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Artrosc. (B. Aires) ; 30(2): 88-95, 2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1451226


La inestabilidad patelofemoral es uno de los problemas más frecuentes en pacientes jóvenes, y representa del 2 al 3% de todas las lesiones de rodilla. Significa una causa importante de morbilidad debido a la limitación de varias actividades de la vida diaria, y a largo plazo el surgimiento de artrosis. La inestabilidad patelofemoral es descripta como la deficiencia de la constricción pasiva que genera un desplazamiento lateral de la patela total o parcial de su posición normal con respecto a la tróclea. Los desórdenes patelofemorales son el resultado de una anatomía aberrante, están dados por una alteración en la alineación ósea y generan un desequilibrio biomecánico. Existen cuatro factores clásicos que generan inestabilidad patelar: patela alta, displasia troclear, alteración en la distancia (TT-TG) y excesiva inclinación patelar. Al generarse una luxación, el ligamento patelofemoral medial (LPFM) se ve afectado en al menos el 25% de los casos. El complemento diagnóstico se realiza a través de rayos X, tomografía computarizada y resonancia magnética. La restauración de la función por tratamiento quirúrgico ha mostrado resultados similares al conservador en primoluxaciones, sin embargo, se ha visto que la reconstrucción del ligamento patelofemoral medial presenta mejores resultados clínicos para el paciente. Hasta el momento, hemos intervenido diecinueve pacientes con la técnica descripta, para los cuales no hay reportada una reluxación de rótula y tienen una escala de Lysholm de 87 puntos que se encuentra dentro del parámetro "bueno".

Patellofemoral instability is one of the most frequent problems in young patients, and represents 2 to 3% of all knee injuries. It denotes an important cause of morbidity due to the limitation of various activities of daily living and in the long term the appearance of osteoarthritis. Patellofemoral instability is defined as the deficiency of passive constriction that generates a total or partial lateral displacement of the patella from its normal position with respect to the trochlea. Patellofemoral disorders are the result of an aberrant anatomy, they are given by an alteration in bone alignment and generates a biomechanical imbalance. There are four classic factors that generate patellar instability: high patella, trochlear dysplasia, alteration in distance (TT-TG) and excessive patellar inclination. When generating the dislocation, the medial patellofemoral ligament is affected in at least 25% of cases. The diagnostic complement is carried out through X-rays, computed tomography and nuclear magnetic resonance.Restoration of function surgical treatment has shown similar results to conservative treatment in primoluxations, however it has been seen that reconstruction of the medial patellofemoral ligament presents better clinical results for the patient.To date, nineteen patients we have been operated on with the technique described of whom there is no reported reluxation of the patella and who have a Lysholm scale of 85 points that is within a good parameter.

Minimally Invasive Surgical Procedures , Patellofemoral Joint/surgery , Joint Instability , Knee Joint/surgery
Chinese Medical Journal ; (24): 1539-1550, 2023.
Article in English | WPRIM | ID: wpr-980814


BACKGROUND@#Patellofemoral joint (PFJ) degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty (UKA). More recently, some researchers have proposed that PFJ degeneration can be ignored in medial UKA, and others have proposed that this change should be reviewed in PFJ degenerative facets and severity. This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures (PROMs) and revision rates after medial UKA.@*METHODS@#Electronic databases (PubMed, Embase, Web of Science, etc.) were searched for studies assessing the influence of PFJ degeneration on medial UKA. A random-effects meta-analysis was conducted for the Oxford knee score (OKS), Knee society score (KSS), and revision rates and stratified by PFJ degenerative facets (medial/lateral/trochlear/unspecified), severe PFJ degeneration (bone exposed), and bearing type (mobile/fixed). Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.@*RESULTS@#A total of 34 articles with 7007 knees (2267 with PFJ degeneration) were included (5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified). Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS, and only lateral facets significantly decreased the OKS (mean difference [MD] = -2.18, P   <  0.01) and KSS (MD = -2.61, P   <  0.01). The severity degree of PFJ degeneration had no additional adverse effect on the OKS, KSS, or revision rates. For mobile-bearing UKA, only lateral PFJ degeneration significantly decreased the OKS (MD = -2.21, P  < 0.01) and KSS (MD = -2.44, P  < 0.01). For fixed-bearing UKA, no correlation was found between PROMs/revision rates and PFJ degeneration.@*CONCLUSION@#For medial mobile-bearing UKA, slight to moderate degenerative changes in the PFJ, except lateral facet, did not compromise PROMs or revision rates. For medial fixed-bearing UKA, although it might not be conclusive enough, PROMs or revision rates were not adversely affected by PFJ degeneration (regardless of the facet).

