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1.
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
2.
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
3.
Medisan ; 25(1)ene.-feb. 2021. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1154858

ABSTRACT

La inestabilidad patelofemoral es una entidad que afecta principalmente a adolescentes y adultos jóvenes. En su diagnóstico se consideran elementos clínicos e imagenológicos, en especial para medir la distancia entre la tuberosidad anterior de la tibia y el surco intercondíleo, que permite la selección de la técnica quirúrgica en cada paciente, en específico la transferencia de la tuberosidad anterior de la tibia. En este artículo se exponen brevemente algunos aspectos de interés sobre el tema: métodos imagenológicos empleados en estos pacientes (radiografía simple, tomografía axial computarizada, imagen por resonancia magnética) y valores de referencia considerados como normales; también se describe por pasos cómo medir la distancia entre la tuberosidad anterior de la tibia y el surco intercondíleo.


The patellofemoral instability is an entity that mainly affects adolescents and young adults. In its diagnosis clinical and imaging elements are considered, especially to measure the tibial-tuberosity to trochlear groove distance that allows the selection of the surgical technique in each patient, in specific the transfer of the tibial-tuberosity. In this work some aspects of interest on the topic are shortly exposed: the imaging methods used in these patients (simple x-rays, computerized axial tomography, magnetic resonance imaging) and the reference values considered as normal; it is also described step by step how to measure the tibial-tuberosity to trochlear groove distance.


Subject(s)
Tomography, X-Ray Computed , Patellofemoral Joint/pathology , Magnetic Resonance Imaging , Patellofemoral Joint/diagnostic imaging
4.
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
5.
Artrosc. (B. Aires) ; 28(3): 238-242, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1348326

ABSTRACT

La técnica de reconstrucción del ligamento patelofemoral medial es eficaz, segura, reproducible y con baja morbilidad para el tratamiento de la luxación patelar recurrente. Los pasos a seguir son: 1) Paciente en decúbito dorsal. 2) Artroscopía diagnóstica con liberación del retináculo lateral y valoración de lesiones asociadas. 3) Incisión de 2 a 3 cm sobre el borde superomedial de la patela. 4) Realización de dos túneles de 20 a 22 mm de profundidad y 4 mm de diámetro a través del grosor de la patela bajo fluoroscopia. 5) Fijar dos anclas desde el borde medial de la patela y anudar al aloinjerto con sutura de alta resistencia. 6) Identificar el punto de Schöttle bajo fluoroscopia. 7) Incisión de 2 a 3 cm a nivel del epicóndilo medial. 8) Colocar un Kirschner de 2 mm de medial a lateral, de posterior a anterior y de distal a proximal. 9) Medir la longitud, el grosor y la tensión final deseada del aloinjerto. 10) Realizar el túnel femoral con broca canulada, 1 mm mayor al grosor del aloinjerto. 11) Utilizar el clavo con ojal para pasar la sutura y traccionar el aloinjerto de medial a lateral. 12) Fijar el aloinjerto con un tornillo biodegradable con la rodilla a 30° de flexión valorando la tensión final deseada. 13) Realizar el lavado y cierre por planos. Nivel de Evidencia: IV


The medial patellofemoral ligament reconstruction technique is effective, safe, reproducible and with low morbidity in the treatment of recurrent patellar luxation. The steps in this technique: 1) Patient in supine position. 2) Diagnostic arthroscopy with release of the lateral retinaculum and assessment of associated lesions. 3) 2 to 3 cm incision on the supero - medial border of the patella. 4) Make two tunnels 20 to 22 mm deep and 4 mm in diameter through the thickness of the patella under fluoroscopy. 5) Fix two anchors from the medial edge of the patella and tie to the allograft with high strength suture. 6) The Schöttle's point is identified under fluoroscopy. 7) 2 to 3 cm incision in the medial epicondyle. 8) A 2 mm Kirschner is placed from medial to lateral, posterior to anterior, and distal to proximal. 9) The length, thickness and desired final tension of the allograft are measured. 10) The femoral tunnel is made with a cannulated drill, 1 mm greater than the thickness of the allograft. 11) The eyelet nail is used to pass the suture and pull the allograft from medial to lateral. 12) The allograft is fixed with a biodegradable screw with the knee at 30 ° flexion, assessing the desired final tension. 13) The washing and closing are carried out by planes up to the skin. Level of Evidence: IV


Subject(s)
Arthroscopy/methods , Patellar Dislocation , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Allografts , Knee Joint/surgery
6.
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
7.
Artrosc. (B. Aires) ; 28(1): 13-21, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252436

