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1.
BMJ Case Rep ; 15(4)2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-35393276

RESUMO

We present a case report of a man in his 20s with osteochondritis dissecans of the talus, treated with autologous transplantation of a vascularised osteochondral flap. The patient with high level of activity presented to our orthopaedic outpatient department for progressive limping and pain, mainly related to sports. An osteochondritis dissecans grade IV of the medial talus was identified by MRI. A microvascular transfer of osteochondral tissue was performed successfully. At follow-up 1 year after surgery, the MRI examination revealed vital cartilage; the patient was free of pain and had returned to his previous level of activity.


Assuntos
Fraturas Intra-Articulares , Osteocondrite Dissecante , Osteocondrite , Tálus , Cartilagem , Humanos , Masculino , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/cirurgia , Dor , Tálus/diagnóstico por imagem , Tálus/cirurgia , Transplante Autólogo
2.
Foot (Edinb) ; 51: 101901, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35259580

RESUMO

INTRODUCTION: Freiberg's osteochondrosis is an uncommon cause of foot pain. Following a national survey circulated by the British Foot and Ankle Society it was found that no classification is used to guide surgical treatment. This study aimed to create a simple, reproducible CT based classification to preoperatively plan whether an osteotomy is required. METHODS: A retrospective review of 24 CT scans of new Freiberg's diseasediagnoses over a 10 year period was conducted. These images were assigned a study number and anonymised. The scans were then reviewed in their entirety by three independent specialists who determined whether an osteotomy would be of benefit. The sagittal CT slice that displayed the widest portion of proximal articular margin of the proximal phalanx was identified and divided the articular surface into 2 zones - plantar and dorsal and this formed the basis for our classification. These sagittal slices were then reviewed independently by two surgeons to determine if patients had disease in one or both zones and re-reviewed two weeks later to assess intra-observer reliability. RESULTS: All 24 cases involved the second metatarsal. From reviewing the sagittal CT slices, it was felt that 18 patients were suitable for osteotomy and 6 were suitable for debridement +/- arthroplasty alone. The current classification demonstrated that 18 patients had disease confined to zone 1 only and the remaining patients had disease in both zones. Inter-observer reliability assessment had 95.8% agreement (Krippendorff's Alpha 0.897). Intra-observer reliability was 100%. Correlation of those observed to have isolated zone 1 disease and suitability for osteotomy was absolute (Pearson r = 1). CONCLUSION: Dividing the metatarsal head into two zones on the widest sagittal slice of the CT scan offers an easy reproducible way to preoperatively plan surgical treatment for Freiberg's osteochondrosis. Patients with isolated zone 1 disease should be suitable for an osteotomy.


Assuntos
Ossos do Metatarso , Osteocondrite , Osteocondrose , Humanos , Ossos do Metatarso/cirurgia , Metatarso/anormalidades , Osteocondrite/congênito , Reprodutibilidade dos Testes
3.
Am J Sports Med ; 50(4): 977-983, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35142232

RESUMO

BACKGROUND: Inferior pole patellar sleeve fractures (PSFs) are rare injuries that occur in skeletally immature patients that may be missed or falsely diagnosed as an inferior pole fracture (IPF) or Sinding-Larsen-Johansson syndrome (SLJS). PURPOSE: The objective of this study was to evaluate and compare clinical and radiographic features of patients with PSF, IPF, and SLJS. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Retrospective review of skeletally immature patients diagnosed with PSF, IPF, and SLJS between 2011 and 2019 at a single urban academic center was performed. Chart and radiographic review was completed. Between-group differences were assessed using analysis of variance, Kruskal-Wallis test, and Fisher exact test, as appropriate to variable distributions. RESULTS: In total, 125 patients (82% male) were included, with a mean (SD) age of 10.7 (2) years (16 PSF, 51 IPF, 58 SLJS). There were no significant differences in patient characteristics between the 3 groups. One hundred percent of the patients with PSF (P < .001) and IPF (P < .001) had acute trauma, compared with 24% of patients with SLJS. Fewer patients with PSF had an intact straight leg raise (38%) compared with those with IPF (94%; P < .001) and SLJS (98%; P < .001). Fewer patients with SLJS had knee swelling (41%) compared with those with PSF (93%; P < .001) and IPF (94%; P < .001). More patients with PSF had knee effusion (81%) compared with those with IPF (37%; P = 0.011) and SLJS (3%; P < .001). More patients with SLJS were able to bear weight (88%) compared with those with IPF (12%; P < .001) and PSF (0; P < .001). Radiographically, compared with those with IPF and SLJS, patients with PSFs had increased mean prepatellar swelling (6.1 [P < .001] and 6.5 [P < .001] vs 12.9 mm), intra-articular effusion (6.1 [P = .014] and 4.9 [P = .001] vs 9.2 mm), maximum fragment size (26 [P = .004] and 17.7 [P < .001] vs 45.3 mm), and maximum fragment displacement (1.24 [P = .002] and 1.45 [P = .003] vs 13.30 mm), respectively. Compared with those with SLJS (1.10), patients with PSF (1.92; P < .001) and IPF (1.22; P < .001) had patella alta with higher mean Insall-Salvati ratios >1.2. CONCLUSION: Differences in clinical features such as ability to straight leg raise, knee swelling, knee effusion, ability to bear weight, and radiographic features, such as prepatellar swelling, intra-articular effusion, fragment displacement/size/shape/location, and patellar height, can all be helpful in recognizing rare pediatric inferior patellar pathology, thus increasing efficiency in indicating for higher-level imaging to reach a prompt diagnosis and provide appropriate treatment.


