Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 877
Filtrar
1.
Jt Dis Relat Surg ; 32(3): 649-657, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34842097

RESUMO

OBJECTIVES: In this study, we aimed to examine patients over 40 years of age who underwent failed primary isolated type 2 superior labrum anterior posterior (SLAP) repair arthroscopically and to evaluate the outcomes of tenotomy. PATIENTS AND METHODS: Between March 2011 and December 2019, a total of 32 patients (19 males, 13 females; median age: 55.1 years; range, 41 to 59 years) who underwent primary repair for SLAP due to high activity levels and in whom the treatment failed were retrospectively analyzed. Biceps tenotomy was applied to all patients. The Constant-Murley Score (CMS), Visual Analog Scale (VAS) pain scores, and muscle strength before and after re-arthroscopy were compared. RESULTS: The median follow-up time was 27 (9-84) months after biceps tenotomy. During arthroscopy, failure was detected in three (9.37%) patients and additional pathologies were detected in five (15.62%) patients. Patients with biceps tenosynovitis were 29 (90.62%). The mean pre- and postoperative CMS scores were 40.5±11.1 and 86.3±8.1, respectively (p<0.001). The mean pre- and postoperative VAS-pain scores were 7.3±1.5 and 2.1±0.8, respectively (p<0.001). CONCLUSION: Although the primary repair technique has been successfully performed in patients with SLAP lesions over 40 years of age and high physical activity, the clinical outcomes are unsatisfactory. Biceps tenotomy improves functional and clinical results in patients with SLAP lesions who do not benefit from primary repair.


Assuntos
Articulação do Ombro , Tenodese , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Tenotomia
2.
Orthopedics ; 44(6): 333-340, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618647

RESUMO

Biceps tenodesis and tenotomy are increasingly being used as treatment options for shoulder pathology, but patient satisfaction remains largely unstudied. A systematic review of the MEDLINE database was conducted to identify clinical outcome studies on isolated biceps tenodesis or tenotomy that reported patient satisfaction. Within the 15 investigations that were included, the indication for tenotomy was rotator cuff pathology, whereas the indication for tenodesis was biceps pathology or type 2 superior labral tear from anterior to posterior. Patients undergoing tenotomy were 13.6 years older than those undergoing tenodesis (P<.001). Patient satisfaction was high following both procedures, at 85.6% following tenotomy and 92.3% following tenodesis. [Orthopedics. 2021;44(6):333-340.].


Assuntos
Lesões do Manguito Rotador , Tenodese , Artroscopia , Humanos , Músculo Esquelético/cirurgia , Satisfação do Paciente , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Tenotomia
3.
Arthroscopy ; 37(10): 3022-3024, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602145

RESUMO

Tendinopathy of the long head of the biceps tendon (LHB) encompasses a range of pathology, including inflammatory tendinitis to degenerative tendinosis that can lead to pain, as well as instability of the LHB and its surrounding stabilizers. Accordingly, tenodesis of the LHB during shoulder surgery has been increasingly cited in the literature as a viable surgical option for the treatment of LHB pathology. While current treatment options include the use of multiple devices for tenodesis of the LHB, there remains a paucity of literature that investigates the biomechanical advantages of all-suture anchor devices compared to interference screws.


Assuntos
Tenodese , Fenômenos Biomecânicos , Parafusos Ósseos , Cadáver , Humanos , Âncoras de Sutura
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1293-1297, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651483

RESUMO

Objective: To compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy. Methods: A clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale (VAS) score, Constant score, American Society of Shoulder and Elbow Surgery (ASES) score, Disability of Arm, Shoulder, and Hand (DASH) score, LHBT score (LHBS) between the two groups ( P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups. Results: The operation time was (3.6±2.5) minutes in group A and (8.5±2.3) minutes in group B, showing a significant difference ( t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months (mean, 26.0 months) in group A and 24-31 months (mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at 3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB. At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones ( P<0.05), and there was no significant difference in the differences before and after operation between the two groups ( P>0.05). No Popeye sign appeared during the follow-up. Conclusion: The arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.


