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1.
J Athl Train ; 56(10): 1132-1136, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34662420

RESUMO

We outline a case of success in the rehabilitation of a Romanian first-division soccer player who sustained an anterior cruciate ligament (ACL) rupture with a meniscal tear during competition in the 2012-2013 season. The ligament was reconstructed with an autologous hamstrings graft and partial meniscectomy was performed. The player returned to same-level competition in 7 months and has remained at that level, free of knee injury, to the present (6 years later). Based on postoperative phase 1 as proposed by the Royal Dutch Society for Physical Therapy, we proposed a clinical progression of exercises with video demonstrations to address body functions and structures and the level of activities and participation. All phase 1 objectives were achieved, and all criteria needed to advance to phase 2 of the ACL rehabilitation process were attained.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Futebol , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Meniscectomia
2.
Am J Sports Med ; 49(13): 3561-3568, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34612705

RESUMO

BACKGROUND: Patient-reported outcomes (PROs) measure progression and quality of care. While legacy PROs such as the International Knee Documentation Committee (IKDC) survey are well-validated, a lengthy PRO creates a time burden on patients, decreasing adherence. In recent years, PROs such as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function and Pain Interference surveys were developed as computer adaptive tests, reducing time to completion. Previous studies have examined correlation between legacy PROs and PROMIS; however, no studies have developed effective prediction models utilizing PROMIS to create an IKDC index. While the IKDC is the standard knee PRO, computer adaptive PROs offer numerous practical advantages. PURPOSE: To develop a nonlinear predictive model utilizing PROMIS Physical Function and Pain Interference to estimate IKDC survey scores and examine algorithm sensitivity and validity. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: The MOTION (Military Orthopaedics Tracking Injuries and Outcomes Network) database is a prospectively collected repository of PROs and intraoperative variables. Patients undergoing knee surgery completed the IKDC and PROMIS surveys at varying time points. Nonlinear multivariable predictive models using Gaussian and beta distributions were created to establish an IKDC index score, which was then validated using leave-one-out techniques and minimal clinically important difference analysis. RESULTS: A total of 1011 patients completed the IKDC and PROMIS Physical Function and Pain Interference, providing 1618 complete observations. The algorithms for the Gaussian and beta distribution were validated to predict the IKDC (Pearson = 0.84-0.86; R2 = 0.71-0.74; root mean square error = 9.3-10.0). CONCLUSION: The publicly available predictive models can approximate the IKDC score. The results can be used to compare PROMIS Physical Function and Pain Interference against historical IKDC scores by creating an IKDC index score. Serial use of the IKDC index allows for a lower minimal clinically important difference than the conventional IKDC. PROMIS can be substituted to reduce patient burden, increase completion rates, and produce orthopaedic-specific survey analogs.


Assuntos
Traumatismos do Joelho , Estudos de Coortes , Documentação , Humanos , Joelho , Traumatismos do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente
3.
Am J Sports Med ; 49(13): 3479-3487, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34623936

