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1.
BMC Musculoskelet Disord ; 23(1): 11, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980055

RESUMO

BACKGROUND: The plantar plate is an important static stabilizer of the lesser metatarsophalangeal joints, and disruptions of the plantar plate can lead to significant instability and lesser toe deformities. In recent years, direct plantar plate repair has been proposed. Although direct repair via a dorsal approach is attractive, a torn plantar plate is small and difficult to access using regular instruments in a restricted operative field. METHODS: In this report, a unique method for plantar plate repairs was used to repair various configurations of plantar plate tears with standard operative instruments that are available in most operating rooms. RESULTS: Using this method, 10 patients underwent plantar plate repairs, and the mean follow-up period was 24 (range, 14-38) months. The mean visual analog scale score for pain preoperatively was 4.1 (range, 0-6) and decreased to 0.6 (range, 0-3) at last follow-up. Postoperatively, the mean visual analog scale score for satisfaction was 9.6 (range, 8-10) and the mean American Orthopedic Foot and Ankle Society forefoot score was 88.8 (range, 75-100). CONCLUSIONS: Our study proposes an inexpensive and versatile method for plantar plate repair via a dorsal approach that uses standard operative instruments. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04949685 . July 2, 2021 - Retrospectively registered, LEVEL OF CLINICAL EVIDENCE: 4.


Assuntos
Deformidades do Pé , Instabilidade Articular , Articulação Metatarsofalângica , Placa Plantar , Humanos , Osteotomia , Placa Plantar/cirurgia
2.
BMC Musculoskelet Disord ; 23(1): 12, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980078

RESUMO

BACKGROUND: Seizure predisposes patients to shoulder dislocation. However, there is no consensus regarding the best management approach for recurrent shoulder dislocation in patients who have a history of seizures. In this study, we report the outcome of arthroscopic Bankart repair augmented by Remplissage for the recurrent anterior shoulder dislocation in a series of patients with a history of seizures. METHODS: In this retrospective study, 27 patients with 29 recurrent anterior shoulder dislocations who were treated with the arthroscopic Bankart repair were included. All cases had deep Hill-Sachs lesions according to Hardy classification that was managed with a Remplissage technique. Patients with a glenoid defect of more than 20% in the CT scan were excluded. Twenty-two patients had an epileptic seizure, while the remaining five patients had convulsions due to other causes. The mean age of the patients was 28.3 ± 6.2 years. The mean follow-up of the patients was 3.1 ± 1.2 years. Outcome measures included the shoulder range of motion that was compared with the non-injured side in the unilateral subjects and the shoulder function that was evaluated by the Rowe score and the Walch-Duplay score. RESULTS: The mean forward flexion, abduction, external rotation, and internal rotation were not significantly different between injured and non-injured shoulder (p = 0.34, p = 0.41, p = 0.11, p = 0.23). The mean Rowe score was 49.1 ± 7.8 before the surgery and 92.1 ± 6.4 at the last visit (p < 0.001). According to the Walch-Duplay score, the shoulders were categorized as excellent, good, and fair in 17 (58.7%), 11 (37.9%), and 1 (3.4%) shoulder, respectively. The overall rate of instability recurrence was 17.2% (n = 5). CONCLUSION: In patients with a history of seizures, arthroscopic Bankart repair augmented by Remplissage could be regarded as a safe and efficient method for the treatment of recurrent anterior shoulder dislocation with glenoid defect < 20%.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Adulto , Artroscopia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Amplitude de Movimento Articular , Recidiva , Estudos Retrospectivos , Convulsões/diagnóstico por imagem , Convulsões/cirurgia , Ombro , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Adulto Jovem
3.
BMC Musculoskelet Disord ; 23(1): 28, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983476

