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Background Monitoring the microcirculation in human feet is crucial in assessing peripheral vascular diseases, such as diabetic foot. However, conventional imaging modalities are more focused on diagnosis in major arteries, and there are limited methods to provide microvascular information in early stages of the disease. Purpose To investigate a three-dimensional (3D) noncontrast bimodal photoacoustic (PA)/US imaging system that visualizes the human foot morphologically and also reliably quantifies podiatric vascular parameters noninvasively. Materials and Methods A clinically relevant PA/US imaging system was combined with a foot scanner to obtain 3D PA and US images of the human foot in vivo. Healthy participants were recruited from September 2020 to June 2021. The collected 3D PA and US images were postprocessed to present structural information about the foot. The quantitative reliability was evaluated in five repeated scans of 10 healthy feet by calculating the intraclass correlation coefficient and minimal detectable change, and the detectability of microvascular changes was tested by imaging 10 healthy feet intentionally occluded with use of a pressure cuff (160 mm Hg). Statistically significant difference is indicated with P values. Results Ten feet from six healthy male volunteers (mean age ± standard deviation, 27 years ± 3) were included. The foot images clearly visualized the structure of the vasculature, bones, and skin and provided such functional information as the total hemoglobin concentration (HbT), hemoglobin oxygen saturation (SO2), vessel density, and vessel depth. Functional information from five independent measurements of 10 healthy feet was moderately reliable (intraclass correlation coefficient, 0.51-0.74). Significant improvements in HbT (P = .006) and vessel density (P = .046) as well as the retention of SO2 were observed, which accurately described the microvascular change due to venous occlusion. Conclusion Three-dimensional photoacoustic and US imaging was able to visualize morphologic and physiologic features of the human foot, including the peripheral microvasculature, in healthy volunteers. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Mezrich in this issue.
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Imageamento Tridimensional , Extremidade Inferior , Adulto , Hemoglobinas , Humanos , Imageamento Tridimensional/métodos , Masculino , Microvasos , Reprodutibilidade dos Testes , Adulto JovemRESUMO
PURPOSE: This study aimed to establish the normal values for knee patellofemoral alignment as measured using 3-dimensional computed tomography (3D CT), to standardize the technique, and to show the inter- and intra-observer reliability of this measurement. METHODS: The present study included 62 asymptomatic volunteers (124 knees). 3D CT scanning was performed with each volunteer in the supine position with 15° of knee flexion, and consistent 3D axial images of the patellofemoral joint were obtained with alignment in the desired stereographic baseline direction in anterior-posterior, lateral, and axial rotations. Two independent observers measured patellofemoral alignment parameters, including the sulcus angle, congruence angle, lateral patellofemoral angle, condyle-patellar angle, and lateral trochlear inclination angle. RESULTS: Based on 3D CT measurement, the mean values of the parameters were 145.9° ± 9.2° for the sulcus angle, 12.6° ± 22.6° for the congruence angle, 9.2° ± 4.6° for the lateral patellofemoral angle, 14.1° ± 6.4° for the condyle-patellar (lateral facets) angle, - 8.5° ± 8.4° for condyle-patellar (patellar axis) angle, and 16.5° ± 6.3° for the lateral trochlear inclination angle. A statistically significant difference was observed between men and women in the sulcus and condyle-patellar (patellar axis) angles (p = 0.045, 0.011, respectively). All parameters showed excellent inter- and intra-observer reliability. CONCLUSION: The normal values and ranges for patellofemoral alignment parameters were evaluated using 3D CT. The results of this study provide reference information that may facilitate diagnosis and treatment planning of patellofemoral disorders in skeletally mature non-pathologic patients. LEVEL OF EVIDENCE: II.
