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ObjectiveTo investigate the injury risk of simplified 24-action Taiji Quan wild horse mane splitting practice at different postures with mechanical analysis. MethodsThe mechanical model of the action of Taiji Quan wild horse mane splitting was establishied, and then the coordinates, velocity, acceleration and horizontal angle of thigh and lower leg were determined by image analysis. The force arm of quadriceps femoris was detected by X-ray, and the quadriceps femoris tension, femoral tibial joint force and patellofemoral joint pressure of wild horse mane splitting practice with different postures were compared. ResultsCompared with the high posture, the coordination and velocity decreased, the average angle of knee joint decreased from 128° to 115° at the low posture; and the knee moment, the quadriceps femoris tension, femoral tibial joint force and patellofemoral joint pressure significantly increased (F > 37.187, P < 0.001). ConclusionWhen practicing Taiji Quan wild horse mane splitting, the risk of knee injury at the low posture is higher than that at high posture.
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Objectives@#1) To translate and cross-culturally adapt the Knee Injury and Osteoarthritis Outcome Score (KOOS) into Filipino; 2) To validate the Filipino translation of KOOS using the Filipino Short-Form 36 Health Survey (SF-36) among patients with knee osteoarthritis (kOA) at a tertiary hospital. @*Methodology@#A Filipino version of the KOOS was translated and cross-culturally adapted from the original English version and validated following standard guidelines. Adult Fiipino patients with knee osteoarthritis at the University of the Phiippines-Philippine General Hospital were asked to complete identical questionnaires containing the Filipino KOOS and Filipino SF-36, with re-test on the same patients after a median of 14 days. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients (ICC); dimensionality using convergent and divergent construct validity. @*Results@#The Filipino translation of the KOOS was administered to 30 patients with knee OA (kOA). Cronbach's α across the Filipino KOOS domains ranged from 0.71 to 0.89 suggesting good internal consistency. The reproducibility of measurements of all KOOS subscales by ICC ranged from 0.97 to 1.0. For convergent construct validity, there was moderate correlation between KOOS ADL (0.38, p =0.03) and knee-related QoL (0.42, p=0.02) by SF-36 Physical Functioning (PF). A strong correlation (0.51, p=0.003) was observed between KOOS sports and recreation domain with SF-36 PF. For divergent construct validity, there was weak correlation between KOOS pain (0.015, p=0.93) and symptoms (0.15, p=0.42) with SF 36 Social Functioning. @*Conclusion@#The Filipino version of the KOOS is a valid and reliable instrument to measure the different aspects of disability affecting quality of life of Filipino patients with kOA.
Subject(s)
Osteoarthritis, Knee , Knee InjuriesABSTRACT
@#Locked knees are commonly caused by meniscal tears, floating osteochondral bodies, ruptured anterior cruciate ligament (ACL) stump, or other mechanical origins in the knee. Some locked knees occur spontaneously, while in most cases, by a preceding knee trauma. Locked knees are rarely caused by a pathological growth in the knee. More unusually is the occurrence of locked knee caused by a pre-existing pathological entity after a traumatic event. We report a rare case of locking in the knee by a pre-existing knee condition presented only after trauma to the knee. This case emphasizes that locking in the knee can be caused by a pathology that may be asymptomatic until it is revealed by a traumatic event.
