Tratamento cirúrgico de luxação recidivante da mandíbula: relato de caso / Surgical treatment of recurrent mandible luxation: case report

Introdução: A articulação temporomandibular (ATM) é uma estrutura especializada e excepcional, relacionada com funções estomatognáticas e propensa à disfunções associadas ao sistema maxilo-mandibular. Dentre essas alterações, a luxação é uma entidade patológica importante. Possui patogênese multifatorial e pode se manifestar de modo recidivante. Diversos tratamentos são propostos, dentre eles, a criação de anteparos aloplásticos. Paciente do sexo feminino, 22 anos com história de luxação mandibular recidivante com sintomatologia congruente ao quadro. Realizou-se tratamento cirúrgico com instalação de miniplacas de titânio do sistema 2.0 mm em forma de duplo T com curvatura de aproximadamente 90°, na região de eminencia articular. Após 1 ano e 6 meses, a paciente segue assintomática, sem lesões nervosas e sem luxações. A luxação da ATM é um quadro clínico angustiante, sendo a segunda luxação mais frequente e incidente em mulheres. Caracteriza-se por: incapacidade de fechar a boca, depressão cutânea pré-auricular, ptialismo e musculatura mastigatória tensa. A paciente apresentava severas luxações recidivantes, juntamente com ansiedade e angústia social. A utilização de placas evitou a hiperexcussão e remissão do quadro. É um procedimento menos agressivo e reversível. A técnica utilizada demonstrou bom prognóstico e, dentre as opções cirúrgicas, é uma técnica mais conservadora... (AU)

Introduction: TMJ dislocation is a multifactorial joint pathology that occurs when the mandibular condyle exceeds the articular eminence and cannot return to its original anatomical position, making it impossible for the patient to close the mouth. A 22-year-old female patient complaining of succes sive episodes of mandibular dislocation, characterizing the condition of dislocation redicivant TMJ. Surgical treatment was performed with the installation of 2.0 mm double T-shaped titanium miniplates with approximately 90° curvature in the region of articular eminence. After 8 months, the patient has no complaints, no signs of facial nerve damage and no episodes of dislocation. TMJ dislocation is a socially and psychologically distressing clinical condition, being the second most frequent dislocation in the body and with higher incidence in female patients. Key features are inability to close the mouth, pre auricular cutaneous depression, excessive salivation, and tense and spasmodic masticatory muscles. In this case, the patient presented severe relapsing dislocations, along with anxiety and social anguish. The use of plates acts as a mechanical barrier for condylar movements, avoiding hyperexcussion, being a less aggressive and reversible procedure, having only the disadvantage of the possibility of plate frac ture. The technique used with the objective of limiting condyle movement, among the surgical options, is a more conservative technique... (AU)

Arthroscopic reconstruction of medial patellofemoral ligament combined with medial displacement of lateral hemitibial tuberosity for treatment of recurrent dislocation of patella / 中国修复重建外科杂志

Objective: To observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella. Methods: Retrospectively analyse the clinical data of 24 patients (24 knees) with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) values more than 15 mm who were admitted between September 2014 and September 2018. Of which 7 were male and 17 were female; aged 16-35 years old with an average of 25.8 years. The disease duration ranged from 15 to 46 months, with an average of 26.7 months. All patients had a history of knee trauma, and a positive result of apprehension test on the affected knee. All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity. Before and after operation, Kujala score was used to evaluate patellofemoral joint function, Lysholm score was used to evaluate knee joint function; CT and MRI were used to measure and compare the changes of congruence angle (CA), patellar tilt angle (PTA), and lateral patella displacement (LPD) in order to evaluate patella stability. Results: All incisions healed by first intention, and no infection or neurovascular injury occurred. Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively, and the thrombosis disappeared after symptomatic treatment. All the 24 patients were followed up 12-14 months (mean, 12.9 months). During follow-up, no patellar dislocation reoccurred in the affected knee. At last follow-up, the apprehension test was negative in every patients. The TT-TG, CA, PTA, and LPD were significantly improved when compared with those before operation ( P<0.05). The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation, and the above scores at last follow-up were significantly better than those at 1 month after operation ( P<0.05). According to Lysholm score, the patients' knee joint functions were excellent in 13 cases, good in 10 cases, and fair in 1 case, and the excellent and good rate was 95.8%. Conclusion: Arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness. It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.

