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Rev. bras. ortop ; 58(3): 388-396, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1449815


Abstract Objective The purpose of this meta-analysis is to compare ligament healing on autograft and allograft in anterior cruciate ligament (ACL) reconstruction. Methods The selection of appropriate studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We made a statistical analysis using a review manager. Electronic reports were searched using the PubMed, Medline, and Cochrane Library databases. The inclusion criteria were animal studies and cellular histology of both grafts as an outcome. Results The initial search revealed 412 potential articles. After duplicates were removed, 246 articles remained. Then, 14 articles were obtained and screened for relevance and eligibility. The relevant articles were searched manually, checking for eligibility and details in order not to miss included reports. Subsequently, 5 studies were included, with a total of 232 samples, reporting the biopsied results with quantitative histology of ligament healing between allograft and autograft. The biopsy samples in those studies were examined under light or electron microscope, to analyze the cellular distribution area and ligamentization stages in each group. Meta-analyses found significant difference between autograft and allograft (Heterogeneity, I2 = 89%; Mean Difference, 95% confidence interval [CI] =-34.92, -54.90, -14.93; p = 0.0006). There is also a significant difference on both graft in cellular count at over 24 weeks (Heterogeneity, I2 = 26%; Mean Difference, 95% CI = -14.59, -16.24, -12.94; p < 0.00001). Conclusion In the current meta-analysis, autograft shows a significant difference when compared to allograft, with more cellular accumulation and faster remodeling response on the ligamentization process being noticed in the former. However, a larger clinical trial will be needed to emphasize this literature's result.

Resumo Objetivo O objetivo desta metanálise comparar a cicatrização de ligamentos no autoenxerto e aloenxerto na reconstrução do ligamento cruzado anterior (LCA). Métodos A seleção dos estudos adequados foi realizada de acordo com as diretrizes de Relatórios Preferenciais para Revisões Sistemáticas e Metanálises (Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA). Uma análise estatística foi feita usando um gerente de revisão. Os relatórios eletrônicos foram pesquisados usando os bancos de dados PubMed, Medline e Cochrane Library. Os critérios de inclusão foram estudos em animais e a histologia celular de ambos os enxertos como desfecho. Resultado A pesquisa inicial revelou 412 artigos potenciais. Após a retirada das duplicatas, restaram 246 artigos. Então, 14 artigos foram obtidos e selecionados pela relevância e elegibilidade. Os artigos relevantes foram pesquisados manualmente, verificando sua elegibilidade e detalhando os estudos para não perder os relatórios incluídos. Posteriormente, foram incluídos 5 estudos, com um total de 232 amostras, relatando os resultados de biópsia com histologia quantitativa de cicatrização de ligamento entre aloenxerto e autoenxerto. As amostras de biópsia nesses estudos foram examinadas sob microscópio leve ou eletrônico, para análise da área de distribuição celular e estágios de ligamentização em cada grupo. As metanálises encontraram diferença significativa entre autoenxerto e aloenxerto (Heterogeneidade, I2 = 89%; Diferença média, 95% intervalo de confiança [IC] =-34,92, -54,90, -14,93; p = 0,0006). Também há uma diferença significativa nosdoisenxertosnacontagem celular de mais de 24 semanas (Heterogeneidade, I2 = 26%; Diferença média, 95% IC = -14,59 , -16,24, -12,94; p < 0,00001). Conclusão Na presente metanálise, o autoenxerto mostra resultados significativos quando comparado ao aloenxerto, com mais acúmulo celular e resposta de remode-lagem mais rápida no processo de ligamentizaçãosendoobservadonoprimeiro.No entanto, será necessário um estudo clínico maior para enfatizar o resultado desta literatura.

Humans , Adolescent , Anterior Cruciate Ligament Reconstruction , Allografts
Rev. bras. ortop ; 58(1): 79-84, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1441352


Abstract Objective To calculate the minimal important clinical difference (MICD) value for the Lysholm and International Knee Documentation Committee (IKDC) scores in a sample of patients submitted to anterior cruciate ligament reconstruction. Methods Primary, observational, retrospective, analytical study of participants submitted to anterior cruciate ligament reconstruction from March 2019 to December 2020 by the same surgeon, with a minimum follow-up of 6 months, analysis of knee function in the pre- and postoperative period by the Lysholm and IKDC scores, and answer to an anchor question at 6 months postoperatively for the calculation of the MICD of each score. Results A total of 59 patients participated in the study, with a mean age of 27.1 ± 5.7 years old. In the comparison between pre- and postoperative scores of all groups, there was an increase in values with statistical significance after intervention. The MICD was 5.5 for the Lysholm score, and the MICD value for the IKDC score could not be determined. Conclusion For the Lysholm score, the calculation of the MICD value by the anchor question method in the sample evaluated was 5.5. It was not possible to determine the value of the MICD for the IKDC score.

Resumo Objetivo Calcular o valor da mínima diferença clinicamente importante (MDCI) para os escores de Lysholm e International Knee Documentation Commitee (IKDC) na amostra de pacientes submetidos a reconstrução de ligamento cruzado anterior. Métodos Estudo primário, observacional, retrospectivo, analítico, de participantes submetidos a reconstrução do ligamento cruzado anterior no período de março de 2019 a dezembro de 2020, pelo mesmo cirurgião, com seguimento mínimo de 6 meses, análise da função do joelho no período pré e pós-operatório pelos escores de Lysholm e IKDC, e resposta a uma pergunta âncora aos 6 meses de seguimento pós-operatório, para o MDCI de cada escore. Resultados Participaram do estudo 59 pacientes, com média de idade de 27,1 ± 5,7 anos. Na comparação dos escores pré- e pós-operatórios de todos os grupos, observa-se aumento dos valores com significância estatística após a intervenção. A MDCI foi de 5,5 para o escore de Lysholm, não tendo sido possível determinar o valor para o IKDC. Conclusão O cálculo do valor da MDCI pelo método da pergunta âncora, na amostra avaliada, foi de 5,5 para o escore de Lysholm. Não foi possível determinar o valor da MDCI para o IKDC.