Assuntos
Fraturas Ósseas , Traumatismos do Joelho , Osteocondrite , Criança , Estudos Transversais , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Patela/diagnóstico por imagem , Patela/lesões
4.
J Foot Ankle Surg ; 61(1): 181-184, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34400091

RESUMO

Polyvinyl alcohol hydrogel synthetic cartilage implants are increasingly used to treat advanced Freiberg disease. We report a case with recurrence of symptoms within 6 weeks and required revision for fracture of the implant. We describe a revision technique with modified osteochondral bone graft to deal with the variables of revision surgery namely: the bone loss, collateral ligament insufficiency, and changes to the proximal phalanx articular surface. We describe a postoperative plan, recovery and a good outcome achieved in 12 month follow-up.


Assuntos
Cartilagem Articular , Osteocondrite , Humanos , Metatarso/anormalidades , Osteocondrite/congênito , Álcool de Polivinil
5.
Clin Podiatr Med Surg ; 39(1): 105-111, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809789

RESUMO

OCDs of the ankle are the third most common lesion in the body and a physician should include this in the differential while evaluating the pediatric population with the history of injury and/or pain in the ankle. Pain, stiffness, and swelling are the most common presenting complaints about the pediatric and adolescent patients with an OCD. Conservative treatment options should be attempted before attempting surgical intervention. Multiple surgical procedures exist to manage the lesion based on location, size, and other factors.


Assuntos
Osteocondrite Dissecante , Osteocondrite , Tálus , Adolescente , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Criança , Humanos , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/cirurgia , Tálus/diagnóstico por imagem , Tálus/cirurgia
7.
Eur J Med Res ; 26(1): 124, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666837

RESUMO

BACKGROUND: Talus osteochondral lesion is commonly associated with trauma, avascular necrosis or even genetic factors, but gouty tophus as a cause of Hepple stage V type talus osteochondral lesion is rare. CASE PRESENTATION: Here, we report a case of an 18-year-old man who complained of left medial deep ankle pain on ambulation. This young man had an extreme liking of sea food rich in purines and also sugar-sweetened drinks. He was diagnosed with a Hepple stage V type talus osteochondral lesion and was treated with medial malleolus osteotomy and an osteochondral graft. The talus osteochondral lesion was found to be a gouty tophus and was completely removed. Hypouricemic therapy was prescribed for 2 months, which allowed the patient to walk with a visual analogue score (VAS) score of 1. He was followed up for 12 months. CONCLUSIONS: Young people with an extreme liking of sea food rich in purines and also sugar-sweetened drinks may be at a risk of developing gout. Acute onset of ankle atraumatic pain, swelling with a high level of serum uric acid and a talus osteochondral lesion with cyst formation should make physicians consider a diagnosis of gout.


Assuntos
Articulação do Tornozelo/patologia , Gota/complicações , Osteocondrite/patologia , Tálus/patologia , Adolescente , Articulação do Tornozelo/cirurgia , Humanos , Masculino , Osteocondrite/etiologia , Osteotomia
8.
Foot (Edinb) ; 49: 101816, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34536816

RESUMO

Tuberculosis arthritis of the ankle accounts for 10% of all cases of osteoarticular tuberculosis (OT). Because of its rarity and insidious symptoms, diagnosing it may be challenging. Furthermore, its imaging findings mimic those of other diseases. The case of ankle tuberculosis arthritis misdiagnosed as talus necrosis is reported. The difficulties faced by clinicians when confronting such situations are also illustrated.


