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1.
Rev. bras. ortop ; 57(1): 180-184, Jan.-Feb. 2022. graf
Article in English | LILACS | ID: biblio-1365736

ABSTRACT

Abstract Although it is a versatile tendon, only 1% of surgeons choose to use the quadricipital tendon as a graft in anterior cruciate ligament (ACL) reconstruction. The present article aims to describe a quadricipital graft removal technique in which its deepest part is maintained. The technique consists of an approach in which the first incision is made in the medial part of the quadricipital tendon to prevent it from getting too short. This is due to its triangular design. The technique also addresses the depth and identification of the three layers of the quadricipital tendon so that it is possible to preserve its deepest part. This approach aims to preserve the extensor apparatus and to not communicate it with the joint environment, avoiding fluid extravasation both in the trans and postoperative periods.


Resumo Ainda que seja um tendão versátil, apenas 1% dos cirurgiões optam por utilizar o tendão quadricipital como enxerto na reconstrução do ligamento cruzado anterior (LCA). O presente artigo tem o objetivo de descrever uma técnica de retirada do enxerto quadricipital na qual a sua porção mais profunda é mantida. A técnica consiste em uma abordagem na qual a primeira incisão é feita na porção medial do tendão quadricipital para evitar que ele fique muito curto. Isso acontece devido ao seu desenho triangular. A técnica também aborda a profundidade e a identificação das três camadas do tendão quadricipital para que seja possível preservar sua porção mais profunda. Esta conduta tem o objetivo de uma maior preservação do aparelho extensor e de não haver comunicação com o meio articular, evitando extravasamento de líquido tanto no trans- quanto no pós-operatório.


Subject(s)
Humans , Postoperative Period , Anterior Cruciate Ligament , Transplants , Knee
2.
Rev. bras. ortop ; 56(1): 24-30, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1288658

ABSTRACT

Abstract The present research aims to compare the outcomes from the combined reconstruction of the anterior cruciate ligament (ACL) and of the anterolateral ligament (ALL) with the standard isolated ACL reconstruction in patients with chronic ACL injury. To do so, a meta-analysis was carried out to determine whether the combined ACL and ALL reconstruction would lead to a significant improvement in knee function according to the International Knee Documentation Committee (IKDC), the Lysholm test and KT-2000 evaluation scores and lower graft rupture rates in comparison with isolated reconstruction. To identify randomized controlled trials (RCTs) comparing the combined ACL and ALL reconstruction with the isolated ACL reconstruction, papers published between 2010 and 2019 were searched in the MEDLINE, EMBASE, SPORTDiscus, LILACS and Cochrane Central Register of Controlled Trials databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The stability of the knee joint is only marginally improved with the combined reconstruction of ACL and ALL, and both reconstruction techniques show functional results. The main outcomes sought were patient function and graft stability and rupture rates after ACL reconstruction. Out of the 421 studies identified, 6 were included in our meta-analysis. Study quality (internal validity) was assessed using the Cochrane risk-of-bias tool; in general, the studies included presented moderate-quality evidence. The graft rupture rate was higher in patients undergoing isolated ACL reconstruction (relative risk, 0.22; 95% confidence interval, 0.12 to 0.41; p < 0.00001).


Resumo O objetivo da presentepesquisa é comparar, por meio de uma metanálise, os resultados da reconstrução combinada do ligamento cruzado anterior (LCA) e do ligamento anterolateral (LLA), comparado com a reconstrução isolada padrão, em pacientes com lesão crônica do ligamento cruzado anterior. Buscando alcançar o objetivo da pesquisa, foi realizada uma meta-análise para determinar se a combinação da reconstrução combinada LCA e LLA levaria àmelhoria significativa da função do joelho, medida pelos escores de avaliação International Knee Documentation Committee (IKDC), Lysholm, KT-2000 e menor taxa de ruptura do enxerto, em comparação com a reconstrução isolada. Para identificar ensaios clínicos randomizados (ECR) comparando a reconstrução combinada do LCA e LLA com a reconstrução isolada do LCA, foram pesquisados artigos publicados entre 2010 e 2019 nas bases MEDLINE, EMBASE, SPORTDiscus, LILACS e Cochrane Central RegisterofControlledTrials e seguiram os critérios de Itens de Relatórios Preferidos para Revisões Sistemáticas e Metanálises (PRISMA). A estabilidade da articulação do joelho é apenas marginalmente aprimorada com a reconstrução combinada de LCA e LLA, e ambas as técnicas de reconstrução mostram resultados funcionais. Os principais desfechos procurados foram a função do paciente e as taxas de estabilidade e ruptura do enxerto após a reconstrução do LCA. Dos 421 estudos identificados, 6estudos foram incluídos em nossa meta-análise. A qualidade do estudo (validade interna) foi avaliada usando o instrumento Cochrane risco-de-viés; em geral, foi encontrada uma qualidade moderada de evidências dos estudos incluídos. Os pacientes submetidos à reconstrução isolada do LCA mostraram maior taxa de ruptura do enxerto (RR 0,22; índice de confiança [IC]95%: 0,12-0,41; p< 0,00001).


Subject(s)
Rupture , Wounds and Injuries , Anterior Cruciate Ligament , Anterior Cruciate Ligament Injuries , Knee Joint , Ligaments
3.
Rev. bras. ortop ; 56(1): 47-52, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288647

ABSTRACT

Abstract Objective The objective of the present study was to evaluate the relationship between patients with anterior cruciate ligament (ACL) injury by indirect trauma and increased posterior tibial inclination. Methods Retrospective study, performed by analysis of medical records and digital radiographs of patients, present in a database of a tertiary orthopedic hospital. The sample consisted of two groups, the first group consisting of patients diagnosed with ACL injury by indirect trauma, and a control group matched by age. Results Each group consisted of 275 patients, whose measurements of posterior tibial inclination were measured by three specialists. It was observed that the group of patients with ACL lesion presented a significantly higher tibial slope (in degrees) than the control group in the total sample and in the subsamples stratified by gender. The best cutoff point for the first group was identified as a posterior tibial inclination ≥ 8º, achieving a sensitivity of 63.3% and a specificity of 62.5%. The first group also had a tibial slope ratio ≥ 8º (63.3%), significantly higher than the control group (37.5%), with an odds ratio of 2.8. Conclusion It was concluded that the increase of the posterior tibial inclination is associated with an increased risk for injury of the ACL by indirect trauma, mainly for values ≥ 8º.