Humans , Surveys and Questionnaires , Reproducibility of Results , Anterior Cruciate Ligament , Anterior Cruciate Ligament Reconstruction , Knee Joint
Article in Chinese | WPRIM | ID: wpr-981715


OBJECTIVE@#To investigate the outcome of lateral femoral notch (LFN) after early anterior cruciate ligament (ACL) reconstruction and evaluate the recovery of knee joint function after the operation.@*METHODS@#The clinical data of 32 patients who underwent early ACL reconstruction from December 2015 to December 2019 were retrospectively analyzed. The study included 18 males and 14 females, aged 16 to 54 years old, with an average age of (25.39±2.82) years. The body mass index (BMI) of the patients ranged from 20 to 30 kg/cm2, with an average of (26.15±3.09) kg/cm2. Among them, 6 cases were caused by traffic accidents, 19 by exercise, and 7 by the crush of heavy objects. MRI of all patients showed LFN depth was more than 1.5 mm after injury, and no intervention for LFN was performed during surgery. Preoperative and postoperative depth, area, and volume of LFN defects were observed by MRI data. International Cartilage Repair Society (ICRS) score, Lysholm score, Tegner activity levels, and knee injury and osteoarthritis outcome score (KOOS) were analyzed before and after the operation.@*RESULTS@#All patients were followed up from 2 to 6 years with an average of (3.28±1.12) years. There was no significant difference in the defect depth of LFN from (2.31±0.67) mm before the operation to (2.53±0.50) mm at follow-up (P=0.136). The defect area of LFN was decreased from (207.55±81.01)mm2 to (171.36±52.69)mm2 (P=0.038), and the defect volume of LFN was decreased from (426.32±176.54) mm3 to (340.86±151.54)mm3 (P=0.042). The ICRS score increased from (1.51±0.34) to (2.92±0.33) (P<0.001), the Lysholm score increased from (35.37±10.54) to (94.46±8.45) (P<0.001), and the Tegner motor score increased from (3.45±0.94) to (7.56±1.28), which was significantly higher than that of the preoperative data (P<0.001). The KOOS score of the final follow-up was 90.42±16.35.@*CONCLUSION@#With the increase of recovery time after anterior cruciate ligament reconstruction, the defect area and volume of LFN decreased gradually, but the defect depth remained unchanged. The knee joint function of the patients significantly improved. The cartilage of the LFN defect improved, but the repair effect was not good.

Male , Female , Humans , Young Adult , Adult , Adolescent , Middle Aged , Anterior Cruciate Ligament Injuries/surgery , Retrospective Studies , Magnetic Resonance Imaging , Anterior Cruciate Ligament Reconstruction , Femur/surgery , Treatment Outcome , Knee Joint/surgery
Article in Chinese | WPRIM | ID: wpr-981680


OBJECTIVE@#To investigate the feasibility of establishing an anterior cruciate ligament (ACL) reconstruction model using hamstring tendon autograft in cynomolgus monkeys.@*METHODS@#Twelve healthy adult male cynomolgus monkeys, weighing 8-13 kg, were randomly divided into two groups ( n=6). In the experimental group, the ACL reconstruction model of the right lower limb was prepared by using a single bundle of hamstring tendon, and the ACL of the right lower limb was only cut off in the control group. The survival of animals in the two groups was observed after operation. Before operation and at 3, 6, and 12 months after operation, the knee range of motion, thigh circumference, and calf circumference of the two groups were measured; the anterior tibial translation D-value (ATTD) was measured by Ligs joint ligament digital body examination instrument under the loads of 13-20 N, respectively. At the same time, the experimental group underwent MRI examination to observe the graft morphology and the signal/ noise quotient (SNQ) was caculated.@*RESULTS@#All animals survived to the end of the experiment. In the experimental group, the knee range of motion, thigh circumference, and calf circumference decreased first and then gradually increased after operation; the above indexes were significantly lower at 3 and 6 months after operation than before operation ( P<0.05), and no significant difference was found between pre-operation and 12 months after operation ( P>0.05). In the control group, there was no significant change in knee range of motion after operation, showing no significant difference between pre- and post-operation ( P>0.05), but the thigh circumference and calf circumference gradually significantly decreased with time ( P<0.05), and the difference was significant when compared with those before operation ( P<0.05). At 6 and 12 months after operation, the thigh circumference and calf circumference were significantly larger in the experimental group than in the control group ( P<0.05). At 3 and 6 months after operation, the knee range of motion was significantly smaller in the experimental group than in the control group ( P<0.05). Under the loading condition of 13-20 N, the ATTD in the experimental group increased first and then decreased after operation; and the ATTD significantly increased at 3, 6 months after operation when compared with the value before operation ( P<0.05). But there was no significant difference between the pre-operation and 12 months after operation ( P>0.05). There was no significant change in ATTD in the control group at 3, 6, and 12 months after operation ( P>0.05), and which were significantly higher than those before operation ( P<0.05). At each time point after operation, the ATTD was significantly smaller in the experimental group than in the control group under the same load ( P<0.05). The MRI examination of the experimental group showed that the ACL boundary gradually became clear after reconstruction and was covered by the synovial membrane. The SNQ at each time point after operation was significantly higher than that before operation, but gradually decreased with time, and the differences between time points were significant ( P<0.05).@*CONCLUSION@#The ACL reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation was successfully established.