Assuntos
Lesões do Manguito Rotador , Tendinopatia , Tenodese , Braço , Artroscopia , Humanos , Estudos Retrospectivos , Lesões do Manguito Rotador/cirurgia , Ombro , Tendinopatia/cirurgia , Tendões/cirurgia
5.
J Am Podiatr Med Assoc ; 111(4)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478537

RESUMO

BACKGROUND: Footdrop, or the inability to actively dorsiflex the foot, may result from numerous pathologic conditions, including poliomyelitis and cerebral palsy. Although the gait of patients with footdrop can be improved by performing an extensor hallucis longus (EHL) to tibialis anterior (TA) tendon transfer, the success rate of this procedure is relatively low. METHODS: Seven paralytic patients with footdrop were surgically treated using a new buttonhole-type technique that involves passing a loop of the EHL through a TA split using umbilical tape and suturing at the four corners of the EHL attaching to the TA while the foot is dorsiflexed. RESULTS: Eight years after surgery, all three patients who were available for follow-up displayed active dorsiflexion, improved mobility, and a palpable TA-EHL tenodesis, with no cockup deformity. CONCLUSIONS: This new approach, which we term Can Tho transfer, improves the mechanical strength of TA-EHL tenodesis.


Assuntos
Tenodese , , Humanos , Perna (Membro) , Músculo Esquelético/cirurgia , Transferência Tendinosa , Tendões/cirurgia
6.
Acta Orthop Belg ; 87(2): 339-346, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34529390

RESUMO

Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN. 61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer's classification, calcar-length and medial hinge integrity. 40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature. In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures.


Assuntos
Osteonecrose , Fraturas do Ombro , Tenodese , Fixação Interna de Fraturas/efeitos adversos , Humanos , Cabeça do Úmero , Úmero/cirurgia , Incidência , Osteonecrose/epidemiologia , Osteonecrose/etiologia , Osteonecrose/cirurgia , Estudos Retrospectivos , Fraturas do Ombro/cirurgia , Tenodese/efeitos adversos
7.
Rev. bras. ortop ; 56(4): 497-503, July-Aug. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1341165

RESUMO

Abstract Objective The objective of the present study was to determine whether there is fatty infiltration (FI) of the biceps brachii muscle mass after tenotomy or tenodesis for the treatment of tendon injuries in the long head of the biceps and to establish a relationship between FI with changes in the length of muscle fibers. Methods Clinical and imaging analysis of 2 groups of patients (biceps tenodesis [16 patients] and biceps tenotomy [15 patients]). In both groups, we compared the findings on the contralateral side of each patient (control group). All patients had undergone unilateral biceps tenodesis or tenotomy, with postoperative follow-up of > 1 year. Magnetic resonance imaging (MRI) was performed on both arms of each patient following a specific protocol. Strength of elbow flexion was measured with a manual dynamometer, and the results were subjected to statistical analysis. Results The mean postoperative period before the MRI was 5 years, and no case of FI was observed in the anterior compartment of either arm of the evaluated patients. Seven patients had moderate or severe deformity in the operated arm. We found no significant relationship between arm deformity (p = 0.077), flexion strength percentage (p = 0.07) or pain on palpation of the bicipital groove (p = 0.103). Conclusion None of the evaluated patients had evidence of FI in the muscle mass of the anterior arm compartment after the procedures. It was not possible to establish a correlation between the discrepancy of the biceps muscle length measured by MRI and the presence of FI in the anterior compartment of the arm.


Resumo Objetivo O objetivo do presente estudo foi determinar a existência de infiltração gordurosa (IG) na massa muscular do bíceps braquial após a tenotomia ou tenodese para tratamento de lesão no tendão da cabeça longa do bíceps e estabelecer uma relação entre a IG e alterações no comprimento das fibras musculares. Métodos Análise clínica e de imagens de 2 grupos de pacientes (submetidos à tenodese do bíceps [16 indivíduos] ou tenotomia do bíceps [15 indivíduos]). Nos dois grupos, os achados foram comparados àqueles do lado contralateral de cada indivíduo (grupo controle). Todos os pacientes foram submetidos à tenodese ou tenotomia unilateral do bíceps, com acompanhamento pós-operatório > 1 ano. Exames de ressonância magnética (RM) foram realizados em ambos os braços de cada paciente de acordo com um protocolo específico. A força de flexão do cotovelo foi medida com dinamômetro manual e os resultados foram submetidos à análise estatística. Resultados O período pós-operatório médio antes da realização da RM foi de 5 anos, e nenhum caso de IG foi observado no compartimento anterior de ambos os braços dos pacientes avaliados. Sete pacientes apresentaram deformidade moderada ou grave no braço operado. Não houve relação significativa entre deformidade do braço (p = 0,077), percentual de força de flexão (p = 0,07) ou dor à palpação do sulco bicipital (p = 0,103). Conclusão Nenhum dos pacientes avaliados apresentou evidência de IG na massa muscular do compartimento anterior do braço após os procedimentos. Não foi possível estabelecer uma correlação entre a discrepância do comprimento do músculo bíceps, medido à RM, e a presença de IG no compartimento anterior do braço.