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Patela , Articulação Patelofemoral , Feminino , Humanos , Articulação do Joelho , Masculino , Articulação Patelofemoral/diagnóstico por imagem , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios XRESUMO
Hallux valgus is a progressive angular deformity of the big toe, the degree of which is aggravated in weightbearing stance. Hallux valgus and intermetatarsal angles on postoperative weightbearing images are usually larger than those of intraoperative fluoroscopic and immediate postoperative non-weightbearing images. Here, we hypothesized that various angular parameters of hallux valgus would increase postoperatively with weightbearing. A total of 66 feet (58 patients) of moderate to severe hallux valgus were reviewed on consecutive plain foot anteroposterior radiographs. The changes of hallux valgus, intermetatarsal, hallux valgus interphalangeal, and distal metatarsal articular angles were compared. Hallux valgus and intermetatarsal angles were significantly increased with weightbearing postoperatively (p < .001). Hallux valgus interphalangeal and distal metatarsal articular angles did not show significant changes with weightbearing (p > .5). Hallux valgus and intermetatarsal angles were increased with weightbearing after hallux valgus surgery. Mean angular changes were 5.3 and 2.7 degrees, respectively. These values should be considered in the preoperative planning and intraoperative correction processes.
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The incidence of Achilles tendon rupture is increasing. Postoperative rehabilitation after repairing acute Achilles tendon rupture is very important because the choice of treatment during the rehabilitation period can influence the results. Moreover, the method of functional rehabilitation varies and is developing steadily. Recent studies recommend a functional rehabilitation protocol, and this approach is accepted widely. This study aimed to introduce our most accelerated functional rehabilitation protocol following surgery for acute Achilles tendon rupture and to review the results retrospectively. From July 2014 to July 2016, 67 patients underwent surgery for acute Achilles tendon rupture by one surgeon. Age, sex, body mass index, injury mechanism, rehabilitation method and progress, time to return to previous physical activity, and complications were evaluated. The mean time to be able to squat fully was 10 ± 4.7 (4-20) weeks. Full squatting was possible in 92.8% (52 patients). The mean time to perform a single-limb heel rise and repetitive single-limb heel rise was 12.6 ± 3.9 (6-24) and 23.3 ± 7.7 (8-40) weeks, respectively. The mean time to return to sports was 20.6 ± 5.2 (12-32) weeks. The major complication rate was 3.5% (one re-rupture and one tendon elongation). The mean pre- and postoperative Achilles Tendon Total Rupture Score was 29.5 ± 3.7 (20-38) and 79.3 ± 18.5 (20-98) points, respectively. The increase was significant (p < .01). In conclusion, immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results.
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Tendão do Calcâneo , Traumatismos do Tornozelo , Traumatismos dos Tendões , Tendão do Calcâneo/lesões , Doença Aguda , Tornozelo , Humanos , Estudos Retrospectivos , Ruptura/reabilitação , Ruptura/cirurgia , Traumatismos dos Tendões/reabilitação , Resultado do Tratamento , Suporte de CargaRESUMO
PURPOSE: The purpose of this study was to evaluate the radiographic and clinical outcomes of patients with hallux valgus (HV) with concomitant metatarsus adductus (MA) treated with distal chevron metatarsal osteotomy (DCMO), without any procedure for the second or third metatarsal. METHODS: A multicentre retrospective study involving four hospitals was conducted. A total of 45 feet from 38 patients who had received DCMO for HV with MA with at least one year post-operative follow-up were analysed. HV angle (HVâ), inter-metatarsal angle (IMâ), MA angle (MAâ), and the lateral sesamoid grade were measured. Foot function index (FFI) and visual analogue scale (VAS) were recorded. Patients were divided into mild (18° ≤ MAâ < 20°) and moderate (20° ≤ MAâ) MA groups, and results were compared. RESULTS: The mean HVâ and IMâ improved significantly from 35.1° and 14.4° pre-operatively to 10.6° and 7.1° one year post-operatively (p < 0.001). There were no differences in pre-operative HVâ, IMâ, or the sesamoid grade, and also no difference in post-operative HVâ or the sesamoid grade between mild and moderate MA groups. Only the mean post-operative IMâ showed a difference between the two groups (8.3° vs. 6.3°; p = 0.019). All clauses of FFI and VAS improved significantly (p < 0.001). When the extent of improvement was compared between the two groups, there were no significant differences in any category (p > 0.05). The total rate of recurrence (HVâ ≥ 20°) was 11.1% (5/45), and although the moderate group (4/29, 13.8%) had a higher proportion than the mild group (1/16, 6.3%), this was not statistically significant (p = 0.641). CONCLUSION: DCMO for patients with HV with MA had satisfactory radiographic and clinical outcomes with minimal recurrence. Except in cases of severe combined deformity, we recommend performing DCMO alone without any additional procedure or manipulation of the other metatarsals as a viable treatment option.