RESUMO

BACKGROUND: A new anterior cruciate ligament (ACL) injury after ACL reconstruction is a feared outcome. PURPOSE: To study the risk of new knee injuries in female soccer players 5 to 10 years after primary unilateral ACL reconstruction and to compare players who returned to soccer with (1) players who did not return and (2) knee-healthy soccer players (controls). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Demographic, soccer-specific, and surgical data were recorded at baseline for 317 female soccer players (mean ± SD age, 20.1 ± 2.7 years) 1.6 ± 0.7 years after ACL reconstruction and for 119 matched controls (mean age, 19.5 ± 2.5 years). Data on new knee injuries and soccer-playing status were collected 5 to 10 years after ACL reconstruction via a questionnaire. RESULTS: Among players with ACL reconstruction, 222 (70%) responded at a mean 6.5 ± 1.0 years after primary ACL reconstruction. We compared 3 cohorts: (1) among 163 players with ACL reconstruction who returned to soccer, 68 (42%) sustained 44 reruptures and 29 contralateral ruptures; (2) among 59 players with ACL reconstruction who did not return to soccer, 11 (19%) sustained 9 reruptures and 2 contralateral ruptures; and (3) among 113 knee-healthy controls, 12 (11%) sustained 13 ACL injuries. Players who returned had a >2-fold higher risk of a new ACL injury than players who did not return (risk ratio, 2.24; 95% CI, 1.27-3.93; P = .005) and a 4-fold higher risk than controls (risk ratio, 3.93; 95% CI, 2.23-6.91; P <.001). A new ACL, meniscal, or cartilage injury was the most frequent new knee injury. Among players who returned to soccer, 68% reported a new knee injury, and they had a 2- to 5-times higher risk of any new knee injury and knee surgery than players who did not return and controls. CONCLUSION: Two-thirds of female soccer players with ACL reconstruction who returned to soccer sustained a new knee injury within 5 to 10 years; 42% had a new ACL injury. Their risk of a new knee injury and knee surgery was 2 to 5 times greater than that for players who did not return and for knee-healthy controls. New injury may have negative consequences for long-term knee health and should be a critical consideration in the decision to return to play.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Futebol , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/cirurgia , Volta ao Esporte , Adulto Jovem
4.
Acta Orthop Belg ; 87(2): 359-365, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34529393

RESUMO

Medial Collateral Ligament (MCL) injury may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. While good results have been reported using the Marx technique, some issues have been observed. To address the mentioned issues, a modification to the Marx technique has been devised. Eleven patients were enrolled and their ligaments were repaired by the fixation of allograft on the proximal and distal attachment footprints of the superficial MCL. For preventing loss of knee ROM, MCL and other ligaments were reconstructed in 2 separate stages. At the last follow up the ROM, knee ligament laxity and functional outcome scores, subjective (IKDC) and Lysholm score were evaluated and recorded. Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degrees of knee flexion. Both were treated for combined MCL and PCL tear, the rest were stable. The average IKDC-subjective score was 93 ± 4 and the average Lysholm score was 92 ± 3. All patients were satisfied and returned to their previous level of activity. In this technique, the superficial MCL was recon- structed closer to its anatomical construct. Patients didn't have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Patients didn't have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Also reconstructing the ligaments in 2 stages helped to preserve the knee motion. Level of Evidence : Level IV therapeutic.


Assuntos
Instabilidade Articular , Traumatismos do Joelho , Ligamento Colateral Médio do Joelho , Aloenxertos , Ligamento Cruzado Anterior , Seguimentos , Humanos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Ligamento Colateral Médio do Joelho/cirurgia , Resultado do Tratamento
5.
Clin Sports Med ; 40(4): 657-675, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509204

RESUMO

Preoperative and postoperative imaging of knee ligament injury hinges on the appropriate use of available modalities. Knowledge of injury patterns as well as the surgical significance of certain image findings enhances injury detection and supports appropriate preoperative planning. The radiologist must be familiar with the strengths and weaknesses of each modality for evaluating specific aspects of ligamentous pathology. This article focuses on preoperative and postoperative imaging of knee ligament injury. Basic topics pertaining to preoperative image modality selection and isolated injury detection are addressed. More advanced areas including ligamentous injury patterns, surgical indications, and postoperative imaging are also discussed.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Ligamentos Articulares , Lesões dos Tecidos Moles , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/cirurgia , Imageamento por Ressonância Magnética , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/cirurgia
6.
Medicine (Baltimore) ; 100(38): e27316, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34559148