Soft-tissue Fixation of Medial Patellofemoral Ligament Reconstruction for Treatment of Recurrent Dislocation of the Patella in Adolescents / 中国运动医学杂志

Objective To explore the efficacy of the soft-tissue fixation in reconstruction of the medial patellofemoral ligament(MPFL) in treating the recurrent dislocation of patella in adolescents.Methods A total of 12 adolescents undergoing MPFL reconstruction for the recurrent dislocation of patella between March 2014 and October 2015 were included.The autologous hamstring tendon was harvested and fixated using the soft-tissue fixation method in the MPFL reconstruction.A rapid rehabilitation program was carried out postoperatively.Clinical outcomes were evaluated using the Lysholm,international knee documentation committee(IKDC),Kujala knee scores preoperatively and during the postoperative follow-up.Moreover,the degree of satisfaction to the surgery and the restoration of sports activities were also surveyed.Results All patients were followed up for 6 to 18 months,with an average of 12 months.There was no recurrence of dislocation.During the final follow-up,all patients restored the full range of activity and normal medial patellar stability.The Lysholm,IKDC and Kujala knee scores were significantly improved postoperatively compared with those preoperatively (P＜0.01).Ten patients were very satisfied with the operation and the other 2 were satisfied with the surgery.Among all the patients (non-professional athletes),75％(9/12) fully regained their sport abilities in 6 months after the surgery.Conclusions Reconstruction of MPFL with the soft-tissue fixation method has achieved remarkable clinical results without severe complications associated with bony procedures.For the adolescent patients with open growth plates,this is a safe,effective and reliable surgical technique.

Traumatic Recurrent Dislocation of the Hip with Bankart Type Lesion: A Case Report / 대한고관절학회지

The recurrent dislocation of hip in adult can be uncommonly induced by neuromuscular disease or dysplasia of hip. But in the case of traumatic dislocation of hip with acetabular fracture, the possibility of recurrent dislocation can be decreased if treated with accurate fixation or traction. We have experienced a case of hip dislocation with comminuted acetabular fracture, which was treated only with soft tissue suture and without fixation because of severity of the acetabular fracture. An inappropriate conservative management was done during the post operation period, eventually result in recurrent dislocation and degeneration of posterior wall and head of femur which resembled bony Bankart lesion of the shoulder. The reduction was not able to be maintained, as a result THRA was done. A year after the operation, good prognosis was found in replaced hip without any recurrent dislocation.

Arthroscopic Evaluation on Intra-Articular Pathology in Recurrent Shoulder Dislocation Aged Over 40 Years

PURPOSE: This study is to analyze the prevalence of various intra-articular lesions in patients with traumatic recurrent anterior dislocation of shoulder over 40 years and suggest clinical implications for treatment. MATERIALS AND METHODS: We retrospectively studied 16 cases that underwent surgical treatment for recurrent anterior dislocation of shoulder from January 2001 to May 2009. There were 9 males and 7 females, and the mean age was 52.7years. We carried out arthroscopic exam for all patients based on standard protocol, which included labrum, capular lesion, cuff, bony lesions. RESULTS: All 16 cases showed Hill-Sachs lesion, 3 patients (19%) had bony Bankart lesion, 6 patients (38%) had labral tear. Capsular tear were found 15 patients (94%). Twelve (75%) had ruptured supraspinatus and 5 (31%) had subscapularis tear. Only one (6%) had SLAP lesion. CONCLUSION: There was relatively higher incidence of capsular and rotator cuff tears in patients over age 40 years. Preoperative planning to address these lesions is highly recommended.

Operative Treatment of Chronic Recurrent Dislocation of Peroneal Tendon: A Case Report / 대한족부족관절학회지

Traumatic dislocation of the peroneal tendon is an infrequent injury. This injury is caused by forceful dorsiflexion of the foot accompanied by a powerful contraction of the peroneal muscles. This mechanism of injury tears the superior peroneal retinaculum and allows the tendons to snap anteriorly. We experienced a case of chronic recurrent dislocation of the peroneal tendon, which was treated by bone block surgery using autograft of lateral fibula and reattachment of the superior peroneal retinaculum. The clinical result was satisfactory.