Humans , Arthroplasty, Replacement, Knee , Patellofemoral Joint/surgery , Treatment Outcome , Osteoarthritis, Knee/surgery , Knee Prosthesis , Bone Diseases , Knee Joint/surgery , Retrospective Studies
Chinese Journal of Reparative and Reconstructive Surgery ; (12): 1230-1237, 2023.
Article in Chinese | WPRIM | ID: wpr-1009050


OBJECTIVE@#To evaluate the operability and effectiveness of a self-developed patellar bone canal locator (hereinafter referred to as "locator") in the reconstruction of the medial patellofemoral ligament (MPFL).@*METHODS@#A total of 38 patients with recurrent patellar dislocation who met the selection criteria admitted between January 2022 and December 2022 were randomly divided into study group (the patellar canal was established with a locator during MPFL reconstruction) and control group (no locator was used in MPFL reconstruction), with 19 cases in each group. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, body mass index, disease duration, patella Wiberg classification, constituent ratio of cartilage injury, Caton index, tibia tubercle-trochlear groove, and preoperative Lysholm score, Kujal score, Tegner score, visual analogue scale (VAS) score, and so on. The Lysholm score, Kujal score, Tegner score, and VAS score were used to evaluate knee joint function before operation and at 3 days,1 month, 3 months, and 6 months after operation. The ideal prepatellar cortical thickness and canal length were measured before operation, and the actual prepatellar cortical thickness and canal length after operation were also measured, and D1 (the distance between the ideal entrance and the actual entrance), D2 (the ideal canal length minus the actual canal length), D3 (the ideal prepatellar cortical thickness minus the actual prepatellar cortical thickness) were calculated.@*RESULTS@#Patients in both groups were followed up 6-8 months (mean, 6.7 months). The incision length and intraoperative blood loss in the study group were smaller than those in the control group, but the operation time was longer than that in the control group, the differences were significant ( P<0.05). There was no complication such as incision infection, effusion, and delayed healing in both groups, and no further dislocation occurred during follow-up. One patient in the study group had persistent pain in the anserine area after operation, and the symptoms were relieved after physiotherapy. The VAS score of the two groups increased significantly at 3 days after operation, and gradually decreased with the extension of time; the change trends of Lysholm score, Kujal score, and Tegner score were opposite to VAS score. Except that the Lysholm score and Kujal score of the study group were higher than those of the control group at 3 days after operation, and the VAS score of the study group was lower than that of the control group at 3 days and 1 month after operation, the differences were significant ( P<0.05), there was no significant difference in the scores between the two groups at other time points ( P>0.05). Patellar bone canal evaluation showed that there was no significant difference in preoperative simulated ideal canal length, prepatellar cortical thickness, and postoperative actual canal length between the two groups ( P>0.05). The postoperative actual prepatellar cortical thickness of the study group was significantly smaller than that of the control group ( P<0.05). D1 and D3 in the study group were significantly higher than those in control group ( P<0.05), but there was no significant difference in D2 between the two groups ( P>0.05).@*CONCLUSION@#The locator can improve the accuracy of MPFL reconstruction surgery, reduce the possibility of intraoperative damage to the articular surface of patella and postoperative patellar fractures.

Humans , Patella/surgery , Patellar Dislocation/surgery , Patellofemoral Joint/surgery , Knee Joint/surgery , Joint Dislocations , Ligaments, Articular/surgery
Rev. chil. ortop. traumatol ; 62(2): 104-112, ago. 2021. tab, ilus
Article in Spanish | LILACS | ID: biblio-1413015


INTRODUCCIÓN: La inestabilidad rotuliana recurrente puede conducir a malos resultados funcionales y daño articular progresivo a largo plazo, y con frecuencia se aborda mediante la reconstrucción del ligamento patelofemoral medial (RLPFM), con múltiples técnicas que suelen diferir en el método de fijación de la rótula. OBJETIVO: Evaluar los resultados de RLPFM utilizando una técnica novedosa de fijación rotuliana mediante suturas transóseas. El objetivo principal es determinar las tasas de reluxación y los resultados funcionales incluyendo retorno deportivo. Los objetivos secundarios incluyen la evaluación de las complicaciones y de otras variables relacionadas, y la comparación entre los resultados de RLPFM aislada y asociada a una osteotomía de la tuberosidad tibial. MÉTODOS: Estudio transversal de 34 pacientes sometidos a RLPFM desde 2013 hasta 2019 con un seguimiento mínimo de 12 meses. La reconstrucción fue realizada por el mismo primer cirujano con autoinjerto de gracilis de doble banda en todos los casos. La fijación del injerto en la cara medial de la rótula se realizó utilizando dos puntos de fijación transóseos independientes con suturas de alta resistencia, y la fijación femoral anatómica, con un tornillo interferencial mediante referencias anatómicas y radiológicas. Hubo 27 pacientes con RLPFM aislada, y 7 con osteotomía de la tuberosidad tibial asociada. RESULTADOS: La edad media fue de 22,8 años (desviación estándar [DE]: 9,1). El 50% eran hombres. El seguimiento desde la cirugía hasta el cuestionario fue de 30,4 meses (rango: 12 a 72 meses). La puntuación media de Kujala en el seguimiento fue de 89,4 (DE: 12,8; mediana: 93,5; rango: 51 a 100). No hubo casos de reluxación. No se identificaron otras complicaciones durante el seguimiento. El 81% de los pacientes regresó a los deportes, y el 47% regresó a su nivel previo de participación. No se encontraron diferencias significativas al comparar RLPFM aislada con grupos de osteotomía asociada. CONCLUSIÓN: La RLPFM mediante sutura transósea para fijación en la rótula mostró que la estabilidad rotuliana fue restaurada en el corto y mediano plazo. Esta técnica es segura, tiene excelentes resultados funcionales, y evita posibles complicaciones de los túneles rotulianos o morbilidad asociada al uso de implantes.