Animals , Male , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Hamstring Tendons/surgery , Knee Joint/surgery , Macaca fascicularis , Transplantation, Autologous
Article in Chinese | WPRIM | ID: wpr-981676


OBJECTIVE@#To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral locator based on the apex of deep cartilage (ADC) combined with patient imaging data.@*METHODS@#Between January 2021 and January 2022, a total of 40 patients with primary ACL rupture were selected and randomly divided into study group (ACL reconstruction assisted by personalized femoral locator based on ADC) and control group (ACL reconstruction assisted by intraoperative fluoroscopy and traditional femoral locator), with 20 cases in each group. There was no significant difference in gender, age, body mass index, affected side, cause of injury, and preoperative International Knee Documentation Committee (IKDC) score, Lyshlom score, and Tegner score between the two groups ( P>0.05). IKDC score, Lyshlom score, and Tegner score were used to evaluate the functional recovery of the affected knee before operation and at 3, 6, and 12 months after operation. CT scan and three-dimensional reconstruction were performed before and after operation to measure the horizontal distance from ADC to the anterior cartilage margin (L) and the horizontal distance from ADC to the center of the femoral canal (I), and the anteroposterior position of the bone canal (R) was calculated by I/L; the distance from the center to the distal cartilage margin (D) was measured on the two-dimensional cross section; the R value and D value were compared between the two groups.@*RESULTS@#The operation time of the study group was significantly less than that of the control group [ MD=-6.90 (-8.78, -5.03), P<0.001]. The incisions of the two groups healed by first intention, and no complication such as intra-articular infection, nerve injury, and deep vein thrombosis of lower limbs occurred. There was no significant difference in the R value and D value between the preoperative simulated positioning and the actual intraoperative positioning in the study group [ MD=0.52 (-2.85, 3.88), P=0.758; MD=0.36 (-0.39, 1.11), P=0.351]. There was no significant difference in the actual intraoperative positioning R value and D value between the study group and the control group [ MD=1.01 (-2.57, 4.58), P=0.573; MD=0.24 (-0.34, 0.82), P=0.411]. The patients in both groups were followed up 12-13 months (mean, 12.4 months). The IKDC score, Lysholm score, and Tegner score of the two groups increased gradually with time, and there were significant differences between pre- and post-operation ( P<0.05). There was no significant difference in the scores between the two groups at each time point after operation ( P>0.05).@*CONCLUSION@#The personalized femoral locator based on ADC can accurately assist the femoral tunnel positioning in ACL reconstruction, which can shorten the operation time when compared with traditional surgical methods, and achieve satisfactory early effectiveness.

Humans , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction/methods , Cartilage/surgery , Knee Joint/surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-981649


OBJECTIVE@#To investigate the changes of knee joint kinematics after anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral positioner based on the apex of deep cartilage (ADC).@*METHODS@#Between January 2021 and January 2022, a total of 40 patients with initial ACL rupture who met the selection criteria were randomly divided into the study group (using the personalized femoral positioner based on ADC design to assist ACL reconstruction) and the control group (not using the personalized femoral positioner to assist ACL reconstruction), with 20 patients in each group. Another 20 volunteers with normal knee were collected as a healthy group. There was no significant difference in gender, age, body mass index, and affected side between groups ( P>0.05). Gait analysis was performed at 3, 6, and 12 months after operation using Opti _ Knee three-dimensional knee joint motion measurement and analysis system, and the 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, internal and external displacement) and motion cycle (maximum step length, minimum step length, and step frequency) of the knee joint were recorded. The patients' data was compared to the data of healthy group.@*RESULTS@#In the healthy group, the flexion and extension angle was (57.80±3.45)°, the varus and valgus angle was (10.54±1.05)°, the internal and external rotation angle was (13.02±1.66)°, and the anteroposterior displacement was (1.44±0.39) cm, the superior and inferior displacement was (0.86±0.20) cm, and the internal and external displacement was (1.38±0.39) cm. The maximum step length was (51.24±1.29) cm, the minimum step length was (45.69±2.28) cm, and the step frequency was (12.45±0.47) step/minute. Compared with the healthy group, the flexion and extension angles and internal and external rotation angles of the patients in the study group and the control group decreased at 3 months after operation, and the flexion and extension angles of the patients in the control group decreased at 6 months after operation, and the differences were significant ( P<0.05); there was no significant difference in the other time points and other indicators when compared with healthy group ( P>0.05). In the study group, the flexion and extension angles and internal and external rotation angles at 6 and 12 months after operation were significantly greater than those at 3 months after operation ( P<0.05), while there was no significant difference in the other indicators at other time points ( P>0.05). There was a significant difference in flexion and extension angle between the study group and the control group at 6 months after operation ( P<0.05), but there was no significant difference of the indicators between the two groups at other time points ( P>0.05).@*CONCLUSION@#Compared with conventional surgery, ACL reconstruction assisted by personalized femoral positioner based on ADC design can help patients achieve more satisfactory early postoperative kinematic results, and three-dimensional kinematic analysis can more objectively and dynamically evaluate the postoperative recovery of knee joint.

Humans , Biomechanical Phenomena , Knee Joint/surgery , Femur/surgery , Anterior Cruciate Ligament Injuries/surgery , Range of Motion, Articular , Cartilage/surgery , Anterior Cruciate Ligament Reconstruction/methods
Article in Chinese | WPRIM | ID: wpr-981635


OBJECTIVE@#To investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction.@*METHODS@#A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups ( P>0.05). However, the proportion of female in the injured group was significantly higher than that of male ( P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group ( P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values.@*RESULTS@#Univariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury ( P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury ( P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] ( χ 2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years]( χ 2 =302.479, P<0.001).@*CONCLUSION@#Female and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.

Humans , Male , Female , Anterior Cruciate Ligament Injuries/surgery , Knee Joint/surgery , Risk Factors , Tibia/surgery , Retrospective Studies , Anterior Cruciate Ligament Reconstruction/methods
Article in Chinese | WPRIM | ID: wpr-981622


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.