RESUMO

ABSTRACT: To summarize the surgical technique and clinical effects of the extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI involving the posterolateral column tibial plateau.From January 2015 through December 2018, 28 patients with tibial plateau fractures involving the posterolateral column were included in the study. Among them, 16 patients were Schatzker type II treated using an extended anterolateral approach with lateral tibial locking compression plate fixation. Twelve patients were Schatzker type V or VI treated using an extended anterolateral combined with a medial approach using lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15 to 31 months, with an average follow-up of 22.5 ±â€Š3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Knee Surgery score and the range of motion were used to evaluate knee function. Additionally, the Lachman and knee Valgus (Varus) stress tests were used to evaluate anteroposterior and lateral stability of the knee.All fractures healed. At the 12-month follow-up, the Schatzker type II group revealed a mean TPA of 86.38 ±â€Š3.92°, a mean PA of 7.43 ±â€Š2.68°, and a mean Rasmussen radiological score of 16.00 ±â€Š2.06 points. The Schatzker type V/VI group showed a mean TPA of 84.91 ±â€Š3.51°, a mean PA of 9.68 ±â€Š4.01°, and a mean Rasmussen radiological score of 15.33 ±â€Š2.99 points. During the 1-year follow-up, when the postoperative PA was re-measured, the TPA and Rasmussen score of the 2 groups did not change significantly (P > .05). At the last follow-up, the Schatzker type II group showed a knee flexion angle of 110° to 135° and a mean HHS score of 88.37 ±â€Š10.01 points. The Schatzker type V/VI group revealed a knee flexion angle of 100° to 130° and a mean HHS score of 82.17 ±â€Š10.76 points. Additionally, up to the last follow-up, the Lachman and knee Valgus (Varus) stress test results of the 2 groups were negative. No complications were found.The extended anterolateral approach is a good choice to treat tibial plateau fractures involving the posterolateral column.


Assuntos
Fixação Interna de Fraturas/métodos , Traumatismos do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Idoso , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico por imagem
8.
Rev. bras. ortop ; 56(4): 533-536, July-Aug. 2021. graf
Artigo em Inglês | LILACS | ID: biblio-1341172

RESUMO

Abstract A deviated osteochondral fracture of the anterolateral tibia associated with fibular head avulsion in a 50-year-old patient is reported. In general, avulsion fracture of the iliotibial tract is associated with injuries in the cruciate ligament, in the meniscus and in lateral knee structures, as in the case herein reported.


Resumo Uma fratura osteocondral desviada da tíbia anterolateral associada a avulsão da cabeça da fíbula em um paciente de 50 anos é relatada. A fratura avulsão do trato iliotibial em geral está associada lesões do ligamento cruzado, do menisco, e das estruturas laterais do joelho, como no caso em questão.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Tíbia , Fraturas do Fêmur , Traumatismos do Joelho/cirurgia
9.
Injury ; 52(10): 3091-3098, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34275642

RESUMO

PURPOSE: Floating knee injuries are complex high velocity injuries with a simultaneous breach of skeletal integrity both above and below the knee joint. Intraarticular fractures, severe comminution, soft tissue insult, associated other skeletal and systemic injuries have been the most common factors influencing the outcome. With our previous experience we framed a conglomerated comprehensive classification, which includes important prognosticating factors that influences the outcome. Aim of this study is to analyse the efficacy of this classification system for floating knee injury by studying the duration of hospitalisation, number of procedures required for completion of treatment, prognosticating functional outcomes and complications. METHODS: This classification is a conglomeration of the existing standard classifications (Fraser, AO, Gustilo and Andersons) along with modifiers like disruption of exensor mechanism M1, avulsion fractures around knee M2 and fractures around hip and ankle joints M3. This classification system was applied to all FKI cases presented to our institution between 2015 and 2018, it has 4 types, 3 subtypes and 3 modifiers. 92 cases were prospectively analysed, the standard treatment protocol was followed as per flowchart, only stable and borderline stable patients were included, functional outcome and recovery of these patients was assessed using modified Karlstrom and Olerud scoring after fracture union. Demographic data, duration of hospitalisation, number of procedures required for completion of treatment, functional outcomes and complications were collected and statistical analysis was done. RESULTS: Statistical Analysis showed significant difference between groups I and IV of conglomerated comprehensive classification in the number of days of hospitalisation and number of procedures with p value 0.006 and 0.018 respectively. CONCLUSION: Conglomerated comprehensive classification using prognostic factors and existing standard classifications enables better prognostication of these complex floating knee injuries. Identifing and addressing these factors and modifiers included in this classification system will surely improve the outcome. A multicentric study will validate this classifaction in a better way.