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Hallux Valgus , Ossos do Metatarso , Metatarso Varo , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Osteotomia , Estudos RetrospectivosRESUMO
When there is a varus knee deformity, the ankle and foot compensate. However, the association between pain and angular change in the compensatory mechanism is not well understood. Therefore, we investigated the relationship between pain and angular change of the lower extremity in genu varus patients. Standing whole-lower-leg plain radiographs of 127 legs (77 patients) with >4° of genu varum were evaluated. Pain was assessed separately at the ankle, forefoot, and hindfoot. Knee, ankle, and subtalar joint angles were measured. Patients were divided into 3 groups according to the degree of lower leg angular imbalance (group 1, mild; group 2, moderate; group 3, severe). The presence of multiple pain locations differed significantly between groups and was significantly higher in group 3 than group 1 (pâ¯=â¯.0061). Likewise, the subtalar angle was significantly more varus in group 3 than group 1 (pâ¯=â¯.012). In conclusion, an unbalanced lower extremity with genu varum was associated with multiple foot and ankle pain, and the subtalar joint played a primary role in compensation for genu varum deformity.
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Genu Varum , Tornozelo , Artralgia , Genu Varum/diagnóstico por imagem , Genu Varum/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Extremidade InferiorRESUMO
Complex comminuted fractures involving the distal tibia, ankle joint, and talus are often accompanied by bone loss and are highly prone to complications such as soft tissue infection, fixation failure, and posttraumatic arthrosis, with joint reconstruction being difficult in cases with severe joint destruction or bone loss. In this case, bone transport and fusion procedures were performed to treat a patient with an open fracture involving total talar dislocation, talar bone loss, and distal tibial bone loss. Just as in this case, where the surrounding soft tissues remain healthy, limb salvage via segmental bone transport may be a reasonable option in fractures with massive bone loss that include joints.
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Transplante Ósseo/métodos , Fraturas Cominutivas/cirurgia , Fraturas Expostas/cirurgia , Salvamento de Membro/métodos , Tálus/lesões , Fraturas da Tíbia/cirurgia , Adulto , Feminino , Humanos , Luxações Articulares/cirurgiaRESUMO
PURPOSE: This study aimed to establish normal values for wrist carpal alignment measured by 3-dimensional computed tomography (CT) and to show the inter- and intraobserver reliability of this measurement compared with simple radiography. METHODS: The study utilized 3-dimensional CT and simple radiography of wrist joints in 30 asymptomatic volunteers. The wrist position was standardized using a custom-designed positioning device. Three independent observers measured carpal alignment parameters including distal radius articular angle, radiolunate angle, radioscaphoid angle, radiocapitate angle, radius-third metacarpal angle, scapholunate angle, lunocapitate angle, and lunate-third metacarpal angle. RESULTS: Based on 3-dimensional CT measurement, the mean values of these parameters were: 12.9° ± 1.8° for the distal radius articular angle; 1.2° ± 3.8° for the radiolunate angle; 54.2° ± 5.6° for the radioscaphoid angle; 1.9° ± 2.2° for the radiocapitate angle; -1.0° ± 2.5° for the radius-third metacarpal angle; 52.9° ± 6.9° for the scapholunate angle; 0.7° ± 4.1° for the lunocapitate angle; -2.3° ± 4.6° for the lunate-third metacarpal angle. All parameters showed high inter- and intraobserver reliability in the 2 modalities. CONCLUSIONS: The normal values and ranges for carpal alignment angles were evaluated by using 3-dimensional CT. We could obtain high reliability in 3-dimensional CT as well as plain radiograph for the measurement of carpal alignment. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.
