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1.
Rev. bras. ortop ; 57(1): 33-40, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365743

ABSTRACT

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.


Subject(s)
Tenodesis , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries , Joint Instability
2.
Rev. cuba. ortop. traumatol ; 35(1): e187, 2021. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289546

ABSTRACT

Introducción: El ligamento patelofemoral medial se considera el principal estabilizador medial de la rótula. La reconstrucción está indicada en pacientes con luxación recidivante, cuando el tratamiento conservador ha fallado. Objetivo: Describir y evaluar una técnica de reconstrucción del ligamento patelofemoral medial con el tendón del aductor mayor en pacientes con esqueleto inmaduro. Métodos: Estudio anatómico y descriptivo de pacientes en los que se empleó el tendón del aductor mayor para reconstruir el ligamento patelofemoral medial. Después de la cirugía se evaluó reluxación, inestabilidad y satisfacción, con escala de Kujala. Resultados: Se disecaron 5 piezas de cadáveres frescos. El tendón del aductor mayor fue de 8 a 9 cm de longitud. Se realizaron ocho cirugías en siete pacientes entre 8-17 años, uno de ellos con síndrome de Down. El seguimiento mínimo fue 12 meses. No hubo reluxación, el paciente con síndrome de Down presentó subluxación rotuliana. La flexión y extensión de rodillas fue completa. Conclusiones: En pacientes con esqueleto inmaduro con placa de crecimiento del fémur distal presente y cercana al punto isométrico del ligamento, acarrea dificultades para la reconstrucción del ligamento patelofemoral medial. La técnica descrita por Avikainen permite reconstrucción no anatómica del ligamento sin realizar túneles femorales que pongan en riesgo la físis. Este trabajo describe la técnica con aductor mayor. De las ocho rodillas operadas, en solo una se presentó subluxación, en las otras se obtuvo buen resultado, sin luxación, y los pacientes quedaron satisfechos con el resultado(AU)


Introduction: The medial patellofemoral ligament is considered the main medial stabilizer of the patella. Reconstruction is indicated in patients with recurrent dislocation, when conservative treatment has failed. Objective: To describe and evaluate a reconstruction technique of the medial patellofemoral ligament with the adductor magnus tendon in patients with an immature skeleton. Methods: Anatomical and descriptive study of patients in which the adductor magnus tendon was used to reconstruct the medial patellofemoral ligament. After surgery, reluxation, instability and satisfaction were evaluated with Kujala scale. Results: Five pieces of fresh corpses were dissected. The adductor magnus tendon was 8 to 9 cm long. Eight surgeries were performed in seven patients between 8-17 years old, one of them with Down syndrome. The minimum followup period was 12 months. There was no relaxation. The patient with Down syndrome had patellar subluxation. The flexion and extension of the knees was complete. Conclusions: The reconstruction of the medial patellofemoral ligament causes difficulties in patients with immature skeleton, plate growth of the distal femur close to the isometric point of the ligament. The technique described by Avikainen allows non-anatomical reconstruction of the ligament without performing femoral tunnels that put the physis at risk. This paper describes the adductor magnus technique. Only one knee, out of the eight operated, had subluxation. The rest had good result, with no dislocation, and the patients were satisfied with the result(AU)


Subject(s)
Humans , Child , Adolescent , Patellar Dislocation , Surgical Wound , Joint Instability , Ligaments, Articular/surgery
3.
Rev. bras. ortop ; 56(3): 275-280, May-June 2021. graf
Article in English | LILACS | ID: biblio-1288680

ABSTRACT

Abstract Most shoulder injuries occur due to repetitive overhead movements. Before studying the treatment of these shoulder injuries, it is paramount that health professionals have an understanding of the etiology of and the underlying mechanisms for shoulder pathologies. The act of overhead throwing is an eloquent full-body motion that requires tremendous coordination from the time of force generation to the end of the pitch. The shoulder is a crucial component of the upper-body kinetic chain, as it transmits force created in the lower body to the arm and hand to provide velocity and accuracy to the pitch.


Resumo A maioria das lesões do ombro ocorre devido aos movimentos repetitivos acima do nóvel da cabeça. Antes de estudar o tratamento dessas lesões, é fundamental que os profissionais de saúde tenham um entendimento da etiologia e dos mecanismos que causam essas patologias. O ato do arremesso acima do nóvel da cabeça exige considerável coordenação de todo o corpo, desde o momento de geração de força até o final do arremesso. O ombro é um componente crucial da cadeia cinética da extremidade superior, por transmitir a força gerada na extremidade inferior para o braço e mão para produzir velocidade e precisão no lançamento da bola.