Humans , Return to Sport/psychology , Reinjuries/surgery , Anterior Cruciate Ligament Injuries/surgery , Lower Extremity/surgery , Anterior Cruciate Ligament Reconstruction/methods
Artrosc. (B. Aires) ; 30(1): 16-20, 2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1427237


Introducción: Los factores de riesgo de re-ruptura de LCA son errores técnicos, características del injerto, lesiones meniscales, condrales o lesiones no tratadas. El objetivo de nuestro trabajo fue reconocer predictores modificables que nos ayuden a obtener un mejor resultado en la cirugía de revisión de LCA. Materiales y métodos: estudio descriptivo transversal. Serie de pacientes tratados en nuestro centro entre 2011 y 2021 a los cuales se les realizó cirugía de revisión de LCA. Se registraron edad, sexo, falla de cirugía primaria traumática, o no, fijación utilizada, ubicación de ambos túneles, injerto utilizado en la cirugía primaria, lesiones articulares condrales y meniscales antiguas y nuevas y tipo de injerto utilizado en cirugía de revisión. Resultados: se analizaron un total de ciento nueve pacientes. Con mayor frecuencia, los pacientes masculinos se sometieron a revisión entre los veinte y los cuarenta años. La principal causa traumática fue la práctica deportiva (40.37%), seguida de accidente de tránsito o en domicilio (7.33%) y en ambiente laboral (24.8%), y sin causa demostrable (27.5%). La mala posición del túnel femoral aislada fue la falla técnica más común en un 41.29%, sin error técnico en 38.53%, y falla de colocación de túnel tibial aislada en 2.75%. En el total de los pacientes evaluados, el 28.44% (treinta y un pacientes) no presentó lesión meniscal previa ni actual; mientras que el 71.56% (setenta y ocho pacientes) evidenció algún tipo de lesión. La elección del injerto fue autoinjerto de H-T-H (30.28%), aloinjerto de tibial posterior (30.28%), aloinjerto de tibial anterior (19.27%), autoinjerto de ST-RI (11.01%), y otros aloinjertos Aquiles, Peroneos y ST (9.17%).Discusión: serán necesarios más estudios para determinar si esta tasa de falla persiste a pesar de nuestro mayor conocimiento de la técnica y diversos aspectos de la cirugía de revisión. Nivel de Evidencia: IV

Introduction: Risk factors for ACL rupture are technical errors, graft characteristics, meniscal and chondral injuries, or untreated injuries. The objective of our work was to recognize modifiable predictors that help us obtain a better result in ACL revision surgery. Materials and methods: cross-sectional descriptive study. Series of patients treated at our center between 2011 and 2021 who underwent ACL revision surgery. Age, sex, traumatic or non-traumatic primary surgery failure, fixation used, location of both tunnels, graft used in primary surgery, old and new chondral and meniscal joint injuries and type of graft used in revision surgery were recorded. Results: a total of one hundred and nine patients were analyzed. Most often, male patients underwent revision between the ages of twenty and forty. The main traumatic cause was sports practice (40.37%), followed by traffic accident or at home (7.33%) and in the work environment (24.8%), and without demonstrable cause (27.5%). Isolated femoral tunnel malposition was the most common technical failure at 41.29%, no technical error at 38.53%, and isolated tibial tunnel placement failure at 2.75%. In all the patients evaluated, 28.44% (thirty-one patients) did not present a previous or current meniscal lesion; while 71.56% (seventy-eight patients) showed some type of injury. Graft choice was H-T-H autograft (30.28%), posterior tibial allograft (30.28%), anterior tibial allograft (19.27%), ST-RI autograft (11.01%), and other Achilles, fibular, and ST allografts (9.17%) Discussion: more studies will be necessary to determine if this failure rate persists despite our greater knowledge of the technique and various aspects of revision surgery. Level of Evidence: IV

Reoperation , Anterior Cruciate Ligament/surgery , Treatment Outcome , Anterior Cruciate Ligament Reconstruction
Artrosc. (B. Aires) ; 30(1): 37-40, 2023.
Article in English | LILACS, BINACIS | ID: biblio-1427240


Recently, the anterolateral ligament has gained attention in knee surgery for its ability to improve rotational stability in ACL reconstructions. However, the lateral extra-articular tenodesis (LET) procedure, which involves creating a femoral tunnel using the modified Lemaire technique, presents a risk of overlapping with the femoral tunnel used in the ACL reconstruction. This can lead to complications and limit the success of the surgery. To avoid these issues without needing additional fixation, we describe an easily reproducible surgical technique in which a single femoral tunnel is shared for both ACL reconstruction and LET using the iliotibial tract

Recientemente, el ligamento anterolateral ha ganado atención en la cirugía de rodilla por su capacidad para mejorar la estabilidad rotacional en las reconstrucciones del LCA. Sin embargo, el procedimiento de tenodesis lateral extraarticular (TLE), que implica la creación de un túnel femoral utilizando la técnica modificada de Lemaire, presenta un riesgo de solapamiento con el túnel femoral utilizado en la reconstrucción del LCA. Esto puede provocar complicaciones y limitar el éxito de la cirugía. Para evitar estos problemas, sin necesidad de una fijación adicional, describimos una técnica quirúrgica fácilmente reproducible en la que se comparte un solo túnel femoral tanto para la reconstrucción del LCA como para LET utilizando el tracto iliotibial

Anterior Cruciate Ligament , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries
Artrosc. (B. Aires) ; 30(2): 59-63, 2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1451221


Introducción: La mayoría de las personas que se someten a una reconstrucción del LCA están en edad de conducir, por lo tanto, es importante saber cuándo es seguro para el paciente reanudar la conducción. El objetivo de este trabajo es evaluar de manera prospectiva cuándo los pacientes recuperan las habilidades de manejo y de reacción de frenado después de la reconstrucción primaria de LCA, y compararlos con un grupo control de voluntarios sanos. Materiales y métodos: estudio prospectivo de una serie de pacientes que se sometieron a reconstrucción primaria del LCA utilizando injerto semitendinoso y recto interno. Se excluyeron pacientes en los que se empleó otro tipo de injerto o se les realizó otro gesto quirúrgico y laborales. Se evaluó la capacidad de volver a manejar de manera segura a las 2-3 semanas y a las 4-5 semanas postoperatorias mediante test de reacción simple y de resistencia a la monotonía, y se compararon los resultados con un grupo control de voluntarios sanos. Resultados: en total fueron ciento sesenta y seis pacientes, treinta fueron casos y ciento treinta y seis, controles. Se hallaron diferencias significativas (p = 0.03) entre los casos y controles en las pruebas realizadas tempranamente en cuanto a la aprobación, y no, de los test. Según el promedio en segundos obtenido en cada test realizado, se observan diferencias significativas en el primera prueba de resistencia a la monotonía (p = 0.0001) a favor del grupo control. Discusión: de acuerdo a la prueba de reacción simple y al test a la monotonía evaluados en nuestro trabajo, los pacientes que se someten a reconstrucción del LCA con autoinjertos de ST-RI están en condiciones de manejar un automóvil luego de las 4-5 semanas de la cirugía