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Ossos do Carpo/diagnóstico por imagem , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Articulação do Punho/diagnóstico por imagem , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Reprodutibilidade dos Testes , Adulto JovemRESUMO
Background and purpose - The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Patients and methods - This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3-10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results - No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle-hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Interpretation - Nonoperative treatment can be considered a good option for patients with OCL.
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Osteocondrite/terapia , Tálus , Adulto , Progressão da Doença , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite/diagnóstico , Osteoartrite/etiologia , Osteocondrite/diagnóstico , Osteocondrite/fisiopatologia , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Suporte de Carga/fisiologiaRESUMO
We report a case of valgus ankle degenerative arthritis due to chronic isolated deltoid insufficiency combined with tibial varus that was treated successfully with ankle joint preserving surgery. A 63-year-old male complained of right lateral ankle pain with 10 minutes of maximal pain-free walking time. The assessed American Orthopaedic Foot and Ankle ankle-hindfoot scale score was 33 points. The ankle joint showed 18° of valgus deformity with 6° of tibia varus. Medial displacement calcaneal osteotomy, supramalleolar open wedge osteotomy, and deltoid ligament imbrication were performed. At the 2-year follow-up examination, the ankle joint showed 10° of valgus and the tibial plafond showed flattening. The hindfoot showed 7° of valgus. He could run for 2 hours on the treadmill without pain. The American Orthopaedic Foot and Ankle ankle-hindfoot scale score was 90 points. In conclusion, valgus ankle degenerative arthritis with isolated deltoid insufficiency and tibial varus could be treated successfully with realignment using a double osteotomy and additional deltoid imbrication.
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Articulação do Tornozelo/cirurgia , Mau Alinhamento Ósseo/cirurgia , Osteoartrite/cirurgia , Tíbia/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Mau Alinhamento Ósseo/diagnóstico por imagem , Humanos , Ligamentos Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteotomia , Tíbia/diagnóstico por imagemRESUMO
OBJECTIVE: Silicone gel sheeting has been introduced to prevent scarring, but objective evidence for its usefulness in scar healing is limited. Therefore, the authors' objective was to examine the effectiveness of silicone gel sheeting by randomly applying it to only unilateral scars from a bilateral hallux valgus surgery with symmetrical closure. DESIGN: In a prospective randomized, blinded, intraindividual comparison study, the silicone gel sheeting was applied to 1 foot of a hallux valgus incision scar (an experiment group) for 12 weeks upon removal of the stitches, whereas the symmetrical scar from the other foot was left untreated (a control group). The scars were evaluated at 4 and 12 weeks after the silicon sheet application. The Vancouver Scar Scale was used to measure the vascularity, pigmentation, pliability, height, and length of the scars. Adverse effects were also evaluated, and they included pain, itchiness, rash, erythema, and skin softening. RESULTS: At weeks 4 and 12, the experiment group scored significantly better on the Vancouver Scar Scale in all items, except length (P < .05 for all except the length of scar), compared with the control group. In all items, adverse effects of the experiment group were significantly lower than those of the control group at week 12, suggesting that direct attachment of the silicone sheet does not cause adverse effects (P < .05). CONCLUSIONS: To the authors' knowledge, this is one of the first models to minimize bias related to scar evaluation by using symmetrical scars. The early silicone sheet application did show a significant improvement in prevention of postoperative scarring.