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Durante las últimas décadas, hemos visto un aumento exponencial de las lesiones traumáticas alrededor de la rodilla en niños y adolescentes. La rodilla pediátrica tiene características particulares, que la diferencian de los adultos, y la predisponen a lesiones distintivas que requieren un manejo acorde. El aumento de su incidencia obliga a los médicos a verse enfrentados con mayor frecuencia a patologías como la luxación patelar, la avulsión de espinas tibiales, la avulsión de la tuberosidad anterior de la tibia y la lesión meniscal en probable contexto de un menisco discoideo. Es fundamental conocer los diferentes diagnósticos diferenciales y su enfrentamiento inicial para realizar una derivación oportuna con el fin de que estos pacientes obtengan un tratamiento adecuado
Over the past few decades, we have seen an exponential increase in traumatic injuries around the knee in children and adolescents. The pediatric knee is different from the adult knee, with special characteristics that predispose it to certain types of injuries that require a specific management. The increase in its incidence has faced attendants more frequently with pathologies such as patellar dislocation, tibial eminence fracture, tibial tubercle fractures and meniscal injury in the setting of a discoid meniscus. It is essential to know the differential diagnoses of this age-group, how to obtain an adequate study for a prompt referral
Subject(s)
Humans , Child , Adolescent , Knee Injuries/diagnosis , Knee Injuries/therapy , Knee Injuries/etiologyABSTRACT
OBJECTIVE@#To verify the clinical effect of acupuncture on knee osteoarthritis (KOA).@*METHODS@#Forty-two patients with KOA were randomly divided into an acupuncture group (21 cases, 1 case dropped off) and a sham acupuncture group (21 cases, 1 case dropped off). The patients in the acupuncture group were treated with routine acupuncture at 5-6 local acupoints [Dubi (ST 35), Neixiyan (EX-LE 4), Heding (EX-LE 2), Yinlingquan (SP 9), Xuehai (SP 10), Zusanli (ST 36), etc.] and 3-4 distal acupoints [Fengshi (GB 31), Waiqiu (GB 36), Xuanzhong (GB 39), Zulinqi (GB 41), etc.]. The patients in the sham acupuncture group were treated with shallow needling technique at non-acupoint. The needles were retained for 30 min in both groups. All the treatment was given three times a week for 8 weeks. Knee injury and osteoarthritis outcome score (KOOS) were recorded before and after treatment and 18-week follow-up.@*RESULTS@#Compared before treatment, the scores of 5 dimensions of KOOS [pain, symptoms (except pain), daily activities, sports and entertainment, and quality of life] were increased after treatment and during follow-up in the two groups (@*CONCLUSION@#Acupuncture can reduce the pain symptoms and improve daily activities in patients with KOA.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Knee Injuries , Osteoarthritis, Knee/therapy , Quality of Life , Treatment OutcomeABSTRACT
Knee is a major weight bearing and largest joint that provides mobility and stability during physical activities as well as balance while standing. Due to its wide range of functions it is exposed to forces beyond its physiological range, and thus bone and soft tissue of knee are at risk of injuries. We wanted to study MRI appearances of cruciate ligaments and meniscal tears in cases of knee injuries and correlate the MRI findings of knee injury with clinical observations/other radiological investigations/ arthroscopic findings. We also wanted to evaluate the sensitivity, specificity, PPV, NPV and accuracy of MRI in detecting knee injuries taking arthroscopy as gold standard (wherever performed).METHODSThis prospective diagnostic descriptive study was conducted in the Department of Radiodiagnosis of Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, among 100 patients presenting with knee injuries referred to Department of Radiodiagnosis for MR imaging. MR scans were carried out on 1.5 tesla MR machine Achieva (by Phillips Medical System) and studies were performed with the sense extremity coil. Arthroscopic knee surgery was performed in 39 patients. MR findings were correlated with clinical and arthroscopic findings wherever possible.RESULTSMR diagnosis of 100 cases was as follows: in ACL tear 50%; PCL tear 19%; MCL tear 17%; LCL tear 16%; MM tear 49%; LM tear 31%; Sensitivity, specificity, NPV, PPV and accuracy of MRI in detecting the knee injuries taking arthroscopy as gold standard are as follows ACL- 100%, 90.9%, 100%, 96.5% and 97.4 %; lateral meniscus-100%, 94.5%, 100%, 50% and 94.8%; medial meniscus 90.4%, 66.7%, 85.7%, 76% and 79.5% respectively. Correlation between MRI and arthroscopic findings regarding presence and absence of posterior cruciate ligament tear was highest with sensitivity -100%, specificity- 94.5%, NPV- 100% and accuracy-94.8%, There were 6 false positives for meniscus tear on MR examinations accounting for low positive predictive value (72%) of MR examination. Posterior horn tears of menisci are likely to be missed on arthroscopy. Out of 6 false positive cases of meniscus tear, 4 were located predominately in the posterior horn and 2 in the anterior horn. Thus, acceptance of MRI findings as false positive is controversial.CONCLUSIONSMRI is a useful non-invasive modality having high diagnostic accuracy, sensitivity and negative predictive value making it a very reliable screening test for diagnosis of internal derangements of knee joint. Thus, MRI saves many knees from unnecessary arthroscopies.