Assuntos
Humanos , Manguito Rotador , Tenodese , Tenotomia , Músculos Isquiossurais
8.
J Hand Surg Asian Pac Vol ; 26(3): 371-376, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380400

RESUMO

Background: Since the Sauvé-Kapandji procedure was introduced in 1936, many modifications were created using dynamic stabilizer, such as the ECU (extensor carpi ulnaris), the FCU (flexor carpi ulnaris), pronator teres to solve proximal ulnar stump pain. We believe that this modification is also another option for distal ulnar stump instability. Methods: From January 1998 to February 2017, there were 13 patients received the Sauvé-Kapandji (S-K) procedure with tenodesis of the ECU to the carpus and interosseous membrane. The average age at operation was 52 years (range, 28 to 63 years). Four had traumatic arthritis (two from distal radial fracture malunion, two had instability of distal radioulnar joint from Essex-Lopresti injury), four had primary osteoarthritis of the distal radio-ulnar joint, two had rheumatoid arthritis, one had gouty arthritis, two had madelung deformity. The average follow-up was 30 months (range, 15 to 72 months). Results: Postoperative pronation/supination of the forearm had significantly improved with the exception of the wrist flexion/extension. After surgery, the mean radioulnar distance was narrowed from 11 mm to 9 mm, but no significant difference in 12 patients. All patients had improved in wrist pain, 10 patients had no pain and 3 patients with mild pain over the distal ulnar stump. The mean grip strength had significantly improved from 51% of the contralateral side to 75%. The lateral and stress X-ray films showed no instability of the distal ulnar stump after surgery. Conclusions: In conclusion, the modified S-K procedure using the tenodesis of ECU provides a multi-directional stability and is a reliable surgical procedure for distal radioulnar disorders.


Assuntos
Tenodese , Adulto , Antebraço , Humanos , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Ulna/diagnóstico por imagem , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
9.
Am J Sports Med ; 49(11): 2898-2907, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34314283

RESUMO

BACKGROUND: There is concern that utilization of lateral extra-articular tenodesis (LET) in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) may disturb lateral compartment contact mechanics and contribute to joint degeneration. HYPOTHESIS: ACLR augmented with LET will alter lateral compartment contact mechanics in response to simulated pivoting maneuvers. STUDY DESIGN: Controlled laboratory study. METHODS: Loads simulating a pivot shift were applied to 7 cadaveric knees (4 male; mean age, 39 ± 12 years; range, 28-54 years) using a robotic manipulator. Each knee was tested with the ACL intact, sectioned, reconstructed (via patellar tendon autograft), and, finally, after augmenting ACLR with LET (using a modified Lemaire technique) in the presence of a sectioned anterolateral ligament and Kaplan fibers. Lateral compartment contact mechanics were measured using a contact stress transducer. Outcome measures were anteroposterior location of the center of contact stress (CCS), contact force from anterior to posterior, and peak and mean contact stress. RESULTS: On average, augmenting ACLR with LET shifted the lateral compartment CCS anteriorly compared with the intact knee and compared with ACLR in isolation by a maximum of 5.4 ± 2.3 mm (P < .001) and 6.0 ± 2.6 mm (P < .001), respectively. ACLR augmented with LET also increased contact force anteriorly on the lateral tibial plateau compared with the intact knee and compared with isolated ACLR by a maximum of 12 ± 6 N (P = .001) and 17 ± 10 N (P = .002), respectively. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress by 0.7 ± 0.5 MPa (P = .005) and by 0.17 ± 0.12 (P = .006), respectively, at 15° of flexion. CONCLUSION: Under simulated pivoting loads, adding LET to ACLR anteriorized the CCS on the lateral tibial plateau, thereby increasing contact force anteriorly. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress at 15° of flexion. CLINICAL RELEVANCE: The clinical and biological effect of increased anterior loading of the lateral compartment after LET merits further investigation. The ability of LET to anteriorize contact stress on the lateral compartment may be useful in knees with passive anterior subluxation of the lateral tibia.