Assuntos
Artrite , Osteocondrite , Tálus , Tuberculose Osteoarticular , Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Humanos , Tálus/diagnóstico por imagem , Tuberculose Osteoarticular/diagnóstico
9.
Cell Tissue Res ; 385(3): 727-737, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34410480

RESUMO

The bone is a dynamic and metabolically active organ in which growth and resorption of the osteochondral matrix is orchestrated by osteoblasts and osteoclasts. For decalcified paraffin-embedded specimens, decalcifying agents alter the staining intensity, and excess decalcification interferes with bone staining. Robust bone staining methods independent of the decalcification conditions and animal species are lacking. In this study, we have developed a novel polychrome staining method, named JFRL staining, which stains the components of osteochondral tissue in different colors. With this staining we could visualize the hyaline cartilage as blue by alcian blue, osteoid as red by picrosirius red, and mineralized bone as green by picro-light green SF or picro-naphthol green B and easily distinguished osteoblasts, osteocytes, and osteoclasts. In mineralized bone, this staining revealed the obvious lamellar structures and woven bone. Notably, this staining was independent of the decalcification conditions and experimental animal species examined. To verify the usefulness of JFRL staining, we observed cotton rat tail which has shorter length and shows a false autotomy. The caudal vertebrae were normally developed via endochondral ossification without a fracture plane. At 6 months of age, the number of chondrocytes declined and the hypertrophic zone was absent at the epiphyseal plate, which might reflect the shorter tail. In conclusion, JFRL staining is the first method to simultaneously distinguish osteochondral matrix and bone cells in one section regardless of decalcifying conditions. This robust staining will provide new information for a wide number of biomedical fields, including bone development, physiology, and pathology.


Assuntos
Desenvolvimento Ósseo/fisiologia , Osteocondrite/patologia , Animais , Masculino , Camundongos , Parafina
10.
Sci Rep ; 11(1): 17384, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34462509

RESUMO

Osteochondral destruction and a high recurrence rate after surgery are major concerns that make difficult the treatment course of tenosynovial giant cell tumor. The aims of this study were to elucidate rates of postoperative local recurrence and osteochondral destruction, as correlated with various demographic factors. Eighty surgically treated patients with intra-articular tumors (knee: 49, ankle and foot: 12, hip: 10, others: 9) were included in this study. Factors including age, disease type (diffuse/localized), location, existence of osteochondral destruction were correlated with local recurrence or development/progression of osteochondral destruction. The 5-year local recurrence free survival rate was 71.4%. Diffuse type (n = 59, localized: n = 21) (P = 0.023) and knee location (P = 0.002) were independent risk factors for local recurrence. Diffuse type (P = 0.009) was a significant risk factor, and knee location (P = 0.001) was a negative factor for osteochondral destruction at the initial examination. Progression of osteochondral destruction was observed more often in cases with local recurrence (P = 0.040) and findings of osteochondral destruction at the initial examination (P = 0.029). Diffuse type is a factor that should be noted for both local recurrence and osteochondral destruction, while local recurrence occurs but osteochondral destruction is less observed in the knee.


Assuntos
Tumor de Células Gigantes de Bainha Tendinosa/patologia , Osteocondrite/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Tumor de Células Gigantes de Bainha Tendinosa/mortalidade , Tumor de Células Gigantes de Bainha Tendinosa/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Osteocondrite/diagnóstico por imagem , Osteocondrite/cirurgia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
11.
Medicine (Baltimore) ; 100(25): e26330, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160396