RESUMO

PURPOSE: The Brostrom-Gould procedure is currently the gold standard surgical choice for the treatment of chronic ankle instability; it can significantly improve ankle function and stability in patients. However, recent studies have reported doubts regarding the feasibility of the inferior extensor retinaculum (IER) after Brostrom-Gould and therapeutic effects compared with the Brostrom procedure. The purpose of the present study was to observe the anatomical characteristics of the lateral part of the IER using cadaveric bodies in order to guide the surgical operation of chronic ankle instability. METHODS: Twenty-three cadaveric ankles were dissected. The morphology of the IER and its internal structure was observed and recorded for each ankle. The shortest distance between the Stem ligament of the IER and the anterior fibular periosteum (AFP) was measured and recorded, then attempts were made to suture the Stem to the AFP. RESULTS: Twelve of the cadaveric ankles were observed as having an oblique superolateral band (OSLB) that had a tough texture upward of the lateral IER connecting with SL, as are the characteristics of the oblique superolateral band (OSLB) reported in previous studies. The inner and outer membrane of the OSLB were connected with inner and outer membrane of Stem. The average value of the distance between the Stem and AFP was 11.60 ± 2.71 mm, and the maximum and the minimum distance were 19.04 mm and 6.53 mm, respectively. The P -value (P = 0.2) resulting from a single sample K-S test confirmed that the distribution of distances conformed to normality. None of the SL in the study could be sutured to the AFP. CONCLUSION: The OSLB of the IER has a tough texture and connects with the Stem, and has the potential be utilised in the Brostrom-Gould procedure. However, we do not recommend utilization of the Stem in this operation regardless of the distance between the AFP and the Stem. When the Stem cannot be used to enhance repair in this operation, other solutions can be used for strengthening and to protect the repaired ATFL.


Assuntos
Instabilidade Articular , Ligamentos Laterais do Tornozelo , Tornozelo , Articulação do Tornozelo/cirurgia , Humanos , Instabilidade Articular/cirurgia , Ligamentos
4.
Arthroscopy ; 38(1): 125-127, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34972553

RESUMO

Lateral extra-articular tenodesis and other anterolateral procedures improve patient outcomes when combined with anterior cruciate ligament reconstruction. Failure rates are >50% lower in young patients at high risk of reinjury. We defined patients at high risk as those aged 14 to 25 years with 2 or more factors of the following criteria: 1) returning to contact pivoting sport, 2) high-grade anterolateral rotatory laxity, as measured by pivot shift test (grade 2 or higher), and 3) generalized ligamentous laxity (Beighton score greater than 4) or knee hyperextension recurvatum of greater than 10°. Other indications may include Segond fracture, chronic anterior cruciate ligament lesion, radiographic lateral femoral notch sign, and lateral coronal plane laxity. A clearer understanding of indications determined by a comprehensive clinical assessment and risk stratification is needed. As indications continue to be "stretched," we need to better understand the role of lateral extra-articular tenodesis and when to employ it in our practice.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Tenodese , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia
5.
Arthroscopy ; 38(1): 28-30, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34972556

RESUMO

The optimal management of anterior shoulder instability remains a heated topic of debate, particularly after first-time shoulder dislocation. From expedited rehabilitation to arthroscopic Bankart repair and Latarjet coracoid transfer, the shoulder community has staunchly defended its approach with carefully tailored data describing patient satisfaction, instability recurrence, revision surgery, and timeline to return to play or preinjury activity. However, not all patients require surgical stabilization, and a "wait-and-see" approach can often result in favorable outcome. The Nonoperative Instability Severity Index Score has been proposed as a unique tool to stratify risk for failure among athletes after an anterior shoulder instability event. While not a standalone tool for predicting further shoulder dislocation in a broader athletic population, the Nonoperative Instability Severity Index Score reflects a movement toward personalized medicine, where clinical decision making is executed on the individual level based on unique risk factors and circumstances.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia , Humanos , Instabilidade Articular/cirurgia , Recidiva , Ombro , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia
6.
J Orthop Traumatol ; 23(1): 5, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34997890

RESUMO

BACKGROUND: Large Hill-Sachs lesions are considered a risk factor for recurrence of instability after arthroscopic Bankart repair alone. The aim of this study was to demonstrate that remplissage is a safe procedure that effectively reduces the risk of recurrent dislocations without causing fatty degeneration of the infraspinatus at medium-term follow-up. METHODS: Patients who underwent arthroscopic Bankart repair and remplissage with a minimum 3 years of follow-up were included. Constant-Murley (CMS), American Shoulder and Elbow Surgeons (ASES), and Walch-Duplay scores were evaluated. Magnetic resonance imaging (MRI) was performed to detect the appearance of fatty infiltration inside the infraspinatus muscle, the percentage of the Hill-Sachs lesion filled by the tendon and its integration, and the onset of rotator cuff tears. RESULTS: Thirteen patients (14 shoulders) with a mean follow-up of 55.93 (± 18.16) months were enrolled. The Walch-Duplay score was 95.00 [87.25-100.00], with a return to sport rate of 100%. Both the CMS and the ASES indicated excellent results. The affected shoulders showed a statistically significant reduction in active external rotation both with the arm at the side (ER1) and with the arm at 90° of abduction (ER2) (p = 0.0005 and p = 0.0010, respectively). A reduction in infraspinatus isometric strength was found for both ER1 and ER2, but this reduction was only statistically relevant in ER2 (p = 0.0342). There was a traumatic recurrence of instability in two cases (14.28%). MRI evaluation demonstrated an absence of adipose infiltration in 50% of cases and only a minimal amount in the remaining 50%. In 12 cases (85.72%), the capsulotenodesis completely filled the lesion and good tendon-bone integration was observed. CONCLUSION: Arthroscopic remplissage provided successful clinical outcomes without fatty infiltration of the infraspinatus and with good healing of the tissues. The low risk of recurrence was associated with an objective limitation on active external rotation, but this did not influence the patients' daily or sports activities. LEVEL OF EVIDENCE: Cohort study, level of evidence 3.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia , Estudos de Coortes , Seguimentos , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Recidiva , Estudos Retrospectivos , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia
9.
Clin Sports Med ; 41(1): 1-13, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782067