Assuntos
Lesões do Ligamento Cruzado Anterior , Instabilidade Articular , Tenodese , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular
10.
Arthroscopy ; 37(7): 2235-2236, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34226011

RESUMO

How to restore native knee kinematics following complex knee injuries is still debated and under investigation. To better reproduce the native anterior cruciate ligament (ACL), surgeons have a host of different options, including graft choice, technique, fixation method, and single-, double-, and triple-bundle techniques, etc. Isolated ACL reconstruction alone is not effective in controlling complex instability patterns, especially regarding internal and external rotations. Several techniques have been described to address such instabilities, like single- or double- bundle ACL reconstruction plus lateral extra-articular tenodesis. In truth, chronic ACL injury requires reconstruction plus lateral tenodesis to control rotational instability. Additional technical complexity may result in complications without improved outcomes. Neither single-bundle nor double-bundle techniques are "truly" anatomic. Keep it simple; keep it safe.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Tenodese , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia
11.
Acta Biomed ; 92(S3): e2021027, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34313655

RESUMO

Background Anterior cruciate ligament reconstructions are a very frequent surgery. The key role of the anterolateral ligament in the knee rotational stability has been undelighted in recent years. Extra-articular tenodesis in association with ACL reconstructions, serves to eliminate anterolateral rotatory instability. The aim of our study is to compare treated knees with the contralateral uninjured knee in those cases whom been treated with ACL arthroscopic reconstruction and lateral extra-articular tenodesis in revision surgery, and evaluate clinical results with kinematic and kinetic examinations methods. Materials and methods Sixteen patients (10 males and 6 females) with ages from 21 to 37 had been treated at the Orthopaedic Clinic of Udine for failure of previous ACL reconstruction. In all patients was performed ACL arthroscopic reconstruction with the association of a lateral extra-articular tenodesis (Coker-Arnold). We have decided to asses the patients at one year after surgery with GNRB arthrometer and Bioval inertial sensor system. Results All patients treated with arthroscopic ACL reconstruction and lateral extra-articular tenodesis have regained pre-injury sagittal knee stability and gait dynamics.


Assuntos
Lesões do Ligamento Cruzado Anterior , Tenodese , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Projetos Piloto , Reoperação
12.
Acta Biomed ; 92(S3): e2021026, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34313657

RESUMO

The treatment of massive rotator cuff tears poses a challenge to orthopedic surgeons. The prevalence of massive rotator cuff tears is 40% of all rotator cuff tears. Compared with smaller tears, massive rotator cuff tears are often complicated by structural failure and poor outcomes and present a higher rate of recurrent tearing after surgical repair. Several management options are available but the selection of the most appropriate treatment for each patient can be challenging. To achieve the best outcomes, the orthopedic surgeon should have a good understanding of the indications, the pathomechanics and the clinical outcomes of the various treatment modalities. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. The purpose of this article is to review treatment options and clinical outcomes for the management of massive rotator cuff tears.


Assuntos
Lesões do Manguito Rotador , Tenodese , Artroscopia , Humanos , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Tendões
13.
J ISAKOS ; 6(4): 204-211, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34272296

RESUMO

Superior labrum, anterior and posterior (SLAP) lesions are common and identified in up to 26% of shoulder arthroscopies, with the greatest risk factor appearing to be overhead sporting activities. Symptomatic patients are treated with physical therapy and activity modification. However, after the failure of non-operative measures or when activity modification is precluded by athletic demands, SLAP tears have been managed with debridement, repair, biceps tenodesis or biceps tenotomy. Recently, there have been noticeable trends in the operative management of SLAP lesions with older patients receiving biceps tenodesis and younger patients undergoing SLAP repair, largely with suture anchors. For overhead athletes, particularly baseball players, SLAP lesions remain a difficult pathology to manage secondary to concomitant pathologies and unpredictable rates of return to play. As a consequence, the most appropriate surgical option in elite throwers is controversial. The objective of this current concepts review is to discuss the anatomy, mechanism of injury, presentation, diagnosis and treatment options of SLAP lesions and to present current literature on outcomes affecting return to sport and work.