INTRODUCTION: Recurrent patellar instability can lead to poor functional results and progressive articular damage in the long term, and is frequently addressed by medial patellofemoral ligament reconstruction (MPFLR), with multiple techniques that most commonly differ regarding the method of patellar fixation. OBJECTIVE: To evaluate the results of MPFLR using a novel technique of patellar fixation using transosseous sutures. The main objective is to determine the redislocation rates and functional results. The secondary goals include an assessment of complications and of other related variables, and a comparison between isolated MPFLR and MPFLR associated to tibial tubercle osteotomy. METHODS: A cross-sectional study of 34 patients who underwent MPFLR from 2013 to 2019 with a minimum of 12 months of follow-up. The reconstruction was performed by the same first surgeon with double-bundle gracilis autograft in all cases. Fixation of the graft to themedial aspect of the patella was performed with two independent transosseous fixation points with high resistance sutures, and anatomic femoral fixation with an interference screw using anatomical and radiological landmarks. There were 27 patients with isolated MPFR, and 7 with associated tibial tubercle osteotomy. RESULTS: The mean age was of 22.8 years (standard deviation [SD]: 9.1). Men comprised 50% of the sample. The mean follow-up from surgery to the application of the questionnaire was of 30.4 months (range: 12 to 72 months). The mean Kujala score at follow-up was of 89.4 (SD: 12.8; median: 93.5; range: 51 to 100). There were no cases of redislocation. No other complications were identified during the follow-up. In total, 81% of patients returned to sports, with 47% returning to their previous level of participation. No significant differences were found when comparing isolated MPFLR with MPFLR associated osteotomy groups. CONCLUSION: The MPFLR procedure using transosseous patellar fixation showed that patellar stability was restored in the short term to the midterm. This technique is safe and has excellent functional outcomes, and it prevents potential complications of patellar tunnels or the morbidity associated to the use of implants.

Humans , Male , Female , Adolescent , Adult , Patellar Ligament/surgery , Plastic Surgery Procedures/methods , Patellofemoral Joint/surgery , Exercise , Cross-Sectional Studies , Surveys and Questionnaires , Treatment Outcome
Rev. chil. ortop. traumatol ; 62(1): 46-56, mar. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1342673


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.

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
Artrosc. (B. Aires) ; 28(1): 13-21, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252436


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

Child , Minimally Invasive Surgical Procedures/methods , Joint Dislocations , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Knee Joint/surgery
Artrosc. (B. Aires) ; 28(3): 238-242, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1348326


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

Arthroscopy/methods , Patellar Dislocation , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Allografts , Knee Joint/surgery
Acta ortop. mex ; 34(6): 403-411, nov.-dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1383456


Resumen: Objetivo: Presentar los diferentes procedimientos quirúrgicos en el tratamiento de las inestabilidades femoropatelares objetivas, incluyendo la osteotomía de la tuberosidad tibial anterior y la trocleoplastía femoral. Material y métodos: Con un diseño prospectivo con seguimiento a cinco años que incluyó a 21 pacientes (21 rodillas) tratados por luxación rotuliana recidivante entre Marzo de 2010 y Agosto de 2014, tratándose de forma quirúrgica mediante dos técnicas diferentes según el tipo de inestabilidad estructural de base. Para determinarlo, se analizó el índice radiográfico de Caton-Deschamps (para la evaluación de la altura rotuliana) y parámetros tomográficos para valorar el configuración troclear y distancia desde la tuberosidad tibial anterior hasta la tróclea femoral (TT-TG) en la superposición de imágenes en el plano axial. Resultados: Hemos tenido resultados satisfactorios tanto con la transferencia de la tuberosidad tibial anterior como con la trocleoplastía. En ambos procedimientos se realizó una reconstrucción del ligamento patelofemoral medial (LPFM). Conclusiones: La recurrencia de inestabilidad es muy rara después de estos procedimientos y es más probable que ésta resulte de anomalías asociadas no diagnosticadas o subestimadas. Se requiere una planificación precisa preoperatoria para determinar la altura rotuliana, la ubicación de la tuberosidad tibial anterior y la configuración troclear para obtener resultados satisfactorios.