Resumo Objetivo O objetivo do presente estudo foi avaliar a relação entre pacientes com lesão do ligamento cruzado anterior (LCA) por trauma indireto e o aumento da inclinação posterior da tíbia. Métodos Estudo retrospectivo, realizado por análise de prontuários e radiografias digitais de pacientes, presentes em banco de dados de um hospital terciário de ortopedia e traumatologia. A amostra foi composta por dois grupos, sendo o primeiro formado por pacientes com diagnóstico de lesão do LCA, por trauma indireto, e um grupo controle pareado por idade. Resultados Cada grupo foi formado por 275 pacientes, cujas medidas de inclinação tibial posterior foram aferidas por 3 especialistas. Observou-se que o grupo dos pacientes com lesão do LCA apresentou slope tibial (em graus) significativamente maior que o grupo controle na amostra total e nas subamostras estratificadas por gênero. Identificou-se como o melhor ponto de corte (cutoff) para o primeiro grupo uma inclinação tibial posterior ≥ 8º, atingindo uma sensibilidade de 63,3% e uma especificidade de 62,5%. O primeiro grupo também apresentou proporção de slope tibial ≥ 8º (63,3%), significativamente maior que o grupo controle (37,5%), com razão de chances de 2,8. Conclusão Concluiu-se que o aumento da inclinação tibial posterior está associado com um maior risco para lesão do LCA por trauma indireto, principalmente para valores ≥ 8º,


Subject(s)
Humans , Tibia , Anterior Cruciate Ligament , Knee Injuries , Ligaments
4.
Article in Chinese | WPRIM | ID: wpr-921936

ABSTRACT

OBJECTIVE@#To compare the femoral and tibial tunnel positions of anterior cruciate ligament reconstruction using the modified transtibial (MTT) technique and anteromedial (AM) portal technique.@*METHODS@#Between January 2017 and September 2020, 78 patients with anterior cruciate ligament rupture underwent single-bundle reconstruction with the modified transtibial technique in 39 cases (group MTT) and through anteromedial approach in 39 cases (group AM). There were 25 males and 14 females in group MTT, with an average age of (37.0±2.3) years old; 27 males and 12 females in group AM, with an average age of (37.5±2.2) years old. CT scan of the affected knee was conducted one week after the surgery to measure and compare the femoral tunnels positioning (Fx, Fy), tibial tunnels positioning in the frontal plane(Tx1), tibial tunnels positioning in the sagittal plane (Ty1), and tibial tunnels positioning in the axial plane (Tx2, Ty2) in patients undergoing anterior cruciate ligament reconstruction through Mimics software.@*RESULTS@#Three-dimensional CT reconstruction after the surgery showed that the average Fx and Fy were(25.2±2.1)% and (34.9±3.0)% respectively and the Tx1 and Ty1 were (45.5±3.3)% and (44.7± 3.0)% respectively, while the Tx2 and Ty2 were (47.0±3.0)% and (39.9±4.2)% respectively in group MTT. In group AM, the average Fx and Fy were (26.0±2.0)% and (36.1±3.9)% respectively and the Tx1 and Ty1 were (46.5±3.1)% and (45.6± 3.1)% respectively, while the Tx2 and Ty2 were (47.4±2.5)% and (39.6±3.9)% respectively. There were no statistically significant differences in the femoral and tibial tunnels between the two groups (@*CONCLUSION@#Both the MTT and AM technique can achieve good anatomical positioning of the femoral and tibial tunnels, without significant differences in the positioning of the bone tunnels.


Subject(s)
Adult , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Female , Femur/surgery , Humans , Knee Joint/surgery , Male , Software , Tibia/surgery , Tomography, X-Ray Computed
5.
Article in Chinese | WPRIM | ID: wpr-921932

ABSTRACT

OBJECTIVE@#To observe the curative effect of one-stage reconstruction of anterior cruciate ligament(ACL), posterior cruciate ligament (PCL) and medial collateral ligament (MCL) in patients with KD-Ⅲ-M knee injury, and to compare the operation time, hospitalization cost and curative effect after arthroscopic reconstruction of PCL with LARS artificial ligament and autogenous hamstring tendon, ACL reconstruction with autogenous hamstring tendon and MCL repair combined with limited incision.@*METHODS@#From March 2016 to January 2019, a total of 36 patients met the criteria of this study. Twenty patients in group A were treated with autogenous hamstring tendon reconstruction of ACL and PCL and repair of MCL, including 17 males and 3 females, with an average age of (34.7±9.2) years old. Sixteen patients in group B with LARS artificial ligament reconstruction of PCL, with an autogenous hamstring tendon reconstruction of PCL and MCL repair as before as group B, including 15 males and 1 female, with an average age of (36.8±8.6) years old. The operation time, hospitalization time and total hospitalization cost were compared between the two groups. The preoperative and postoperative functions of the two groups were evaluated by Hospital for Sepcial Surgery (HSS) score and Lysholm score respectively, and the curative effects were compared within and between groups.@*RESULTS@#All the patients in the two groups were followed up for at least 1 year. There were no complications such as infection and poor wound healing in both groups. There was significant difference in operation time between (120.25±9.55) min in group A and (106.63±8.85) min in group B (@*CONCLUSION@#There was no significant difference in the average hospitalization days between the two groups, but the operation time in group A was longerthan that in group B, and the hospitalization cost in group B was higher than that in group A. There was no difference in HSS score and Lysholm score before and follow-up for a certain period of time after operation.


