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1.
Knee Surg Sports Traumatol Arthrosc ; 30(4): 1352-1361, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33963878

RESUMO

PURPOSE: The purpose of this study was to identify the causes of failure of previous medial patellofemoral ligament reconstruction (MPFL-R), and to furthermore report the surgical techniques available for MPFL revision surgery. METHODS: Four databases [PubMed, Ovid (MEDLINE), Cochrane Database, and EMBASE] were searched until September 29, 2020 for human studies pertaining to revision MPFL. Two reviewers screened the literature independently and in duplicate. Methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria, or the CAse REport guidelines (CARE), where appropriate. RESULTS: Fourteen studies (one level II, one level III, two level IV, ten level V) were identified. This search resulted in a total of 76 patients with a mean age (range) of 22 (14-39) years. The patients were 75% female with a mean (range) time to revision of 24.1 (1-60) months and mean (range) follow-up of 36.2 (2-48) months. The most common indication for revision surgery was malpositioning of the femoral tunnel (38.1%), unaddressed trochlear dysplasia (18.4%), patellar fracture (11.8%). Femoral tunnel malposition was typically treated via revision MPFL-R with quadriceps tendon or semitendinosus autograft and may retain the primary graft if fixation points were altered. Unaddressed trochlear dysplasia was treated with deepening trochleoplasty with or without revision MPFL-R, and patella fracture according to the nature of the fracture pattern and bone quality. Though generally, outcomes in the revision scenario across all indications were inferior to those post-primary procedure, overall, revision patients demonstrated positive improvements in pain and instability symptoms. Transverse patella fractures treated with debridement and filling with demineralized bone matrix if required with further fixation according to the fracture pattern. CONCLUSION: The most common causes of MPFL failure in literature published to date, in order of decreasing frequency, are: malposition of the femoral tunnel, unaddressed trochlear dysplasia, and patellar fracture. Although surgical techniques of revision MPFL-R to manage these failures were varied, promising outcomes have been reported to date. Larger prospective comparative studies would be useful to clarify optimal surgical management of MPFL-R failure at long-term follow-up. LEVEL OF EVIDENCE: IV.


Assuntos
Fraturas Ósseas , Instabilidade Articular , Traumatismos do Joelho , Luxação Patelar , Articulação Patelofemoral , Adulto , Feminino , Fraturas Ósseas/complicações , Humanos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/complicações , Ligamentos Articulares/cirurgia , Masculino , Patela/cirurgia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Estudos Prospectivos , Adulto Jovem
2.
Knee Surg Sports Traumatol Arthrosc ; 29(5): 1432-1452, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33084911

RESUMO

PURPOSE: The purpose of this study was to examine the existing literature to determine the dimensions of the acetabular labrum, with a focus on hypotrophic labra, including the modalities and accuracy of measurement, factors associated with smaller labra, and any impacts on surgical management. METHODS: Four databases (PubMed, Ovid [MEDLINE], Cochrane Database, and EMBASE) were searched from database inception to January 2020. Two reviewers screened the literature independently and in duplicate. Methodological quality of included papers was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Where possible, data on labral size were combined using a random effects model. RESULTS: Twenty-one studies (5 level II, 9 level III, 7 level IV) were identified. This resulted in 6,159 patients (6,436 hips) with a mean age of 34.3 years (range 8.4-85). The patients were 67.3% female with an average follow-up of 57.3 months. There was no consistent definition of labral size quoted throughout the literature. The mean width on MRI/MRA was 7.3 mm (95% CI 6.9-7.8 mm), on computed tomography arthrography was 8.7 mm (95% CI 8.0-9.3), and during arthroscopy was 5.0 mm (95% CI 4.9-5.2). Inter-observer reliability was good to excellent in all modalities. Labral hypotrophy may be associated with increased acetabular coverage. Hypertrophic labra were highly associated with acetabular dysplasia (r = - 0.706, - 0.596, - 0.504, respectively; P < 0.001). CONCLUSION: Labral width can reliably be measured utilizing imaging techniques including magnetic resonance and computed tomography. The pooled mean labral width was 6.2 mm, and height 4.6 mm. The establishment of a gold-standard of measurement on arthroscopy and advanced imaging would aid in clinical decision-making regarding treatment options for patients presenting with a painful hip, particularly those with hypoplastic labra, and provide radiological guidelines for standardized labrum size classifications. LEVEL OF EVIDENCE: Level IV.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrografia/métodos , Artroscopia/métodos , Criança , Feminino , Quadril/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/patologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Padrões de Referência , Reprodutibilidade dos Testes , Adulto Jovem
3.
Neurosci Biobehav Rev ; 123: 61-71, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33440196

RESUMO

Neuroimaging studies have shown that, despite the abstractness of music, it may mimic biologically rewarding stimuli (e.g., food) in its ability to engage the brain's reward circuitry. However, due to the lack of research comparing music and other types of reward, it is unclear to what extent the recruitment of reward-related structures overlaps among domains. To achieve this goal, we performed a coordinate-based meta-analysis of 38 neuroimaging studies (703 subjects) comparing the brain responses specifically to music and food-induced pleasure. Both engaged a common set of brain regions, including the ventromedial prefrontal cortex, ventral striatum, and insula. Yet, comparative analyses indicated a partial dissociation in the engagement of the reward circuitry as a function of the type of reward, as well as additional reward type-specific activations in brain regions related to perception, sensory processing, and learning. These results support the idea that hedonic reactions rely on the engagement of a common reward network, yet through specific routes of access depending on the modality and nature of the reward.


Assuntos
Música , Encéfalo , Humanos , Imageamento por Ressonância Magnética , Neuroimagem , Prazer , Recompensa
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