Assuntos
Fraturas do Fêmur , Traumatismos do Joelho , Fraturas da Tíbia , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
10.
J Am Acad Orthop Surg ; 29(21): 910-919, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34293795

RESUMO

Articular cartilage injuries of the knee are being observed with increasing frequency in athletes and have proven to be difficult to treat given the limited regenerative ability of cartilage and the potential for progressive joint degeneration. A wide range of surgical treatments such as microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft have demonstrated promising results in these high-demand individuals. These procedures permit healing of cartilage defects while decreasing pain and restoring function with patient-reported outcomes demonstrating significant improvement at short-, mid-, and long-term follow-up. Most athletes are able to return to play after cartilage restoration of the knee, regardless of the surgical technique used. Although there is a large degree of heterogeneity across the literature and no consensus as to the optimal technique, osteochondral autograft transfer seems to offer the highest rate of return to sport and return to play at preinjury level. However, autologous chondrocyte implantation and osteochondral allograft transplantation are often used for larger defects or salvage after previous procedures, so results may be confounded. In addition, a multitude of factors including patient history, characteristics of the chondral lesion, and postoperative management may affect functional outcomes in athletes.


Assuntos
Cartilagem Articular , Traumatismos do Joelho , Atletas , Cartilagem Articular/cirurgia , Condrócitos , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Volta ao Esporte , Transplante Autólogo
11.
Rev Med Suisse ; 17(745): 1301-1309, 2021 Jul 14.
Artigo em Francês | MEDLINE | ID: mdl-34264032

RESUMO

The menisci have several important biomechanical functions. Traumatic meniscal injuries present a wide spectrum of presentation and several types of lesions. They can concern the body of the meniscus and its fixation. An easy and clear classification of traumatic meniscus tears is essential for helping the physicians to achieve the correct surgical indication and the accurate postoperative rehabilitation protocol. The aim of this current concept review is to clearly describe some classical as well new type of meniscal and menisco-synovial lesions such as ramp lesions, root tears and instability of the lateral meniscus associated to rotational laxity. The goal is to focus on the definition, diagnosis, classification, giving some guidelines and discussing the different rehabilitation protocols.


Assuntos
Doenças das Cartilagens , Traumatismos do Joelho , Lesões do Menisco Tibial , Artroscopia , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/cirurgia , Meniscos Tibiais , Lesões do Menisco Tibial/diagnóstico , Lesões do Menisco Tibial/cirurgia
12.
J Orthop Trauma ; 35(Suppl 2): S36-S37, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34227604

RESUMO

SUMMARY: This video depicts the materials and steps for the repair of a Schenck classification knee dislocation IV multiligamentous injury and peroneal nerve palsy. The patient had bilateral injuries after a car pinned him to a garage in his cabinet. The video demonstrates primary repair of the avulsions of the right knee with acute repair of anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and posterior lateral corner in the patient.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamentos Colaterais , Luxação do Joelho , Traumatismos do Joelho , Ligamento Cruzado Posterior , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Luxação do Joelho/diagnóstico por imagem , Luxação do Joelho/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Masculino , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia
14.
Int J Mol Sci ; 22(13)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34281202

RESUMO

Autologous chondrocyte implantation (ACI) is a cell therapy for the treatment of focal cartilage defects. The ACI product that is currently approved for use in the European Union (EU) consists of spheroids of autologous matrix-associated chondrocytes. These spheroids are spherical aggregates of ex vivo expanded human autologous chondrocytes and their self-synthesized extracellular matrix. The aim is to provide an overview of the preclinical and nonclinical studies that have been performed to ensure reproducible quality, safety, and efficacy of the cell therapy, and to evaluate the clinical data on ACI with spheroids. A systematic review was performed to include all English publications on self-aggregated spheroids of chondrocytes cultured in autologous serum without other supplements. A total of 20 publications were included, 7 pre- and nonclinical and 13 clinical research publications. The pre- and nonclinical research publications describe the development from concept to in vivo efficacy and quality- and safety-related aspects such as biodistribution, tumorigenicity, genetic stability, and potency. The evaluation of clinical research shows short- to mid-term safety and efficacy for the ACI with spheroid-based treatment of cartilage defects in both randomized clinical trials with selected patients, as well as in routine treatment providing real-world data in more complex patients.