Assuntos
Lesões do Ombro , Articulação do Ombro , Tenodese , Artroscopia , Humanos , Volta ao Esporte , Lesões do Ombro/cirurgia , Articulação do Ombro/cirurgia
14.
Arthroscopy ; 37(6): 1777-1778, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34090564

RESUMO

The optimal treatment for proximal biceps tendon lesions identified at the time of arthroscopic rotator cuff repair remains a topic for debate. The decision between biceps tenotomy and tenodesis is one in which we will likely never have a clear-cut answer. Proponents of biceps tenotomy and biceps tenodesis will cite the pros and cons of each surgical option to support their treatment of choice. Several meta-analyses have shown no superior outcomes with either treatment. Cost analysis and surgical efficiency may favor biceps tenotomy, whereas the possible development of a Popeye deformity, biceps cramping, and supination strength favor tenodesis. The surgical treatment of choice requires an informed discussion and shared decision making between surgeon and patient to determine patients' expectations and maximize surgical outcomes for each individual patient.


Assuntos
Lesões do Manguito Rotador , Tenodese , Artroscopia , Tomada de Decisões , Humanos , Estudos Prospectivos , Lesões do Manguito Rotador/cirurgia , Ombro , Tenotomia
15.
Am J Sports Med ; 49(9): 2379-2386, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34133234

RESUMO

BACKGROUND: Lateral extra-articular tenodesis (LET) is one of the most widely used procedures to restore anterolateral stability. Clinical outcomes after the addition of LET to anterior cruciate ligament (ACL) reconstruction (ACLR) have been widely investigated; however, the potential influence of LET on the ACL ligamentization process has not been examined. PURPOSE/HYPOTHESIS: The purpose was to use 10-month postoperative magnetic resonance imaging (MRI) scans to determine whether the maturity of grafts after hamstring autograft ACLR was affected by concomitant LET. The hypothesis was that when modified Lemaire lateral extra-articular tenodesis (MLLET) was performed, the MRI parameters of ACL graft maturity would be modified. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study included patients treated between December 2017 and December 2018 who had undergone anatomic 3-strand hamstring tendon autograft ACLR, with or without concomitant MLLET, and had undergone MRI 10 months postoperatively. Thus, the study included 30 patients who had isolated ACLR and 22 patients who had ACLR plus MLLET. The 2 groups were comparable based on all criteria analyzed. To evaluate graft maturity, the signal-to-noise quotient (SNQ) was measured in 3 regions of interest of the proximal, midsubstance, and distal ACL graft. Lower SNQ ratios indicate less water content and, theoretically, better maturity and healing of the graft. RESULTS: The mean ± SD for SNQ was 4.62 ± 4.29 (range, 3.12-6.19) in the isolated ACLR group and 7.59 ± 4.68 (range, 4.38-8.04) in the ACLR plus MLLET group (P = .012). Upon comparing the mean values of the 3 portions between the 2 groups, we found a significant difference between the 2 groups for the proximal and middle portions (P = .007 and P = .049, respectively) but no difference in the distal portion (P = .369). CONCLUSION: At the 10-month follow-up, hamstring tendon autografts for anatomic ACLR with MLLET did not show the same MRI signal intensity compared with isolated hamstring anatomic ACLR.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Tenodese , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos de Coortes , Tendões dos Músculos Isquiotibiais/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética
17.
J Shoulder Elbow Surg ; 30(12): 2720-2728, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33964429

