ABSTRACT
Contexto: las roturas del ligamento cruzado anterior (LCA) en pacientes con fisis abiertas representan el 3,3% de las roturas del LCA, En el tratamiento de las roturas intersticiales del LCA en pacientes con fisis abiertas existe controversia en la elección entre tratamiento conservador y tratamiento quirúrgico. Objetivo: analizar la reconstrucción del ligamento cruzado anterior LCA con fisis abierta en el Servicio de Ortopedia y Traumatología del Hospital de Especialidades FFAA No 1. Sujetos y métodos: estudio retrospectivo en pacientes sometidos a cirugía artroscópica para tratamiento de lesión del LCA con fisis abiertas, en el periodo enero 2012 y abril de 2015. En relación al tratamiento, se utilizó la técnica transfisaria completa (monotúnel); el injerto se fija al fémur con un endobotón y a la tibia con un tornillo de interferencia; el injerto fue obtenido del músculo semitendinoso. Resultados: fueron intervenidos 9 pacientes de sexo masculino, con edades entre 13 y 16 años, con lesiones del ligamento cruzado anterior en rodilla derecha (n=7, 78%) e izquierda (n=2, 22%); la ruptura del menisco es la lesión asociada más frecuente. Conclusión: las roturas del LCA con fisis abiertas son cada vez más frecuentes en la actualidad. La reconstrucción del LCA debe ser precoz para evitar lesiones condrales y meniscales. Se recomienda el tratamiento quirúrgico por los óptimos resultados clínicos y funcionales. (AU)
Background: anterior cruciate ligament (ACL) tears in open physis patients represent 3.3% of ACL tears. In the treatment of ACL interstitial tears in patients with open physis, there is controversy in the choice between conservative treatment and surgical treatment. Objective: to analyze the reconstruction of the anterior cruciate ligament ACL with open physis in the Orthopedics and Traumatology Service of the Specialty Hospital FFAA No 1. Subjects and methods: retrospective study in patients undergoing arthroscopic surgery for treatment of ACL injury with open physis, in the period January 2012 and April 2015. In relation to the treatment, the complete transfusion technique (monotunnel) was used; the graft is fixed to the femur with an endobotton and to the tibia with an interference screw; the graft was obtained from the semitendinous muscle. Results: were operated on 9 male patients, with ages between 13 and 16 years, with injuries of the anterior cruciate ligament in the right knee (n = 7, 78%) and left (n = 2, 22%); the rupture of the meniscus is the most common associated lesion. Conclusion: ACL tears with open physis are becoming more frequent today. The reconstruction of the ACL must be early to avoid chondral and meniscal lesions. Surgical treatment is recommended for optimal clinical and functional results. (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Orthopedics , Anterior Cruciate Ligament , Ligaments , Skeleton , Specialties, Surgical , TherapeuticsABSTRACT
Introducción: La reconstrucción del LCA es uno de los procedimientos ortopédicos más comunes. Los tornillos por interferencia biocompuestos están integrados por un polímero y algún material osteoconductor, cuya función es promover el crecimiento óseo en el sitio del implante al mismo tiempo que éste se reabsorbe. Material y método: se incluyeron un total de 28 pacientes, operados de reconstrucción artroscópica de LCA fijados con tornillo Milagro y tornillo bio-intrafix. Todos los pacientes fueron valorados con TAC, se realizaron mediciones del diámetro del túnel tibial en el segmento proximal, medio y distal, con trazo libre utilizando por lo menos 10 puntos de referencia para cada trazo. Así como una valoración subjetiva en relación a la presencia o ausencia de esclerosis adyacente al tornillo. Resultados: del total de la muestra, 12 pacientes no presentaron datos de osteointegración y 16 pacientes sí, encontrándose una asociación significativa entre osteointegración y el tornillo Milagro (p=0.006). En cuanto a degradación, no se observó ningún paciente sin datos de degradación. 53 por ciento se catalogaron como degradación parcial y 47 por ciento como total, de éstos el 76.9 por ciento pertenecían al grupo con tornillo Milagro encontrándose así una asociación entre el tornillo Milagro y degradación (p=0.006). Discusión y conclusiones: el tornillo Milagro fue el que se asoció con osteointegración. El área total en el túnel tibial incrementó, siendo éste porcentaje mayor para el tornillo bio-intrafix. Sin embargo, no se encontró una relación lineal entre el tiempo transcurrido desde la cirugía y el cambio en el área del túnel tibial; sugerente de que existen otros factores que influyen en este proceso. A pesar de los resultados clínicos satisfactorios, la adición de una cerámica osteoconductora no resultó en osteointegración completa de ninguno de los tornillos. Nivel de evidencia: III. Tipo de estudio: Cuasiexperimental, transversal, ambilectivo.