Mid to Long Term Evaluation of Elmslie-Trillat-Marquet procedure for Recurrent Patellar Subluxation or Dislocation

PURPOSE: To evaluate mid to long term results of Elmslie-Trillat-Marquet procedures for recurrent patellar subluxation or dislocation. MATERIALS AND METHODS: From May 1993 to February 2004, 21 knees in 20 patients who got Elmslie-Trillat-Marquet procedures were evaluated. Mean follow-up periods were 80.5 months. Clinical tests such as Lysholm knee scoring scale, IKDC subjective knee evaluation form, visual analog scale and radiological tests such as Insall-Salvati index and congruence angle were evaluated. RESULTS: Lysholm knee score was improved to average 91 points, IKDC knee score 82, visual analog scale 28. Q angle was improved from average 28degrees preoperatively to 12.5degrees. Insall-Salvati index and congruence angle were significantly corrected and no subluxation or dislocation were observed at final follow up. Fracture of tibial tubercle in 1 case which was treated with refixation and medial instability in 3 cases were observed. CONCLUSION: Elmslie-Trillat-Marquet procedure can be a useful method to correct patellofemoral malalignment in long term follow up but meticulous care to reduce the complication was needed.

Current treatment of recurrent patellar dislocation / 中华创伤骨科杂志

Patients who suffer from recurrent patellar dislocation frequently complain of diffuse pain around the knee, swelling and dislocation or subluxation of the patella. Anatomical abnormalities should be responsible for the condition, such as increased Q angle, a high-riding patella, dysplasia of the femoral condyles, abnormal shape of the patella, atrophy of the vastus medialis and hypertrophy of the vastus lateralis. We reviewed 45 reports about the treatment of recurrent dislocation of the patella. The current more than 100 methods can be classified as: lateral release, proximal realignment, distal realignment, proximal and distal realignment, patella-tomy and plastic repair of quadriceps. Of all these methods, proximal realignment is the best, but there has been no method which can successfully and generally repair the recurrent patellar dislocation.

Torg's Modified Bristow Procedure for Recurrent Anterior Dislocation of the Shoulder Joint / 中国运动医学杂志

Objective To introduce Torg's modified Bristow procedure for recurrent anterior dislocation of the shoulder joint,and to evaluate it's clinical result.Methods 25 shoulders with recurrent anterior dislocation were treated with Torg's modified Bristow procedure from January 2002 to December 2006.Based on history,physical examination and X-ray examination,all the diagnosis were confirmed.The follow-up period ranged from 1 to 5 years,with an average of 3.1 years.Results All the cases had Hillsachs lesions and Bankart lesions.After 2 years,only one shoulder had redislocated and 96% of patients were satisfied with the operative repair.The Rowe standard rating scale:excellent 72%;good 24%;fair 4%;poor 0%.Conclusion Torg's modified Bristow procedure provided a good functional result in patients with recurrent shoulder dislocations.

Case report of chronic recurrent dislocation treated by subperiosteal dissection of masticatory muscles

Evaluation of the Elmslie-Trillat-Marquet Procedure for Recurrent Patellar Subluxation or Dislocation / 대한정형외과학회잡지

PURPOSE: To assess the clinical and radiographic results of the Elmslie-Trillat-Marquet procedure used to treat recurrent patellar subluxation or dislocation with patellar malalignment. MATERIALS AND METHODS: A total of 15 knees in 14 patients were evaluated at an average of 54.5 months (12 to 106) following the Elmslie-Trillat-Marquet procedure; carried out between May 1993 and March 2000. The evaluation included subjective, objective and radiographic assessments. RESULTS: The causes of recurrent patella dislocation were patella alta (11 knees), tight lateral retinaculum (8 knees), patella dysplasia (7 knees), femoral condyle dysplasia (13 knees) and joint hyperlaxity (1 case). The average preoperative Q-angle was 28.5degrees and the postoperative angle 13 degrees. Subjective evaluation using Cox's criteria showed excellent or good results in 13 knees (87%), and the objective evaluation using Fulkerson's functional knee score showed excellent or good results in 14 knees (93%). The mean anterior tibial tubercle displacement was 8 mm (7-11 mm), and the patella congruence angle and Insall-Salvati index were significantly corrected (p<0.001). Lateral subluxation and patellar tilt angle were corrected in all cases. The only complication was an irritation due to nonabsorbable suture material. There were no redislocations, infections, nonunions, or fractures of the transferred tibial tubercle during the follow-up period. CONCLUSION: The Elmslie-Trillat-Marquet procedure for recurrent patellar subluxation or dislocation can basically correct malalignment tridimensionally.