RESUMO

PURPOSE: This systematic review aimed to identify the available evidence regarding the comparative effectiveness and safety of various operative treatments in adult patients with osteochondral lesions of the talus (OLT). MATERIALS AND METHODS: The PubMed, Embase, ISI Web of Knowledge, and the Cochrane Controlled Trial Register of Controlled Trials were searched from their inception date to September 2019. Two reviewers selected the randomized controlled trials (RCTs) and non-RCTs assessing the comparative effectiveness and safety of various operative treatments for OLT. The meta-analysis was performed using Revman 5.3. RESULTS: Eight studies (1 RCT and 7 non-RCTs) with 375 patients were included in this review. The difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score between the cartilage repair and replacement was not significant. The cartilage regeneration with or without cartilage repair had significant superiority in improving the AOFAS score compared with the cartilage repair. The difference in the magnetic resonance observation of cartilage repair tissue score between the cartilage repair and replacement and between cartilage repair and cartilage repair plus regeneration was significant. CONCLUSIONS: Cartilage regeneration and cartilage repair plus regeneration had significant superiority in improving the ankle function and radiological evaluation of OLT, although the trials included did not have high-level evidence. Moreover, which treatment between the 2 was safer could not be addressed in this review as most of the trials did not report the safety outcome. Further studies are needed to define the best surgical option for treating OLT.


Assuntos
Articulação do Tornozelo/cirurgia , Cartilagem Articular/cirurgia , Osteocondrite/cirurgia , Tálus/cirurgia , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Artroplastia Subcondral/estatística & dados numéricos , Transplante de Medula Óssea/estatística & dados numéricos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Condrócitos/transplante , Humanos , Imageamento por Ressonância Magnética , Ensaios Clínicos Controlados não Aleatórios como Assunto , Osteocondrite/diagnóstico , Osteocondrite/patologia , Plasma Rico em Plaquetas , Ensaios Clínicos Controlados Aleatórios como Assunto , Tálus/diagnóstico por imagem , Tálus/patologia , Transplante Autólogo/métodos , Transplante Autólogo/estatística & dados numéricos , Resultado do Tratamento
12.
J Orthop Surg Res ; 16(1): 243, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33832525

RESUMO

BACKGROUND: This study presents patient-reported outcome measures after combined matrix-associated autologous chondrocyte implantation and autologous bone grafting in high-stage osteochondral lesions of the talus in adolescents. METHODS: A total of 12 adolescent patients (13 ankles) received matrix-associated autologous chondrocyte implantation and autologous bone grafting for a solitary osteochondral lesion of the talus at a single centre. The Foot and Ankle Outcome Score and Foot and Ankle Ability Measure were defined as outcome measures (median follow-up 80 months [range 22-107 months]). Pre- and postoperative ankle radiographs were evaluated according to the van Dijk ankle osteoarthritis scale. RESULTS: The study population consisted of four male and nine female cases (mean age at the time of surgery, 17.7 ± 2.1 years). Eight lesions were classified as traumatic and five as idiopathic. Twelve lesions were located medial vs one lateral in the coronal plane and all central in the sagittal plane. The median lesion size and depth were 1.3 cm2 (range 0.9-3.2 cm2) and 5 mm (range 5-9 mm), respectively. There were no perioperative complications in any of the cases. In 9 cases patient-reported outcome measures were available. The results of the Foot and Ankle Outcome Score subscales were symptoms, 70 ± 14; pain, 83 ± 10; activities of daily living, 89 ± 12; sports/recreational activities, 66 ± 26; and quality of life, 51 ± 17. The mean overall Foot and Ankle Outcome Score was 78 ± 13. The results of the Foot and Ankle Ability Measure subscales were activities of daily living, 81 ± 20; function/activities of daily living, 84 ± 13; sports, 65 ± 29; and function/sports, 73 ± 27. According to the function overall subscale of the Foot and Ankle Ability Measure, in two cases, the patients assessed the ankle function as normal, in three as nearly normal, and in three as abnormal (missing data, n = 1). Preoperative van Dijk scale: stage 0 in five cases and stage I in eight cases; postoperative van Dijk scale: stage 0 in four cases, stage I in 9 cases CONCLUSIONS: Patient-reported outcome measures following matrix-associated autologous chondrocyte implantation and autologous bone grafting for high-stage osteochondral lesions of the talus in adolescents show heterogeneous results. Long-term limitations mainly affect sports and recreational activities. Osteochondral lesions of the talus are associated with osteoarthritis, even preoperatively. However, we did not find significant osteoarthritis progression after matrix-associated autologous chondrocyte implantation and autologous bone grafting in the long term.