RESUMO

BACKGROUND: The purpose of this study was to compare outcomes of patients who underwent posterior labral repair with and without concomitant glenohumeral chondral pathology. METHODS: A retrospective review was performed on patients aged ≥18 years who underwent primary posterior labral repair over 5 years. Charts were reviewed to determine the presence and location of high-grade (Outerbridge grade III or IV) pathology. Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Western Ontario Stability Index (WOSI), visual analog scale (VAS), and Simple Shoulder Test (SST) scores were collected at median 71.5-month follow-up and compared between patients with and without concomitant chondral pathology during the index procedure. RESULTS: Of 100 patients who underwent primary posterior labral repair, 43% had glenoid and/or humeral-sided high-grade chondral pathology. Patients with chondral pathology were older than those without (P < .001). A higher proportion of patients with chondral pathology underwent concomitant biceps tenodesis (19.3% vs. 37.2%, P = .046). The type of anchor (all-suture or solid body, P = .010) used was different between patients with and without chondral pathology at time of posterior labrum repair. There was no difference in reoperation rates at final follow-up between patients with and without chondral damage at time of index procedure (P = .200). All outcome scores were similar between all comer patients with and without chondral pathology. Isolated glenoid pathology was significantly associated with lower QuickDASH (P = .018), higher SST (P = .013), lower VAS (P = .016), and lower WOSI scores (P = .046) compared to patients with bipolar lesions. After stratifying by age, there was an association between chondral pathology and lower VAS and WOSI scores in patients aged <35 years, and there was an association between chondral pathology and lower SST scores in patients aged ≥35 years. CONCLUSION: Based on median QuickDASH, SST, WOSI, and VAS scores, subjective and functional outcomes after primary arthroscopic posterior labral repair were not negatively influenced by the presence of concomitant chondral damage at the time of surgery for patients aged <35 years at minimum 2-year follow-up. Although our primary outcome score, the QuickDASH, was not significantly associated with the presence of chondral damage in patients aged >35 years, SST scores were negatively influenced by concomitant chondral damage in this older cohort, but this may not be adequately powered. It appeared that patients with chondral damage localized to the glenoid tended to have better outcomes scores that those with bipolar damage.


Assuntos
Articulação do Ombro , Tenodese , Adolescente , Adulto , Artroscopia , Seguimentos , Humanos , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do Tratamento
18.
J ISAKOS ; 6(6): 356-362, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34016736

RESUMO

IMPORTANCE: Arthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are two surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior to posterior (SLAP) tears. There is insufficient knowledge regarding the clinical superiority of one technique over the other. OBJECTIVE: To systematically review the literature in order to compare the clinical outcomes and safety of ABT and OBT for treatment of LHBT or SLAP pathology. EVIDENCE REVIEW: A systematic review was performed by searching PubMed, the Cochrane Library and Embase to identify studies that compared the clinical efficacy of ABT versus OBT. The search phrase used was: (bicep OR biceps OR biceps brachii OR long head of biceps brachii OR biceps tendinopathy) AND (tenodesis). Patients were assessed based on the American Shoulder and Elbow Surgeons Score, the visual analogue scale, the Single Assessment Numeric Evaluation, Constant-Murley Score, clinical failure, range of motion, bicipital groove pain and strength. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and both the Cochrane Collaboration's and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) risk of bias tools were used to evaluate risk of bias. FINDINGS: Eight studies (one level I, seven level III) met inclusion criteria, including 326 patients undergoing ABT and 381 patients undergoing OBT. No differences were found in treatment failure rates or patient-reported outcome scores between groups in any study. One study found OBT patients to experience significantly increased range of shoulder forward flexion when compared with ABT patients (p=0.049). Two studies found ABT patients to experience significantly more postoperative stiffness when compared with OBT patients (p<0.05). CONCLUSIONS: Patients undergoing ABT and OBT can be expected to experience similar improvements in clinical outcomes at latest follow-up without differences treatment failure or functional performance. ABT patients may experience an increased incidence of stiffness in the early postoperative period. LEVEL OF EVIDENCE: III.


Assuntos
Tenodese , Braço/cirurgia , Artroscopia , Humanos , Músculo Esquelético/cirurgia , Tendões/cirurgia
19.
Bone Joint J ; 103-B(5): 939-945, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934641