Subject(s)
Humans , Athletic Injuries , Shoulder , Therapeutics , Lower Extremity , Upper Extremity , Joint Instability
4.
Rev. bras. ortop ; 56(3): 307-312, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1288664

ABSTRACT

Abstract Objective The Latarjet procedure is a well-accepted treatment of shoulder instability. This technique is associated with a unique set of complications with overall rates of up to 30%. The purpose of the present study was to investigate the incidence and risk factors associated with complications after open Latarjet procedure. Methods We retrospectively reviewed 102 patients submitted to open Latarjet procedure. Complications were divided into three types: clinical; graft-related; and screw-related. All of the patients were submitted to radiography and computed tomography (CT). The risk factors analyzed were gender, age, previous surgery, epilepsy, experience of the surgeon. Results A total of 102 consecutive patients (108 cases) underwent the Latarjet procedure. The mean age was 33.7 years old (18 to 61 years old), with 88 males and 14 females. The overall complication rate was 21.2%, being 12% clinical-related, 7.4% graft-related, and 2.7% screw-related. The most frequent were anterior apprehension (eight cases) and lateral overhang of the graft in six patients. Computed tomography scan at a minimum of 6 months was performed in 79 cases (73%), and graft union occurred in 75 patients (94.9%). There were no cases of instability in the remaining four cases of nonunion. Ten patients (9.2%) required revision surgery. The risk factors associated with complications were epilepsy (p = 0.0325), experience of the surgeon (p = 0.0499) and patients ≥ 40 years old at the time of the surgery (p = 0.0151). There was no correlation with gender and previous surgery. Conclusion The complication rate following the Latarjet procedure was 21.2%, with 9% requiring revision surgery. Epilepsy, age ≥ 40 years old and experience of the surgeon were risk factors.


Resumo Objetivo A cirurgia de Latarjet é bem estabelecida para o tratamento da instabilidade anterior do ombro. Apresenta complicações específicas com taxas de até 30%. Nosso objetivo é avaliar a incidência e os fatores de risco associados às complicações após a cirurgia de Latarjet. Métodos Analisamos retrospectivamente 102 pacientes submetidos ao procedimento. Dividimos as complicações em três tipos: clínicas, relacionadas ao enxerto e relacionadas aos implantes. Todos os pacientes foram submetidos a radiografias e tomografia computadorizada (TC). Os fatores de risco analisados foram gênero, idade, cirurgia prévia, epilepsia e experiência do cirurgião. Resultados Um total de 102 pacientes consecutivos (108 casos) foram avaliados. A média de idade foi 33,7 anos (18 a 61 anos), com 88 homens e 14 mulheres. A taxa de complicações foi de 21,2%, sendo 12% clínicas, 7,4% relacionadas ao enxerto e 2,7% relacionadas ao implante. As mais frequentes foram apreensão anterior (oito casos) e posicionamento lateral do enxerto, em seis casos. A TC foi realizada com o mínimo de 6 meses em 79 casos (73%), evidenciando a consolidação do enxerto em 75 pacientes (94.9%). Nenhum caso de não união apresentou instabilidade. Dez pacientes (9.2%) precisaram de cirurgia de revisão. Os fatores de risco relacionados às complicações foram epilepsia (p = 0.0325), experiência do cirurgião (p = 0.0499) e pacientes ≥ 40 anos (p = 0.0151). Não houve correlação com gênero e cirurgia prévia. Conclusão A taxa de complicações após a cirurgia de Latarjet foi de 21,2%, com 9% necessitando de revisão cirúrgica. Epilepsia, idade ≥ 40 anos e experiência do cirurgião foram fatores de risco.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Shoulder Dislocation , Tomography, X-Ray Computed , Risk Factors , Joint Instability/complications
5.
Rev. bras. ortop ; 56(2): 147-153, Apr.-June 2021. tab
Article in English | LILACS | ID: biblio-1251340

ABSTRACT

Abstract Patellar instability is a multifactorial clinical condition that affects a significant number of patients and occurs due to morphological variations of the joint and patellofemoral alignment. The present literature review study aimed to identify and summarize current concepts on patellar instability, in relation to associated risk factors, diagnostic criteria, and the benefits and risks of conservative and surgical treatments. For this purpose, a search was conducted in the following electronic databases: MEDLINE (via Pubmed), LILACS and Cochrane Library. It is concluded that the accurate diagnosis depends on the detailed clinical evaluation, including the history and possible individual risk factors, as well as imaging exams. The initial treatment of patellar instability is still controversial, and requires the combination of conservative and surgical interventions, taking into consideration both soft tissues and bone structures, the latter being the most common reason for choosing surgical treatment, especially lateral patellar instability.


Resumo A instabilidade patelar é uma condição clínica multifatorial, que acomete um número expressivo de pacientes, ocorrendo devido a variações anatómicas, morfológicas da articulação e do alinhamento patelofemoral. O presente estudo de revisão e atualização da literatura teve como objetivos identificar e sumarizar os conceitos atuais sobre instabilidade patelar em relação aos fatores de risco associados, os critérios diagnósticos e os benefícios e riscos dos tratamentos conservador e cirúrgico. Para tanto, foi realizado um levantamento nas bases de dados eletrónicas MEDLINE (via Pubmed), LILACS e Cochrane Library. Conclui-se que o diagnóstico preciso depende da avaliação clínica detalhada, incluindo o histórico e possíveis fatores de risco individuais, além de exames de imagem. O tratamento inicial da instabilidade patelar é ainda controverso, e requer a combinação de intervenções conservadoras e cirúrgicas, levando em consideração tanto os tecidos moles quanto as estruturas ósseas, sendo estas últimas a razão mais comum para a escolha do tratamento cirúrgico, principalmente instabilidade patelar lateral.