ABSTRACT

Introducción: La luxación patelofemoral representa el 3% de las lesiones traumáticas de la rodilla. Dos tercios se producen en menores de veinte años. La recidiva luego del segundo episodio supera el 50%, lo que puede causar gran limitación funcional en pacientes jóvenes, disminuyendo su calidad de vida. El ligamento patelofemoral medial (LPFM) es el principal estabilizador medial de la rótula a 30° de flexión. En la actualidad su reconstrucción anatómica, preservando la fisis, parece ser la mejor opción en los pacientes con esqueleto inmaduro. Materiales y métodos: estudiamos el resultado funcional de dos grupos de pacientes tratados con dos técnicas diferentes de reconstrucción del LPFM, una anatómica con semitendinoso autólogo (ST) y otra no anatómica con hemitendón cuadricipital autólogo (QT). Ambos grupos fueron evaluados mediante el score de Kujala antes de la cirugía y durante el seguimiento. Las medias y los ítems del score se compararon utilizando la prueba de Wilcoxon.Resultados: veintidós rodillas fueron evaluadas, once en cada grupo. La edad de los pacientes varió entre ocho y quince años. La media de seguimiento fue de 19.4 meses. Los resultados muestran una mejora en la media del score de Kujala de 51 a 88 en el grupo QT, y de 52 a 97 en el grupo ST (ambos con valor-p = 0.003). No se encontró una diferencia significativa entre ambas técnicas. Solo se registró un caso de reluxación (grupo QT). Conclusiones: podemos afirmar que la reconstrucción del LPFM es una opción válida para la luxación patelofemoral, y las técnicas propuestas son confiables


Introduction: Patellofemoral dislocation accounts for 3% of traumatic knee injuries, with two-thirds occurring in patients under twenty years of age. Recurrence after the second episode is greater than 50%, which can cause great functional limitation in young patients, reducing their quality of life. Medial patellofemoral ligament (MPFL) is the main medial stabilizer of the patella at 30° flexion, currently its anatomic reconstruction preserving the physis appears to be the best option in patients with immature skeleton. Materials and methods: functional results of two groups of patients treated by two different techniques of MPFL reconstruction were evaluated. One anatomic technique, with autologous Semitendinosus (ST) and the other non-anatomic, with autologous quadricipital hemi tendon (QT). Both groups were evaluated through the Kujala score before surgery and during follow-up. Means and score items were compared using Wilcoxon signed-rank test.Results: twenty-two knees were evaluated, eleven in each group. Patient's age ranged between eight and fifteen years old. The mean follow-up was 19.4 months. An improvement in the average Kujala scores for the ST group from 51 to 88 and in the QT group from 52 to 97 was shown. Kujala score was statistically significantly higher in the postoperative evaluation with both technics (p-value 0.003 for both groups), no differences were found between both technics. Only one case of patella redislocation was registered during the study period (QT group). Conclusions: we can affirm that MPFL reconstruction is a valid therapeutic option for patellofemoral dislocation and the proposed techniques are reliable choices


Subject(s)
Child , Minimally Invasive Surgical Procedures/methods , Joint Dislocations , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Knee Joint/surgery
8.
Article in Chinese | WPRIM | ID: wpr-879383

ABSTRACT

OBJECTIVE@#To study mechanism of improvement of stress concentration on patellofemoral joint by stiletto needle releasing lateral patellar retinaculum guided by the theory of Jinshugu() and based on the finite element model of knee joint. and to elucidate the biomechanical mechanism of stiletto needle releasing changing patellar trajectory and reducing patellofemoral joint pressure.@*METHODS@#CT data of knee joint from a normal male (aged 29, heighted 171 cm, weighted 58 kg) was selected. Starting with construction of three-dimensional model of knee joint by using finite element software, the finite element model of knee joint with complete tendonand bone structures were established through several steps, such as geometric reconstruction, reverse engineering, meshing, material assignment and loading analysis. The loading condition was set as 500 N load on knee joint, and the average tensile stress of quadriceps femoris tendon was about 200 N. To simulate the release of lateral patellar retinaculum by stiletto needle at 30 and 90 position of knee flexion in finite element model separately, and to compare the improvement of stress concentration of patellofemoral joint by stiletto needle intervention under different knee flexion conditions.@*RESULTS@#The peak stress of patellofemoral joint and tibiofemoral joint decreased after stiletto needle releasing of patellofemoral lateral retinaculum compared with before intervention, which was(1) knee flexion at 30 degrees:patellar cartilage decreased by 0.498 MPa (decreased 9.06%), femoral trochlea decreased by 0.886 MPa(decreased 16.27%);(2) knee flexion at 90 degrees:patellar cartilage decreased by 0.558 MPa (decreased 8.6%), femoral trochlea decreasedby 0.607 MPa (decreased 9.94%).@*CONCLUSION@#Releasing lateral patellofemoral retinaculum with stiletto needle could effectively alleviate the stress concentration of patellofemoral joint and reduce local stress peak value, which it is helpful to improve patellar trajectory and make stress distribution more uniform.