Abstract: Objective: To present the different surgical procedures in the treatment of objective femoropateral instability, including osteotomy of anterior tibial tuberosity and femoral trocleoplasty. Material and methods: With a prospective 5-year follow-up design that included 21 patients (21 knees) treated for relapsing patellar dislocation between March 2010 and August 2014, treated surgically using 2 different techniques depending on the type of basic structural instability. To determine this, the Caton-Deschamps X-Ray Index (for the evaluation of the patellar height) and tomographic parameters were analyzed to assess the troclear configuration and distance from the anterior tibial tuberosity to the femoral trochlea (TT-TG) in the overlapping of images in the axial plane. Results: We have had satisfactory results both with the transfer of the anterior tibial tuberosity and with the trocleoplasty. In both procedures, a reconstruction of the medial patelo-femoral ligament (LPFM) was performed. Conclusion: Recurrence of instability is very rare after these procedures and is more likely to result from undiagnosed or underestimated associated abnormalities. Precise preoperative planning is required to determine the patellar height, location of the anterior tibial tuberosity, and troclear configuration for satisfactory results.

Humans , Patellar Dislocation , Patellofemoral Joint , Joint Instability , Tibia/surgery , Tibia/diagnostic imaging , Prospective Studies , Follow-Up Studies , Patellar Dislocation/surgery , Patellar Dislocation/diagnostic imaging , Patellofemoral Joint/surgery , Patellofemoral Joint/diagnostic imaging , Joint Instability/surgery , Joint Instability/diagnostic imaging
Article in Spanish | LILACS, BINACIS | ID: biblio-1003005


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

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


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

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
Artrosc. (B. Aires) ; 26(4): 118-122, 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1118210


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

Adult , Osteotomy/methods , Postoperative Complications , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Joint Instability/surgery , Knee Joint/surgery , Treatment Outcome
Article in Spanish | LILACS, BINACIS | ID: biblio-908046


Introducción: Se han descripto múltiples técnicas quirúrgicas para estabilizar la patela. Se realizó un estudio retroprospectivo analizando los resultados al año del tratamiento de la luxación recidivante de rótula mediante reconstrucción del ligamento patelofemoral medial (LPFM) con injerto de semitendinoso autólogo. Material y Métodos: Entre enero de 2010 y abril de 2012 se operaron 37 pacientes (24 hombres y 13 mujeres con edad promedio de 21 años) por inestabilidad patelofemoral recurrente. Se incluyeron los que se les realizó reconstrucción del ligamento patelofemoral medial con injerto autólogo de semitendinoso. Se excluyeron 4 pacientes a los que se les realizó una ostetomía de TAT. Mediante un riguroso exámen fisico y estudios de imágenes (Rx, TAC y RNM), se evaluó estabilidad articular, ángulo Q, versión femoral y rotación tibial, daño osteocondral. Los pacientes fueron evaluados a las 6 semanas, 3 meses y al año. En el preoperatorio y el último seguimiento se realizó una evaluación con score de Lysholm y de Kujala. Resultados: Ninguno presentó recidivas hasta el año postoperatorio. 31 pacientes comenzaron la actividad deportiva 6 meses después de la cirugía. Como complicaciones se registraron: dos infecciones de herida quirúrgica y un caso con hipotrofia muscular cuadricipital. No se registraron fracturas ni trombosis venosa profunda. Ninguno necesitó reintervenciones. El score Kujala promedio mejoró de 48 en el preoperatorio a 90, 32 al año de seguimiento y el score de Lysholm de 53 el preoperatorio a 87,5 al año. Discusión: El LPFM actua como una rienda restringiendo la traslación externa de la patela desde la extensión hasta los 30 grados de flexión para luego relajarse en el resto de la flexión. En nuestra serie, la reconstrucción de LPFM con injerto autólogo de semitendinoso, mejoró los scores funcionales, presentando un bajo índice de complicaciones y sin recidivas al año de seguimiento.