Subject(s)
Patella , Patellar Dislocation , Patellofemoral Joint , Joint Instability
6.
Rev. chil. ortop. traumatol ; 62(1): 46-56, mar. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1342673

ABSTRACT

El manejo de la inestabilidad patelofemoral se basa en una adecuada evaluación de alteraciones anatómicas predisponentes. Patela alta es una de las causas más importantes de inestabilidad objetiva. La alteración biomecánica que ésta produce puede conducir a luxación patelar recurrente, dolor y cambios degenerativos focales. El examen físico es fundamental en la toma de decisiones. La evaluación imagenológica ha evolucionado desde métodos basados en radiografía hacia mediciones en resonancia magnética, que permiten una orientación más acabada de la relación existente entre la rótula y la tróclea femoral. El tratamiento se fundamenta en la corrección selectiva de los factores causales, donde la osteotomía de descenso de la tuberosidad anterior de la tibia y la reconstrucción del ligamento patelofemoral medial son herramientas que deben considerarse racionalmente. Este artículo realiza una revisión de la literatura, otorgando los fundamentos quirúrgicos que explican la importancia del tratamiento específico de patela alta en inestabilidad rotuliana.


Patellofemoral instability management is based on a thorough evaluation of predisposing anatomical factors. Patella alta is one of the utmost causes of objective instability. As a result, biomechanical disturbance can lead to recurrent patellar instability, pain, and focal degenerative changes. Physical examination is paramount in decision making. Imaging evaluation has evolved from X-rays based methods to magnetic resonance measurements, which allows a more accurate assessment of the patellotrochlear relationship. Treatment is based on a selective risk factors correction, where tibial tubercle distalization osteotomy and medial patellofemoral ligament reconstruction must be considered altogether. This article reviews the surgical rationale of patella alta treatment in patellofemoral instability.


Subject(s)
Humans , Osteotomy/methods , Patellar Dislocation/surgery , Patellofemoral Joint/surgery , Joint Instability/surgery , Osteotomy/adverse effects , Postoperative Care , Biomechanical Phenomena , Patellar Ligament/surgery , Knee Dislocation/diagnostic imaging , Patellofemoral Joint/diagnostic imaging , Joint Instability/diagnostic imaging
7.
Article in Chinese | WPRIM | ID: wpr-921922

ABSTRACT

The incidence of posterior instability of shoulder joint was significantly lower than that of anterior instability, but the clinical diagnosis and treatment was difficult, and the misdiagnosis and missed diagnosis rate were high. Its etiology, clinical manifestation and treatment strategy are totally different from the anterior instability. Therefore, the deep understanding of the anatomical structure around the shoulder joint, the mastery of the examination method, and the classification of the shoulder instability based on the anatomy and injury mode are of great importance to improve the accuracy of diagnosis. CT three-dimensional reconstruction is helpful to evaluate the defect of humeral head and glenoid bone, and MRA is helpful for the accurate diagnosis of posterior glenoid lip and joint capsule. The treatment was divided into conservative treatment and surgical treatment. Conservative treatment is recommended for muscular instability. Surgical treatment is recommended for traumatic and dysplastic instability. Different operative methods should be performed according to the injury of glenoid side or humeral head side. According to the condition of bone defect, soft tissue operation, bone grafting or osteotomy were performed to reconstruct the posterior stable structure of the glenoid injury; according to the area of the anterior bone defect, bone grafting or subscapular muscle packing were performed to the head of humerus defect. The former has the advantages of short learning curve and firm fixation, while the latter has the advantages of minimally invasive operation and the ability to observe the lesions from multiple angles and accurately control the location of bone masses. This paper summarizes the above problems.


Subject(s)
Humans , Humeral Head , Joint Instability/surgery , Scapula , Shoulder , Shoulder Dislocation , Shoulder Joint/surgery
8.
Article in Chinese | WPRIM | ID: wpr-921911

ABSTRACT

Recurrent anterior dislocation of shoulder with bone defect is one of the common diseases of shoulder joint. How to effectively repair glenoid bone defect and reduce recurrence rate of shoulder dislocation is a problem that clinicians focus on. Bone grafting could stimulate bone, promote bone regeneration and bone remodeling, and restore the normal anatomical structure of glenoid. Among them, Bristow-Latarjet procedure is a classic operation for recurrent shoulder dislocation. Latarjet procedure could repair larger glenoid bone defects, but with higher surgical skills for surgeons;autogenous iliac grafting is the first choice for revision once Latarjet procedure failed;osteochondral grafting (autogenous and allogenous) has certain advantages in reconstructing original articular surface and preventing joint degeneration, but autologous osteochondral grafting may cause secondary injury, while immune rejection is difficult to avoid for allogenous osteochondral grafting. With the improvement of composite materials, and the mechanism of bone regeneration and remodeling, as well as the advantages and disadvantages of bone grafting, tissue engineering technology may become an effective method for the treatment of glenoid bone defect in the future.