Subject(s)
Adult , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Arthroscopy , Female , Hamstring Tendons/surgery , Humans , Knee Dislocation , Knee Joint/surgery , Male , Middle Aged , Posterior Cruciate Ligament/surgery , Posterior Cruciate Ligament Reconstruction , Treatment Outcome
6.
Article in Chinese | WPRIM | ID: wpr-921931

ABSTRACT

OBJECTIVE@#To investigate and compare the clinical efficacies of remnant-preserving and remnant-non-preserving, remnant-non-preserving remnant segment preserving and remnant root preserving with anterior cruciate ligament reconstruction.@*METHODS@#From March 2014 to December 2017, 204 patients with anterior cruciate ligament (ACL) injuries were treated by single-bundle ACL reconstruction with hamstring tendon autograft. According to the different methods of remnant preservation, the procedures were divided into remnant segment preserving group (A), remnant root preserving group (B), and remnant-non-preserving group (C). There were 37 males and 39 femalesin group A aged from 16 to 43 years old with an average of (28.80±5.41) years old. The time from injury to operation ranged from 2 to 11 weeks with an average of (3.68±1.04) weeks. In group B, there were 39 males and 25 females aged from 18 to 41 years old with an average of (28.42±5.60) years old. The time from injury to operation ranged from 2 to 10 weeks with an average of (3.36±1.68) weeks. In group C, there were 37 males and 27 females aged from 18 to 43 years old with an average of (29.10±6.11) years old. The time from injury to operation ranged from 3 to 11 weeks with an average of (3.54±1.46) weeks. The range of motion (ROM) of the knee was used to assess the range of extension and flextion of the knee at pre-operation and 24 months after operation. Lysholm score and the international knee documentation committee (IKDC) score were used to assess the knee function. The differences among three procedures were judged by comparing among the three groups at 6, 12 and 24 months postoperatively.@*RESULTS@#All incisions got a one stage healing, and no complications, such as vascular injury, nerve damage and articular infect or the like, occurred. All the patients were followed up, and the follow-up duration of group A ranged from 24.00 to 45.96 months with a mean of (35.52±14.40) months;the follow up duration of group B ranged from 27.96 to 48.00 months with a mean of (37.56±10.68) month;and the follow up duration of group C ranged from 24.00 to 66.00 months with a mean of (37.08±13.44) month. There were no significant differences in follow up time among three groups (@*CONCLUSION@#Compared with remnant-non-preserving group, the residual tissue of anterior cruciate ligament is preserved, which is conducive to promote the healing and remodeling of tendon graft and accelerate the recovery of joint function. Proper fixation of residual tissue and restoration of its tension are the key factors affecting the postoperative efficacy.


Subject(s)
Adolescent , Adult , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Arthroscopy , Case-Control Studies , Female , Humans , Knee Joint/surgery , Male , Treatment Outcome , Young Adult
7.
Article in Chinese | WPRIM | ID: wpr-879428

ABSTRACT

OBJECTIVE@#To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) with a tibialis anterior allograft (TAA)versus hamstring tendon autograft (HTA) after 10 years follow-up.@*METHODS@#A clinical data of 107 patients who underwent arthroscopic ACLR with a single bundle tendon between March 2007 and March 2010 was retrospectively analyzed. Among the patients, 48 patients were reconstructed with a tibialis anterior allograft (TAA group), including 26 males and 22 females, ranging in age from 16 to 38 years, with a mean of 27.2±6.2 years;59 patients were reconstructed with a hamstring tendon autograft (HTA group), including 31 males and 28 females, ranging in age from 16 to 40 years, with a mean of 28.0±7.6 years. The preoperative tibial anterior displacement and knee joint function, as well as knee joint stability, tibial anterior displacement and knee joint function at 10 years after operation were observed. Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee;KT-2000 side-to-side difference (SSD) was used to measure tibial anterior displacement;International Knee Documentation Committee(IKDC) score and Lysholm score were used to evaluate knee function.@*RESULTS@#The incisions of both groups were healed by first intention, and no early complications occurred after operation. All patients were followed-up 10 to 13 years, the mean time was 11.7 years. There was no graft failure were found during the follow up period. The KT-2000 SSD of the TAA group and the HTA group at ten years after operation were 1.9±0.7 and 1.8±0.6 respectively, which were significantly improved than 8.8±0.9 and 8.6±1.0 preoperatively(@*CONCLUSION@#The TAA and HTA have equal long term effect in ACL reconstruction, doctors and patients can choose the graft according to the actual situation.


Subject(s)
Adolescent , Adult , Allografts , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Arthroscopy , Autografts , Female , Hamstring Tendons , Humans , Knee Joint/surgery , Male , Retrospective Studies , Treatment Outcome , Young Adult
8.
Article in Chinese | WPRIM | ID: wpr-879260

ABSTRACT

The anterior cruciate ligament (ACL) reconstruction mostly relies on the experience of surgeons. To improve the effectiveness and adaptability of the tension after ACL reconstruction in knee joint rehabilitation, this paper establishes a lateral force measurement model with relaxation characteristics and designs an on-line stiffness measurement system of ACL. In this paper, we selected 20 sheep knee joints as experimental material for the knee joint stability test before the ACL reconstruction operation, which were divided into two groups for a comparative test of single-bundle ACL reconstruction through the anterolateral approach. The first group of surgeons carried out intraoperative detection with routine procedures. The second group used ACL on-line stiffness measurement system for intraoperative detection. After that, the above two groups were tested for postoperative stability. The study results show that the tension accuracy is (- 2.3 ± 0.04)%, and the displacement error is (1.5 ± 1.8)%. The forward stability, internal rotation stability, and external rotation stability of the two groups were better than those before operation (


Subject(s)
Animals , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Biomechanical Phenomena , Cadaver , Joint Instability/surgery , Knee Joint/surgery , Range of Motion, Articular , Rotation , Sheep
9.
Article in Chinese | WPRIM | ID: wpr-888328