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Background: Knee osteoarthritis is an important cause for morbidity in elderly people. Therapy is largely symptomatic with nonsteroidal anti-inflammatory drugs which pose risk in the elderly. Methionine is natural body constituent with novel property of blunting S-adenosylmethionine (SAMe) inflammatory process and cartilage degradation. The aim of this study was to compare effectiveness of SAMe, with standard etoricoxib therapy in newly diagnosed knee osteoarthritis cases.Methods: 127 newly diagnosed knee osteoarthritis patients were randomized into two groups. 55 participants received treatment of etoricoxib 600 mg extended release once daily for 90 days (group 1) and 72 received etoricoxib 600 mg extended release once daily and SAMe 400 mg twice daily for initial 15 days followed by SAMe once daily 400 mg as maintenance dose for next 75 days (group 2). The outcomes were measured by knee injury and osteoarthritis outcome score (KOOS). Pre and post treatment KOOS scores of all cases were separately pooled to define the median for whole as well as components of KOOS parameters. Relative frequencies of cases with values around respective medians were compared by MOODS median test. Patient characteristics, disease characteristics were also examined for bearing on outcomes besides the treatment.Results: SAMe treatment was associated with significantly greater improvement in symptoms, activities of daily life, spontaneous recreational activities and the quality of life compared to etoricoxib therapy. The therapy was well-tolerated.Conclusions: The study confirms SAMe as superior therapeutic option in osteoarthritis. SAMe indeed has been reported to have specific anti-arthritic effects and promotive to general well-being.
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OBJECTIVE@#To observe the clinical effect of elastic intramedullary nail in minimally invasive treatment of floating knee injury in children.@*METHODS@#From January 2009 to September 2017, 11 children with floating knee injury were treated with one-off open reduction and elastic intramedullary nail or external fixator fixation, including 7 males and 4 females, aged 5.0 to 11.0 years, with an average age of 8.3 years. The treatment results were evaluated according to karlstrom's standard.@*RESULTS@#Eleven patients were followed up for 8 to 48 months, with an average of 28 months. All the fractures healed at one time, and there were no complications such as nonunion, malunion and serious dysfunction of knee joint. The length of the affected limb in 2 cases was 1.2 to 1.5 cm longer than that in the opposite side without shortening. According to Karlstrom scoring standard, 8 cases were excellent, 1 case was good and 2 cases were middle.@*CONCLUSION@#Elastic intramedullary nail minimally invasive treatment of floating knee injury in children is a safe and effective treatment, which can effectively reduce the fracture and promote bone healing, which is conducive to early functional recovery.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Bone Nails , External Fixators , Fracture Fixation , Fracture Fixation, Intramedullary , Fracture Healing , Internal Fixators , Knee Injuries , General Surgery , Treatment OutcomeABSTRACT
Introducción: la ruptura del ligamento cruzado anterior de la rodilla es una de las lesiones que se presenta frecuentemente en las personas que realizan deporte o actividad física. Objetivo: comparar los tratamientos funcionales utilizados para la recuperación de la ruptura de ligamento cruzado anterior. Metodología: se realizó una revisión bibliográfica de artículos científicos publicados desde enero del 2000 hasta enero de 2018. Las bases de datos consultadas fueron Medline, Scopus y Scielo. Utilizando las siguientes palabras claves: lesión de rodilla, ligamento cruzado anterior, rehabilitación funcional. Se seleccionaron aquellos estudios en los que se hubiese analizado lesiones de ligamento cruzado anterior en cualquier disciplina deportiva. Resultados: se encontró seis estudios, todos de aplicación en los diferentes niveles de experimentación (pre-, cuasi- y experimental). Discusión y conclusiones: el ejercicio funcional, prescrito de una manera individualizada, con un seguimiento mediante test apropiados que se realicen antes durante y después de la rehabilitación de lesiones del ligamento cruzado anterior reduce los tiempos de recuperación de la lesión.