Subject(s)
Bone Transplantation , Humans , Joint Instability , Recurrence , Shoulder , Shoulder Dislocation/surgery , Shoulder Joint
9.
Artrosc. (B. Aires) ; 28(3): 227-231, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1348321

ABSTRACT

El objetivo de este artículo es describir un procedimiento que puede ser aplicado en pacientes esqueléticamente inmaduros con el objetivo de realinear el aparato extensor a nivel distal. Se describe en detalle la técnica y se analizan otras alternativas terapéuticas para este escenario. Diseño del estudio: Técnica quirúrgica. Nivel de Evidencia: V


The aim of this article is to describe a procedure that can be applied in skeletally immature patients for distal realignment of the extensor mechanism. The author makes a detailed description of the technique and analyzes therapeutic alternatives for this scenario. Study design: Surgical technique. Level of Evidence: V


Subject(s)
Child , Tendon Transfer , Patellofemoral Joint/injuries , Joint Instability
10.
Odontoestomatol ; 23(37): e203, 2021. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1250420

ABSTRACT

Resumen El objetivo del estudio fue analizar si la hiperlaxitud articular generalizada (HAG) es un factor de riesgo para los trastornos de la articulación temporomandibular (ATM). Para ello se evaluó la posible asociación entre chasquido de la ATM y el diagnóstico de HAG. Se trabajó con la siguiente hipótesis: el paciente con HAG, tendría mayor prevalencia de chasquido a nivel de la ATM que los que no la presentan, constituyendo la HAG un factor de riesgo para padecer un desorden articular (DA). Se examinaron 214 estudiantes de facultad de odontología (FO) de la Universidad de la República (Udelar) de Uruguay, 161 participantes del sexo femenino y 53 masculino, de entre 18 y 30 años (edad media 23.8 años, DE=2.7). A cada participante se le realizó un cuestionario y un examen clínico para diagnóstico de HAG utilizando el índice de Beighton (IB), chasquido, antecedente de trauma maxilofacial, ortodoncia, dentición completa, bloqueo abierto y turno. Todos los exámenes fueron realizados por un investigador ciego calibrado (calibración interoperador chasquido kappa= 0.68; intraoperador Beighton=0.82, chasquido=1). El estudio fue aprobado por el Comité de Ética y todos los participantes firmaron un consentimiento informado. El análisis estadístico de los datos fue realizado en base a un modelo de regresión logística múltiple. La prevalencia de HAG fue 34.16% en el género femenino y 7.55% en el masculino, de chasquido 24.22% para el femenino y 11.32% en el masculino. Las variables género (OR=3,244, p-valor 0,018) y antecedente de traumatismo (OR=2,478, p-valor 0,041) se asociaron significativamente a la presencia de chasquido. No se encontró asociación entre chasquido e HAG. El género femenino y los antecedentes de traumatismo podrían ser factores de riesgo para desórdenes a nivel de la ATM. La ausencia de asociación entre HAG y chasquido en dicho grupo etario (18-30 años), sugiere que dicho factor podría no ser de riesgo para el desarrollo de dichas patologías.


Resumo O objetivo do estudo foi examinar se a hiperlaxidade articular generalizada (HAG) é um fator de risco para disfuncao articulacao temporomandibular (DAT). Isso foi feito avaliando a possível associação entre cliques atm e diagnóstico hag. O trabalho foi feito com a seguinte hipótese: o paciente com HAG, teria maior prevalência de clique no nível atm do que aqueles que não o fazem, tornando a HAG um fator de risco para DAT. Foram examinados 214 alunos de Odontologia da Universidad de la República (Udelar) do Uruguai, 161 do sexo feminino e 53 do sexo masculino, com idade entre 18 e 30 anos (idade média de 23,8 anos, DE:2,7). Cada participante recebeu questionário e exame clínico para diagnóstico de HAG utilizando o índice Beighton (IB), clique, antecedente de trauma maxilofacial, ortodontia, dentição completa, bloqueio aberto e turno. Todos os testes foram realizados por um pesquisador cego calibrado (calibração interoperadora kappa-click-0,68; intraoperador Beighton-0.82, clique-1). O estudo foi aprovado pelo Comitê de Ética e todos os participantes assinaram consentimento informado. A análise estatística dos dados foi realizada com base em um modelo de regressão logística múltipla. A prevalência de HAG foi de 34,16% no sexo feminino e 7,55% no masculino, de clique 24,22% para o feminino e 11,32% para o masculino. As variáveis de gênero (OR-3.244, valor p 0,018) e antecedente do trauma (OR-2.478, valor p 0,041) estiveram significativamente associadas à presença de clique. Não foi encontrada associação entre clique e HAG. O sexo feminino e o histórico de trauma podem ser fatores de risco para distúrbios no nível do articulacao temporomandibular . A ausência de associação entre HAG e click sugere que esse fator pode não estar em risco para o desenvolvimento de tais patologias.


Abstract This study analyzes whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular joint disorders (TMD). Therefore, we evaluated the potential association between TMD clicking and GJH diagnosis. We worked with the following hypothesis: patients with GJH would have a higher prevalence of TMJ clicking than those without it, making GJH a risk factor for joint disorders. Two hundred and fourteen students from the School of Dentistry of Universidad de la República del Uruguay (UdelaR) were examined: 161 female and 53 male, aged 18 to 30 (average age: 23.8 years, SD=2.7). Each participant was given a questionnaire, and a clinical examination was performed to diagnose GJH using the Beighton score (BS), clicking, history of maxillofacial trauma, orthodontics, full dentition, open lock, and shift. A calibrated blind researcher (kappa inter-rater click calibration = 0.68; intra-rater BS score=0.82, click=1) performed all the examinations. The Ethics Committee approved the study, and all the participants signed an informed consent. A multiple logistic regression model was used to analyze the data statistically. GJH prevalence was 34.16% in women and 7.55% in men; clicking prevalence was 24.22% in women and 11.32% in men. There was a significant association between sex (OR=3.244, p-value 0.018) and history of trauma (OR=2.478, p-value 0.041) and the presence of clicking. No association was found between clicking and GJH. Female sex and history of trauma could be risk factors for TMJ disorders. The lack of association between GJH and clicking in this age group (18-30) suggests that GJH may not be a risk factor for developing these pathologies.