Assuntos
Condrócitos/transplante , Animais , Doenças das Cartilagens/cirurgia , Doenças das Cartilagens/terapia , Cartilagem Articular/cirurgia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Condrócitos/citologia , Condrócitos/metabolismo , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Humanos , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/terapia , Articulação do Joelho/metabolismo , Articulação do Joelho/patologia , Procedimentos Ortopédicos/métodos , Osteoartrite do Joelho/metabolismo , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/terapia , Esferoides Celulares , Transplante Autólogo
15.
J Plast Reconstr Aesthet Surg ; 74(10): 2776-2820, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34229957

RESUMO

Common peroneal nerve (CPN) injury is a recognised complication of traumatic knee dislocation with a direct association between the degree of ligamentous injury and the degree of CPN injury. It is essential explore and repair these injuries in good time to reduce morbidity. Often exploration only involves the portion of this nerve associated with the joint as it courses around the fibular head. However, a recent case highlighted the importance of proximal exploration to its branching point from the sciatic nerve, a known point of fragility, even if other defects have been identified.


Assuntos
Luxação do Joelho/complicações , Traumatismos do Joelho/complicações , Procedimentos Neurocirúrgicos/métodos , Traumatismos dos Nervos Periféricos , Nervo Fibular , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Traumatismos em Atletas/diagnóstico , Ciclismo , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/cirurgia , Masculino , Equipe de Assistência ao Paciente , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/lesões , Nervo Fibular/cirurgia , Tempo para o Tratamento , Índices de Gravidade do Trauma , Resultado do Tratamento
16.
Oper Orthop Traumatol ; 33(5): 445-455, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34081174

RESUMO

OBJECTIVE: Description of a reproducible surgical technique for single-bundle anterolateral reconstruction of the posterior cruciate ligament (PCL) based on a septum-sparing approach. This technique is less traumatic than the trans-septum approach. The article illustrates surgical steps to simplify the technical aspects of the procedure. INDICATIONS: A complete grade III symptomatic tear of the PCL associated with instability and often discomfort (deceleration, stairs) or subsequent gonalgia arising from the medial compartment or patellofemoral joint. Injury of the peripheral joint stabilizers alongside the PCL including the posterolateral corner or a complete medial knee injury. The procedure is indicated in chronic cases, but also in acute cases of posterior instability > 10 mm, if it is an intraligamentous tear with dislocated PCL stumps. CONTRAINDICATIONS: Bony avulsions of the PCL suitable for refixation, soft tissue compromise, infection, advanced osteoarthritic disease. SURGICAL TECHNIQUE: After diagnostic arthroscopy of the knee, the ipsilateral semitendinosus and gracilis tendons are harvested and prepared as a 6-strand graft for PCL reconstruction. One high anterolateral viewing portal, one low anterolateral portal, one anteromedial portal, and a posteromedial portal are used for single-bundle reconstruction via one femoral and one tibial bone tunnel and hybrid graft fixation. POSTOPERATIVE MANAGEMENT: Weight bearing is restricted to 20 kg for 6 weeks. PCL brace with tibial support for a period of 12 weeks. Flexion is limited to 30° in the first 2 postoperative weeks, then 60° for 2 weeks, and 90° for 2 further weeks. Passive flexion in prone position is performed. Active focused muscle strengthening exercise is begun after 6 weeks postoperatively and participation in competitive sports is not recommended before full muscle strength and coordination is re-established, at the earliest 9-12 months postoperatively. RESULTS: Two isolated and 19 combined PCL injuries were treated. Mean patient age was 27.4 years, and the minimal follow-up was 12 months. On average, we found good clinical outcome with slight degree of posterior laxity (4.1 mm) after PCL reconstruction in comparison with the contralateral knee. No patient showed signs of effusion at follow-up. Range of motion was fully restored in 19 of 21 patients. One patient suffered failure due to persistent posterior instability and persistence of symptoms.