Assuntos
Transplante Ósseo/métodos , Cartilagem Articular/cirurgia , Condrócitos/transplante , Procedimentos Ortopédicos/métodos , Osteoartrite/cirurgia , Osteocondrite/cirurgia , Tálus/cirurgia , Adolescente , Fatores Etários , Feminino , Seguimentos , Humanos , Masculino , Fatores de Tempo , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
13.
Postgrad Med ; 133(3): 320-329, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33406375

RESUMO

Patients with foot pain commonly present to their primary care physicians for their initial management and treatment. These patients and their respective foot or lesser toe pain can present the physician with a complex problem with a long differential list. Depending on the timing of the pain and underlying pathology, these differentials can be divided into acute and acute exacerbation of chronic conditions. This review categorizes the history, physical exam, radiological findings, conservative treatment, and surgical management for each major cause of lesser toe pain, whether acute or chronic. The acute conditions surrounding lesser toe pain in the adult population discussed are toe fractures, toe dislocations, and metatarsal head and neck fractures. The chronic pathologies surrounding lesser toe pain in the adult population evaluated in this review include metatarsalgia, Morton's neuroma, Freiberg infraction, brachymetatarsia, bunionettes, and lesser toe disorders.


Assuntos
Metatarsalgia/patologia , Metatarsalgia/terapia , Dedos do Pé/patologia , Doença Aguda , Joanete do Alfaiate/patologia , Joanete do Alfaiate/terapia , Dor Crônica , Órtoses do Pé , Fraturas Ósseas/patologia , Fraturas Ósseas/terapia , Humanos , Imobilização/métodos , Luxações Articulares/patologia , Luxações Articulares/terapia , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Metatarso/anormalidades , Metatarso/patologia , Osteocondrite/congênito , Osteocondrite/patologia , Osteocondrite/terapia , Exame Físico
14.
J Foot Ankle Surg ; 60(3): 630-633, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33509717

RESUMO

Osteochondritis dissecans is a fairly recognized entity affecting the talus dome but subtalar joint involvement is not that common. We report a case of a 34-year-old male with osteochondritis dissecans of lateral process talus which was missed on imaging studies and identified intraoperatively. The patient was treated with curettage of the subchondral cyst at talus, followed by bone grafting and fixation of the osteochondral lesion with a 4-mm partially threaded cancellous screw. At the 1-year follow-up evaluation, there were no signs of recurrence and the patient resumed his complete activities including sports. We believe that the threshold for diagnosing these lesions should be low in cases with nonspecific chronic ankle pain, and surgeons are encouraged to consider this diagnosis.


Assuntos
Osteocondrite Dissecante , Osteocondrite , Articulação Talocalcânea , Tálus , Adulto , Curetagem , Humanos , Masculino , Recidiva Local de Neoplasia , Osteocondrite/cirurgia , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/cirurgia , Articulação Talocalcânea/diagnóstico por imagem , Articulação Talocalcânea/cirurgia , Tálus/diagnóstico por imagem , Tálus/cirurgia
15.
Foot Ankle Surg ; 27(6): 606-614, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32917526

RESUMO

BACKGROUND: Freiberg's disease is an osteonecrosis of the metatarsal head bone. Numerous surgical interventions can be provided; however, the literature is limited in systematic reviews discussing the various options. The study aimed to systematically review the quantity and quality of literatures exploring the surgical interventions. METHODS: Fifty articles were found to be relevant for assessing the efficacy of common surgical interventions. The articles were assigned a level of evidence (I-V) to assess their quality. Next, the studies were reviewed to provide a grade of recommendation (A-C, I). RESULTS: Two studies were found at level III that explored osteotomy and autologous transplantation; the other studies were level IV-V. There is poor evidence (grade C) in supporting of joint sparing and joint sacrificing for Freiberg's disease. CONCLUSION: Poor evidence exists to support the surgical interventions for Freiberg's disease, higher quality trials are needed to support the increasing application of these surgical techniques. LEVEL OF EVIDENCE: Level IV, Systematic review.