Subject(s)
Joint Instability , Temporomandibular Joint/injuries , Temporomandibular Joint Disorders
11.
Artrosc. (B. Aires) ; 28(2): 171-174, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1282684

ABSTRACT

La inestabilidad de la articulación tibioperonea proximal puede presentarse con una luxación, con escasos síntomas laterales de la rodilla, dolor, malestar e incomodidad durante distintas actividades o síntomas relacionados con la irritación del nervio peroneo común. Un preciso diagnóstico prequirúrgico es imperativo, así como el tratamiento conservador con inmovilización y kinesiología por cuatro a seis semanas. En la población adolescente, el planeamiento prequirúrgico puede ser dificultoso por la presencia de los cartílagos abiertos, por lo tanto, se debe tomar precaución en la realización de los túneles y en la colocación de implantes en relación con la fisis abierta. El objetivo del siguiente trabajo es presentar el caso de un niño de once años con inestabilidad tibioperonea proximal recurrente, además mostrar detalles de la técnica quirúrgica, protocolo postoperatorio y sus excelentes resultados


Instability of the proximal tibiofibular joint (PTFJ) can present as dislocations, vague symptoms of lateral knee pain, discomfort during activity, or symptoms related to irritation of the common peroneal nerve. An accurate preoperative diagnosis is imperative and should include a trial of taping of the PTFJ for a 4- to 6-week time frame before surgical reconstruction is indicated. In the adolescent population, surgical planning can be complicated by the presence of open physes; therefore, caution must be taken to avoid drilling through or placing screw fixation across the physes. Potential complications include growth arrest and limb length discrepancy. Therefore, the purpose of this case report is to describe the surgical technique for addressing PTFJ instability in adolescent patients. The aim of this case report is to present a case of instability of the proximal tibiofibular joint (PTFJ) treated surgically in an eleven-year-old male soccer player, focused on technical tips, strict rehab protocol with excellent results


Subject(s)
Child , Tibia/surgery , Fibula/surgery , Growth Plate/surgery , Joint Instability , Knee Joint/surgery
12.
Artrosc. (B. Aires) ; 28(2): 181-191, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1282686

ABSTRACT

La mala alineación patelofemoral se manifiesta con dolor y/o inestabilidad y genera deterioro articular precoz. La etiología es multifactorial y es un desafío valorar todos los factores que la producen para realizar un tratamiento adecuado para cada paciente. Las alteraciones torsionales, tanto femorales como tibiales, han demostrado su influencia en la articulación patelofemoral. La combinación entre la anteversión femoral, la torsión tibial y el ángulo de progresión de la marcha pueden generar torsión interna o externa de la rodilla. El objetivo de este estudio es presentar nuestro protocolo tomográfico funcional, con la medición de la torsión interna de rodilla en una posición de simulación de marcha; este índice torsional es una nueva herramienta útil para la toma de decisiones.Relevancia clínica: este es el primer protocolo tomográfico en estudiar la torsión de rodilla en relación con la línea de dirección de avance del cuerpo.Tipo de estudio: Metanálisis


Patellofemoral malalignment manifest with pain or instability, generating early arthritis. The etiology is multifactorial, and it is a challenge to assess all the factors involved, to perform an individualized treatment. Torsional disorders, both femoral and tibial, has shown their influence in patellofemoral joint. The correlation between femoral anteversion, tibial torsion and foot progression angle, can generate internal or external torsion of the knee. The objective of this study is to present our CT functional patellofemoral joint protocol, with the measurement of the knee internal torsion, in a simulating gait position of the knee in the space, and the description of a torsional index as a new tool for the decision making in treatment.Clinical relevance: this is the first CT protocol that assess the axial torsion of the knee in relationship to the direction of movement of the body. Type of study: Meta-analysis


Subject(s)
Tomography, X-Ray Computed , Patellofemoral Joint , Joint Instability
13.
Artrosc. (B. Aires) ; 28(1): 22-29, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252438

ABSTRACT

Introducción: La lesión de LCA en niños con fisis abierta va en aumento debido a una mayor participación en deportes de contacto y al diagnóstico precoz. El tratamiento conservador de este tipo de lesiones está asociado al desarrollo de lesiones secundarias condrales y meniscales por lo que, sobre la base de la bibliografía actual, su tratamiento en pacientes esqueléticamente inmaduros con inestabilidad anterior de rodilla objetiva y sintomática es quirúrgico. Materiales y métodos: en el siguiente trabajo se presenta una revisión de dieciocho pacientes esqueléticamente inmaduros con reconstrucción de LCA y un seguimiento promedio de veintiséis meses (entre doce y cincuenta y seis) evaluados con los scores Lysholm, Tegner e IKDC, y telemetrías postoperatorias con mejoría de los scores funcionales permitiendo el retorno al mismo nivel de actividad deportiva en la mayoría de los casos. Conclusión: en esta población, no se han observado cambios en la angulación del miembro intervenido en las telemetrías postoperatorias de control, ni en el desarrollo de alteraciones del crecimiento. Tipo de estudio: Serie de Casos. Nivel de evidencia: IV


