigate is how to prevent recurrent meniscal extrusion after a root repair. Nonanatomic repair significantly alters tibiofemoral biomechanics and results in notably increased meniscal extrusion. In contrast, biomechanical studies show anatomic repair of the meniscus attachment within 1 cm of the meniscus attachment site restores joint loading close to normal.


Assuntos
Artroplastia do Joelho , Doenças das Cartilagens , Traumatismos do Joelho , Menisco , Lesões do Menisco Tibial , Humanos , Meniscos Tibiais/cirurgia , Lesões do Menisco Tibial/cirurgia , Menisco/cirurgia , Doenças das Cartilagens/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia
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