RESUMO

Patellofemoral pain is one of the most common symptoms of patients presenting to sports medicine clinics. Obtaining a pertinent history and performing a thorough examination is crucial to identifying the subset of patients with instability who are most likely to benefit from surgical stabilization. A comprehensive radiographic work-up that includes standard radiographs and advanced imaging helps elucidate the diagnosis and provides crucial information for preoperative planning. This article reviews the evaluation, physical examination, and interpretation of radiographic imaging of patients with patellofemoral pain as an introduction to subsequent articles in this issue discussing surgical interventions.


Assuntos
Instabilidade Articular , Articulação Patelofemoral , Humanos , Patela/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Exame Físico , Radiografia
10.
Clin Sports Med ; 41(1): 109-121, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782068

RESUMO

Management of the patient with multiple risk factors for recurrent patellar instability is complex. Surgeons must possess familiarity with the anatomic risk factors that are associated with first time and recurrent instability events and weigh them in the patient's individualized surgical "menu" options for surgical patellar stabilization. Addressing individual risk factors, pairing imaging findings with physical examination, and thoughts on prioritizing risk factors to determine which should be prioritized for surgical correction are discussed.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/epidemiologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Recidiva , Fatores de Risco
11.
Clin Sports Med ; 41(1): 137-155, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782070

RESUMO

Cartilage defects of the patellofemoral joint are commonly found in association with patellar instability owing to abnormal biomechanics. Strategies to address chondral defects of the patellofemoral joint secondary to instability should first address causes of recurrent instability. Most patellofemoral chondral defects associated with instability are less than 2 cm2 and do not generally require intervention beyond chondroplasty. Larger defects of the patella and/or the trochlea can be repaired with osteochondral or surface cartilage repair.


Assuntos
Doenças das Cartilagens , Instabilidade Articular , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Patela/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia
12.
Clin Sports Med ; 41(1): 15-26, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782071

RESUMO

Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has evolved to include uniplanar and multiplanar osteotomies, which allows patient-specific treatment. With a careful understanding of the complex pathoanatomy, including osseous, soft tissue, and dynamic muscular factors, an appropriately designed tibial tubercle osteotomy (TTO) is an invaluable tool for the orthopedic surgeon to improve joint biomechanics and off-load articular injuries. Current techniques have improved TTO surgery to limit complications and produce reliably good results.


Assuntos
Instabilidade Articular , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Osteotomia , Patela , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/cirurgia
13.
Clin Sports Med ; 41(1): 157-169, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782072

RESUMO

Patellar instability is one of the most prevalent knee disorders, with dislocations occurring in 5 to 43 cases per 10,000 annually. Traumatic patellar dislocation can result in significant morbidity and is associated with patellofemoral chondral injuries and fractures, medial soft tissue disruption, pain, and reduced function, and can lead to patellofemoral osteoarthritis. Chronic and recurrent instability can lead to deformation and incompetence of the medial soft tissue stabilizers. Despite recent gains in understanding the pathoanatomy of this disorder, the management of patients with this condition is complex and remains enigmatic.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho , Ligamentos Articulares/cirurgia , Luxação Patelar/epidemiologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
14.
Clin Sports Med ; 41(1): 171-183, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782073

RESUMO

The lateral patellofemoral complex is an important stabilizer to medial and lateral displacement of the patella. Soft tissue abnormalities can range from pathologic tightness to laxity, presenting with symptoms related to patellar instability, anterior knee pain, or arthritis. Clinical evaluation should be performed to confirm patellar dislocation, assess the integrity of the lateral and medial soft tissues, and explore other pathoanatomic factors that may need to be addressed. Lateral retinacular lengthening is recommended over lateral release owing to the potential of iatrogenic medial instability with release, and a lateral patellofemoral ligament reconstruction can be performed to effectively treat medial instability.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Patela , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
15.
Clin Sports Med ; 41(1): 27-46, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782074