RESUMO

AIMS: The purpose was to evaluate early clinical, patient-reported, and radiological outcomes of the scapholunate ligament 360° tenodesis (SL 360) technique for treatment of scapholunate (SL) instability. METHODS: We studied the results of nine patients (eight males and one female with a mean age of 44.7 years (26 to 55)) who underwent the SL 360 procedure for reducible SL instability between January 2016 and June 2019, and who were identified from retrospective review of electronic medical records. Final follow-up of any kind was a mean of 33.7 months (12.0 to 51.3). Clinical, radiological, and patient-reported outcome data included visual analogue scale (VAS) for pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Mayo Wrist Score (MWS), and Patient-Rated Wrist Examination (PRWE). Means were analyzed using paired t-test. RESULTS: Before surgery, patients with SL instability were significantly impaired with respect to wrist flexion, extension, and grip strength (mean flexion, 51° (20° to 85°) vs 73° (45° to 90°); mean extension, 46° (15° to 70°) vs 66° (45° to 80°); mean grip strength, 25 kg (20 to 31) vs 50 kg (35 to 68) compared to the unaffected side). The mean SL gap (4.9 mm (2.3 to 7.3) vs 2.1 mm (1.6 to 2.9)) and mean SL angle (71° (59° to 105°) vs 50° (38° to 64°) were also significantly greater in the affected wrist. At final follow-up, there was mean improvement regarding clinical, radiological, and functional outcomes comparing preoperative to final postoperative values for the VAS for pain scale, QuickDASH, MWS, PRWE, and SL gap and SL angle. CONCLUSION: In our small series, the SL 360 procedure for reducible SL instability has favourable early clinical, patient-reported, and radiological outcomes at a mean of 33.7 months (12.0 to 51.3). The suture tape and tendon construct confers robust stability, permitting earlier mobilization without the inherent disadvantages of Kirschner wire stabilization. Cite this article: Bone Joint J 2021;103-B(5):939-945.


Assuntos
Instabilidade Articular/cirurgia , Tenodese/métodos , Articulação do Punho/cirurgia , Adulto , Avaliação da Deficiência , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Osso Semilunar , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide , Articulação do Punho/diagnóstico por imagem
20.
J Shoulder Elbow Surg ; 30(8): 1733-1740, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34022365

RESUMO

BACKGROUND: The purpose of this study was to determine the incidence of Popeye deformity following biceps tenotomy vs. tenodesis and evaluate risk factors and subjective and objective outcomes. METHODS: Data for this study were collected as part of a randomized clinical trial in which patients aged ≥18 years undergoing arthroscopic shoulder surgery for a long head of the biceps tendon lesion were allocated to undergo tenotomy or tenodesis. The primary outcome measure for this secondary analysis was rate of Popeye deformity at 24 months postoperation as determined by an evaluator blinded to group allocation. Those with a deformity indicated their satisfaction with the appearance of their arm on a 10-cm visual analog scale, rated their pain and cramping, and completed the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form and the Western Ontario Rotator Cuff index. Isometric elbow flexion and supination strength were also measured. Cohen kappa was calculated to measure inter-rater reliability between patient and evaluator on the presence of a deformity. Logistic regression was performed to identify predictors of presence or absence of a Popeye deformity. RESULTS: One hundred fourteen patients were randomly assigned to 2 groups, of which 42 to the tenodesis group and 45 to the tenotomy group completed a 24-month follow-up. Based on clinical observation, the odds of a Popeye in the tenotomy group were 4.3 times greater than in the tenodesis group (P = .018) with incidence of 33% (15/45) and 9.5% (4/42), respectively. Surgical technique was the only significant predictor of perceived deformity, with male gender trending toward significance (odds ratio 7.33, 95% confidence interval 0.867-61.906, P = .067). Mean (standard deviation) satisfaction score of those with a deformity regarding appearance of their arm was 7.3 (2.6). Increasing satisfaction was correlated with increasing age (r = 0.640, P = .025), but there was no association with gender (r = -0.155, P = .527) or body mass index (r = -0.221, P = .057). Differences in subjective outcomes were dependent on whether the Popeye was clinician- or self-assessed. CONCLUSION: The odds of developing a perceived Popeye deformity was 4.3 higher after tenotomy compared to tenodesis based on clinician observation. Male gender was trending toward being predictive of having a deformity. Pain and cramping were increased in those with a self-reported Popeye. Younger patients were significantly less satisfied with a deformity despite no difference in functional outcomes at 24 months. Thus, biceps tenodesis may be favored in younger male patients to minimize the risk of Popeye and the risk of dissatisfaction in the appearance of their arm following surgery.


Assuntos
Lesões do Manguito Rotador , Tenodese , Adolescente , Adulto , Braço , Artroscopia , Índice de Massa Corporal , Humanos , Incidência , Masculino , Ontário , Satisfação Pessoal , Estudos Prospectivos , Reprodutibilidade dos Testes , Lesões do Manguito Rotador/cirurgia , Tenotomia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...