Transferencia de trapecio inferior con injerto autólogo de semitendinoso y recto interno / Transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendon

Existen múltiples opciones de tratamientos para las rupturas masivas irreparables posterosuperiores del manguito rotador. Describiremos la transferencia del trapecio inferior con aumentación utilizando semitendinoso y recto interno autólogos, bajo asistencia. De esta manera devolvemos el balance muscular y restablecemos las cuplas de fuerza para la correcta movilidad del hombro afectado. Esta técnica se realiza con dos incisiones y tres portales artroscópicos: la primera para la toma del recto interno y semitendinoso en la rodilla del mismo lado del hombro afectado (aumentación), y la segunda en la escápula para la toma del trapecio inferior y para el pasaje de los tendones al espacio subacromial y posterior fijación con anclas sin nudo

In massive irreparable posterosuperior rotator cuff ruptures, there are several options for treatment. We will describe the transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendons autologous, under arthroscopic assistance. In this way, muscular balance is restored for correct shoulder mobility. This technique is performed with two incisions and three arthroscopic portals, the first for harvest of the gracillis and semitendinosus tendons, in the knee on the same side of the affected shoulder (augmentation) and the second in the scapula for the harvest of the lower trapezius muscle tendon, and for passage to the subacromial, and fixation with knotless anchors

Short term clinical results of single bundle ACL reconstruction, with a quadruple autologous hamstring graft, modified transtibial versus anteriomedial portal approach for femoral tunnel

Anteriior cruciate ligament injuries are known to be the most common spots injuries, and ACL reconstruction is widely used because of the low success rate of convservative treatment. This study was aimed to compare the short-terma functional results of modifying transtibial and transportal technique for femoral tunnel drilling. This Retrospective comparative case control study included 76 patients with an isolated ACL tear, operated with ST tendon autograft ACL reconstruction by the same surgical tea. 36 patients operated with a modified transtibial approach and 40 patients with an antreomedial approach for femoral drilling. The results of the current study revealed that the mean age in the series was 26 years; the majority of patients were male, only 6 patient's asses again after two years of surgery, by instability tests and lysholm scores reveal no significant differences between two group regarding anterioposterior and rotatory instability, also comparable lysholm score results. The Study concluded that modified transtibial femoral drilling of the femoral tunnel in ACL reconstruction surgery is still useful and give comparable results as tranportal drilling (AU)

Reconstrucción artroscópica del ligamento cruzado anterior maximizando la utilización de los injertos isquiotibiales autólogos / Arthroscopic reconstruction of anterior cruciate ligament maximizing the use of hamstring grafts

Introducción: La ruptura del ligamento cruzado anterior (LCA) es una lesión ligamentaria frecuente de la rodilla que causa discapacidades significativas. En nuestro medio en la actualidad es de elección cada vez frecuente el injerto combinado de tendones isquiotibiales (IT) semitendinoso (ST) y recto interno (RI) para la reconstrucción del LCA. Objetivo: Determinar los resultados funcionales e índice de re ruptura después de una reconstrucción de LCA con IT, con técnica de simple banda y maximizando la utilización de los injertos isquiotibiales obteniendo el mayor diámetro final posible del injerto de acuerdo a la altura, sexo y edad, evaluando posteriormente los resultados clínico-quirúrgicos de la reconstrucción del LCA con un seguimiento mínimo de 13 meses. Materiales y métodos: Estudio de cohorte prospectivo en 123 pacientes con ruptura de LCA. Análisis en 3 etapas, prequirúrgica (Rayos x, Resonancia magnética nuclear RMN, examen clínico por maniobras, examen bajo anestesia y aplicación de fórmula predictiva del diámetro del neo LCA), intra quirúrgico (largo de los injertos, medición diámetro con técnica cuádruple, diámetro con técnica quíntuple o séxtuple, medición largo de túneles femoral y tibial ,largo final del injerto plegado, elección de largos y diámetros de los sistemas de fijación, examen fluoroscopico final) y post quirúrgica (RMN, KT1000, Lysholm e IKDC). Resultados: La edad media al momento de la cirugía fue de 25.7 años (rango, 15-40) con un período medio de seguimiento 26.5 meses (rango 15-38 meses). La longitud del semitendinoso fue de 292.8 mm (+/- 22.2 SD) y del recto interno fue de 264.9 mm (+/- 29 SD). El diámetro promedio fue de 9.43 mm (+/- 0.60) y la longitud promedio del injerto final una vez plegado fue de 92.65 mm (+/- 6.9). A 40 pacientes se les efectuó injerto quíntuple (33%) y a 83 pacientes injerto séxtuple (67%). Se encontró diferencia significativa en el diámetro del injerto obtenido, y porcentaje de descarte cuando se compararon quíntuples versus séxtuple. Para la evaluación general se utilizaron las puntuaciones de la actividad del Comité Internacional de Documentación de Rodilla (IKDC) (A:59%, B:33%, C:4% y D:4%) y Lysholm (E:90%, B:6%, C:4%). Los parámetros objetivos utilizados para la evaluación incluyeron pruebas de cambio de pivote y Lachman (9) mientras que la laxitud anterior se midió utilizando el artrómetro de rodilla KT-1000 comparativa en milímetros (<3mm:72%, 3-5mm:24%, >5:4%). Se encontró un 4% de re rupturas independientemente de la técnica utilizada. Conclusión: La reconstrucción del LCA con simple banda maximizando la utilización de los injertos isquiotibiales con técnica quíntuple o séxtuple proporciona un diámetro de injerto con excelentes resultados a corto y mediano plazo. Tipo de estudio: Serie de casos. Nivel de evidencia: IV