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Cicatriz Hipertrófica/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Queloide/tratamento farmacológico , Curativos Oclusivos , Géis de Silicone/administração & dosagem , Administração Tópica , Adulto , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/prevenção & controle , Feminino , Hallux Valgus/cirurgia , Humanos , Queloide/etiologia , Queloide/prevenção & controle , Masculino , Procedimentos Ortopédicos/efeitos adversos , Estudos ProspectivosRESUMO
PURPOSE: The aim of this study was to investigate the difference in clinical and radiographic outcomes between conventional open lateral soft tissue release (OLSTR) and transarticular lateral soft tissue release (TLSTR) in patients undergoing distal chevron metatarsal osteotomy (DCMO) for hallux valgus (HV) correction. METHODS: This study included weight-bearing anteroposterior radiographs of 138 patients (185 feet) with HV that underwent DCMO and Akin phalangeal osteotomy at a mean age of 51.7 years (21-74) with a mean 26 months of follow-up between June 2004 and June 2010. Patients were classified into two groups: OLSTR as group 1 (84 feet) and TLSTR as group 2 (101 feet). We evaluated clinical and radiographic outcomes between the two groups using the American Orthopaedic Foot and Ankle Society hallux score, visual analogue scale pain score, hallux valgus angle, intermetatarsal angle and complications, pre- and post-operatively. RESULTS: There were no significant differences between the two groups except for post-operative complications such as first metatarsophalangeal joint (MTPJ) stiffness (group 1) and post-operative hallux varus (group 2). CONCLUSIONS: Clinical and radiographic outcomes between OLSTR and TLSTR in HV correction using DCMO were not significantly different except for post-operative limitation of motion of the first MTPJ and hallux varus tendency. Different precautions should be taken into account when choosing the type of lateral soft tissue release due to possible complications associated with each technique.
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Hallux Valgus/cirurgia , Osteotomia/métodos , Adulto , Idoso , Feminino , Hallux Valgus/diagnóstico por imagem , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento , Adulto JovemRESUMO
As the aging population increases, the number of patients with osteoporosis is gradually rising. Osteoporosis is a metabolic bone disease characterized by low bone mass and the microarchitectural deterioration of bone tissue, resulting in reduced bone strength and an increased risk of low-energy or fragility fractures. Thus, the use of anti-resorptive agents, such as bisphosphonates (BPs), to prevent osteoporotic fractures is growing annually. BPs are effective in reducing hip and other fractures. However, the longer a patient takes BPs, the higher the risk of an atypical femoral fracture (AFF). The exact mechanism by which long-term BP use affects the development of AFFs has not yet been clarified. However, several theories have been suggested to explain the pathogenesis of AFFs, such as suppressed bone remodeling, impaired bone healing, altered bone quality, and femoral morphology. The management of AFFs requires both medical and surgical approaches. BPs therapy should be discontinued immediately, and calcium and vitamin D levels should be evaluated and supplemented if insufficient. Teriparatide can be used for AFFs. Intramedullary nailing is the primary treatment for complete AFFs, and prophylactic femoral nailing is recommended if signs of an impending fracture are detected.
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Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is important to select the proper method. Intermetatarsal angle (IMA) determines the severity of hallux valgus, which is influenced by the translated metatarsal head and the reduction of the first tarsometatarsal joint. We hypothesized that both of the mechanisms simultaneously contribute to the correction of IMA. Hallux valgus (70 feet) operated with a Scarf osteotomy with the Akin procedure were reviewed. Hallux valgus angle (HVA), IMA (mechanical and anatomical), hallux valgus interphalangeal angle (HVIP), distal metatarsal articular angle (DMAA), and sesamoid position were checked. The ratio of contributions to the IMA changes were calculated and compared. When the individual contributions by metatarsal head translation and first tarsometatarsal joint reduction were compared, metatarsal head translation contributed by 82%, whereas first tarsometatarsal joint reduction contributed by 18%. Both were responsible for mechanical IMA correction. However, IMA change by metatarsal head translation was a major correction mechanism compared to anatomical IMA change by first tarsometatarsal joint reduction.
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Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Hiperplasia , Ossos do Metatarso/cirurgia , Articulação Metatarsofalângica/cirurgia , Osteotomia/métodos , Radiografia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA. METHODS: Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4-22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS). RESULTS: All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively (P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15-130) at the final follow-up (P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant (P = 0.1). Major postoperative complications were reported in five of the knees (33.3%). CONCLUSIONS: The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees. LEVEL OF EVIDENCE: A retrospective case series, Level IV.