Introduction: Most people who undergo ACL reconstruction are of driving age, it is important to know when it is safe for the patient to resume driving. The objective of this work was to prospectively evaluate when patients recover driving skills and brake reaction skills after ACL reconstruction and compare them with a control group of healthy volunteers. Materials and methods: prospective study of a series of patients who underwent primary ACL reconstruction using semitendinosus and medial rectus graft. Patients in whom another type of graft was used, or another surgical and labor gesture was performed, were excluded. The ability to return to driving safely at 2-3 weeks and 4-5 weeks postoperatively was evaluated using the simple reaction and resistance to monotony tests, and the results were compared with a control group of healthy volunteers.Results: a total of 166 patients, 30 are cases and 136 controls. Significant differences (p = 0.03) were found between cases and controls in the tests carried out early in terms of passing and not passing the tests. The relationship according to the average in seconds obtained in each test carried out, significant differences are observed in the first test of resistance to monotony (p = 0.0001) in favor of the control group. Discussion: according to the simple reaction test and the monotony test evaluated in our study, patients who undergo ACL reconstruction with ST-RI autografts are able to drive a car 4-5 weeks after surgery

Automobile Driving , Anterior Cruciate Ligament/surgery , Treatment Outcome , Anterior Cruciate Ligament Reconstruction , Knee Joint
Rev. bras. ortop ; 57(4): 682-688, Jul.-Aug. 2022. graf
Article in English | LILACS | ID: biblio-1394881


Abstract Objective To describe all ligamentous, capsular, tendinous and bone landmarks structures of the medial region of the knee, as well as a new ligamentous structure identified in a series of anatomical dissections of cadaveric specimens. Methods Twenty cadaver knees were dissected to study the medial compartment. The main structures of this region were identified during dissection. The morphology of the structures and their relationship with known anatomical parameters were determined both qualitatively and quantitatively. The collected data were analyzed and interpreted using descriptive statistics. Results In the dissection of all specimens, all ligamentous structures previously described in the anatomical study of the medial part of the knee were identified, and objective measures that can help as parameters for surgical ligament reconstruction were identified. When dissecting the medial collateral ligament, a bony prominence immediately distal to its proximal tibial insertion was observed and described, as well as a bursa below the ligament, in which it was not inserted. We also described a ligamentous structure with extracapsular location, originated anteriorly to the medial epicondyle and following obliquely towards the tibia. These structures were named, respectively, interinsertional tubercle, interinsertional bursa and anterior oblique ligament. Conclusion In addition to the description and measurement of the structures and parameters already existing in the anatomical study of the medial part of the knee, it was possible to describe three new structures not yet described in the literature: the interinsertional tubercle, the interinsertional bursa, and the anterior oblique ligament. These structures were found in all dissections performed.

Resumo Objetivo Descrever todas as estruturas ligamentares, capsulares, tendinosas e marcos ósseos da região medial do joelho, assim como uma nova estrutura ligamentar identificada em uma série de dissecções anatômicas de espécimes cadavéricos. Métodos Vinte joelhos de cadáveres foram dissecados para estudar o compartimento medial. As principais estruturas dessa região foram identificadas durante a dissecção. A morfologia das estruturas e sua relação com parâmetros anatômicos conhecidos foram determinados tanto de forma qualitativa quanto de forma quantitativa. Os dados coletados foram analisados e interpretados por meio de estatística descritiva. Resultados Na dissecção de todos os espécimes, foram identificadas todas as estruturas ligamentares já descritas anteriormente no estudo anatômico da porção medial do joelho, e foram realizadas medidas objetivas que podem auxiliar como parâmetros para a reconstrução ligamentar cirúrgica. Foram observados e descritos, ainda, ao se desprender o ligamento colateral medial superficial, uma proeminência óssea imediatamente distal à sua inserção tibial proximal, uma bursa abaixo do ligamento, na qual o mesmo não se mostrava inserido, assim como uma estrutura ligamentar localizada extracapsularmente e com origem na face anterior do epicôndilo medial, seguindo obliquamente em direção à tíbia, aos quais foram dados os nomes, respectivamente, de tubérculo interinsercional, bursa interinsercional e ligamento oblíquo anterior. Conclusão Além da descrição e medida das estruturas e parâmetros já existentes no estudo anatômico da porção medial do joelho, foi possível a descrição de três novas estruturas: o tubérculo interinsercional a bursa interinsercional e o ligamento oblíquo anterior, ainda não descritos na literatura. Essas estruturas foram encontradas em todas as dissecções realizadas.

Humans , Anterior Cruciate Ligament , Medial Collateral Ligament, Knee , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries , Joint Instability , Knee/anatomy & histology
Rev. bras. ortop ; 57(3): 429-436, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1388014


Abstract Objective To compare the effectiveness of the early accelerated rehabilitation and delayed conservative rehabilitation protocols after arthroscopic anterior cruciate ligament reconstruction, in terms of the International Knee Documentation Committee (IKDC) score, pain (according to the Visual Analog Scale), laxity, and stiffness one year postoperatively to determine the best outcome. Materials and Methods A total of 80 subjects were divided into 2e groups (early accelerated group and delayed conservative group), which were analyzed by the Pearson Chi-squared and Wilcoxon rank-sum tests. Results One year postoperatively, knee laxity was significantly higher (p = 0.039) in the early accelerated group compared with the delayed conservative group. Regarding postoperative pain (according to the Visual Analogue Scale) and IKDC scores, both groups presented similar results. The postoperative range of motion was better in the early accelerated group, but this was not statistically significant (p = 0.36). Conclusion One year postoperatively, the early accelerated rehabilitation protocol was associated with significant knee laxity compared to the delayed conservative rehabilitation protocol.