Assuntos
Traumatismos do Joelho , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Adulto , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia , Resultado do Tratamento
17.
Acta Orthop Traumatol Turc ; 55(3): 271-276, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100370

RESUMO

Complex tibial plateau fractures in elderly patients exhibiting severe osteoporosis and articular surface collapse are challenging. Decision-making is difficult when the posterior column is involved. Open reduction and internal fixation of complex tibial plateau fractures in patients with severe osteoporosis are prone to failure. In this paper, we describe a new method for the maintenance of the articular surface of complex tibial plateau fractures in elderly patients. An anterior horizontal rafting plate (3.5-mm-thick reconstruction and locking plate [Zimmer Inc., Warsaw, IN, USA]) is placed via conventional posteromedial and anterolateral incisions. The plate is inserted between the anterior bony surface of the proximal tibia and the subpatellar fat pad; plate positioning is checked under direct vision. The patient is encouraged to begin functional recovery soon after operation. Progressive weight-bearing begins at 10 weeks postoperatively and is gradually increased during fracture healing. Clinical follow-up was performed at 4, 8, and 12 weeks, 6 and 12 months, and yearly thereafter. No articular collapse or fragment displacement was evident on three-dimensional computed tomography performed 6 months after surgery. The knee range of motion was 5-130º at the last follow-up (4 years after surgery). This technique may be a good option for treating complex tibial plateau fractures, especially in elderly patients with severe osteoporosis.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Traumatismos do Joelho , Articulação do Joelho/fisiopatologia , Fraturas por Osteoporose , Tíbia , Fraturas da Tíbia , Idoso , Deambulação Precoce/métodos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Processamento de Imagem Assistida por Computador/métodos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Tíbia/lesões , Tíbia/patologia , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Suporte de Carga
20.
J Orthop Traumatol ; 22(1): 23, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34152483

RESUMO

BACKGROUND: Matrix-induced autologous chondrocyte implantation (mACI) can be performed in a full arthroscopic or mini-open fashion. A systematic review was conducted to investigate whether arthroscopy provides better surgical outcomes compared with the mini-open approach for mACI in the knee at midterm follow-up. METHODS: This systematic review was conducted following the PRISMA guidelines. The literature search was performed in May 2021. All the prospective studies reporting outcomes after mACI chondral defects of the knee were accessed. Only studies that clearly stated the surgical approach (arthroscopic or mini-open) were included. Only studies reporting a follow-up longer than 12 months were eligible. Studies reporting data from combined surgeries were not eligible, nor were those combining mACI with less committed cells (e.g., mesenchymal stem cells). RESULTS: Sixteen studies were included, and 770 patients were retrieved: 421 in the arthroscopy group, 349 in the mini-open. The mean follow-up was 44.3 (12-60) months. No difference between the two groups was found in terms of mean duration of symptoms, age, body mass index (BMI), gender, defect size (P > 0.1). No difference was found in terms of Tegner Score (P = 0.3), Lysholm Score (P = 0.2), and International Knee Documentation Committee (IKDC) Score (P = 0.1). No difference was found in the rate of failures (P = 0.2) and revisions (P = 0.06). CONCLUSION: Arthroscopy and mini-arthrotomy approaches for mACI in knee achieve similar outcomes at midterm follow-up. LEVEL OF EVIDENCE: II, systematic review of prospective studies.


Assuntos
Condrócitos/transplante , Artroscopia , Doenças das Cartilagens/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Transplante Autólogo
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