Introduction: ACL injury in children with open physis is increasing due to greater participation in contact sports and early diagnosis. Conservative treatment of this type of injury is associated with the development of secondary chondral and meniscal injuries, so based on current literature the treatment of this type of injury in skeletally immature patients with objective and symptomatic anterior knee instability is surgical. Materials and methods: the following work presents a review of eighteen skeletally immature patients with ACL reconstruction and an average follow-up of twenty-six months (between twelve and fifty-six months) evaluated with the Lysholm, Tegner and IKDC scores and postoperative telemetries with improvement in functional scores allowing return at the same level of sports activity in most cases. Conclusion: in this population, no changes in the angulation of the operated limb have been observed in the postoperative control telemetries or the development of growth alterations in any case. Type of study: Case series. Level of evidence: IV


Subject(s)
Adolescent , Arthroscopy/methods , Joint Instability , Knee Injuries/surgery , Knee Joint/surgery
14.
Artrosc. (B. Aires) ; 28(1): 74-80, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252454

ABSTRACT

Introducción: La luxación recurrente anteroinferior del hombro es consecuencia de una luxación aguda traumática que, en pacientes jóvenes, menores de veinte años, se ha estimado puede llegar al 97% de recurrencia, pero que disminuye a medida que aumenta la edad, excepto en pacientes mayores con rupturas asociadas del manguito rotador. Al ser una patología incapacitante que afecta la calidad de vida de las personas, hay una mayor tendencia a tratarla por métodos quirúrgicos que con rehabilitación. La lesión fundamental es el desprendimiento del labrum anterior de la glenoides conocida como la lesión de Bankart-Perthes, estructura que tiene limitaciones para cicatrizar de manera anatómica con tratamientos incruentos, perpetuando la inestabilidad. A medida que recurre la luxación se presentan lesiones óseas asociadas tanto en la glenoides denominada Bankart ósea, así como en la cabeza humeral en su región posterosuperior o lesión de Hill-Sachs, que aumentan la posibilidad de recurrencia. Se han descripto diferentes técnicas abiertas y artroscópicas para corregir la luxación, pero por la heterogeneidad de la lesión no hay un tratamiento para corregirla que sea patrón de oro. Nuestro objetivo es describir los resultados clínicos en pacientes con luxación recurrente anteroinferior de hombro que fueron sometidos a cirugía artroscópica de reparación de Bankart/plicatura y remplissage y correlacionar los resultados con la escala preoperatoria de ISIS. Materiales y métodos: se revisaron las historias clínicas de pacientes con diagnóstico de luxación de la articulación del hombro (S430) (M253), que fueron llevados a cirugía entre junio de 2015 y enero de 2019, analizando características de la(s) lesión(es), clasificación preoperatoria de acuerdo con la escala de ISIS, tipo de procedimiento(s) quirúrgico realizado y número de implantes. Resultados: de veinticinco pacientes operados por el autor senior (MMA) de luxación recurrente de hombro, veintitrés completaron el seguimiento con los procedimientos de reparación de Bankart/plicatura y la adición de un remplissage en casos de lesiones Hill-Sachs enganchantes. Todos tenían una escala de ISIS preoperatoria igual o inferior a 6. Al final del seguimiento ningún paciente reportó recurrencia de su luxación. Conclusión: en nuestra casuística, la reparación de Bankart/plicatura en pacientes con lesiones Hill-Sachs no enganchantes en asocio del remplissage produce excelentes resultados a corto y mediano plazo cuando la escala de ISIS es igual o inferior a 6. Nivel de evidencia: IV


Introduction: Recurrent anteroinferior shoulder dislocation is the consequence of an acute traumatic dislocation which, in young patients, under twenty years old, has been estimated to reach 97% of recurrence, but which decreases with increasing age, except in older patients with associated rotator cuff tears. Being a disabling pathology that affects people's quality of life, there is a greater tendency to treat it by surgical methods than with rehabilitation. The fundamental lesion is the detachment of the anterior labrum of the glenoid known as the Bankart-Perthes lesion, a structure that has limitations to heal anatomically with bloodless treatments, perpetuating instability. As the dislocation recurs, there are associated bone lesions both in the glenoid called Bony Bankart, as well as in the humeral head in its posterior superior region or Hill-Sachs lesion, which increase the possibility of recurrence. Different open and arthroscopic techniques have been described to correct dislocation, but due to the heterogeneity of the lesion, there is no gold standard treatment to correct it. Our objective is to describe the clinical results in patients with recurrent anteroinferior shoulder dislocation who underwent arthroscopic Bankart/plication repair and fill surgery and correlate the results with the preoperative ISIS scale. Materials and methods: the medical records of patients with a diagnosis of shoulder joint dislocation (S430) (M253), who were taken to surgery between June 2015 and January 2019, were reviewed, analyzing characteristics of the injury(s), classification preoperative according to the ISIS scale, type of surgical procedure(s) performed and number of implants. Results: of twenty-five patients operated by the senior author (MMA) for recurrent shoulder dislocation, twenty-three completed follow-up with Bankart/plication repair procedures and the addition of a fill in Hill-Sachs engaging lesions. All had a preoperative ISIS scale equal to or less than 6. At the end of follow-up, no patient reported recurrence of their dislocation.Conclusion: in our casuistry, Bankart/plication repair in patients with non-engaging Hill-Sachs lesions in association with filling produces excellent results in the short and medium term when the ISIS scale is equal to or less than 6. Level of Evidence: IV