Resumo Objetivo Comparar a eficácia dos protocolos de reabilitação acelerada precoce e de reabilitação conservadora retardada após reconstrução artroscópica do ligamento cruzado anterior, em termos da escala do International Knee Documentation Committee (IKDC), da dor (segundo a Escala Visual Analógica), da frouxidão e da rigidez no pós-operatório de um ano para determinar o melhor desfecho. Materiais e Métodos Um total de 80 participantes foram divididos em dois grupos (grupo da acelerada precoce e grupo da conservadora retardada), que foram analisados pelos testes do Qui-quadrado de Pearson e da soma dos postos de Wilcoxon. Resultados A frouxidão do joelho no pós-operatório de 1 ano foi significativamente mais alta (p = 0,039) no grupo da acelerada precoce do que no grupo da conservadora retardada. Em termos de dor pós-operatória (pela Escala Visual Analógica) e pontuações no IKDC, ambos os grupos apresentaram resultados similares. A amplitude de movimento pós-operatória foi melhor no grupo da acelerada precoce, mas isso não foi estatisticamente significativo (p = 0,36). Conclusão O protocolo de reabilitação acelerada precoce foi associado com uma frouxidão significativa do joelho em um ano de pós-operatório em comparação com o protocolo de reabilitação conservadora retardada.

Humans , Male , Female , Adult , Middle Aged , Outcome and Process Assessment, Health Care , Anterior Cruciate Ligament Reconstruction/rehabilitation , Anterior Cruciate Ligament Injuries/rehabilitation
Rev. bras. ortop ; 57(3): 422-428, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1388025


Abstract Objective To evaluate the incidence and epidemiological profile of meniscal ramp lesions in patients undergoing anterior cruciate ligament (ACL) reconstruction surgery, and to determine the related risk factors. Methods In total, 824 patients undergoing ACL reconstruction surgery were retrospectively analyzed. Patients who presented medial meniscal instability were submitted to evaluation of the posteromedial compartment of the knee. In case of injury, surgical repair was performed. Potential risk factors associated with the lesions were analyzed. Results The overall incidence of ramp lesions in the population studied was of 10.6% (87 lesions in 824 patients). The multivariate analysis through the Chi-squared test showed that the presence of meniscal ramp lesions was significantly associated with the following risk factors: right laterality and chronic lesions. Gender, age and sports activity were not statistically significant. Soccer was the most frequent cause of ramp injuries related to sport, with 78.2% of the cases. However, it was not shown to be a risk factor. The annual incidence from 2014 to 2019 ranged from 4.0% to 20.6%. Conclusion The incidence of meniscal ramp lesions was of 10.6% in ACL reconstruction surgeries, being more frequent among patients with chronic lesions. The increasing annual incidence ranged from 4.0% in 2014 to 20.6% in 2019.

Resumo Objetivo Avaliar a incidência e o perfil epidemiológico das lesões da rampa meniscal nos pacientes submetidos a cirurgia de reconstrução do ligamento cruzado anterior (LCA), e determinar os fatores de risco relacionados. Métodos Foram analisados retrospectivamente 824 pacientes submetidos a cirurgia de reconstrução do LCA. Os pacientes que apresentaram instabilidade meniscal medial foram submetidos a avaliação do compartimento posteromedial do joelho. Em caso de lesão, o reparo cirúrgico foi realizado. Potenciais fatores de risco associados às lesões foram analisados. Resultados A incidência geral de lesões da rampa na população estudada foi de 10,6% (87 lesões em 824 pacientes). A análise multivariada pelo teste do Qui-quadrado demonstrou que a presença de lesões da rampa meniscal foi significativamente associada aos seguintes fatores de risco: lateralidade direita e lesões crônicas. Sexo, idade e atividade esportiva não foram estatisticamente significantes. O futebol foi a causa mais frequente de lesões da rampa relacionadas ao esporte, com 78,2% dos casos. No entanto, não se mostrou ser um fator de risco. De 2014 a 2019, a incidência anual variou de 4,0% a 20,6%. Conclusão A incidência das lesões da rampa meniscal foi de 10,6% nas cirurgias de reconstrução do LCA, sendo mais frequente em pacientes com lesões crônicas. A incidência anual foi crescente, e variou de 4,0%, em 2014, a 20,6%, em 2019.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Arthroscopy , Health Profile , Risk Factors , Anterior Cruciate Ligament Reconstruction , Knee Injuries/epidemiology
Rev.chil.ortop.traumatol. ; 63(1): 9-16, apr.2022. ilus, tab
Article in Spanish | LILACS | ID: biblio-1435486


INTRODUCCIÓN El error técnico más común durante la reconstrucción del ligamento cruzado anterior (LCA) es la ubicación incorrecta del túnel. Es incierto si un túnel tibial mal ubicado puede corregirse en el intraoperatorio. OBJETIVO Medir el desplazamiento del injerto de tejido blando con tornillos de interferencia tibial.MATERIALES Y MÉTODOS Estudio experimental ex vivo en 28 rodillas porcinas. Se cosechó el tendón flexor de la extremidad posterior, que fue duplicado y dimensionado para que pasara a través de un túnel tibial mal posicionado. Las muestras se dividieron en 4 grupos según el cuadrante de entrada (anterior [A], posterior [P], medial [M], o lateral [L]) de un tornillo de interferencia tibial de 9 mm con relación al injerto. Se ubicó una regla milimétrica en la meseta tibial, la cual fue fotografiada con una cámara EOS T6 (Canon Inc., Ota, Tokio, Japón), y la imagen fue digitalizada, y puesta en escala a tamaño. La distancia y dirección de los desplazamientos del injerto se midieron con Adobe Photoshop CC 2019 (San José, CA, EEUU). Se analizaron las diferencias medias entre los grupos por análisis de la varianza (analysis of variance, ANOVA, en inglés) unidireccional. El análisis estadístico se realizó con el programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, EEUU), versión 25.0 (p ≤ 0,05)).RESULTADOS La distancias medias de los desplazamientos del injerto fueron similares en todos los grupos: A ­ 4,4 mm; P ­ 4,6 mm; M ­ 4,5 mm; y L ­ 4,3 mm, sin diferencias estadísticamente significativas (p = 0,894). Las direcciones medias de los desplazamientos del injerto también fueron similares entre los 4 grupos: A ­ 176° (desviación estándar [DE]: ± 15,4°); P ­ 165° (DE: ± 16,6°); M ­ 166° (DE: ± 12,1°); y L ­ 169° (DE: ± 10,6°). No se encontraron diferencias estadísticamente significativas (p = 0.42).CONCLUSIONES Independientemente del cuadrante de entrada, se observó un desplazamiento constante del injerto hacia el lado opuesto cuando el tornillo tibial alcanzaba la superficie articular. Relevancia clínica: el tornillo tibial mal posicionado puede corregirse en el intraoperatorio con fijación proximal en cuadrante específico, y debe alcanzar la superficie articular para generar un desplazamiento efectivo del injerto. Sin embargo, no podemos predecir la magnitud de error en todos los túneles mal brocados, que debe ser evaluada caso a caso.