Introduction: Multiple surgical techniques have been described to stabilize the patella. This retrospective study analyzes the results at one year follow up of the medial patello femoral ligament (MPFL) reconstruction, with autologous semitendinosus tendon graft, for the treatment of recurrent patella dislocation. Methods: 37 patients with recurrent patella dislocation were operated between January 2010 and April 2012 (24 men and 13 women with an average age of 21 years). We included 33 patients with isolated MPFL reconstruction using an autologous semitendinosus graft. Four patients were excluded because of concomitant tibial tubercle osteotomy. With a thorough physical examination and imaging studies (Xray, CT scan and MRI) we evaluated the stability, Q angle, femoral and tibial rotation and osteochondral damage. The 33 patients were evaluated at 6 weeks, 3 months and one year. Lysholm and Kujala scores were performed before the surgery and at one year follow up. Results: There were no postoperative patella dislocation at the final follow up. 31 patients started sporting activity 6 months after surgery. The complications were two wound infections and one muscular quadriceps hypotrophy. No postoperative fractures, or DVT were registered. No patient required reinterventions. The mean Kujala score was 48 before surgery and of 90.32 at the 12 months follow up. The mean Lysholm score was 53 the before surgery and 87.5 at 12 months follow up. Discussion: The MPFL acts as a rein restraining the patella from lateral translation between maximum extension until 30 degrees of flexion and then, it loosens in the rest of flexion. In our series, MPFL reconstruction with autologous semitendinosus graft shows improvement in the functional scores, with a low complication rate and no recurrent dislocation at one-year follow-up.

Adult , Young Adult , Joint Instability/surgery , Ligaments, Articular/surgery , Patellar Dislocation/surgery , Patellofemoral Joint/surgery , Plastic Surgery Procedures/methods , Recurrence
Artrosc. (B. Aires) ; 24(4): 151-153, 2017.
Article in Spanish | LILACS, BINACIS | ID: biblio-907444


Introducción: La reconstrucción del ligamento patelofemoral medial es uno de los tratamientos más indicados para la inestabilidad rotuliana en la actualidad asociado en algunos casos a correcciones de la altura patelar o la morfología troclear. El objetivo del siguiente estudio fue evaluar los resultados clínicos de la reconstrucción del ligamento patelofemoral medial en pacientes operados por inestabilidad patelar. Material y método: Entre abril de 2011 y febrero de 2015, se realizaron 27 reconstrucciones del ligamento patelofemoral medial en 25 pacientes, los cuales padecieron dos o más episodios de luxación patelar con un mínimo de un año de seguimiento. Se excluyeron a pacientes con lesiones ligamentarias asociadas o fracturas asociada. Se les realizó la reparación del mismo con autoinjerto de recto interno, fijándolo con arpones de biotenodesis. Se requirió la osteotomía de la tuberosidad anterior tibial en 33% de los pacientes. Resultados: La puntuación de Kujala promedio fue de 90,1 puntos (rango 64 - 100) al momento de la evaluación clínica. Los resultados de los pacientes con osteotomía de la tuberosidad anterior de la tibia no fueron diferentes con respecto a los pacientes que se realizó la reconstrucción ligamentaria aislada. No se produjo ningún episodio de luxación, subluxación o revisión quirúrgica en la población de estudio. Conclusión: La reconstrucción del ligamento patelofemoral medial presenta excelentes resultados clínicos a corto y mediano plazo, con 0% de re-luxación, independientemente del requerimiento de osteotomía de la tuberosidad anterior de la tibia. Tipo de estudio: Serie de casos. Nivel de evidencia: IV.

Introduction: The reconstruction of the medial patellofemoral ligament (MPFL) is the most suitable treatment for the patellar instability at the present in patients with two or more episodes of dislocation or only one with condral lesion. This is because it is the principal medial stabilizer of the patella. This process could be supplemented with an osseous correction as tibial tuberosity transference. Objectives: assess the clinical results of the reconstruction of the MPLF in patients with patellar instability. Material and Method: We enroll all patients with this procedure between form April 2011 to February 2015, the sample has 27 reconstruction in 25 patients, who has two or more episodes of patellar dislocation. The graft used was gracilis tendon, set with suture anchor, and tibial tuberosity transfer in 9 patients who need an osseous procedure. Results: The average Kujala score was 90,1 points (64-100). Was necessary tibial tuberosity transference in one third of se sample. And in those patients there no difference compared with the isolated reconstruction.There was no episode of patellar dislocation or a second surgical time in the sample. Conclusion: The reconstruction of MPLF show excellent clinical outcomes in a short and medium terms, with 0% of dislocation and no second surgical time, in this kind of patients. Type of Study: Case series. Level of evidence: IV.