Subject(s)
Adult , Middle Aged , Arthroscopy/methods , Recurrence , Shoulder Dislocation , Severity of Illness Index , Treatment Outcome , Joint Instability
15.
Article in Chinese | WPRIM | ID: wpr-888318

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability by using Meta-analysis.@*METHODS@#Search PubMed, Medline, Embase, Cochrane, China National Knowledge Infrastructure(CNKI), Wanfang database, China Biological Literature system(CBM) and VIP database. Review all retrospective or prospective cohort studies and randomized controlled trials on open and arthroscopic Latarjet procedure for anterior shoulder instability. Binary variables (postoperative recurrence rate, incidence of intraoperative and postoperative complications) and continuousvariables [shoulder external rotation range of motion, Walch-Duplay score, Rowe score, WOSI score, postoperative visual analogue scale (VAS), postoperative anxiety degree and operation time] were selected for analysis. NOS bias risk assessment criteria (recommended by Cochrane collaboration Network) were used to evaluate the literature quality of retrospective or prospective cohort studies, and modified Jadad scale was used to evaluate the quality of randomized controlled trials. Literature screening, literature quality evaluation and data extraction were carried out independently by two observers. RevMan 5.3 software was used for Meta analysis.@*RESULTS@#(1)A total of 9 studies were included, including 8 retrospective cohort studies and 1 prospective cohort study. A total of 956 patients were included in this study, including open Latarjet procedure(@*CONCLUSION@#The arthroscopic Latarjet stabilisation shows satisfactory and comparable results to open procedure, and the postoperative recurrence and complication rates are low in both group. Both open and arthroscopic Latarjet procedure are reliable surgical procedures in the treatment of anteriorly shoulder instability. Arthroscopic procedure has longer learning curve than open procedure, the doctors may either choose arthroscopic or open Latarjet procedure based on personal skills and preference, as well as the patient's condition. However, all the literatures included in this study are cohort studies with low level of evidence. The research lack randomized controlled trials, and small sample size is small. In the future, randomized controlled studies with large sample size and high level of evidence are still needed to determine the efficacy difference between the two.


Subject(s)
Arthroscopy , China , Humans , Joint Instability , Prospective Studies , Recurrence , Retrospective Studies , Shoulder , Shoulder Dislocation , Shoulder Joint
16.
Article in Chinese | WPRIM | ID: wpr-888302

ABSTRACT

OBJECTIVE@#To investigate the method and clinical effects of the treatment of recurrent anterior dislocation of shoulder with Hill-Sachs injury by arthroscopic Bankart repair and Remplissage.@*METHODS@#From March 2016 to March 2019, 106 patients with recurrent anterior dislocation of shoulder with glenoid bone defect less than 20% underwent arthroscopic Bankart repair, including 76 males and 30 females, aged from 18 to 45 (27.3±8.6) years, 59 cases of left shoulder and 47 cases of right shoulder. Range of motion (ROM), American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score and Rowe score were used to evaluate shoulder functionand stability before and after operation.@*RESULTS@#All patients were followed up, and the duration ranged from 21 to 60 months, with a mean of (41.5± 8.5) months. One patient developed infection after operation, and the infection was controlled after arthroscopic debridement again. The remaining patients did not have clinical complications such as infection, intra articular hematocele and redislocation. Shoulder flexion and lifting increased from (158.33±15.72) ° preoperatively to (169.43±10.04) ° at the latest follow up, and internal rotation changed from T7 (T4 to T10) preoperatively to T8 (T5 to T10) at the latest follow up;the average lateral external rotation and abduction 90 ° external rotation decreased from (58.46±15.51) ° preoperatively and (99.37±14.09) ° to (53.18±14.90) ° and (92.52±13.10) ° at the latest follow up, respectively. The ASES score, Constant -Murley score and Rowe score were significantly improved.@*CONCLUSION@#The clinical effect of rehabilitation of Bankart repair combined with Remplissageunder arthroscopy in the treatment of recurrent dislocation of shoulder joint in adults with Hill-Sachs defect is satisfactory. Although the external rotation function is weaker than that before operation, it can effectively reconstruct the shoulder function and avoid the occurrence ofdislocation after operation.


Subject(s)
Adult , Arthroplasty , Arthroscopy , Female , Humans , Joint Instability/surgery , Male , Range of Motion, Articular , Recurrence , Shoulder/surgery , Shoulder Dislocation/surgery , Shoulder Joint/surgery
17.
Article in Chinese | WPRIM | ID: wpr-888301

ABSTRACT

OBJECTIVE@#To evaluate the reliability and repeatability of three-dimensional (3D)-CT measurement of glenoid track.@*METHODS@#Glenoid and Hill-Sachs bone defects in 60 patients with recurrent anterior dislocation of the unilateral shoulder were evaluated by 3D-CT and analyzed by three independent observers(shoulder orthopedists) according to the Di Giacomo method. These injuries were classified to formulate a surgical protocol. All the patients were repeatedly measured 1 week later. Intraclass correlation coefficient (ICC) and coefficient of variation (COV) were used for reliability analysis.@*RESULTS@#Interobserver reliability was "very good" for both measurements of glenoid diameter and glenoid bone defects, and "good" for measurements of Hill-Sachs interval. Interobserver agreement was high on the assessment of the extent of the glenoid defect, and poor on track/off track assessment of the Hill-Sachs lesion. Intraobserver reliability for measurements of glenoid diameter, glenoid defect, and Hill-Sachs interval was "very good". The COV was 4.1% for glenoid diameter, 4.4% for glenoid defect, and 21.1% for Hill-Sachs interval.@*CONCLUSION@#The reliability and reproducibility of 3D-CT measurements of glenoid bone defects are good, but the assessment of humeral head bone defects shows large variability with poor reliability.