ABSTRACT

OBJECTIVE@#To study the three-approach and traditional anterior medial technique to establish the femoral tunnel of position, length, and coronal angle and the early efficacy of anterior cruciate ligament reconstruction.@*METHODS@#Through retrospective research, from December 2018 to June 2019, a total of 36 patients diagnosed with simple anterior cruciate ligament tear and undergoing surgery were collected. All patients had a clear history of knee sprains and were divided into two groups. A group of 16 patients, including 11 males and 5 females, with an average age of (30.13±6.54) years and an injury time of 7 to 60 (30.19±15.78) days, three-approach technique was used to drill the femoral tunnel to reconstruct the anterior cruciate ligament. Another group of 20patients, including 15 males and 5 females, with an average age of (30.80±8.60) years, and an injury time of 7 to 60 (27.35±15.50) days, the traditional anterior medial approach was used to drill the femoral tunnel to reconstruct anterior cruciate ligament. CT 3D reconstruction technique was used to evaluate the femoral tunnel and the knee joint function was evaluated by Lysholm score of the knee joint.@*RESULTS@#All patients achieved primary healing after the surgical incision. No femoral tunnel fracture, vascular and nerve damage, difficulty in graft passage during the operation, and venous thrombosis occurred. All 36 patients were followed up on an outpatient basis, with a follow up period of 9 to 15 (12.00±2.83) months. Three-dimensional CT reconstruction was used to evaluate the femoral tunnel of the patients. The position of the femoral tunnel was described using the quartile method as the three-approach group:the lower (27.83±1.97) % of the femoral condyle and the posterior (25.57±3.20) %;the traditional approach group:the lower (28.38±3.21) % of the femoral condyle and the posterior (26.23±3.20) %. Bone tunnel length, three-approach group:(35.20±5.52) mm in total length, (23.20±2.07) mm in thick bone tunnel;traditional approach group:(34.60±4.26) mm in total length, (22.56±2.50) mm in thick bone tunnel. Coronal plane angle, three-approach group:(47.93±5.98) °;traditional approach group:(41.78±6.62) °. Knee joint Lysholm score, three-approach group:48.67±4.18 before surgery;97.00±2.48 at last follow up;traditional approach group:49.75±5.33 before surgery, 97.30±2.68 at last follow up, there were significant differences before and after surgery, no significant statistical difference between two groups.@*CONCLUSION@#The positions of the femoral tunnel drilled by the two methods were within the range of the anatomic stop of the anterior cruciate ligament, and there was no statistical difference. Compared with the traditional anterior medial approach, the coronal plane angle of the femoral tunnel drilled by the three-approach approach is relatively large, and there were no statistical differences in the length of the tunnel, the early postoperative effect of the two surgical methods, and the operation time. But the three approach has a wider and clearer vision. In addition, the knee flexion angle required for drilling the femoral tunnel during surgery is significantly smaller than that of traditional approach technology, which reduces the difficulty of surgery.


Subject(s)
Adult , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Female , Femur/surgery , Humans , Knee Joint/surgery , Male , Retrospective Studies , Young Adult
10.
Artrosc. (B. Aires) ; 28(3): 210-215, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1348318

ABSTRACT

Introducción: En la reconstrucción del LCA, la pérdida de tejido muscular durante la extracción del injerto de tendones isquiotibiales dependerá del tamaño de stripper (tenótomo) que se utilice. El objetivo de este trabajo es comparar y cuantificar la pérdida de tejido muscular sano al realizar la extracción del injerto, y de esta forma poder evaluar una estrategia para reducir la morbilidad de la zona dadora.Materiales y métodos: realizamos un trabajo comparativo. Utilizamos diez preparados anatómicos (veinte rodillas) a los que se les realizó la extracción del injerto de isquiotibiales, semitendinoso y recto interno utilizando dos tenótomos (strippers) de distinto diámetro, de 5 y 7 mm. Evaluamos peso y volumen del tejido muscular resecado. Resultados: se compararon los resultados obtenidos, los que mostraron una diferencia estadísticamente significativa (p <0.01) tanto en el volumen como en el peso del material muscular extraído, en ambos músculos involucrados. Conclusión: nuestra hipótesis fue confirmada, encontramos diferencias que varían desde un 33 hasta un 65% más de peso de músculo sano extraído por la simple utilización de un tenótomo (stripper) de mayor diámetro al requerido. Recomendamos la utilización de tenótomo de 5 mm para disminuir la morbilidad de la zona dadora, y resecar menor volumen de tejido muscular. Nivel de Evidencia: III


Introduction: The loss of muscle tissue during hamstring graft harvest in ACL reconstruction, will depend on the size of the tendon stripper used. Our aim is to compare and quantify the loss of healthy muscle tissue when the graft is extracted, thus, be able to evaluate a strategy to reduce the donor site morbidity. Materials and methods: we harvested hamstring graft, semitendinosus and gracilis, in ten cadaver specimens (twenty knees) using two tendon strippers of 5 mm and 7 mm respectively. Then, we measured the weight and volume of the resected muscle tissue by each stripper. Results: outcome measures were compared, showing a statistically significant difference (p <0.01) in both, volume and weight of the extracted material, for both muscles involved.Conclusion: our hypothesis was confirmed. Results show a 33 to 65% higher weight and volume of healthy muscle tissue extraction, only by using a higher diameter stripper than the one required. We strongly recommend using a 5 mm stripper to reduce donor site morbidity and resect a lower volume of muscle tissue. Level of Evidence: III


Subject(s)
Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Reconstruction/methods , Hamstring Tendons , Epidemiology, Experimental
11.
Artrosc. (B. Aires) ; 28(1): 1-12, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1248390