Subject(s)
Humans , Male , Female , Rehabilitation , Anterior Cruciate Ligament , Knee Injuries , Athletic Injuries , Motor ActivityABSTRACT
Background:Numerous studies have reported factors associated with recurrent or subsequent contralateral anterior cruciate ligament disruption, but a comprehensive review of the literature has not been performed. Purpose: This study attempts to systematically review the literature and provide an overview of the currently reported risk factors for recurrent and subsequent contralateral ACL reconstructions in order to allow for more efficient identification and intervention of high-risk patients. Study Design:Systematic Review.Methods:The Pubmed and Embase databases were searched using a combination of keywords such as “ACL reconstruction” and “bilateral or recurrent” and “risk factors” and medical subject headings. All studies were screened by two independent reviewers, and articles that met inclusion criteria (non-contact ACL injury, study analyzed risk factors for contralateral ACL injury or graft rupture) were downloaded and read. Results:The initial search yielded 129 articles, of which 36 met inclusion criteria. After duplicates
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Abstract Aim: To assess the frequency of injuries among male and female handball athletes, identifying injured anatomic parts, injury diagnostics, their severity and type. Methods: The participants were composed of 122 handball players from São Paulo state teams, being 63 male (21.2±5.3 years) and 59 female (19.9±5.3 years) athletes who were interviewed using the "Champion Profile" questionnaire. The injuries were sorted by type: acute or overuse; and severity (major, moderate, slight, minor), given by the period of absence from team activities (training sessions and matches), and our results are presented as descriptive statistics. Results: The majority of injuries was found in the lower limbs, both in female (69.6%) and male (47.4%) players, as well as the knee was the most commonly injured anatomic part, representing 33.7% and 20.8% of the total number of injuries for the respective genders. We found a higher number of major injuries in female (35.8%) and male (20.8%) players when compared to the other severity categories. The acute injuries were more common among the total sample (48%) when compared to overuse injuries (22.7%), while a sprain was the most commonly diagnosed injury. Conclusion: It was observed that Brazilian handball players demonstrated an important number of major and acute injuries, forcing them to abstain from training sessions and matches, which can lead to both team and athlete performance losses. Furthermore, we suggest the inclusion of preventive training to reduce the frequency of injuries in handball athletes.
Subject(s)
Humans , Team Sports , Knee Injuries/epidemiology , Athletic Injuries/epidemiology , Epidemiology, Descriptive , Surveys and QuestionnairesABSTRACT
Introducción: La lesión multiligamentaria de la rodilla en pacientes con fracturas del miembro inferior ipsilateral es una entidad poco frecuente y que suele pasar desapercibida en la etapa aguda. El objetivo de este trabajo es analizar una serie de pacientes con fractura de miembro inferior asociado a lesión multiligamentaria de rodilla. Materiales y método: Se realizó una búsqueda retrospectiva de enero 2010 a diciembre 2016, de aquellos pacientes atendidos en nuestro centro con fractura de miembro inferior asociada a inestabilidad multidireccional de la rodilla ipsilateral. Se evaluó el patrón de fractura, la lesión ligamentaria asociada, si presentaba Resonancia Magnética (RM) inicial que pesquisara el diagnóstico de dicha lesión, y la decisión del momento del tratamiento quirúrgico. Se realizó una valoración del dolor con la Escala Visual Analógica (EVA) y funcional con escala de Lysholm y Tegner a todos aquellos pacientes con más de 12 meses de evolución postoperatoria. Resultado: Se encontraron 6 pacientes con un promedio de edad de 26 años. Cinco pacientes presentaban resonancia magnética al momento del trauma. El intervalo de tiempo promedio entre la resolución de la fractura y la reparación ligamentaria fue de 4 días. El promedio de las escalas evaluadas fue: EVA 0.2, Tegner 4 y Lysholm 87. Conclusión: En pacientes con fractura de miembro inferior de alta energía el compromiso ligamentario no debe subestimarse. Consideramos que la realización de una RM durante la atención inicial del paciente optimiza los tiempos en el diagnóstico y tratamiento de dichas lesiones y conlleva a mejores resultados funcionales al final del tratamiento. Tipo de studio: Serie de casos. Estudio retrospectivo. Nivel de evidencia: IV.