Subject(s)
Humans , Joint Instability , Reproducibility of Results , Shoulder , Shoulder Dislocation , Shoulder Joint , Tomography, X-Ray Computed
18.
Article in Chinese | WPRIM | ID: wpr-879626

ABSTRACT

OBJECTIVE@#To explore the genetic basis for a child suspected for Say-Barber-Biesecker-Young-Simpson syndrome.@*METHODS@#Genomic DNA was extracted from peripheral blood samples of the child and her parents. Whole exome sequencing was carried out for the proband. Suspected variants were validated by Sanger sequencing. The impact of the variants was predicted by bioinformatic analysis.@*RESULTS@#The child was found to harbor a de novo missense variant c.2623C>T (p.Asp875Tyr) in exon 13 of the KAT6B gene. The variant was previously unreported, and was not recorded in the major allele frequency database and predicted to be pathogenic based on PolyPhen-2, MutationTaster and PROVEAN analysis. As predicted by UCSF chimera and CASTp software, the variant can severely impact the substrate-binding pocket of histone acetyltransferase, resulting in loss of its enzymatic activity. Based on standards and guidelines by the American College of Medical Genetics and Genomics, the variant was classified to be likely pathogenic (PS2+PM2+PP3).@*CONCLUSION@#The child's condition may be attributed to the de novo missense c.2623C>T (p.Asp875Tyr) variant of the KAT6B gene.


Subject(s)
Blepharophimosis , Child , Congenital Hypothyroidism , Facies , Female , Heart Defects, Congenital , Histone Acetyltransferases/genetics , Humans , Intellectual Disability , Joint Instability , Mutation , Phenotype
19.
Article in Chinese | WPRIM | ID: wpr-879467

ABSTRACT

The surgical treatment of recurrent anterior shoulder dislocation is a difficult problem in the field of sports injury medicine. The main reason focus on dynamic and osseous constraints of shoulder joint could not recover well. At present, arthroscopic surgery is used at home and abroad, and could receive statisfied postoperative effect, but the choice of specific surgical methods is still controversial. According to presence and size of glenoid and humeral skull defects, different treatments should be selected in clinic. The author recommends that no articular glenoid defect or glenoid defect 40% or Bristow-Latarjet if the surgical repair fails, bone grafting is used. In addition, if (humeral avulsion of glenohumeral ligaments, HAGL) injury existed, HAGL injury repair should be used. In addition to considering the important factor of bone defects, it is necessary to combine patient's age, exercise level and surgeon's technique to comprehensively select the bestsurgical method.


Subject(s)
Arthroscopy , Humans , Joint Instability , Recurrence , Scapula , Shoulder Dislocation/surgery , Shoulder Joint
20.
Article in Chinese | WPRIM | ID: wpr-879386

ABSTRACT

OBJECTIVE@#To explore clinical effects of single-tunnel pullout structure fixation and anatomical reconstruction of lateral ligament complex in treating chronic lateral ankle instability.@*METHODS@#From January 2016 to December 2018, clinical data of 23 patients with chronic lateral malleolus instability who underwent anatomical reconstruction of lateral malleolus ligament complex with single-tunnel pullout structure fixation, were retrospectively studied. Among them, including 7 males and 16 females, aged from 17 to 33 years old with an avergae of (26.0±4.3) years old;16 patients classified to grage 0, and 7 patients classified to gradeⅠaccording to Kellgren-Lawrence(K-L) grading;the time of sprain ranged form 2 to 15 with an average of (5.7±2.9) times;the time from injury to operation ranged to 4 to 18 months with an average of (9.0±3.3) months. The range of movement of operative and uninjured ankle joints were measured at 24 months after opertaion, visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate ankle joint function and improvement of pain, K-L grading and MRI scoring of osteoarthritis of ankle (MSOA) were used to evaluate degree of cartilage degeneration of ankle joint.@*RESULTS@#All patients were followed up from 24 to 48 months with an average of (33.4±6.7) months. All the anterior talofibular ligaments and calcaneofibular ligaments were dissected and reconstructed by single-tunnel pullout structure fixation. The range of motion of dorsiflexion, plantarflexion, varus, and valgus on the operative side of ankle joint were smaller than those on the healthy side. There were no statistically differences in dorsiflexion and eversion between operative side and healthy side of ankle joint (@*CONCLUSION@#Treatment of chronic lateral ankle instability with reconstruction of lateral ligament complex with single-tunnel pullout structure fixation could provide better tendon and bone healing conditions, improve surgical safety and could achieve satisfactory clinical outcomes.


Subject(s)
Aged , Ankle , Ankle Joint/surgery , Female , Humans , Infant , Joint Instability/surgery , Lateral Ligament, Ankle/surgery , Male , Retrospective Studies
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