ABSTRACT

Introducción: el propósito de este trabajo es hacer una evaluación retrospectiva clínica, funcional e imagenológica de una serie de pacientes con esqueleto inmaduro Tanner I y II intervenidos quirúrgicamente mediante la técnica de preservación fisaria de reconstrucción extra e intraarticular con autoinjerto de bandeleta iliotibial, técnica de Micheli. Evaluar si existieron alteraciones del crecimiento o angulares relacionadas con la cirugía. Materiales y métodos: se analizaron un total de veintidós rodillas en veinte pacientes con edad ósea promedio de 10.1 años y un seguimiento promedio de 5.6 años. Se realizó una evaluación clínica de movilidad, estabilidad incluyendo artrometría KT-1000, escalas funcionales y valoración por imágenes de discrepancia de longitud de miembros inferiores, alteraciones angulares y evaluación de integridad por resonancia magnética.Resultados: no hubo déficit de la movilidad con respecto a la rodilla contralateral, el test de Lachman, Pivot shift y la evaluación con KT-1000 fue normal en el 91, 95 y 95% de los pacientes, respectivamente. Se presentaron dos re-rupturas del injerto (9%). No hubo deformidades angulares del fémur o tibia ni discrepancia longitudinal de las extremidades inferiores. Las escalas funcionales mostraron un IKDC de 95.4 y un IKDC pediátrico de 92.3 en los pacientes a los que se les alcanzó a aplicar esta escala. Lysholm de 94.1 y un Tegner de 7 con un retorno al mismo deporte o actividad que causó la lesión del 90%. En la evaluación por resonancia magnética, el 100% de los pacientes que no presentaron re-ruptura tuvieron integridad del injerto. Conclusión: el procedimiento quirúrgico es seguro, reproducible, restaura la estabilidad anteroposterior y rotacional de la rodilla, sin causar alteraciones del crecimiento en este grupo poblacional, obteniendo excelentes puntajes en las escalas de valoración subjetivas, y un alto índice de retorno deportivo con un porcentaje menor de re-rupturas. Nivel de Evidencia: IV


Introduction: the purpose of this paper is to retrospectively evaluate clinical, functional and imagenological outcomes of a series of patients with skeletal immaturity Tanner 1 and 2, surgically intervened by physis preservation intra and extra articular reconstruction with iliotibial band autograft method described by Micheli. Evaluate growth or angular disturbances related to the surgical technique. Materials and methods: twenty-two knees in twenty patients with average bone age 10.1 years were evaluated with a 5.6 year follow up. Clinical evaluation of ROM and stability was made by arthrometry KT-1000, functional scales were applied, image evaluation of length discrepancy, angular deformity and integrity evaluation by magnetic resonance were also done. Results: no ROM deficit compared with the contralateral knee was observed, Lachman, Pivot shift tests and KT-1000 evaluation were normal in 91, 95 and 95% of patients, respectively. There were two cases of graft rupture (9%). No angular femoral or tibial deformities or length discrepancies were observed. Functional scales showed IKDC 95.4, pediatric IKDC 92.3 in patients who underwent the scale, Lysholm 94.1 and Tegner 7 with return to sports of 90% to pre level activity. 100% of patients without graft rupture had graft integrity in the RM evaluation. Conclusion: the surgical technique is safe and reproductible, restores anteroposterior and rotational stability of the knee without growth arrest in this population, obtaining excellent scores in subjective rating scales, high return to sports index with low rerupture rates. Level of Evidence: IV


Subject(s)
Child , Follow-Up Studies , Anterior Cruciate Ligament/surgery , Treatment Outcome , Anterior Cruciate Ligament Reconstruction/methods , Autografts , Knee Injuries , Knee Joint/surgery
12.
Rev. bras. ortop ; 55(4): 410-414, Jul.-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1138056

ABSTRACT

Abstract Objective To evaluate different decontaminants for tendon grafts, proposing an antiseptic protocol for contaminated grafts. Methods A total of 25 patients were tissue donors for the study. Each participant donated a 2.5-cm tendon sample, which was divided into 5 fragments with 5 mm each during anterior cruciate ligament (ACL) reconstruction surgery. The collected material was divided into 5 groups, totaling 125 samples. In total, four fragments of each patient were placed on the operating room floor for one minute for contamination, simulating the fall of the graft on the floor during surgery. The other fragment was immediately placed in a sterile container (group 1). One of the contaminated fragments was placed in the sterile container without being previously immersed in decontaminating solution (group 2). The remaining fragments were immersed for ten minutes in decontaminating solution: 0.5% chlorhexidine (group 3), 0.9% saline (group 4) and 0.55% ortho-phthalaldehyde (group 5), and, after this time, they were individually placed in a sterile container. The samples from the 5 groups were submitted to microbiological examination. Results Bacteria were detected in 26% of the total samples in the microbiological tests, and in group 1 there was no growth of microorganisms. In group 2, bacterial growth was observed in 16 samples. Considering the evaluation of test groups 3, 4 and 5, the percentage of decontamination was higher than the growth of microorganisms in the respective cultures. Conclusion The protocol suggested by the study showed that intraoperative graft decontamination is possible.