Dislocation of the Bilateral Temporomandibular Joint due to Generalized Tonic-Clonic Seizures / 대한간질학회지

Dislocations or fractures of the limbs can arise from muscle contraction during epileptic seizures. Dislocation complication of the bilateral temporomandibular joint from seizures is reported very rarely. A 36-year-old woman, who had no history of epilepsy, presented recurrent dislocations of the bilateral temporomandibular joint and generalized tonic-clonic seizures. EEG showed intermittent generalized slow activity. We report a case of bilateral temporomandibular joint dislocation that occurred during generalized tonic-clonic seizures, which has not previously been reported in Korea.

Surgical management for traumatic recurrent dislocation of the peroneal tendons / 中国微创外科杂志

Objective To study surgical techniques for the treatment of traumatic recurrent dislocation of the peroneal tendons. Methods A total of 21 cases of traumatic dislocation of the peroneal tendons from 1986 to 2003 were treated with the Watson-Jones operation. Results A follow-up series was carried out in 15 cases for 1~15 years (mean, 4.9 years). Recurrence of dislocation occurred in 1 case, as a result of trauma, while the rest of 14 cases had returned to normal sports or competitions. Conclusions The Watson-Jones operation for recurrent dislocation is technically feasible and minimally invasive, offering satisfactory outcomes.

Recurrent Dislocation and Subluxation of the Patella: Experience of 22 Knees / 대한정형외과학회잡지

Recurrent dislocation of the patella is a relatively uncommon disease, which is most commonly seen in females in late adolescence. The condition is usually spontaneous and only rarely fallows traumatic dislocation. Dislocation is nearly always lateral and about one thirdis bilateral. The theoretical rationale of the treatment of the recurrent dislocation and subluxation of the patella is the realignment of the extensor mechanisms. We experienced with recurrent dislocation and subluxation of the patella on 22 knees in 18 patients at Seoul National University Hospital from July 1981 to Oct. 1987 and obtained the following results. 1. The age at operation ranged from 4 to 33 years and its mean was 15.8 years. Among 18 patients thirteen were female and five, male. 2. The most common presenting symiptom was pain (11 knees) and the most common presenting sign was quadriceps muscle atrophy (11 knees). 3. The prominent radiologic finding was patella alta in 6 knees (27.3%), genu valgum in 10 knees (45.3%), and hypoplasia of the lateral condyle of the femur in 2 cases (9%). 4. In two knees supracondylar osteotomy were performed and followed by proximal extensor mechanism realignment. In twelve knees only proximal reconstruction was performed. Four knees were treated by Hauser's technique and three knees with Roux-Gold-thwait technique. And these distal reconstruction procedures were performed with other procedures. 5. Mean follow up period was 1 year and 5 months. And the results are excellent in 8 knees, good in 12 knees and fair in 2 knees.

Bilateral Recurrent Dislocation of the Peroneal Tendon: A Case Report / 대한정형외과학회잡지

Recurrent dislocation of the peroneal tendon is infrequent but often the injury is a disabling one, and the result of conservative treatment is unsatisfactory. Dislocation of these tendons may be the result of a congenitally shallow groove in the lateral malleolar or of a complete abscence of the groove and the dislocation may be present at birth or may be caused by trauma. We are reporting one case of bilateral recurrent dislocation of the peroneal tendons with- out any history of trauma in which disturbed superior peroneal retinaculum was reconstructed by transposition of the calcsneofibular ligament to the lateral side of the peroneal tendons. The calcaneal insertion of the calcaneofibular ligament was mobilised with a small bone block and reinserted in its bed after the transposition. After a follow up of 13 months, the result was satisfactory.

Treatment of the Patella Using Gracilis as a Static and Dynamic Stabilizer: A Case Report / 대한정형외과학회잡지

More than 100 surgical methods were described as the treatment of recurrent patella dislocation. These can be divided into two categories, the proximal, dynamic reconstruction and the distal, static reconstruction. We treated a case of recurrent patella dislocation with a new method, using gracilis. The tendon of gracilis was dissected and cut at the point about 7cm proximal to the insertion. A 'H' shaped slot was made subperiosteally in the anterior surface of patella. The both ends of cut gracilis tendon were imbedded into the 'H' shaped slot of patella and sutured. So the gracilis tendon could act as a static and dynamic stabilizer. The result was excellent at 1 year follow up.