Adult , Arthroscopy/methods , Joint Instability/surgery , Knee Injuries/surgery , Ligaments, Articular/surgery , Patellofemoral Joint/surgery , Treatment Outcome
Artrosc. (B. Aires) ; 24(1): 16-21, 2017.
Article in Spanish | LILACS, BINACIS | ID: biblio-868720


Introducción: la luxación de la patela es una patología relativamente frecuente sin embargo, su manejo es controversial. En los últimos años la tendencia a realizar reconstrucciones que asemejen más la anatomía nativa, ha generado un renovado interés por las reconstrucciones del ligamento patelofemoral medial (LPFM). De las estructuras que permiten mantener la patela en adecuada posición, el LPFM es la estructura más importante y su lesión es reconocida como esencial para que se origine una luxación de patela. Objetivo: La reconstrucción del LPFM con la técnica de doble haz fijada anatómicamente y verificada por artroscopia pretende acercarse a los parámetros actuales de reconstrucción. Este estudio busca describir los resultados del tratamiento quirúrgico con esta técnica en pacientes con luxación de patela tratados entre mayo de 2010 y mayo de 2016 mediante la aplicación de escalas funcionales establecidas en la literatura, para identificar la mejoría de los síntomas y la no recidiva un año posterior a finalizar el período de rehabilitación. Resultados: Se intervinieron 16 rodillas en 15 pacientes (una de las pacientes con compromiso bilateral), de las cuales el 81,2% fueron de sexo femenino. El tiempo entre la primera luxación y la intervención quirúrgica fue en promedio 11,81 meses. Al año se encontraron diferencias estadísticamente significativas para las escalas funcionales Lisholm, Tegner, y Kujala y no se realizaron reintervenciones durante el seguimiento. Conclusión: La reconstrucción del LPFM, con doble fijación en patela y fijación asistida por artroscopia, es una variación a la técnica abierta tradicional que, teniendo en cuenta parámetros anatómicos, se puede realizar de forma segura. La evolución clínica de los pacientes es satisfactoria teniendo en cuenta que las escalas funcionales medidas en estos pacientes mejoraron estadísticamente significativo con respecto a los puntajes iniciales.

Introduction: dislocation of the patella is a relatively frequent pathology, however, its handling is controversial. In the recent years the tendency to perform reconstructions that more closely resemble native anatomy has generated a renewed interest in reconstructions of the medial patellofemoral ligament (LPFM).1,2 Of the structures that maintain the patella in a suitable position, LPFM is the most important one and its lesion is recognized as essential for the origin of a patella dislocation.3 Objective: The reconstruction of the LPFM with the anatomically fixed and double-beam technique, which was verified by arthroscopy, aims to approach the current reconstruction parameters. This study looks at the results of the surgical treatment with this technique in patients with patellar dislocation treated between May 2010 and May 2016, through the application of functional scales established in the literature to identify the improvement of symptoms and non-recurrence, one year after the end of the rehabilitation period. Results: 16 knees were involved in 15 patients (one of the patients with bilateral involvement), of whom 81.2% were female. The time between the first dislocation and the surgery had an average of 11.81 months. There were found statistically significant differences for the Lisholm, Tegner, and Kujala functional scales and there were no interventions performed during the year of follow-up. Conclusion: The reconstruction of LPFM, with double fixation in patella and fixation assisted by arthroscopy is a variation to the traditional open technique, taking into account anatomical parameters can be performed safely. The clinical evolution of the patients is satisfactory considering that the functional scales measured in these patients improved compared to their initial scores.

Humans , Adult , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Knee Joint/surgery , Arthroscopy/methods , Ligaments, Articular/surgery , Ligaments, Articular/injuries , Knee Dislocation , Plastic Surgery Procedures/methods , Retrospective Studies , Treatment Outcome
Artrosc. (B. Aires) ; 24(2): 65-70, 2017.
Article in Spanish | LILACS, BINACIS | ID: biblio-868729


Objetivo: la luxación recidivante de rótula es una patología de origen multifactorial. Se han descripto diferentestécnicas quirúrgicas de acuerdo a la etiología de la luxación. La reconstrucción anatómica del ligamento patelofemoralmedial (LPFM) puede realizarse en rodillas con lesión o laxitud residual del mismo, sin alteración severa de la alineaciónpatelofemoral o ausencia de displasia de la tróclea, con la finalidad de restablecer la restricción de la excursión lateral dela rótula. El objetivo de éste trabajo es determinar la evolución clínica y las complicaciones de los pacientes tratados conreconstrucción del ligamento patelofemoral medial como procedimiento único en nuestro servicio.Material y métodos: Se realizó una evaluación retrospectiva incluyendo todos los pacientes, operados entre 2007 y2012, con reconstrucción anatómica del LPFM con injerto autólogo de semitendinoso homolateral con un seguimientomínimo de 3 años; se excluyeron aquellos en los que se realizó además realineación distal. Fueron evaluados mediante laescala subjetiva patelofemoral de Kujala y el nivel de retorno deportivo de Tegner. Se analizaron las complicaciones y elíndice de re-luxación postoperatorios.Resultados: Se seleccionaron 19 pacientes, 9 (47.4%) fueron hombres y 10 (52.6%) mujeres con una edad promediode 25 años. El seguimiento promedio fue de 70 meses (rango 40 a 96). Los resultados de la evaluación de Kujala fueronde 63.21 (rango 24 a 96) en el preoperatorio a 89.14 (rango 65 a 98) en el posoperatorio. La escala de Tegner fue de 7.3preoperatorio y 6.35 posoperatorio. Nueve pacientes (47.4%) retornaron a su actividad deportiva previa, tres (15.7%)pacientes cambiaron de actividad deportiva o bajaron su nivel y 2 (10.5%) no retornaron a su actividad deportiva previa...