Resumo Objetivo Avaliar diferentes descontaminantes para enxertos de tendões, propondo um protocolo de antissepsia para o enxerto contaminado. Métodos Um total de 25 pacientes foram doadores de tecido para o estudo. Cada participante doou uma amostra de 2,5 cm de tendão, a qual foi dividida em 5 fragmentos de 5 mm durante cirurgia de reconstrução do ligamento cruzado anterior (LCA). O material coletado foi dividido em 5 grupos, totalizando 125 amostras. Ao todo, quatro fragmentos de cada paciente foram colocados sobre o piso da sala cirúrgica, durante um minuto, para contaminação, simulando a queda do enxerto no chão durante o ato operatório. O outro fragmento foi, imediatamente, colocado em um recipiente esterilizado (grupo 1). Um dos fragmentos contaminados foi colocado no recipiente esterilizado sem ser previamente imerso em solução descontaminante (grupo 2). Os demais fragmentos foram imersos, por dez minutos, em solução descontaminante: clorexidina 0,5% (grupo 3), soro fisiológico 0,9% (grupo 4) e ortoftaldeído 0,55% (grupo 5), e, após esse tempo, foram colocados individualmente em um recipiente esterilizado. As amostras dos 5 grupos foram submetidas a exame microbiológico. Resultados Houve detecção de bactérias em 26% do total de amostras nos testes microbiológicos, sendo que no grupo 1 não houve crescimento de micro-organismos. No grupo 2, observou-se crescimento bacteriano em 16 amostras. Avaliando-se os grupos de teste 3, 4 e 5, o percentual de descontaminação foi superior ao crescimento de micro-organismos nas respectivas culturas. Conclusão O protocolo sugerido pelo estudo mostrou que é possível a descontaminação transoperatória do enxerto.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Operating Rooms , Tendons , Tissue Donors , Chlorhexidine , Antisepsis , Decontamination , Anterior Cruciate Ligament , Determination , Transplants , Autografts
15.
Rev. bras. ortop ; 55(3): 374-379, May-June 2020. graf
Article in English | LILACS | ID: biblio-1138031

ABSTRACT

Abstract Objective The present study aimed to compare the oblique and vertical incisions in hamstring tendon harvesting in anterior cruciate ligament (ACL) reconstruction and in infrapatellar branch injury of the saphenous nerve. Methods The present study was conducted at a tertiary referral center for 12 months. Patients with an indication of reconstruction of ACL tear were included in the study, who were then randomized into two groups (vertical [VG] and oblique [OG] groups). After excluding a few cases, 92 patients were eligible for further analysis (VG: n= 44; OG: n = 48). They were followed-up for 9 months after the surgery, and loss of sensation over the knee and over the proximal aspect of the operated leg was recorded. Results The mean lengths of the incisions were 27 mm and 38 mm for the OG and VG groups, respectively. The total rate of hypoesthesia was 40% (27 patients). A total of 12 (25%) and 25 patients (56.8%) on the OG and VG groups, respectively, reported hypoesthesia symptoms. The presence of hypoesthesia in patients in the VG group was two times higher than in the OG group. No statistical correlation was observed between the nerve injury and age, gender, education, and delay from injury to reconstruction. Conclusion Oblique incision, which showed lower risk of nerve damage, might be more recommended for graft harvesting. Patients who underwent reconstruction of the ACL in the OG group had a lower incidence of peri-incisional hypoesthesia when compared to those in the VG group.


Resumo Objetivo O presente estudo teve como objetivo comparar as incisões oblíquas e verticais na coleta dos tendões dos isquiotibiais na reconstrução do ligamento cruzado anterior (LCA) e na lesão do ramo infrapatelar do nervo safeno. Métodos O presente estudo foi realizado em um centro de referência terciário por 12 meses. Pacientes com indicação de reconstrução de uma ruptura do LCA foram incluídos no estudo, os quais foram randomizados em dois grupos (vertical [GV] e oblíquo [GO]). Após a exclusão de alguns casos, 92 pacientes foram elegíveis para análise posterior (GV: n= 44; GO: n = 48). Eles foram acompanhados por 9 meses após a cirurgia, e a perda de sensibilidade sobre o joelho e sobre o aspecto proximal da perna operada foi registrado. Resultados Os comprimentos médios da incisão foram de 27 mm e 38 mm para os grupos GO e GV, respectivamente. A taxa total de hipoestesia foi de 40% (27 pacientes). Um total de 12 (25%) e de 25 pacientes (56,8%) dos grupos GO e GV, respectivamente, relataram sintomas de hipoestesia. A presença de hipoestesia em pacientes no grupo GV foi duas vezes maior do que no grupo GO. Não foi observada correlação estatística entre a lesão do nervo e idade, gênero, escolaridade e demora entre a lesão e a reconstrução. Conclusão A incisão oblíqua, que apresentou menor risco de lesão nervosa, pode ser mais recomendada para a coleta do enxerto. Pacientes submetidos à reconstrução do LCA no grupo GO tiveram menor incidência de hipoestesia peri-incisional quando comparados aos pacientes do grupo GV.


Subject(s)
Humans , Male , Female , Wounds and Injuries , Incidence , Anterior Cruciate Ligament , Educational Status , Anterior Cruciate Ligament Reconstruction , Surgical Wound , Procrastination , Gender Identity , Hypesthesia
16.
Acta ortop. mex ; 34(2): 129-133, mar.-abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1345101

ABSTRACT

Resumen: Introducción: La inestabilidad del ligamento colateral medial (LCM) se asocia con lesiones multiligamentarias. Existen varios procedimientos para la reconstrucción del LCM, presentamos una técnica percutánea de aumentación. Nuestro objetivo es describir una nueva técnica de reconstrucción del LCM mediante injerto y fijación con tornillos biocompuestos. Material y métodos: Presentamos la técnica en un total de 21 pacientes consecutivos con lesión del LCM operados en el período de Diciembre de 2011 a Octubre de 2014. La reconstrucción del LCM se realizó con aloinjertos del tendón del peroneo largo, tibial posterior o flexor largo del Hallux en 18 pacientes y solamente en un paciente se utilizó autoinjerto. De los 20 pacientes, 18 presentaron lesiones asociadas: cinco con lesión de menisco medial, ocho con lesión del ligamento cruzado anterior, (LCA), ocho con lesión condral y uno con lesión del menisco lateral. Conclusión: La técnica quirúrgica presentada es sencilla de realizar, sin daño a otras estructuras y con una fijación resistente.