Introduction: Multiligament knee injuries in patients with ipsiletaral inferior limb fractures is a rare entity that can be easily missed. The objective of this work was to analyze a series of patients with multiligament lesion associated with inferior limb fracture. Material and method: A retrospective search was carried out from January 2010 to December 2016 of patients admitted in our hospital with diagnosis of inferior limb fracture associated to multidirectional knee instability. We evaluated the fracture pattern, ligament knee injury, if an initial Magnetic Resonance Imaging (MRI) was performed and the surgical timing. We evaluated pain with Visual Analogue Scale (VAS) and functional outcomes using Tegner and IKDC scores. We included patients with more than one-year postoperative. Results: Six patients were evaluated with an average age of 26 years-old. Five patients presented initial MRI, before the first surgery was performed. The average time between fracture osteosynthesis and ligament reconstruction was 4 days. VAS, Tegner and IKDC mean results were 0.2, 4 and 87 respectively. Conclusion: In patients with high-energy lower limb fractures, ligament compromise must be suspected. We consider that MRI should be performed during the first examination to optimize the diagnosis and treatment of possible associated ligament injuries and to obtain better functional outcomes. Type of study: Retrospective cases serie. Level of evidence: IV.
Subject(s)
Adult , Young Adult , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Knee Injuries , Ligaments, Articular/injuries , Ligaments, Articular/surgery , Range of Motion, Articular , Retrospective StudiesABSTRACT
Objective To develop the finite element model of six-year-old child occupant lower extremity with higher biofidelity and validate the model of knee joints,as well as analyze the biomechanical responses of growth plate under frontal impact load and injury mechanisms of the knee joint by using this model.Methods The sixyear-old child occupant lower extremity with growth plate was modeled based on children's anatomy and CT images,and corresponding material properties of the lower extremity model were assigned.The model was validated according to biomechanical experiments by Kerrigan et aL and Haut et aL and then was used to analyze the injury results of growth plate with different material properties.Results The model validation was qualified by comparing the curves from the experimental and simulation results.The growth plates at knee regions could change injury patterns of the child occupant lower extremity fracture.The material properties of growth plate could affect threshold of axial damage of the femur as well as relative position of the fracture.Conclusions The validated model can be used for related study and application on biomechanical responses and injury mechanisms of sixyear-old child occupant lower extremities.
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Objective To develop the finite element model of six-year-old child occupant lower extremity with higher biofidelity and validate the model of knee joints, as well as analyze the biomechanical responses of growth plate under frontal impact load and injury mechanisms of the knee joint by using this model. Methods The six-year-old child occupant lower extremity with growth plate was modeled based on children’s anatomy and CT images, and corresponding material properties of the lower extremity model were assigned．The model was validated according to biomechanical experiments by Kerrigan et al. and Haut et al. and then was used to analyze the injury results of growth plate with different material properties. Results The model validation was qualified by comparing the curves from the experimental and simulation results．The growth plates at knee regions could change injury patterns of the child occupant lower extremity fracture. The material properties of growth plate could affect threshold of axial damage of the femur as well as relative position of the fracture． Conclusions The validated model can be used for related study and application on biomechanical responses and injury mechanisms of six-year-old child occupant lower extremities．
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Objective To develop the finite element model of six-year-old child occupant lower extremity with higher biofidelity and validate the model of knee joints,as well as analyze the biomechanical responses of growth plate under frontal impact load and injury mechanisms of the knee joint by using this model.Methods The sixyear-old child occupant lower extremity with growth plate was modeled based on children's anatomy and CT images,and corresponding material properties of the lower extremity model were assigned.The model was validated according to biomechanical experiments by Kerrigan et aL and Haut et aL and then was used to analyze the injury results of growth plate with different material properties.Results The model validation was qualified by comparing the curves from the experimental and simulation results.The growth plates at knee regions could change injury patterns of the child occupant lower extremity fracture.The material properties of growth plate could affect threshold of axial damage of the femur as well as relative position of the fracture.Conclusions The validated model can be used for related study and application on biomechanical responses and injury mechanisms of sixyear-old child occupant lower extremities.