Objective: Recurrent patellofemoral dislocation is usually a multifactorial pathology. Different surgical techniques have beendescribed according to the etiology of dislocation. In absence of a severe malalignment or an anatomical patellofemoraldysplasia, reconstruction of Medial Patellofemoral Ligament (MPFL) can restore the normal tracking of the patella, avoidinglateral excursion. The purpose of this study was to evaluate clinical results and complications in patients who underwent aMPFL reconstruction.Material and Methods: We retrospectively evaluated all of patient who underwent an anatomic MPFL reconstruction usingautologous semitendinosus graft between 2007 and 2012. Exclusion criteria were patients with an associated proceduresuch as distal realignment. Clinical outcomes were measured using Kujala score and return to sport rate (Tegner). Weregistered the postoperative complications and recurrence rate.Results: We evaluated 19 patients, 9 (47.4%) were men and 10 (52.6%) women with a mean age of 25 years. Averagefollow-up was 70 months (range 40 a 96). Kujala score improvement was from 63.21 (range 24 a 96) preoperative to 89.14(range 65 a 98) postoperative. Tegner score was 7.3 preoperative to 6.35 postoperative. Nine patients (47.4%) returned totheir previous sport level, 3 (15.7%) changed to another sport or decreased their level and 2 (10.5%) were unable to practiceany sports at all...

Humans , Adolescent , Adult , Young Adult , Patellofemoral Joint/surgery , Knee Joint/surgery , Arthroscopy/methods , Joint Instability , Patellar Ligament/surgery , Patellar Ligament/injuries , Minimally Invasive Surgical Procedures , Retrospective Studies , Follow-Up Studies , Treatment Outcome
Artrosc. (B. Aires) ; 24(2): 71-74, 2017.
Article in Spanish | LILACS | ID: biblio-868730


La inestabilidad rotuliana crónica, relacionada a displasia severa de la tróclea determina plantear procedimientos como la trocleoplastía para restablecer el encarrilamiento rotuliano y la anatomía funcional. Se presenta un caso luxación crónica de rótula asociado a una displasia severa de tróclea, al cual se le realizó una trocleoplastía asociada a osteotomía de la tuberosidad anterior de la tibia y reconstrucción del ligamento patelofemoral medial. Tipo de estudio: Reporte de Caso. Nivel de evidencia: V.

Chronic patellar instability related to severe trochlear dysplasia requires procedures such as trochleoplasty to restore patellar tracking and functional anatomy. We present a case of chronic knee dislocation associated with severe trochlear dysplasia, treated with a trochleoplasty associated to a Tibial Anterior Tuberosity osteotomy and Medial Patello-Femoral Ligament reconstruction. Type of study: Case Report. Level of evidence: V.

Humans , Adolescent , Patellofemoral Joint/surgery , Knee Joint/surgery , Femur/abnormalities , Femur/surgery , Joint Instability/surgery , Plastic Surgery Procedures/methods , Patella/surgery , Treatment Outcome
Rev. bras. ortop ; 51(1): 75-82, Jan.-Feb. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-775658


To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo...

Descrever técnica cirúrgica de reconstrução anatômica do LPFM com tendão quadricipital combinada com a reconstrução do LPTM com tendão patelar e apresentar os resultados iniciais em uma série de casos. MÉTODO: Foi aplicada a técnica proposta em uma série de casos de pacientes do Grupo de Joelho do HC-IOT diagnosticados com instabilidade patelofemoral e com indicação de tratamento cirúrgico...

Humans , Female , Patellofemoral Joint/surgery , Joint Instability/surgery , Patella/surgery , Surgical Procedures, Operative
Clinics in Orthopedic Surgery ; : 171-176, 2015.
Article in English | WPRIM | ID: wpr-69224