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PURPOSE: The purpose of this study was to compare the massive cuff stitch (MCS) with the simple stitch in terms of integrity at 2 years after surgery when used to repair small-sized to medium-sized full-thickness rotator cuff tears. METHODS: Seventy-one patients underwent arthroscopic repair of full-thickness rotator cuff tears between December 2004 and June 2006. The tear sizes ranged from 0.5 to 1.5 cm. The mean patient age was 53 years (range, 40 to 69 years), and the mean follow-up time was 33 months (range, 24 to 41 months). Group I (n = 35) underwent MCS repair, and group II (n = 36) underwent simple stitch repair. Results were analyzed by use of the Wilcoxon signed rank test and the Mann-Whitney test. Follow-up ultrasound was performed 24 to 41 months after repair. RESULTS: All patients showed improvements in the visual analog scale for pain, activities of daily living, and University of California, Los Angeles scores (P < .05), but there were no significant differences in scores between groups (P > .05). The satisfaction rating was similar for group I (4.7) and group II (4.3) (P > .05). The failure (retear) rate was significantly lower in group I (14.3%) than in group II (27.8%) (P < .05). CONCLUSIONS: The clinical outcomes between the MCS and simple stitch were not significantly different, but the MCS was superior to the simple stitch in maintaining repair integrity on ultrasound evaluation after arthroscopic repair of small-sized to medium-sized full-thickness rotator cuff tears. LEVEL OF EVIDENCE: Level III, prospective therapeutic comparative study.
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Artroscopia/métodos , Manguito Rotador/cirurgia , Técnicas de Sutura , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador , Resultado do Tratamento , Ultrassonografia , Ferimentos e Lesões/reabilitaçãoRESUMO
During varus deformity correction in a patient undergoing total knee arthroplasty (TKA), the medial collateral ligament (MCL) could get completely detached from its distal insertion site. Our aim was to evaluate the (1) mid-term clinical outcome and implant survival after conservative treatment in patients with intraoperatively over-released MCL and (2) preoperative risk factors for MCL over-release. A retrospective study was conducted on patients who had undergone a primary TKA between 2001 and 2006. The number of knees with intraoperative MCL over-release (over-released group) was 47 (40 patients); we compared these with the knees that had intact MCL (intact group, 502 knees). Simple anchoring of MCL was performed with no additional protection. The postoperative clinical outcome and implant survival were compared. Risk factors for MCL over-release were identified using multivariate analysis. The average follow-up period was 7.5 years. The mean Knee Society score of the over-released group improved from 23.3 to 92.7 and it was not significantly different from the intact group. Three cases of aseptic loosening occurred in the over-released group and 19 in the intact group (p = 0.423). The survival rates of the implant were 94.4% and 96.1%, respectively, at 13 years postoperatively. Multivariate analysis showed preoperative femoral-tibial angle as the only risk factor for over-release. This study showed that even MCL was over-released inadvertently, but it did not affect the clinical outcome. Preoperative femoral-tibial angle was the only predictable risk factor for MCL over-release.
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Artroplastia do Joelho/efeitos adversos , Tratamento Conservador , Ligamento Colateral Médio do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/terapia , Tíbia/cirurgia , Adulto , Idoso , Feminino , Fêmur/cirurgia , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Falha de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: The purpose was to evaluate and compare the revision rate due to aseptic loosening between a high-flex prosthesis and a conventional prosthesis. MATERIALS AND METHODS: Two thousand seventy-eight knees (1,377 patients) with at least 2 years of follow-up after total knee arthroplasty were reviewed. Two types of implants were selected (LPS-Flex and LPS, Zimmer) to compare revision and survival rates and sites of loosened prosthesis component. RESULTS: The revision rate of the LPS-Flex (4.9%) was significantly higher than that of the conventional prosthesis (0.6%) (pï¼0.001). The 5-, 10-, and 15-year survival rates were 98.9%, 96.2% and 92.0%, respectively, for the LPS-Flex and 99.8%, 98.5% and 93.5%, respectively, for the LPS. The survival rate of the high-flex prosthesis was significantly lower than that of the conventional prosthesis, especially in the mid-term period (range, 5 to 10 years; p=0.002). The loosening rate of the femoral component was significantly higher in the LPS-Flex prosthesis (p=0.001). CONCLUSIONS: The LPS-Flex had a higher revision rate due to aseptic loosening than the LPS prosthesis in the large population series with a long follow-up. The LPS-Flex should be used carefully considering the risk of femoral component aseptic loosening in the mid-term (range, 5 to 10 years) follow-up period after initial operation.