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Objective To develop the finite element model of six-year-old child occupant lower extremity with higher biofidelity and validate the model of knee joints,as well as analyze the biomechanical responses of growth plate under frontal impact load and injury mechanisms of the knee joint by using this model.Methods The sixyear-old child occupant lower extremity with growth plate was modeled based on children's anatomy and CT images,and corresponding material properties of the lower extremity model were assigned.The model was validated according to biomechanical experiments by Kerrigan et aL and Haut et aL and then was used to analyze the injury results of growth plate with different material properties.Results The model validation was qualified by comparing the curves from the experimental and simulation results.The growth plates at knee regions could change injury patterns of the child occupant lower extremity fracture.The material properties of growth plate could affect threshold of axial damage of the femur as well as relative position of the fracture.Conclusions The validated model can be used for related study and application on biomechanical responses and injury mechanisms of sixyear-old child occupant lower extremities.
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<p><b>INTRODUCTION</b>Physiotherapy is an important part of rehabilitation following arthroplasty, but the impact of preoperative physiotherapy on functional outcomes is still being studied. This randomised controlled trial evaluated the effect of preoperative physiotherapy on the short-term functional outcomes of primary total knee arthroplasty (TKA).</p><p><b>METHODS</b>50 patients with primary knee osteoarthritis who underwent unilateral primary TKA were randomised into two groups: the physiotherapy group (n = 24), whose patients performed physical exercises for six weeks immediately prior to surgery, and the nonphysiotherapy group (n = 26). All patients went through a similar physiotherapy regime in the postoperative rehabilitation period. Functional outcome assessment using the algofunctional Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and range of motion (ROM) evaluation was performed preoperatively, and postoperatively at six weeks and three months.</p><p><b>RESULTS</b>Both groups showed a significant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not significant in the sports and recreational activities subscale for both groups (p > 0.05). Significant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No significant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus-treatment analysis (p = 0.928).</p><p><b>CONCLUSION</b>Six-week preoperative physiotherapy showed no significant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Activities of Daily Living , Arthroplasty, Replacement, Knee , Follow-Up Studies , Knee Joint , Osteoarthritis, Knee , Therapeutics , Physical Therapy Modalities , Preoperative Care , Methods , Range of Motion, Articular , Physiology , Recovery of Function , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
ObjectiveTo observe andanalyze the clinical efficacy of needle knife treatment for knee meniscus injury from improving knee biomechanical balance and to provide a therapeutic basis and method for clinical practice.MethodOne hundred patients (112 knees) with knee meniscus injury meeting the inclusion criteria were allocated, in order of visits, to observation and control groups, 50 cases each. They were treated with a needle knife and an injection of sodium hyaluronate injectio into knee joint cavity, respectively. Changes in the indices were observed and assessed in the two groups by recording the plantar pressure analysis score and the knee function score before and after treatment and at follow-up. The clinical therapeutic effects were evaluated in the two groups.ResultThemaximum load, time integral difference value and load ratio around the knee joint decreased significantly in both observation and control groups after treatment and at follow-up (P<0.05). The regulating effect on knee joint force balance was better in theneedle knife group than in the control group (P<0.05). The improving effect on knee joint function was significantly better in the observation group than in the control group (P<0.01). The excellence rate was significantly higher in the observation groupthan in the control group after treatment and at follow-up (P<0.05).ConclusionNeedle knife treatment restores the function of the knee joint by loosing focal soft tissues around the knee joint, improving knee joint load imbalance and correcting the mechanical equilibrium around the knee joint in patient with knee meniscus injury. It has a definite curative effect on the disease.
