Progress in evaluation of return to sports after anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To summarize the evaluation methods of return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) in recent years, in order to provide reference for clinical practice.@*METHODS@#The literature related to the RTS after ACLR was searched from CNKI, Wanfang, PubMed, and Foreign Medical Information Resources Retrieval Platform (FMRS) databases. The retrieval range was from 2010 to 2023, and 66 papers were finally included for review. The relevant literature was summarized and analyzed from the aspects of RTS time, objective evaluation indicators, and psychological evaluation.@*RESULTS@#RTS is the common desire of patients with ACL injury and doctors, as well as the initial intention of selecting surgery. A reasonable and perfect evaluation method of RTS can not only help patients recover to preoperative exercise level, but also protect patients from re-injury. At present, the main criterion for clinical judgement of RTS is time. It is basically agreed that RTS after 9 months can reduce the re-injury. In addition to time, it is also necessary to test the lower limb muscle strength, jumping, balance, and other aspects of the patient, comprehensively assess the degree of functional recovery and determine the different time of RTS according to the type of exercise. Psychological assessment plays an important role in RTS and has a good clinical predictive effect.@*CONCLUSION@#RTS is one of the research hotspots after ACLR. At present, there are many related evaluation methods, which need to be further optimized by more research to build a comprehensive and standardized evaluation system.

Retorno deportivo luego de reconstrucción primaria de ligamento cruzado anterior con injerto hueso-tendón patelar-hueso autólogo: análisis de factores relacionados / Return to play after anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: analysis of related factors

OBJECTIVE: Analyze return to sports and related factors after primary anterior cruciate ligament reconstruction. METHODS: Observational descriptive study. 173 patients operated by the same surgeon and standardized technique (patellar autograft) who answered a questionnaire at least 12 months post procedure were included. Questionnaire included Subjective IKDC, Tegner activity level (Pre and Postoperative) and questions elaborated by the group. RESULTS: Mean age was 30.8 years, 85% were men, 73% practiced soccer and median postoperative IKDC was 71. Follow up until questionnaire response was 28 months. Males had a better return to sports than females (70% vs 48%, p » 0.037). Tegner preinjury level was 5 vs 4.3 postoperative, (p < 0.001). Return to sports was 67% according to Tegner scale and 66% by self-assessment. Return to similar previous activity level was 57% by Tegner scale but 24% by direct questions. Of those patients, 51% have fear of reinjury and 26% by reasons other than knee or surgery. We didn't find association between meniscal injuries and return to sports rate. Patients with chondral injuries had lower rates in return to sports (35% vs 60%, p » 0.002). Subjects that returned to sports had higher IKDC scores (73.5 vs 64.3, p < 0.001). CONCLUSIONS: We found 67% return to sports and 57% to the preinjury level. Positive return to sports factors were male sex, absence of chondral injury and better functional outcome. Psychological factors such as fear of injury is frequent in patients who don't achieve previous levels of activity.

OBJETIVOS: Analizar el retorno deportivo y factores asociados tras la reconstrucción primaria de ligamento cruzado anterior (LCA). MÉTODOS: Estudio observacional descriptivo. Se incluyeron 173 operados entre 2014 y 2017 por el mismo cirujano, los cuales contestaron un cuestionario al menos 12 meses después de la cirugía. El cuestionario incluye IKDC subjetivo, Tegner activity level (pre y post operatorio) y preguntas de elaboración propia. RESULTADOS: La edad promedio es 30,8 años, el 85% son hombres, el 73% practicaba fútbol y la mediana del IKDC fue 71. La media de meses hasta responder el cuestionario fue de 28 meses. Tegner pre-lesión promedio fue de 5 vs 4,3 postoperatorio, p < 0,001. Según la escala Tegner el 57% retorna al mismo nivel previo, sin embargo, de acuerdo con el cuestionario propio solo el 24% lo haría. De ese subgrupo, el 51% tiene temor a lesionarse de nuevo y el 26% reporta razones no relacionadas a la rodilla. No encontramos asociación entre lesiones meniscales y la tasa de retorno. Aquellos que retornan tienen menor prevalencia de lesiones condrales (35% vs 60%, p » 0,002). Los pacientes que retornaron tuvieron un IKDC superior (73,5 vs 64,3, p < 0,001). El sexo masculino tiene una tasa de retorno de 70% vs 48% de su contraparte femenina (p » 0,037). CONCLUSIONES: El 67% retorna al deporte y el 57% lo hace al mismo nivel. Factores positivos relacionados al retorno fueron sexo masculino, ausencia de lesión condral y mejor resultado funcional. Factores psicológicos con el miedo a lesionarse de nuevo son frecuentes en pacientes que no recuperan el nivel previo.

Fractura abierta de pelvis en un accidente: a propósito de un caso y revisión bibliográfica / Open pelvic fracture in an accident: Case report

Las fracturas abiertas de pelvis son un desafío clínico y quirúrgico como consecuencia de la gravedad de las lesiones óseas, de órganos internos, de partes blandas, hemorragia y cobertura cutánea. Su frecuencia es baja con una incidencia del 2-4%. La mortalidad llega a ser del 15-25% en fracturas cerradas y alcanza hasta el 50% en fracturas abiertas. La primera causa de mortalidad suele ser por shock hemorrágico. Presentamos un caso clínico tratado en el Servicio de Cirugía Ortopédica y Traumatología (COT) del Complejo Hospitalario Universitario de Santiago de Compostela (CHUS). Tras el análisis de los datos obtenidos de la revisión de este caso y la bibliografía correspondiente, podríamos afirmar que, ante una fractura de pelvis abierta, en primer lugar hay que asegurar la supervivencia en el momento inicial y proceder al control inicial de la hemorragia y la estabilidad pélvica. Posteriormente, debe llevarse a cabo el tratamiento quirúrgico inicial urgente multidisciplinario. Por último, debe pasarse a un tratamiento definitivo mediante reducción abierta y fijación interna. Hay que considerar también, por su importancia, el gran número de secuelas que produce este tipo de lesiones, algo que debemos prever y minimizar en la medida de lo posible. Nivel de evidencia clínica. Nivel IV.

Open pelvic fractures are a clinical and surgical challenge because of the severity of bone lesions, internal organs, soft tissue, skin coverage and hemorrhage. Its frequency is low with an incidence of 2-4%. The mortality is as high as 15-25% in closed fractures and to 50% in open fractures. The leading cause of death is usually by hypovolemic shock. We report a case treated in the Department of Orthopedic Surgery and Trauma (COT) of the University Hospital of Santiago de Compostela (CHUS). After analyzing the data obtained from the review of this case and the relevant literature, we could say that, in an open fractured pelvis first thing to do is to ensure survival at the initial time and the initial control of bleeding and pelvic stability, subsequently an urgent multidisciplinary initial surgical treatment should be performed. And finally, a definitive treatment by open reduction and internal fixation has to be accomplished. Sequels that this type of injury produce have also been considered since the initial patient evaluation in order to anticipate and minimize them as much as possible. Evidence level. IV.