Subject(s)
Adult , Biomechanical Phenomena , Finite Element Analysis , Humans , Knee Joint , Male , Patella , Patellofemoral Joint , Quadriceps Muscle , Range of Motion, Articular
9.
Rev. bras. ortop ; 55(6): 771-777, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156205

ABSTRACT

Abstract Objective To evaluate different femoral fixation devices for medial patellofemoral ligament reconstruction and compare their effectiveness regarding fixation strength up to failure in porcine knees. Methods Thirty porcine knees were used, divided into three groups of 10 knees. The removed grafts were dissected from the extensor tendons of porcine feet. In each group, the graft was fixed to the femur with an interference screw, an anchor, or adductor tenodesis. The three methods were subjected to biomechanical tests using a universal Tensile testing machine at a speed of 20 mm/minute. Results The highest average linear resistance under lateral traction occurred in group 1, "screw fixation" (185.45 ± 41.22 N), followed by group 2, "anchor fixation" (152.97 ± 49, 43 N); the lower average was observed in group 3, "tenodesis fixation" (76.69 ± 18.90 N). According to the fixed error margin (5%), there was a significant difference between groups (p < 0.001); in addition, multiple comparison tests (between group pairs) also showed significant differences. Variability was small, since the variance coefficient was lower than 33.3%. Conclusion Interference screws in bone tunnels and mountable anchors fixation with high resistance wire are strong enough for femoral fixation in porcine medial patellofemoral ligament reconstruction. Adductor tenodesis, however, was deemed fragile for such purpose.


Resumo Objetivo Avaliar diferentes dispositivos de fixação femoral na reconstrução do ligamento patelofemoral medial para comparar sua eficácia quanto à força de fixação até a falha em joelhos suínos. Métodos Foram ensaiados 30 joelhos de suínos subdivididos em 3 grupos de 10 joelhos. Os enxertos retirados foram dissecados de tendões extensores das patas dos suínos. Cada grupo teve o enxerto fixado ao fêmur com parafuso de interferência, âncora, ou tenodese no tendão adutor. Os 3 métodos foram submetidos à testes biomecânicos utilizando uma máquina universal de ensaio de tração com uma velocidade de 20 mm/min. Resultados Verificamos que a média mais elevada da resistência linear sob tração lateral (185,45 ± 41,22 N) ocorreu no grupo 1: "fixação por parafuso," seguido do grupo 2: "fixação por âncora" (152,97 ± 49,43 N), e a média foi menor no grupo 3: "fixação por tenodese" (76,69 ± 18,90 N). Para a margem de erro fixada (5%), comprovou-se a diferença significativa entre os grupos (p < 0,001) e também através dos testes de comparações múltiplas (entre os pares de grupos) verificou-se a ocorrência de diferenças significativas. A variabilidade expressada por meio do coeficiente de variação mostrou-se reduzida, já que a referida medida foi inferior a 33,3%. Conclusão O uso de parafusos de interferência no túnel ósseo de joelhos porcinos é suficientemente forte para fixação femoral na reconstrução do ligamento patelofemoral medial, assim como a fixação com âncoras montáveis com fio de alta resistência. Entretanto, a tenodese no tendão adutor mostrou-se frágil para essa finalidade.


Subject(s)
Animals , Orthopedic Fixation Devices , Swine , Tendons , Traction , Effectiveness , Biomechanical Phenomena , Bone and Bones , Suture Techniques , Transplants , Models, Animal , Tenodesis , Patellofemoral Joint , Femur , Ligaments , Methods
10.
Arq. bras. med. vet. zootec. (Online) ; 72(5): 1646-1652, Sept.-Oct. 2020. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1131575

ABSTRACT

The objective was to establish the reference standards for elastography of the main structures of the canine stifle joint. The medial meniscus, patellar and cruciate ligaments of thirty healthy beagles was evaluated by B-mode and ARFI elastography (n=60 joints). Analysis detected a positive correlation of the shear wave velocity (SWV) of structures according to age. Patellar ligament presented a gradual stiffness increase in relation to age, while medial meniscus and cruciate ligament were more rigid in puppies than in adults. However, greater stiffness of these structures was observed in elderly animals. Elasticity of each structure was evaluated according to gender and reproductive status. Females presented greater stiffness of all structures, with SWV differing 0.3 and 0.36m/s between genders. Only the medial meniscus was not stiffer in neutered animals when compared to intact animals, differing only 0.02m/s in menisci and 0.4 to 0.47m/s in ligaments between groups. These findings corroborate with literature data that states a higher prevalence of ligament insufficiency in elderly dogs, females and neutered animals. It was concluded that ARFI elastography of the canine stifle joint is feasible and its application can be potentially effective in early diagnosis of ligament and meniscal changes.(AU)