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O tratamento das lesões condrais e osteocondrais do joelho em pacientes jovens ainda permanece um desafio para os médicos ortopedistas. As técnicas de reparo destas lesões atualmente disponíveis no Brasil, como desbridamento, microfraturas e transplante osteocondral autólogo são insuficientes nos tratamentos das lesões condrais e osteocondrais maiores do que 4 cm2. O transplante osteocondral homólogo a fresco (TOF) na articulação do joelho vem sendo usado em outros países com excelentes resultados. Até o presente momento não existem relatos da utilização desta técnica no Brasil, fato que dificulta o tratamento de pacientes jovens ativos que necessitam de reparo biológico. Foram incluídos neste estudo oito pacientes de 15 a 45 anos portadores de lesões osteocondrais maiores que 4 cm2. Os enxertos a fresco foram obtidos de doadores de órgãos, sendo a articulação do joelho captada sem violação da cápsula articular e transportada ao Banco de Tecidos para processamento. O pareamento doador e receptor foi realizado conforme o tamanho, a localização e a prioridade em lista de espera de acordo com os tecidos captados, sendo os mesmos armazenados no meio de preservação Ham F-12 - GIBCO com glutamax (Invitrogen, Life Technologies, Estados Unidos) e com antibióticos. O procedimento cirúrgico foi realizado pelas técnicas de cilindro osteocondral e de superfície, sendo fixados quando necessário. Os pacientes foram avaliados através dos questionários de IKDC objetivo, IKDC subjetivo, KOOS e índice de Merle D'Aubigne e Postel modificado. Foram realizados oito TOFs de março a outubro de 2012. A média de idade dos pacientes transplantados foi de 30,1 anos (17- 44 anos) e a média da área transplantada foi de 10,6 cm2 (4,6 - 22,4 cm2). O intervalo médio em dias entre captação e transplante foi de 15,3 (14 - 16 dias) e o número médio de cirurgias prévias ao TOF foi de 2 cirurgias (0-4 cirurgias). A pontuação na escala de IKDC objetiva no pré-operatório foi B em 12%, C em...
Treatment of chondral and osteochondral lesions of the knee in young patients is still a challenge for Orthopedic Surgeons. The techniques available nowadays in Brazil, as debridement, microfracture and autologous osteochondral transplantation are insufficient for the treatment of chondral and osteochondral lesions larger than 4 cm2. Fresh osteochondral allografts on the knee joint have been used in other countries with great success. Until the present days there are no reports of the utilization of this technique in Brazil, a fact that creates boundaries for the treatment of young active patients that need cartilage repair treatment. Eight patients with age ranging from 15 to 45 years old and osteochondral lesions larger than 4 cm2 were included in this study. Fresh grafts were obtained from organ donors and the knee joint was harvest without violation of synovium capsule and then was transported to the tissue bank for processing. Donor and receptor tissue matching occurred according to size, localization and priority on waiting list and tissue was preserved in Ham F-12 - GIBCO media with glutamax (Invitrogen, Life Technologies, United States) and antibiotics. Surgical procedure was achieved with osteochondral plugs or shell techniques, with additional fixation when needed. Patients were evaluated with IKDC objective, IKDC subjective, KOOS and modified Merle D'Aubigne-Postel outcome scores. Eight fresh osteochondral allografts were performed from march to october, 2012. The average age was 30.1 years old (17-44) and mean graft surface area was 10.6 cm2 (4.6 - 22.4 cm2). Average time from harvest to transplantation was 15.3 days (14-16 days) and mean number of previous surgical procedures was 2 (0 - 4 procedures). Pre-operative objective IKDC score was B in 12%, C in 25% and D in 63% and was A in 12% and B in 88% in 18 months follow-up. Pre-operative IKDC subjective and KOOS score were 31.99 ± 13.4 and 46.8 ± 20.9; and in 18 months...
Subject(s)
Humans , Adolescent , Young Adult , Adult , Middle Aged , Cartilage, Articular , Knee Injuries , Orthopedics , Transplantation, HomologousABSTRACT
A 30-year-old male was involved in a car accident. Radiographs revealed a depressed marginal fracture of the medial tibial plateau and an avulsion fracture of the fibular head. Magnetic resonance imaging showed avulsion fracture of Gerdy's tubercle, injury to the posterior cruciate ligament (PCL), posterior horn of the medial meniscus, and the attachments of the lateral collateral ligament and the biceps femoris tendon. The depressed fracture of the medial tibial plateau was elevated and stabilized using a cannulated screw and washer. The injured lateral and posterolateral corner (PLC) structures were repaired and augmented by PLC reconstruction. However, the avulsion fracture of Gerdy's tubercle was not fixed because it was minimally displaced and the torn PCL was also not repaired or reconstructed. We present a unique case of pure varus injury to the knee joint. This case contributes to our understanding of the mechanism of knee injury and provides insight regarding appropriate treatment plans for this type of injury.