RESUMO

Rotational deformity is a less common cause of patellar instability than trochlear dysplasia and patella alta. In some cases, rotational deformity is the primary bony factor producing the instability and should be corrected surgically. More research is needed on what are normal values for femoral version and tibial torsion, as well as when the axial plane alignment needs to be corrected. Many tools can be used to evaluate the axial plane and surgeons should be familiar with each of them. Understanding the advantages and disadvantages of each site for osteotomy will help the surgeon choose the most appropriate osteotomy.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur/cirurgia , Humanos , Instabilidade Articular/cirurgia , Patela , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/cirurgia
16.
Clin Sports Med ; 41(1): 47-63, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782075

RESUMO

Valgus malalignment is an important risk factor in recurrent patella instability. This article explores the role of corrective osteotomy and discusses the various described methods both on the femoral and tibial sides of the joint. A detailed operative technique of medial closing wedge distal femoral osteotomy is included.


Assuntos
Geno Valgo , Instabilidade Articular , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Geno Valgo/diagnóstico por imagem , Geno Valgo/cirurgia , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteotomia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
17.
Clin Sports Med ; 41(1): 65-76, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782076

RESUMO

Patella alta is described as abnormally high-riding patella in relation to the femur, the trochlear groove, or the tibia with decreased bony stability. Patella alta represents an important predisposing factor for patellofemoral instability. Different measurement methods are used to define patella alta. Despite the clinical importance of patella alta, there is only limited consensus on cutoff values, indications for treatment, and ideal correction. In addition, the impact of patella alta on other risk factors for lateral patellar instability is significant. This must be considered when assessing clinical complaints and choosing the best individual treatment. Combined surgical interventions may be necessary.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Patela/diagnóstico por imagem , Patela/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Fatores de Risco
18.
Clin Sports Med ; 41(1): 77-88, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782077

RESUMO

When? Only patients with high-grade trochlear dysplasia types B and D, in which the prominence of the trochlea (supratrochlear spur) is over 5 mm, recurrent patellar dislocation, and maltracking. How? Sulcus deepening trochleoplasty: modifies the trochlear shape with a central groove and oblique medial and lateral facets; decreases the patellofemoral joint reaction force by reducing the trochlear prominence (spur); and reduces the tibial tubercle and the trochlear groove value by a proximal realignment. Pros: This procedure is highly effective in restoring patellofemoral stability and satisfying the patients. Cons: The patients must be aware of the risk of continuing residual pain and range-ofmotion limitation and that the development of patellofemoral osteoarthritis is not predictable.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Instabilidade Articular/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
19.
Clin Sports Med ; 41(1): 89-96, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782078

RESUMO

Medial patellofemoral ligament reconstruction is used increasingly to treat patellar instability. A number of different techniques have been described to perform this procedure. In this article, we review common pearls and pitfalls to medial patellofemoral ligament reconstruction, as well as tips for troubleshooting the procedure. A special emphasis is placed on femoral tunnel position and intraoperative adjustments that can be made to improve outcomes.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho , Ligamentos Articulares/cirurgia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
20.
J Sci Med Sport ; 25(1): 53-57, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34393051

RESUMO

OBJECTIVES: The purpose of this study was to identify the effects of reduced visual feedback via stroboscopic glasses on dynamic postural control among chronic ankle instability (CAI), lateral ankle sprain (LAS) coper and uninjured control participants. DESIGN: Controlled trial in a laboratory setting. METHODS: Twenty CAI patients, 20 copers, and 20 controls participated in this study. Each participant performed a single-leg hop stabilization test with eyes open (EO) and stroboscopic vision (SV). Two-way ANOVAs (group × condition) were used to examine the differences between group (CAI, coper, and control) and condition (EO and SV). RESULTS: There was a significant group by condition interaction for DPSI scores. CAI patients displayed increased DPSI scores with SV compared to EO (p < 0.01), and CAI patients had increased DPSI scores only with SV when compared with controls. All participants displayed decreased dynamic postural control under the SV condition compared to the EO condition (p < 0.01) regardless of ankle group. CONCLUSIONS: CAI patients rely more on visual feedback during dynamic postural control than copers and controls. However, they may not be as able to compensate for the disrupted visual feedback during a dynamic task. Regardless of ankle injury history, stroboscopic glasses could be cost-effective visual disruption devices during a dynamic balance task.


Assuntos
Retroalimentação Sensorial , Instabilidade Articular , Tornozelo , Articulação do Tornozelo , Humanos , Equilíbrio Postural
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