BACKGROUND The most common technical error during anterior cruciate ligament (ACL) reconstruction is incorrect tunnel placement. It remains unclear if a misplaced tibial tunnel may be corrected intraoperatively. AIM To measure the displacement of soft-tissue grafts with tibial interference screws. MATERIALS AND METHODS Ex-vivo experimental study in 28 porcine knees. The flexor tendon of the posterior limb was harvested, doubled and sized to fit through a 9-mm misplaced tibial tunnel. The specimens were divided into 4 groups according to the quadrant of entry (anterior [A], posterior [P], medial [M], or lateral [L]) of a 9-mm tibial interference screw in relation to the graft. A millimetric ruler was placed at the tibial plateau, which was photographed with a an EOS T6 (Canon Inc., Ota, Tokio, Japan) camera, and the image was digitalized and scaled to size. The length and direction of the graft displacements were measured with Adobe Photoshop CC 2019 (San José, CA, US). The mean differences among the groups were analyzed through one-way analysis of variance (ANOVA). The statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, US) software, version 25.0 (p 0.05) RESULTS The mean lengths of the graft displacements were similar among the groups: A ­ 4.4 mm; P ­4.6 mm; M ­ 4.5 mm; and L ­ 4.3 mm, without statistically significant differences (p » 0.894). The mean directions of the graft displacements were also similar among the groups: A ­ 176° (standard deviation [SD]: 15.4°); P ­ 165° (SD: 16.6°); M ­ 166° (SD: 12.1°); and L ­ 169° (SD: 10.6°). No statistically significant differences were found (p » 0.42). CONCLUSIONS Regardless of the entry quadrant, constant graft displacement to the opposite side was observed when the tibial screw reached the articular surface. Clinical relevance: a misplaced tibial tunnel may be corrected intraoperatively with a quadrantspecific screw, which must reach the articular surface to produce an effective graft displacement. Nevertheless, we cannot predict the magnitude of this error in every poorly-drilled tibial tunnel; it should be assessed case by case.

Animals , Tibia/surgery , Tibia/transplantation , Orthopedic Procedures/methods , Anterior Cruciate Ligament Reconstruction/methods , Swine , Bone Screws , Tissue Transplantation
ABCS health sci ; 47: e022229, 06 abr. 2022. tab, ilus, graf
Article in English | LILACS | ID: biblio-1402544


INTRODUCTION: The anterior cruciate ligament (ACL) is an important structure for knee stability. Transcutaneous electrical nerve stimulation (TENS) is an electrical current applied for significant pain relief. OBJECTIVE: To evaluate the effects of high-frequency TENS on the immediate postoperative period of ACL reconstruction. METHODS: 46 patients in the postoperative period of ACL reconstruction were randomly assigned to a control group (CG=23) and a TENS group (TG=23). Knee range of motion (ROM), pain, muscle strength, and drug intake were assessed before surgery and 24 and 48 hours after surgery. The TENS intervention protocol started in the recovery room, shortly after surgery, and was maintained continuously for the first 48 hours after surgery. RESULTS: The TENS group (TG) significantly controlled the increased level of postoperative pain (p<0.05) and significantly increased flexion ROM (p<0.05). When compared to the Control group (CG), the TENS group had a lower intake of ketoprofen (48.27%), diazepam (256.98%), and dipyrone (121.21%), morphine (320.77%), and tramadol (437.46%). CONCLUSION: Continuous high-frequency TENS significantly reduced pain intensity and significantly improved ROM, muscle strength, and drug intake in the postoperative period of ACL reconstruction.

Humans , Male , Adult , Transcutaneous Electric Nerve Stimulation , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries , Randomized Controlled Trials as Topic , Range of Motion, Articular , Anterior Cruciate Ligament Injuries/drug therapy , Isometric Contraction
Rev. bras. ortop ; 57(1): 33-40, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365743


Abstract Objectives The aim of the present study is to systematically review and analyze the functional outcome of lateral extraarticular tenodesis (LET) procedure in addition to anterior cruciate ligament reconstruction (ACLR) in studies with a high level of evidence. Methods We performed a literature search for clinical studies comparing the LET method as an augmentation to ACL reconstruction with ACL reconstruction alone. The primary outcomes were the International Knee Documentation Committee (IKDC) score, the Lysholm score, and graft failures. Continuous variables were reported as means and 95% confidence intervals (CIs). Results Six clinical studies with 1,049 patients were included in the metaanalysis. The follow-up period was, in average, 24 months (range, 6-63 months). The addition of the LET procedure to ACLR results in better functional outcome based on the IKDC score (p< 0.05). Graft failure was found to be lower in the ACLR plus LET group (16 of 342 patients) compared with the ACLR-only group (46 of 341 patients) (p< 0.05). Conclusion There is high-level evidence that LET procedure in addition to ACLR is preferable in terms of functional outcome and graft failure.