Introduction: The ACL reconstruction is one of the most common procedures in orthopedics. The bio-interference screws are made of a polymer plus an osteoconductive ceramic which function is to promote bone formation at the site of the implant while it reabsorbs. Methods: 28 patient were included, all were submitted to an arthroscopic ACL reconstruction procedure. CT scans were made in all of them, the diameter of the tibial tunnel was measured at the proximal, medial, and distal segments by a 10 point reference free hand line. Also a subjective evaluation was made in relation to the presence of adjacent sclerosis at the screw. Results: from the total sample, 12 patients did not show signs of osseointegration, 16 did, finding a significant association between osseointegration and the Milagro screw (p=0.006). None of the patients had absence of degradation. 53% were classified as partial degradation and 47% as total, from these the 76.9% belong to the Milagro screw group resulting in an association between the Milagro screw and total degradation (p=0.006). Discussion and conclusions: the Milagro screw was associated with osseointegration. The total area of the tibial tunnel increased, being this percentage major for the bio-intrafix screw. Hence, a linear relation was not found between the time from intervention and the change at the area of the tibial tunnel though, suggesting there are other factors that influence this process. Beside the satisfactory clinical results, the addition of an osseoconductive ceramic did not result in a complete osseointegration of neither screw. Level of evidence: III. Type of study: Cuasi experimental, transversal, ambilective.
Subject(s)
Middle Aged , Arthroscopy/methods , Absorbable Implants , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament , Osseointegration , Tomography, X-Ray Computed , Knee Injuries , Treatment Outcome , Bone Screws , Knee Injuries/surgeryABSTRACT
Introduction The incidence of knee injuries is very high in young adults. Anterior cruciate ligament (ACL) rupture is the most frequent of them. The isokinetic dynamometry evaluation determines the functional patterns of strength and muscle balance.Objective To compare the isokinetic hamstring/quadriceps peak torque and work ratios of young adults after surgical reconstruction of the anterior cruciate ligament.Methods We selected 33 medical records filed by the Isokinetic laboratory of the Physiotherapy Clinic of the Catholic University of Paraná (PUCPR), which belonged to patients who had undergone isokinetic assessment at the request of a physiotherapist or physician in Curitiba, Paraná. The tabulated data were: Hamstring/Quadriceps peak torque and work ratios of all injured and non-injured limbs at an angular velocity of 60°/s. Data were processed by the statistical software LHstat. Inferential statistics was used in order to apply the comparison test between means (unpaired t-test) with a confidence interval of 95%.Results The average flexion-extension ratio of the non-involved limb was lower than the involved limb both for peak torque (peak torque ratio of the non-involved limb: 56.1%; peak torque ratio of the involved limb: 66.3%; difference: 10.2%) and work (work ratio of the non-involved limb: 60.1%; work ratio of involved limb: 66.1%; difference: 6%).Conclusion : The average flexion/extension ratio found was adequate for both limbs and variables, however, the subjects presented a greater number of muscle asymmetries in the involved limb than in the non-involved limb.
Introdução A incidência de lesões de joelho em adultos jovens é muito alta, sendo a ruptura do ligamento cruzado anterior (LCA) a mais frequente. A avaliação por Dinamometria Isocinética determina o padrão funcional de força e equilíbrio muscular.Objetivos Comparar a relação das variáveis isocinéticas torque e trabalho de flexores e extensores do joelho em adultos jovens após a reconstrução cirúrgica do ligamento cruzado anterior. Metodologia: Foram selecionados 33 prontuários arquivados pelo laboratório de Isocinética da Clínica de Fisioterapia da Pontifícia Universidade Católica do Paraná (PUCPR), de pacientes que realizaram a avaliação isocinética a pedido de fisioterapeutas e de médicos da cidade de Curitiba (PR). Os dados tabulados foram: relação flexora/extensora de pico de torque e trabalho em todos os membros lesionados e não-lesionados a uma velocidade angular de 60°/s. Os dados foram tratados pelo software de estatística LHstat. A estatística inferencial foi empregada para aplicar o teste de comparação entre médias (Teste t não pareado) com um intervalo de confiança de 95%.Resultados A média da relação flexo-extensora é menor no membro não envolvido tanto no pico de torque (relação pico de torque do membro não envolvido 56,1% e relação do pico de torque do membro envolvido 66,3%, apresentando diferença de 10,2%) quanto no trabalho (relação do trabalho no membro não envolvido 60,1% e relação do trabalho do membro envolvido 66,1% apresentando diferença de 6%).Conclusão A média encontrada da relação flexo-extensora foi adequada para ambos os membros e variáveis, no entanto os indivíduos apresentaram assimetrias musculares em maior número no membro envolvido do que no membro não envolvido.