O objetivo foi estabelecer os padrões normais para elastografia das principais estruturas da articulação do joelho em cães. O menisco medial, ligamento patelar e cruzado de trinta beagles saudáveis foram avaliados pelo modo B e elastografia ARFI (n=60 articulações). A análise detectou uma correlação positiva da velocidade de cisalhamento (SWV) das estruturas com a idade. O ligamento patelar apresentou um aumento gradual da rigidez em relação à idade, enquanto o menisco medial e o ligamento cruzado foram mais rígidos em filhotes do que em adultos. Entretanto, observou-se maior rigidez dessas estruturas em idosos. A elasticidade de cada estrutura foi avaliada de acordo com o sexo e o estado reprodutivo. As fêmeas apresentaram maior rigidez em todas as estruturas, com SWV diferente de 0,3 e 0,36m/s entre os sexos. Somente o menisco medial não foi mais rígido nos animais castrados quando comparado não castrados, diferindo apenas 0,02m/s no menisco e 0,4 a 0,47m/s nos ligamentos entre os grupos. Esses achados corroboram com dados da literatura que afirmam maior prevalência de insuficiência ligamentar em cães idosos, fêmeas e animais castrados. Concluiu-se que a elastografia ARFI da articulação do joelho canino é viável e sua aplicação pode ser eficaz no diagnóstico precoce de alterações ligamentares e meniscais.(AU)


Subject(s)
Animals , Dogs , Patellofemoral Joint/diagnostic imaging , Meniscus/diagnostic imaging , Knee Joint/diagnostic imaging , Ultrasonography/veterinary , Elasticity Imaging Techniques/veterinary
12.
Säo Paulo med. j ; 137(2): 148-154, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1014632

ABSTRACT

ABSTRACT BACKGROUND: The Norwich Patellar Instability (NPI) score is a tool for evaluating the impact of patellofemoral instability on joint function. It has not been translated or culturally adapted for the Brazilian population before. OBJECTIVE: This study had the aims of translating and culturally adapting the NPI score for use in Brazilian Portuguese and subsequently assessing its validity for this population. DESIGN AND SETTING: Translation, cross-cultural adaptation and validation study conducted at the State Public Servants' Institute of São Paulo, Brazil. METHODS: Sixty patients of both sexes (aged 16-40 years) with diagnoses of patellar dislocation were recruited. The translation and cultural adaptation were undertaken through translation into Brazilian Portuguese and back-translation to English by an independent translator. Face validity was assessed by a committee of experts and by 20 patients. Concurrent validity was assessed through comparing the Brazilian Portuguese NPI score with the Brazilian Portuguese versions of the Lysholm knee score and the Kujala patellofemoral disorder score among the other 40 patients. Correlation analysis between the three scores was performed using Pearson correlation coefficients with significance levels of P < 0.05. RESULTS: The Brazilian Portuguese version of the NPI score showed moderate correlation with the Brazilian Portuguese versions of the Lysholm score (r = -0.56; 95% confidence interval, CI: -0.74 to -0.30; P < 0.01) and Kujala score (r = -0.57; 95% CI: -0.75 to -0.31; P < 0.01). CONCLUSION: The Brazilian Portuguese version of the NPI score is a validated tool for assessing patient-reported patellar instability for the Brazilian population.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Surveys and Questionnaires , Patellofemoral Joint/injuries , Joint Instability/diagnosis , Translating , Severity of Illness Index , Brazil , Cultural Characteristics , Patellofemoral Joint/physiopathology
13.
Rev. bras. ortop ; 54(2): 178-182, Mar.-Apr. 2019. tab
Article in English | LILACS | ID: biblio-1013696

ABSTRACT

Abstract Objective The aim of the present study was to evaluate the clinical results, functional outcomes, and risk factors after anatomic reconstructions using knee flexor grafts in athletes. Methods The authors followed-up 32 patients and 34 knees for 1 year in a prospective design case series evaluating pre- and postoperative functional scores (Kujala and Lysholm) and associated risk factors. Results All of the 32 patients had a significant increase of the Lysholm and Kujala scores. Patients with < 5 preoperative dislocations had a better score on the Lysholm and Kujala scales. The mean preoperative Lysholm score was 62.8, and the mean postoperative score was 94.3. The mean preoperative Kujala score was 63.0, and the mean postoperative score was 94.0. Conclusion Medial patellofemoral ligament reconstruction with hamstring graft in athletes with patellar instability improved clinical and functional scores. The bone drilling through the patella and the positioning of the femoral tunnel should be judiciously performed.