BACKGROUND: Approximately 10% of patients with osteoarthritis (OA) of the knee have unicompartmental OA confined to the patellofemoral joint (PFJ). The main surgical options are total knee replacement (TKR) and PFJ replacement (PFJR). PFJR has a number of advantages over TKR, including being less invasive, preserving the unaffected parts of the knee, allowing faster recovery and better range of motion and function. We report our prospective mid-term results of the Avon PFJR for established isolated PFJ arthritis in 61 consecutive procedures. METHODS: Sixty-one Avon PFJRs were performed in 57 patients. The outcome measures were the new Oxford knee score (OKS), Hungerford and Kenna score (HKS), and Crosby Insall knee scores. Only patients with severe isolated PFJ OA were included. The diagnosis was based on a combination of clinical, radiological and, where available, arthroscopic findings. RESULTS: Mean follow-up was 5.09 years (range, 12 to 124 years). There were 2 revisions in the first 5 years. The median HKS score was 80 (interquartile range, 70 to 95) and the mean OKS was 31.8 (+/- standard deviation, 8.7) at 5 years. These were significantly better (p < 0.001) than the preoperative scores. CONCLUSIONS: The Avon prosthesis gives good functional outcomes in the medium term and survives well. Our data support other studies in the literature and is the largest independent prospective study to date.

Aged , Female , Humans , Male , Arthroplasty, Replacement, Knee , Patellofemoral Joint/surgery , Prospective Studies , Time Factors , Treatment Outcome
Rev. cuba. ortop. traumatol ; 28(2): 205-213, jul.-dic. 2014. ilus
Article in Spanish | LILACS, CUMED | ID: lil-740948


La plicatura medial asistida por artroscopia constituye una variedad quirúrgica empleada en pacientes que presentan mala alineación patelofemoral. El paciente de 44 años de edad, blanca, femenina con antecedentes de salud anterior, la cual desde hace aproximadamente un año refiere dolor a nivel de la cara anterior de la rodilla izquierda, para lo cual ha llevado tratamiento en múltiples ocasiones con analgésicos, antiinflamatorios no esteroideos y varias sesiones de terapia de rehabilitación con respuesta muy limitada a sus síntomas. Se realizó liberación del retináculo lateral acompañada de plicatura medial, esta técnica se describe por pasos. La plicatura medial asistida por artroscopia, es un procedimiento simple, que no necesita de una curva larga de aprendizaje y presenta un mínimo de complicaciones.

Arthroscopically-assisted medial placation is a surgical variety used in patients with poor patellofemoral alignment. 44-year-old, white female patient, with previous health history of concerns, refers pain at the anterior aspect of her left knee for about a year. She has been treated with analgesics, NSAIDs multiple times and several rehabilitation therapy sessions with very limited response to her symptoms. Release of the lateral retinaculum accompanied by medial plication was performed on this patiente. This technique is described by steps. Assisted arthroscopic medial plication is a simple procedure which does not require long learning curve and it has a minimum of complications.

La plicature médiale assistée par arthroscopie constitue une technique chirurgicale employée chez les patients atteints d’un mauvais alignement fémoro-pathélaire. Le cas d’un patient (femme âgée de 44 ans, blanche) avec une historie de santé antérieure, référant depuis un an à peu près une douleur au niveau de la face antérieure du genou gauche, plusieurs traitements (analgésiques, antiinflammatoires non stéroïdiens), et pas mal de sessions de rééducation sans réponse satisfaisante, est présenté. On a effectué la libération du rétinaculum latéral, conjointement avec une plicature médiale. La plicature médiale assistée par arthroscopie est une procédure simple n’ayant pas besoin d’une longue courbe d’apprentissage et présentant très peu de complications.

Middle Aged , Arthroscopy/rehabilitation , Patellofemoral Pain Syndrome/rehabilitation , Patellofemoral Pain Syndrome/therapy , Patellofemoral Joint/surgery
Artrosc. (B. Aires) ; 21(3): 74-79, sept. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-731434


La artrosis patelofemoral es una entidad clínica frecuente y muy incapacitante. Numerosos tratamientos han sido propuestos para el tratamiento quirúrgico de esta patología cuando fracasa el tratamiento ortopédico. Los hemos dividido en tratamientos quirúrgicos menores (liberación retináculo lateral- resección osteofito lateral y resección de la faceta lateral) y mayores (osteotomía de la TAT-cultivo de condrocitos- remplazos articulares). El objetivo de este trabajo es realizar una actualización de esta entidad clínica, y presentar una serie de casos mostrando la experiencia personal en el manejo de esta patología. Nivel de Evidencia: V

Patellofemoral osteoarthritis is a common and very disabling clinical entity. Several treatments have been proposed for the surgical treatment of this disease when the orthopedic one fails We’ve divided these treatments into minor surgery (lateral retinaculum release- laterally osteophyte resection and resection of the lateral facet) and major (osteotomy TAT-ACI- joint replacements). The aim of this work is an update of this clinical entity, and presents a series of cases showing personal experience in the management of this condition. Evidence Level: V

Adult , Patellofemoral Joint/surgery , Patellofemoral Joint/pathology , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Osteoarthritis, Knee/physiopathology , Follow-Up Studies , Treatment Outcome