Assuntos
Ossos do Metatarso , Osteocondrite , Humanos , Ossos do Metatarso/cirurgia , Metatarso/anormalidades , Osteocondrite/congênito , Revisões Sistemáticas como Assunto
16.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1353911

RESUMO

Introducción: Las lesiones condrales de la rótula son un reto para el cirujano, principalmente en pacientes jóvenes y activos. La mayoría de los defectos condrales de la rótula son lesiones superficiales y pueden ser manejadas con técnicas de preservación articular; sin embargo, las lesiones profundas pueden requerir otro tipo de manejo. El objetivo de este artículo es comunicar el tratamiento de defectos osteocondrales de la rótula en pacientes jóvenes, mediante la técnica de aloinjerto fresco de donante cadavérico. materiales y métodos: Se seleccionaron pacientes con dolor anterior de rodilla, lesión condral de la rótula grado III-IV y que habían recibido o no algún tipo de manejo médico o quirúrgico. En estos pacientes, se usó un aloinjerto fresco de rótula con el fin de solucionar el cuadro y mejorar la función. Resultados: Todos los pacientes recuperaron la función y los arcos de movilidad, y no refirieron dolor. Se comprobó la integración del aloinjerto fresco al área receptora, sin evidencia de rechazos del tejido o infecciones. Conclusiones: El uso de aloinjerto fresco de rótula para tratar defectos osteocondrales amplios es una téc-nica quirúrgica valiosa, fácil de implementar, que no requiere una curva de aprendizaje extensa y que mejora considerablemente el dolor y la función en pacientes jóvenes. Nivel de Evidencia: IV


Introduction: Chondral lesions of the patella are a challenge for the surgeon, mainly in young and active patients. Most patellar chondral defects are superficial injuries and can be managed with joint preservation techniques; however, deep injuries may require other types of management. The objective of this article is to manage osteochondral defects of the patella in young patients, using the technique of fresh allograft from a cadaveric donor. Materials and methods: Patients with anterior knee pain, with grade III - IV chondral lesion of the patella and who had or had not undergone some type of medical or surgical management were included. They received a fresh patellar allograft that sought to provide a solution and improvement of the functionality. Results: In all cases, recovery of functionality and mobility, absence of pain and integration of the fresh allograft into the recipient area were achieved, without evidence of tissue rejection or infection. Discussion: The use of fresh patellar allograft for the management of wide osteochondral defects is a valuable surgical technique, easy to implement, that does not require a long learning curve and that considerably improves pain and functionality in young patients. Conclusions: The advent of fresh osteochondral grafts allows adequate management and evolution of patients, with the aim of favoring joint preservation and avoiding total knee arthroplasty over time. Level of Evidence: IV


Assuntos
Osteocondrite , Patela/cirurgia , Patela/patologia , Aloenxertos
17.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(4): 303-304, dic. 2020.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1351405

Assuntos
Osteocondrite , Tálus
18.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(4): 447-450, dic. 2020.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1351420

Assuntos
Osteocondrite , Tálus
20.
Bone Joint J ; 102-B(10): 1349-1353, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993333

RESUMO

AIMS: The hypothesis of this study was that bone peg fixation in the treatment of osteochondral lesions of the talus would show satisfactory clinical and radiological results, without complications. METHODS: Between September 2014 and July 2017, 25 patients with symptomatic osteochondritis of the talus and an osteochondral fragment, who were treated using bone peg fixation, were analyzed retrospectively. All were available for complete follow-up at a mean 22 of months (12 to 35). There were 15 males and ten females with a mean age of 19.6 years (11 to 34). The clinical results were evaluated using a visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at the final follow-up. The radiological results were evaluated using classification described by Hepple et al based on the MRI findings, the location of the lesion, the size of the osteochondral fragment, and the postoperative healing of the lesion. RESULTS: The mean VAS and AOFAS score improved significantly from 6.3 (4 to 8) and 70.6 (44 to 78) preoperatively to 1.6 (0 to 5) and 91.1 (77 to 100) at the final follow-up, respectively (p < 0.001). The classification on MRI was stage 2a in nine patients, stage 3 in 14, and stage 4 in two. The lesion was located on the posteromedial aspect of the dome of the talus in 19 patients, the anterolateral aspect in five, and the centrolateral aspect in one. The mean size of the fragment was 11.2 mm (5 to 20) horizontally, 10.4 mm (7 to 18) vertically, and 5.2 mm (3 to 10) deep, respectively. The postoperative healing state was good in 19 patients and fair in six. CONCLUSION: Bone peg fixation for osteochondral lesions of the talus showed satisfactory clinical and radiographic results, without complications. This technique could be a good form of treatment for patients with this condition who have an osteochondral fragment. Cite this article: Bone Joint J 2020;102-B(10):1349-1353.


Assuntos
Osteocondrite/cirurgia , Próteses e Implantes , Tálus/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Osteocondrite/diagnóstico por imagem , Estudos Retrospectivos , Tálus/diagnóstico por imagem
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