Resumo Objetivo Avaliar os resultados clínicos e funcionais da reconstrução anatômica do ligamento patelofemoral medial com tendões flexores em atletas. Métodos Estudo tipo série de casos, prospectivo, que analisou a reconstrução do ligamento patelofemoralmedial em32 pacientes (34 joelhos). A avaliação funcional foi feita pelos escores Lysholm e Kujala nos períodos pré e pós-operatórios e os fatores de risco envolvidos foram avaliados. Resultados Dos 32 pacientes analisados, todos obtiveram melhoria dos escores funcionais comparativamente ao período pré-operatório. Pacientes com menos de cinco episódios de luxação prévios obtiveram melhores resultados funcionais. O valor médio de Lysholm no pré-operatório foi de 62,8 e no pós-operatório de 94,3, quanto ao escore de Kujala a média pré-operatório foi de 63,0 e pós-operatória de 94,0. Conclusão A reconstrução do ligamento patelofemoral medial com enxerto de tendão flexor do joelho em atletas propiciou melhoria dos escores clínicos e funcionais nos pacientes com instabilidade patelofemoral. A perfuração óssea da patela e o posicionamento do túnel femoral devem ocorrer de forma judiciosa.


Subject(s)
Humans , Male , Female , Patellar Dislocation , Patellofemoral Joint , Athletes , Joint Instability
14.
Rev. bras. ortop ; 54(2): 171-177, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013707

ABSTRACT

Abstract Objective To evaluate the classification proposed by David Dejour to describe trochlear dysplasia of the knee through inter- and intraobserver reproducibility measurements. Methods Ten patients with trochlear dysplasia were studied. Three physicians, members of the Sociedade Brasileira de Cirurgia do Joelho (Brazilian Society of Knee Surgery), were invited to evaluate the images. Intra- and interobserver analyses were performed at one-week intervals. Reproducibility was evaluated in four scenarios: using only radiography; using radiography and tomography; using radiography and consulting the classification; and using radiography and tomography, consulting the classification. Results The intraobserver evaluation presented discordant results. In the interobserver analysis, the degree of agreement was low for the analyses that used only radiography and excellent for those in which both radiography and tomography were used. Conclusion The Dejour classification presented a low intra- and interobserver reproducibilitywhenonly the profile radiography was used. It was demonstrated that the use of the radiography alone for classificationmay generate lack of uniformity even among experienced observers. However, when radiography and tomography were combined, reproducibility improved.


Resumo Objetivo Avaliar, pela reprodutibilidade interobservador e intraobservador, a classificação proposta por David Dejour para descrever a displasia troclear do joelho. Métodos Foram estudados dez pacientes com diagnóstico de displasia troclear. Três médicos membros da Sociedade Brasileira de Cirurgia do Joelho foram convidados para avaliar as imagens. Análises intra- e interobservador foram feitas com intervalo de uma semana. A reprodutibilidade foi avaliada em quatro cenários: uso de radiografia; uso de radiografia e tomografia; uso de radiografia, consultando-se a classificação no momento; e uso de radiografia e tomografia, consultando-se a classificação no momento. Resultados A avaliação intraobservador apresentou resultados discordantes. Na análise interobservador, o grau de concordância foi baixo para as análises que usavam apenas a radiografia e excelente para aquelas que associavamradiografia e tomografia. Conclusão A classificação de Dejour apresentou uma baixa reprodutibilidade intra e interobservador quando usada somente a radiografia em perfil. Demonstrou-se que o uso apenas da radiografia para classificar pode gerar falta de uniformidade até mesmo entre observadores experientes. Contudo, quando radiografia e tomografia foram associadas, a reprodutibilidade melhorou.


Subject(s)
Humans , Male , Female , Reproducibility of Results , Patellofemoral Joint , Joint Instability
15.
Article in Spanish | LILACS, BINACIS | ID: biblio-1003005

ABSTRACT

Introducción: La osteotomía de la tuberosidad anterior de la tibia (O-TAT) es una técnica quirúrgica que permite restablecer la alineación distal de la rótula en pacientes esqueléticamente maduros. Los objetivos de este estudio fueron evaluar los resultados funcionales y analizar factores que influyeron en el desarrollo de complicaciones. Materiales y Métodos: Se analizaron retrospectivamente pacientes con O-TAT tratados entre 2008 y 2016. Se documentaron datos demográficos y clínicos. Los resultados fueron evaluados según las escalas de Kujala y Tegner-Lysholm, y las complicaciones, con una adaptación de la clasificación de Clavien- Dindo. Resultados: Se analizaron 33 O-TAT en 29 pacientes (17 mujeres). Mediana de la edad: 18 años (RIC 2, mín.-máx. 14-39). Mediana de seguimiento: 49 meses (RIC 2, mín.-máx. 12-115). Mejoría en las escalas de Kujala y Tegner-Lysholm de 61 y 61,5 a 94 y 92,3, respectivamente (p = 0,001). La mediana de tiempo de consolidación fue de 8 semanas. Hubo 9 complicaciones (27%): 1 grado II (infección superficial) y 8 grado III (artrofibrosis, fracturas de tibia y fracturas de TAT, n = 2). La tasa de complicaciones fue más alta en los pacientes sometidos a desinserción de la TAT (51,5% vs. 11,1%, p = 0,029). Conclusiones: La O-TAT representa una técnica eficaz para tratar diversas patologías de la articulación patelofemoral en adolescentes y adultos jóvenes. Hubo complicaciones en un alto porcentaje de los procedimientos, sin que esto afectara el resultado final. El riesgo de complicaciones fue mayor en las osteotomías que requirieron desinserción de la TAT y la reconstrucción ligamentaria. Nivel de Evidencia: IV