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Eleven patients with bipolar clavicle injuries, including dislocation of both ends of the clavicle, dislocation of the sternoclavicular joint with distal clavicle fracture, dislocation of the acromioclavicular joint with medial clavicle fracture, and segmental fracture of the clavicle, were retrospectively reviewed. The purpose of this study was to report the clinical outcomes and a literature review of bipolar clavicle injury. Nonoperative treatment was performed for 5 patients and surgical treatment for 6 patients. The fracture or dislocation of the lateral end of the clavicle was fixed with a hook plate, and closed reduction of the medial end was performed; if the dislocation was still present, open reduction and anterior sternoclavicular ligament repair was performed. Visual analog scale pain score, Constant score, active range of motion, and radiological images were evaluated. The mean visual analog scale pain score for all patients was 0.7±0.9 (range, 0-2). The mean Constant score for all patients was 89.7±7.6 (range, 72-96). The mean Constant score was 84.2±8.5 (range, 72-96) for conservatively treated patients and 94.3±1.9 (range, 92-96) for surgically treated patients. The mean Constant score was 83.4±7.2 (range, 72-92) for patients in whom optimal reduction of 1 or both ends was not achieved. Residual pain or deformity was seen in 5 patients. The authors suggest operative treatment of bipolar clavicle injuries in younger, active patients when anatomical reduction cannot be achieved and residual deformity, pain, or functional limitations are unacceptable. [Orthopedics. 2018; 41(5):e681-e688.].
Assuntos
Clavícula/lesões , Clavícula/cirurgia , Fraturas Ósseas/terapia , Adulto , Placas Ósseas , Clavícula/diagnóstico por imagem , Feminino , Fixação de Fratura , Fraturas Ósseas/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/lesões , Articulação Esternoclavicular/cirurgia , Tomografia Computadorizada por Raios X , Escala Visual AnalógicaRESUMO
BACKGROUND: A midfoot sprain can be easily missed because of minimal findings on initial radiographs, which are almost universally nonweightbearing. We investigated preoperative nonweightbearing plain radiographic images in patients who were found to have unstable subtle Lisfranc injuries. METHODS: We retrospectively reviewed 51 patients who were operated on between February 2004 and March 2015. Abnormal preoperative radiographic findings and intraoperative instability were compared. The relationship was calculated with Fisher's exact test. RESULTS: Based on intraoperative findings, medial cuneiform (C1)-second metatarsal (M2) instability was observed in 50 cases (98%), which was the most common. Thirty-nine cases (76.4 %) had multiple joint (at least 2) instability. In the preoperative radiologic findings, C1-M2 diastasis was the most common abnormal finding, in 46 cases (90.1%). Specificity and positive predictive value were 1.0 in C1-M2 avulsion, diastasis, and C1-intermediate cuneiform (C2) diastasis. Abnormal findings of C1-C2, C1-M1, and C2-M2 showed a significant relationship with intraoperative instability ( P < .05). CONCLUSION: C1-M2 avulsion and diastasis and C1-C2 diastasis were definite preoperative predictors of instability. In unstable subtle Lisfranc injuries, 90% had at least a minor radiographic abnormality at the C1-M2 joint on nonweightbearing radiographs. However, caution should be exercised to identify instability without radiographic abnormality in the C1-M2 joint. LEVEL OF EVIDENCE: Level IV, retrospective case series.