Resumo Objetivos O objetivo deste estudo é revisar e analisar sistematicamente o desfecho funcional do procedimento de tenodese extra-articular lateral (TEL) em complemento à reconstrução do ligamento cruzado anterior (RLCA) em de estudos com alto nível de evidências. Métodos Realizamos a pesquisa bibliográfica para estudos clínicos comparando o método TEL como complemento à RCLA com a RLCA isolada. Os resultados principais foram a pontuação no Comitê Internacional de Documentação de Joelho (IKDC, na sigla em inglês), pontuação de Lysholm, e falhas no enxerto. Variáveis contínuas foram relatadas, como médias e intervalos de confiança (ICs) de 95%. Resultados Seis estudos clínicos com 1,049 pacientes foram incluídos na metanálise. O período de seguimento foi de, em média, 24 meses (intervalo de 6-63 meses). A adição do procedimento TEL à reconstrução do LCA resultou em melhor resultado funcional com base no escore IKDC (p< 0,05). A falha do enxerto foi menor no grupo RLCA mais TEL (16 dos 342 pacientes) em comparação com o grupo apenas RLCA (46 dos 341 pacientes) (p< 0,05). Conclusão Há evidências de alto nível de que o procedimento TEL como complemento à RLCA é preferível em termos de resultado funcional e falha do enxerto.

Tenodesis , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries , Joint Instability
Article in Chinese | WPRIM | ID: wpr-939622


The study aimed to evaluate the safety and function of poly(lactic-acid-co-ε-caprolactone) (PLCL)/fibrinogen nanofibers (P/F-Ns), and provide theoretical basis for the clinical application. The surface morphology, mechanical properties, the hydrophilicity and the fibrinogen content of P/F-Ns were tested by scanning electron microscope, the material testing machine, the contact angle meter and the microplate reader, respectively. The cell adhesion, proliferation and ligament remodeling genes expression of Hig-82 cells on P/F-Ns were conducted through cell counting kit-8 (CCK-8) and real-time quantitative PCR analyses, respectively. The results showed that with the increase of the fibrinogen content, the pore sizes and hydrophilicity of three P/F-Ns increased, but the mechanical properties decreased. Cell adhesion and proliferation tests showed that P/F-N-2 held the best ability to promote cell adhesion and proliferation. The ligament remodeling genes expressions of Hig-82 cells on P/F-N-1, P/F-N-2 and P/F-N-3 were all up-regulated compared to P/F-N-0 on days 3 and 7. All the three P/F-Ns containing fibrinogen (P/F-N-1, P/F-N-2 and P/F-N-3) had better biocompatibility compared to P/F-N-0, and could be efficiently applied to the reconstruction of anterior cruciate ligament.

Anterior Cruciate Ligament Reconstruction , Cell Adhesion , Fibrinogen , Materials Testing , Nanofibers
Article in English | WPRIM | ID: wpr-922353


PURPOSE@#To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair.@*METHODS@#From May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant.@*RESULTS@#Seven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly (p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years (p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly (p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly (p = 0.046 for both).@*CONCLUSION@#The failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.

Humans , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Menisci, Tibial/surgery , Meniscus , Retrospective Studies
Article in Spanish | LILACS, BINACIS | ID: biblio-1435468


El tratamiento de las roturas de LCA debe considerar el retorno deportivo y la ausencia de complicaciones. El alta médica debe contemplar seis criterios: Desaparición de signos y síntomas, protocolo de rehabilitación completo, imágenes de RMN, evaluación isocinética, hop test y score psicológico ACL-RSI. Se analizó la relación entre el cumplimiento de las pruebas y el retorno deportivo al mismo nivel, complicaciones posoperatorias y score ACL-RSI a cinco años desde el alta. Se incluyeron pacientes que recibieron el alta entre julio y diciembre de 2017. Se otorgó el alta con tres de los seis criterios, registrando los resultados de los tres restantes. Se registró la incidencia de complicaciones, retorno deportivo a los 24 meses y al finalizar el seguimiento, score ACL RSI al finalizar el seguimiento. La muestra fue de 32 pacientes. El seguimiento fue de 53,2 meses. El retorno deportivo al mismo nivel fue del 65,7%. Considerando los seis criterios, el alta se hubiera otorgado al 53,1% de la muestra, y el retorno al mismo nivel hubiera sido del 94,1%. Un paciente sufrió re rotura y dos pacientes lesiones meniscales. Al finalizar el seguimiento el score ACL-RSI se encontró por debajo de 70 puntos en 43% de los pacientes, quienes mantuvieron su nivel deportivo en un 16,7%. La utilización de los seis criterios de alta predice aceptablemente el retorno y nivel deportivo de los pacientes. La confianza y nivel deportivo de los pacientes tienden a descender a lo largo del tiempo

Treatment of ACL injuries should consider return to play and absence of complications. Return to sports indication comprises 6 criteria: absence of signs and symptoms, complete rehabilitation protocol, MRI images, isokinetic testing, hop test and psychological ACL RSI score. The relationship between passing RTS tests and returning to play at same level was analyzed, as well as posop complications and ACL RSI score at 5 years follow up. Patients who were discharged between July and December 2017 were included. Discharge was granted with 3 of the 6 criteria, recording the results of the remaining 3. The incidence of complications, return to sport at 24 months and at the end of follow-up, ACL RSI score at end of follow-up were recorded. The sample was 32 patients. Follow-up was 53.2 months. The sports return at the same level was 65.7%. Considering the 6 criteria, discharge would have been granted to 53.1% of the sample, and return to the same level would have been 94.1%. One patient suffered re-rupture and two patients suffered meniscal injuries. At the end of the follow-up, the ACL-RSI score was below 70points in 43% of the patients, who maintained their sporting level in 16.7%. The use of the 6 discharge criterio acceptably predicts return and sports level of the patients. The confidence and sports level of patients tend to decrease over time

Follow-Up Studies , Anterior Cruciate Ligament , Anterior Cruciate Ligament Reconstruction , Return to Sport