Introduction: Tibial tubercle osteotomy (TTO) is a surgical approach that allows for the restoration of distal patellar alignment in skeletally mature patients. The objectives of this study were to evaluate functional results and to analyze the risk factors associated with complications. Methods: We carried out a retrospective analysis of patients subjected to a TTO between 2008 and 2016 and documented demographic and clinical data. Results were evaluated according to Kujala Anterior Knee Pain Scale and Tegner-Lysholm Knee Scoring Scale. Complications were evaluated with a modified Clavien-Dindo classification of Surgical Complications. Results: We evaluated 33 TTOs in 29 patients (17 women) with a median age of 18 years (IQR 2, range 14-39) and a median follow-up time of 49 months (IQR 2, range 12-115). The Kujala and the Tegner-Lysholm scoring improved from 61 and 61.5 to 94 and 92.3, respectively (p=0.001). Union was achieved at a median of 8 weeks. There were 9 complications (27%): a grade II complication (superficial infection) and 8 grade III complications (arthrofibrosis, tibial fractures, and anterior tibial tubercle fractures). Osteotomies in which tibial tubercle was completely detached had a significantly higher rate of complications (51.5% vs. 11.1%, p=0.029). Conclusions: TTO represents an effective approach for the treatment of several conditions of the patellofemoral joint in adolescents and young adults. In our series, a high percentage of the procedures presented complications, although they did not affect the final result. Osteotomies that involve complete detachment of the tubercle and those associated with ligament reconstruction have an increased risk of complications. Level of Evidence: IV


Subject(s)
Adolescent , Adult , Osteotomy/methods , Tibia/surgery , Patellofemoral Joint/surgery , Joint Instability/surgery , Knee Joint/surgery , Postoperative Complications , Treatment Outcome
16.
Artrosc. (B. Aires) ; 26(4): 118-122, 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1118210

ABSTRACT

Introducción: La osteotomía de la tuberosidad anterior de la tibia es un procedimiento efectivo y seguro para el tratamiento de la inestabilidad patelofemoral. El objetivo del presente trabajo es desarrollar las indicaciones y evaluar las complicaciones de dicho procedimiento realizado en un grupo de pacientes intervenidos por nuestro equipo. Material y método: Se analizaron en forma retrospectiva las historias clínicas de 77 pacientes intervenidos quirúrgicamente por inestabilidad patelofemoral a quienes se les realizó una osteotomía de la TAT, y en quienes se utilizó la misma técnica quirúrgica. Se registró edad, sexo, actividad deportiva y número de intervenciones, y se analizaron las indicaciones quirúrgicas de cada caso. Por último, se cuantifico el número de complicaciones (menores y mayores) y se evaluó el grado de satisfacción postquirúrgica de los pacientes con el score de kujala. Resultados: En la mayoría de los casos los pacientes presentaban un aumento de la distancia ST-TAT de más de 20 mm con un ángulo Q aumentado, asociado a episodios de luxación recidivante de rotula y dolor anterior de rodilla. La complicación más frecuente fue la recidiva del dolor (de menor intensidad y frecuencia que el presentado previo a la cirugía). Registramos dos casos de aflojamiento de material que requirió una segunda cirugía y un caso de secreción persistente de herida quirúrgica que no requirió re intervención. Conclusión: La osteotomía de la TAT es una procedimiento eficaz y con bajo índice de complicaciones postoperatorias para tratar la luxación recidivante de rotula, permitiendo al paciente retornar a sus actividades deportivas con un bajo porcentaje de morbilidad postoperatoria. Tipo de estudio: Serie de casos. Nivel de evidencia: IV


Introduction: Tibial anterior tuberosity osteotomy is an effective and safe procedure for the treatment of patello-femoral instability. The objective of the present paper is to talk about the indications and to evaluate the complications of the mentioned procedure performed in a group of patients who underwent surgery with our team. Material and method: The clinical histories of 77 patients operated due to patello-femoral instability, who underwent TT osteotomy and in whom the same surgical technique was performed, were analyzed retrospectively. Age, gender, sports activity and number of surgeries were registered and surgery indications in each case were analyzed. Lastly, the number of (minor and major) complications was quantified and patients postop satisfaction was evaluated with the Kujala score. Results: In most of cases patients presented a ST-TT distance increase of over 20 mm with an augmented Q angle associated to patellar recurrent luxation episodes and to anterior knee pain. The most frequent complication was pain recurrence (of lower intensity and frequency than that presented prior to surgery). Two cases of loosening material which required a second surgery and one case of persistent secretion from the surgical wound which did not require a new surgery were registered. Conclusion: The TT osteotomy is an effective procedure and with a low postop complications rate to treat patellar recurrent luxation, which allows the patient to resume sports activities with a low rate of postop morbidity. Type study: Case series. Level of evidence: IV