Background: Anterior Cruciate Ligament (ACL) ruptures are a frequent knee ligament injury causing significant disabilities. The combined grafting of both hamstrings Semitendinosus (ST) and Gracilis (Gr) for the ACL reconstruction is nowadays in our country an increasingly common choice. Objective: To determine the functional outcome and the re rupture index after a simple band technique ACL reconstruction, maximizing the use of the hamstrings, obtaining the largest possible final diameter of the graft according to the body height, sex, age of the patient and to assess the clinical outcome with a minimum follow up of 13 months. Materials and methods: Prospective cohort study. 123 patients with ACL rupture. 3 phases analysis. Pre operative (X rays, MRI, clinical testing, examine under anesthesia and application of the neo ACL diameter predictive formula), intra operative (grafts lengths, quadruple graft diameter, quíntuple or séxtuple graft diameter, bone tunnels lenghts, final graft length, loop length and diameter of the fixation devices, final fluorcoscopy examination) y post operative (MRI, KT1000, Lysholm and IKDC) Results: The mean age at surgery was 25.7 years (range, 15-40). The mean follow up was 26,5 months (range, 15-38 m). The length of the semitendinosus was X: 292.8 mm (+/- 22.2 SD) and the Gracilis was X: 264.9 mm (+/- 29 SD). The mean diameter was 9.43 mm (+/- 0.60) and the average length of the final graft once folded was 92.65 mm (+/- 6.9). In 40 patients (32.7%) the five stranded technique was performed meanwhile in 83 patients six stranded graft (67.3%) was performed. A significant difference was found in the diameter of the obtained graft, and the percentage discarded when comparing the five versus six stranded techniques. Follow-up evaluations scales results by subjective and objective tests were (IKDC) (A:59%, B:33%, C:4% y D:4%) and Lysholm (E:90%, B:6%, C:4%). The comparative anterior laxity in millimeters was assessed by the KT-1000 (<3mm:72%, 3-5mm:24%, >5:4%). A 4% rupture was found regardless of the used technique. Conclusion: The reconstruction of the ACL with a single band, maximizing the use of hamstrings graft with a five stranded or six stranded technique, provides a graft diameter with excellent results in the short to medium term. Type of Study: Case series. Level of evidence: IV

Tibial tunnel enlargement and joint instability after anterior cruciate ligament reconstruction. A prospective comparison between autograft and allograft

Abstract Purpose: To investigate tibial tunnel widening and knee instability after ACL reconstruction with hamstring autograft or irradiated soft tissue allograft. Methods: Eight-two patients were divided into two groups: autograft group and allograft group. Radiographic and clinical evaluations were performed. Results: Seventy patients were followed up with median of 36.3 months (range 36-38 months). Tibial tunnel widening was at or greater than 30% for nine patients in the autograft group and 15 patients in the allograft group (P = 0.0417). The average percentage of tibial tunnel widening was 26.7 ± 4.0 % and 29.7 ± 5.3 % in autograft and allograft groups, respectively (P = 0.0090). Knee range of motion was not affected by the reconstruction operation or different grafts. Thigh atrophy improved significantly within 24 months after ACL reconstructions in both groups. ACL reconstruction with the allograft leaded to less knee stability than that with the autograft from one year after operation (P = 0.0023). There was no significant difference between two groups with respect to Lysholm score (P = 0.1925) and Tegner score (P =0 .0918) at the final follow-up. Conclusion: The allograft group reported significantly more tibial tunnel widening and knee instability compared with the autograft group.