Abstract: Introduction: Medial Collateral Ligament (LCM) instability is associated with multi-ligamentary lesions. There are several procedures for the reconstruction of MCL, we present a percutaneous technique of augmentation. Our goal is to describe a new technique of reconstruction of the LCM by grafting and fixing with biocomposite screws. Material and methods: We present the technique in a total of 21 consecutive patients with MCL injury operated in the period of December 2011 to October 2014. Reconstruction of MCL was performed with long, tibial or long hallux tendon allografts in 18 patients and only one patient was used autograft. Eighteen of the 20 patients had associated lesions: 5 with medial meniscus injury, 8 with anterior cruciate ligament injury, (ACL), 8 with condral injury and 1 with lateral meniscus injury. Conclusion: The surgical technique presented is simple to perform, without damage to other structures and with a strong fixation.


Subject(s)
Humans , Collateral Ligaments/surgery , Anterior Cruciate Ligament Injuries , Bone Screws , Anterior Cruciate Ligament , Allografts
17.
Acta ortop. mex ; 34(1): 53-57, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1345086

ABSTRACT

Resumen: Introducción: Cuando existe una lesión en ambas rodillas del ligamento cruzado anterior (LCA), el cirujano tiene la opción de reconstruir ambos de manera escalonada o simultáneamente. Existen algunos reportes y series de casos donde se realiza la reconstrucción simultanea del LCA. En este trabajo, presentamos el caso y resultado con la reconstrucción simultánea de LCA. Caso clínico: Hombre de 40 años de edad sin antecedentes de importancia. Presentaba una lesión bilateral de LCA, por lo que se le realizó cirugía sin torniquete con autoinjerto de isquiotibiales, fijado con endobutton y tornillos de interferencia. En el postoperatorio, la marcha y un programa acelerado de rehabilitación física se inició de manera inmediata. A cinco meses de seguimiento, el paciente se encuentra sin dolor y con arcos de movilidad completos y simétricos, sin complicaciones reportadas. La escala funcional de WOMAC de 35 en el preoperatorio bajó a 6 en la última consulta. Hasta el momento, la reconstrucción simultánea del LCA fue un procedimiento seguro; sin embargo, sabemos que nuestro seguimiento es muy corto para emitir alguna otra aseveración.


Abstract: Introduction: When there is injury to both knees of the anterior cruciate ligament (ACL), the surgeon has the option to reconstruct both in a staggered manner or simultaneously. There are some reports and case series where the ACL is performed simultaneously. In this manuscript we present a case and the result with simultaneous reconstruction. Clinical case: 40-year-old male with no history of importance with bilateral ACL injury; torniquet-free surgery was performed with autograft of hamstrings, secured with endobutton and interference screws. In the postoperative period, and an accelerated program of physical rehabilitation were immediately initiated. At five months of follow-up the patient is painless, with full, symmetrical knee range of motion. No complications reported. WOMAC's functional scale dropped from 35 preoperative to 6 in the last visit. Until now, simultaneous reconstruction of the LCA was a safe procedure; however, we know that our follow-up is too short to make any other assertions.


Subject(s)
Humans , Male , Adult , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament/surgery , Range of Motion, Articular , Knee Joint/surgery
18.
Rev. bras. ortop ; 55(1): 88-94, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092672

ABSTRACT

Abstract Objective To evaluate possible connections between the weight and height of patients submitted to total knee arthroplasty (TKA), with the length, width and area of the anterior cruciate ligament (ACL) fovea, as verified during surgery. Methods A total of 33 proximal tibial joint surfaces, obtained from TKA tibial sections of 33 patients, were used in the present study. The ACL was resected with a delicate scalpel to expose the ACL tibial fovea. Then the periphery of this fovea was delimited with a marker pen by means of small dots. Each piece was photographed, and the ACL tibial fovea length, width, and area were measured with the ImageJ (National Institutes of Health, Bethesda, MD, USA) software. Statistical analysis studied the correlation between anthropometrics data of the patients and the measurements of the ACL tibial fovea. Results The ACL tibial fovea length, width, and area were, respectively, 11.7 ± 2.0 mm, 7.1 ± 1.4 mm and 151.3 ± 22.2 mm2. There was a statistically significant relationship between the height of the patients and the width of the ACL tibial fovea. The width of the ACL fovea could be predicted by the formula: width = 107 . 294 − 133 . 179 × height + 44 . 009 × squared height. Conclusion The height of the patients may predict the width of the ACL tibial fovea, and therefore, may allow surgeons to choose the more adequate graft for each patient in ACL reconstruction.


Resumo Objetivo Avaliar possíveis relações entre o peso e altura de pacientes submetidos à artroplastia total do joelho com o comprimento, largura e área da fóvea do ligamento cruzado anterior, verificados na cirurgia. Métodos Um total de 33 superfícies articulares tibias proximais, obtidas nos cortes tibiais de artroplastia total do joelho de 33 pacientes, foram utilizadas no presente estudo. O ligamento cruzado anterior foi dissecado cuidadosamente e ressecado com bisturi delicado, para expor sua fóvea. Depois, a periferia dessa fóvea foi demarcada por pequenos pontos, com um marcador. Cada peça foi fotografada e as medições do comprimento, largura e área da fóvea tibial do ligamento cruzado anterior foram feitas com o programa ImageJ (National Institutes of Health, Bethesda, MD, EUA). A análise estatística avaliou a correlação entre os dados antropométricos dos pacientes com as medidas da fóvea tibial do ligamento cruzado anterior. Resultados O comprimento, a largura e a área médios da fóvea tibial do ligamento cruzado anterior foram, respectivamente 11,7 ± 2,0 mm, 7,1 ± 1,4 mm e 151,3 ± 22,2 mm2. Houve relação estatisticamente significativa entre a altura dos pacientes e a largura da fóvea tibial do ligamento cruzado anterior. A largura da fóvea do ligamento cruzado anterior pôde ser predita pela fórmula: largura = 107 , 294 − 133 , 179 × altura + 44 , 009 × altura ao quadrado. Conclusão A altura dos pacientes pôde a prever a largura da fóvea tibial do ligamento cruzado anterior e, assim, pode ajudar os cirurgiões escolher o enxerto mais adequado para cada paciente, nas reconstruções do ligamento cruzado anterior.