Subject(s)
Adult , Osteotomy/methods , Postoperative Complications , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Joint Instability/surgery , Knee Joint/surgery , Treatment Outcome
17.
Artrosc. (B. Aires) ; 26(4): 113-117, 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1118209

ABSTRACT

Introducción: La reconstrucción del ligamento patelofemoral medial por inestabilidad rotuliana es un procedimiento reproducible con indicaciones precisas. El objetivo del presente trabajo fue evaluar las indicaciones, las complicaciones y la satisfacción postoperatoria en un grupo de pacientes, tratados con la misma técnica de reconstrucción. Material y método: Se evaluaron en forma retrospectiva 53 rodillas de 49 pacientes intervenidos entre el año 2009 al 2018, por inestabilidad rotuliana, con la misma técnica de reconstrucción de partes blandas asociada o no a otros procedimientos sobre estructuras óseas. Registrando edad, sexo, lado afectado, fecha, número de intervenciones y actividad física. Se evaluaron las indicaciones, las complicaciones y satisfacción postoperatoria con el score de Kujala. Resultados: La indicación de la cirugía fue la luxación recidivante de rotula. Nuestra complicación menor más frecuente fue el dolor, asociado en un bajo porcentaje a inestabilidad subjetiva. Dentro de las complicaciones mayores presentamos un caso de rigidez postoperatoria que requirió movilización bajo anestesia, un caso de reluxación que requirió una reintervención y un caso de retiro de material por dolor. Conclusión: La reconstrucción del ligamento patelofemoral medial es un procedimiento efectivo, con un bajo índice de recidiva, permitiendo el retorno a la actividad física previa. Es fundamental una indicación precisa. Se hallo un porcentaje reducido de complicaciones mayores, pero con un número considerable de complicaciones menores. Tipo de estudio: Serie de casos. Nivel de evidencia: IV


Introduction: The medial patella-femoral ligament reconstruction due to patellar instability is a reproducible procedure which has accurate indications. The objective of the present paper was to evaluate the indications, the complications and postop satisfaction in a group of patients, treated with the same reconstruction technique. Material and method: Fifty-six knees from 52 patients operated between 2009 and 2018, due to patellar instability, were evaluated retrospectively, with the same soft tissue reconstruction technique, whether or not associated with other procedures on bone structures. Age, gender, affected site, date and number of surgeries and physical activity were registered. Indications, complications and postop satisfaction were evaluated with Kujala score. Results: The patellar recurrent luxation was the indication for surgery. Pain was the most frequent minor complication, associated to subjective instability in a low percentage. Within the major complications two cases of postop stiffness that required mobilization under anesthesia were presented, and also was one recurrent luxation case that needed a new surgery. Conclusion: The medial patello-femoral ligament reconstruction is an effective procedure, which has a low recurrent rate, and which allows the return to previous physical activity. An accurate indication is fundamental. A lower rate of major complications was found, but with a non-negligible number of minor complications. Type study: Case series. Level of evidence: IV


Subject(s)
Adult , Patella/injuries , Postoperative Complications , Range of Motion, Articular , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Knee Joint/surgery , Retrospective Studies , Follow-Up Studies , Treatment Outcome
18.
Article in Chinese | WPRIM | ID: wpr-773908

ABSTRACT

OBJECTIVE@#To explore the clinical effect of knee denervation combined with micro-fracture under arthroscope in the treatment of patellofemoral arthritis.@*METHODS@#From May 2015 to May 2018, 60 patients with knee joint degenerative patellofemoral arthritis were treated, including 28 males and 32 females, aged from 24 to 56(40.5±3.35) years old. Among them, 30 cases underwent arthroscopic debridement alone(control group), 30 cases underwent arthroscopic debridement, peripatellar denervation combined with cartilage cone and patellofemoral articular surface microfracture treatment (treatment group). VAS, Lysholm and Kujala scores were used to evaluate the therapeutic effect.@*RESULTS@#No complications such as wound infection, vascular nerve injury and deep venous thrombosis occurred in all patients. The patients were followed up for 7 to 36 months with an average of 12.5 months. The VAS scores of the two groups were improved 4 weeks after operation, and the improvement of the treatment group was significantly better than that of the control group, the difference was statistically significant (<0.05). Lysholm and Kujala scores were compared at the last follow-up of the two groups, the improvement of the treatment group was significantly better than that of the control group.@*CONCLUSIONS@#The treatment of patellofemoral arthritis with patellar denervation combined with microfracture can better relieve pain and improve knee function.