Subject(s)
Humans , Male , Female , Arthroplasty , Tibia , Weights and Measures , Measurements, Methods and Theories , Anterior Cruciate Ligament/anatomy & histology , Arthroplasty, Replacement, Knee , Knee
19.
Article in Chinese | WPRIM | ID: wpr-879368

ABSTRACT

OBJECTIVE@#To investigate the clinical effects of individualized repair and reconstruction surgery for multiple ligament injury and dislocation of knee joint based on stage classification diagnosis.@*METHODS@#From January 2018 to January 2019, 42 patients with multiple ligament injury and dislocation of the knee joint were treated. There were 27 males and 15 females, aged from 30 to 63 (47.35±11.90) years old, including 17 left knees, 23 right knees and 2 bilateral knees. All patients with multiple ligament injuries and dislocations of the knee joint were classified by stages and improved Schenck diagnosis. Among them, 23 cases were in acute stage (≤3 weeks), 19 cases were in old stage (>3 weeks), 27 cases were type Ⅲ dislocation and type Ⅳ dislocation. There were 9 cases of dislocation and 6 cases of type Ⅵ dislocation. The corresponding repair methods such as closed manipulation and open release reduction, direct suture of ligament, anchor suture, bone penetrating suture, and routine ligament reconstruction were performed. The corresponding "progressive progressive excitation" rehabilitation program was adopted after the operation. After 2, 4, 6, 8 weeks and 3, 6, 9, 12 months after operation, the outpatient consultation and evaluation of knee joint function and stability were completed. The knee joint stability, excellent and good rate, disability rate and complication rate were compared before and after operation. Internation Knee Documentation Committee (IKDC) grade, IKDC subjective score, Lysholm score and Tegner score were used to evaluate knee joint function.@*RESULTS@#All patients completed the outpatient follow-up and follow-up on schedule. All patients had gradeⅠwound healing, 4 patients had lower extremity venous thrombosis after operation, and there were no serious complications after anticoagulant treatment; 5 patients with common peroneal nerve injury were treated with release surgery and active postoperative rehabilitation, and neurological function gradually recovered. At 12 months after operation, the muscle strength of the affected limb reached grade Ⅴ and the active and passive range of motion recovered to more than 120 degrees. In the acute stage, the IKDC subjective scores were 20.46±12.61, 22.58±16.83, 0.71±1.14, 69.55±16.57, 77.73±15.14 and 3.14±1.67, respectively. One year after operation, IKDC subjective score was 67.04±19.07, Lysholm was 74.87±14.58, Tegner was 3.06±1.70, and 6 of them were grade A. After 12 months, the knee function scores of all patients were significantly improved compared with those before operation(@*CONCLUSION@#According to the classification of multiple ligament injuries and dislocations of the knee joint, the corresponding surgical repair and reconstructiontreatment were adopted, and the corresponding rehabilitation program was adopted after the operation. The patients achieved good clinical treatment effect 12 months after operation, and the patients' satisfaction was high, which improved the excellent and good rate of treatment and reduced the disability rate.


Subject(s)
Adult , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Female , Humans , Knee Dislocation/surgery , Knee Joint/surgery , Male , Middle Aged , Posterior Cruciate Ligament/surgery , Reconstructive Surgical Procedures , Retrospective Studies , Treatment Outcome
20.
Chinese Journal of Traumatology ; (6): 341-345, 2020.
Article in English | WPRIM | ID: wpr-879641

ABSTRACT

PURPOSE@#To avoid potential problems of double-bundle anterior cruciate ligament reconstruction (ACLR), various modifications have been reported. This study analyzed a novel technique of modified double-bundle (MDB) ACLR without implant on tibial side in comparison to single-bundle (SB) ACLR.@*METHODS@#Eighty cases of isolated anterior cruciate ligament tear (40 each in SB group or MDB group) were included. SB ACLR was performed by outside in technique with quadrupled hamstring graft fixed with interference screws. In MDB group, ACLR harvested tendons were looped over each other at the center and free ends whipstitched. Femoral tunnel was created by outside in technique. Anteromedial tibial tunnel was created with tibial guide at 55°. The anatomic posterolateral aiming guide (Smith-Nephew) was used to create posterolateral tunnel. With the help of shuttle sutures, the free end of gracillis was passed through posterolateral tunnel to femoral tunnel followed by semitendinosus graft through anteromedial tunnel to femoral tunnel. On tibial side the graft was looped over bone-bridge between external apertures of anteromedial and posterolateral tunnel. Graft was fixed with interference screw on femoral side in 10° knee flexion. International Knee Documentation Committee (IKDC), Tegner score, Pivot shift and knee laxity test (KLT, Karl-Storz) were recorded pre- and post-surgery. At one year magnetic resonance imaging (MRI) was done. Statistical analysis was done by SPSS software.@*RESULTS@#Mean preoperative KLT reading of (10.00 ± 1.17) mm in MDB group improved to (4.10 ± 0.56) mm and in SB group it improved from (10.00 ± 0.91) mm to (4.80 ± 0.46) mm. The mean preoperative IKDC score in MDB group improved from (49.49 ± 8.00) to (92.5 ± 1.5) at one year and that in SB group improved from (52.5 ± 6.9) to (88.4 ± 2.6). At one-year 92.5% cases in MDB group achieved their preinjury Tegner activity level as compared to 60% in SB group. The improvement in IKDC, KLT and Tegner scale of MDB group was superior to SB group. MRI confirmed graft integrity at one year and clinically at 2 years.@*CONCLUSION@#MDB ACLR has shown better outcome than SB ACLR. It is a simple technique that does not require fixation on tibial side and resultant graft is close to native ACL.


Subject(s)
Adolescent , Adult , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Reconstruction/methods , Female , Humans , Male , Middle Aged , Prospective Studies , Tibia/surgery , Treatment Outcome , Young Adult
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