Subject(s)
Adult , Aged , Arthritis , Denervation , Female , Femur , Fractures, Stress , Humans , Knee Joint , Male , Patella , Patellofemoral Joint , Treatment Outcome , Young Adult
19.
Rev. bras. ortop ; 53(5): 570-574, Sept.-Oct. 2018. tab
Article in English | LILACS | ID: biblio-977892

ABSTRACT

ABSTRACT Objective: To compare the clinical outcomes and the results of knee functional scores in patients with normal patellar height and patella alta who underwent isolated medial patellofemoral ligament reconstruction. Methods: A total of 37 knees from 33 patients with recurrent patellar dislocation who underwent isolated medial patellofemoral ligament reconstruction were included. Retrospectively, the postoperative clinical results were compared using the Kujala and Lysholm scores in the group of patients with normal patellar height and in those with patella alta. Results: The sample consisted of 37 patients; 16 knees of 14 patients in the group with normal patellar height, 21 knees of 19 patients in the group with patella alta. In the first group, the mean Kujala score was 85.8 and the mean Lysholm score was 85.6. In the second, the mean Kujala score was 78.1 and the mean Lysholm score was 79.7. No significant differences were observed between the groups in relation to the Lysholm (p = 0.296) and Kujala scores (p = 0.181). Conclusion: Isolated medial patellofemoral ligament reconstruction presented similar results in patients with normal patellar height and patella alta.


RESUMO Objetivo: Comparar os resultados clínicos e escores funcionais do joelho em pacientes com altura patelar normal e patela alta submetidos a reconstrução isolada do ligamento patelofemoral medial. Métodos: Foram incluídos 37 joelhos de 33 pacientes com quadro de luxação recidivante da patela submetidos a reconstrução isolada do ligamento patelofemoral medial. Retrospectivamente, foi comparado o resultado clínico pós-operatório pelas escalas de Kujala e Lysholm entre o grupo de pacientes com altura patelar dentro da normalidade e aqueles com patela alta. Resultados: A amostra foi constituída por 37 pacientes; 16 joelhos de 14 pacientes pertenciam ao grupo da patela com altura normal e 21 joelhos de 19 pacientes compuseram o grupo com patela alta. No primeiro grupo, a pontuação média pela escala de Kujala foi de 85,8 e pela de Lysholm, 85,6. No segundo, a pontuação média pela escala de Kujala foi de 78,1 e pela de Lysholm, 79,7. Não foi observada diferença significativa entre os grupos em relação aos escores das escalas de Lysholm (p = 0,296) e de Kujala (p = 0,181). Conclusão: A reconstrução isolada do ligamento patelofemoral medial apresentou resultados semelhantes em pacientes com altura patelar normal e elevada.


Subject(s)
Humans , Male , Female , Patella , Reconstructive Surgical Procedures/methods , Patellar Dislocation , Patellofemoral Joint
20.
Article in English | WPRIM | ID: wpr-759348

ABSTRACT

PURPOSE: High tibial valgus osteotomy (HTO) is a well-established surgical procedure for patients with medial compartment osteoarthritis (OA) of the knee. The hybrid closed-wedge HTO (CWHTO) procedure permits extensive correction in patients with severe deformities or patellofemoral joint OA. The aim of this study was to report the short-term results in a consecutive series of patients treated with hybrid CWHTO. MATERIALS AND METHODS: We retrospectively evaluated the clinical outcomes and radiographic parameters in 29 consecutive knees that underwent hybrid CWTHO to correct medial compartment OA at an average follow-up of 52.6 months. Clinical outcomes were assessed using the Lysholm score and knee scoring system of the Japanese Orthopedic Association (JOA). The Kellgren-Lawrence grading system and pre- and postoperative mechanical axis (MA), femorotibial angle (FTA), posterior tibial slope, and patella height were assessed. RESULTS: The FTA and MA significantly changed from 180.7° to 170.4° and from 22.0° to 60.2°, respectively. No significant differences were observed between the mean pre- and postoperative posterior tibial slope, Insall-Salvati ratio, or Caton-Deschamps index. The postoperative JOA and Lysholm scores significantly improved from 76.7 to 95.8 and from 58.8 to 90.2, respectively. CONCLUSIONS: Satisfactory outcomes can be achieved with hybrid CWHTO in patients with medial OA.


Subject(s)
Asian Continental Ancestry Group , Congenital Abnormalities , Follow-Up Studies , Humans , Knee , Orthopedics , Osteoarthritis , Osteotomy , Patella , Patellofemoral Joint , Retrospective Studies
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