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

ABSTRACT

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


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


Subject(s)
Tenodesis , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries , Joint Instability
2.
Rev. bras. ortop ; 56(4): 497-503, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1341165

ABSTRACT

Abstract Objective The objective of the present study was to determine whether there is fatty infiltration (FI) of the biceps brachii muscle mass after tenotomy or tenodesis for the treatment of tendon injuries in the long head of the biceps and to establish a relationship between FI with changes in the length of muscle fibers. Methods Clinical and imaging analysis of 2 groups of patients (biceps tenodesis [16 patients] and biceps tenotomy [15 patients]). In both groups, we compared the findings on the contralateral side of each patient (control group). All patients had undergone unilateral biceps tenodesis or tenotomy, with postoperative follow-up of > 1 year. Magnetic resonance imaging (MRI) was performed on both arms of each patient following a specific protocol. Strength of elbow flexion was measured with a manual dynamometer, and the results were subjected to statistical analysis. Results The mean postoperative period before the MRI was 5 years, and no case of FI was observed in the anterior compartment of either arm of the evaluated patients. Seven patients had moderate or severe deformity in the operated arm. We found no significant relationship between arm deformity (p = 0.077), flexion strength percentage (p = 0.07) or pain on palpation of the bicipital groove (p = 0.103). Conclusion None of the evaluated patients had evidence of FI in the muscle mass of the anterior arm compartment after the procedures. It was not possible to establish a correlation between the discrepancy of the biceps muscle length measured by MRI and the presence of FI in the anterior compartment of the arm.


Resumo Objetivo O objetivo do presente estudo foi determinar a existência de infiltração gordurosa (IG) na massa muscular do bíceps braquial após a tenotomia ou tenodese para tratamento de lesão no tendão da cabeça longa do bíceps e estabelecer uma relação entre a IG e alterações no comprimento das fibras musculares. Métodos Análise clínica e de imagens de 2 grupos de pacientes (submetidos à tenodese do bíceps [16 indivíduos] ou tenotomia do bíceps [15 indivíduos]). Nos dois grupos, os achados foram comparados àqueles do lado contralateral de cada indivíduo (grupo controle). Todos os pacientes foram submetidos à tenodese ou tenotomia unilateral do bíceps, com acompanhamento pós-operatório > 1 ano. Exames de ressonância magnética (RM) foram realizados em ambos os braços de cada paciente de acordo com um protocolo específico. A força de flexão do cotovelo foi medida com dinamômetro manual e os resultados foram submetidos à análise estatística. Resultados O período pós-operatório médio antes da realização da RM foi de 5 anos, e nenhum caso de IG foi observado no compartimento anterior de ambos os braços dos pacientes avaliados. Sete pacientes apresentaram deformidade moderada ou grave no braço operado. Não houve relação significativa entre deformidade do braço (p = 0,077), percentual de força de flexão (p = 0,07) ou dor à palpação do sulco bicipital (p = 0,103). Conclusão Nenhum dos pacientes avaliados apresentou evidência de IG na massa muscular do compartimento anterior do braço após os procedimentos. Não foi possível estabelecer uma correlação entre a discrepância do comprimento do músculo bíceps, medido à RM, e a presença de IG no compartimento anterior do braço.


Subject(s)
Humans , Rotator Cuff , Tenodesis , Tenotomy , Hamstring Muscles
3.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353916

ABSTRACT

Introducción: El objetivo de este estudio fue evaluar los cambios morfológicos en la zona intrarticular y extrarticular de la porción larga del bíceps de pacientes sometidos a una tenodesis subpectoral.materiales y métodos: Se incluyeron 9 pacientes con diag-nóstico de tendinopatía del bíceps, a quienes se les realizó una tenodesis subpectoral de la porción larga del bíceps. La porción eliminada del tendón del bíceps se colocó en formalina al 10% y se dividió en 2 segmentos. Quedaron definidas la zona proximal, desde la inserción supraglenoidea hasta el borde proximal del pectoral mayor y la zona distal correspondiente a la inserción del pectoral mayor. Los segmentos se tiñeron con hematoxilina y eosina, y se evaluaron histológicamente utilizando el puntaje de Bo-nar.Resultados: Macroscópicamente todos los tendones estaban engrosados en la región proximal. En la evaluación histológica, entre las variables más relevantes evaluadas por el puntaje de Bonar, el puntaje de morfología celular en la zona proximal fue significativamente más alto que en la zona distal (p <0,0001).Conclusiones: Nuestros hallazgos mostraron niveles más altos de patología dentro del bíceps proximal, lo que respalda la eliminación de dicho segmento cuando se realiza un procedimiento para la tendinopatía crónica del bíceps, lo cual se puede lograr con una tenodesis subpectoral. Nivel de Evidencia: IV


Introduction: The objective of the present study was to evaluate the morphological changes in the intra- and extra-articular area of the long head of the biceps in patients who had undergone subpectoral tenodesis. methods: We included 9 patients with a diagnosis of biceps tendinitis, who underwent subpectoral tenodesis of the long head of the biceps. The removed portion of the biceps tendon was placed in 10% formalin and divided into 2 segments. The proximal area extended from the supraglenoid insertion to the proximal edge of the pectoralis major and the distal area corresponded to the insertion of the pectoralis major. The segments were histologically evaluated using the Bonar score. Results: Macroscopically, all the tendons were found to be thickened in the proximal region. In the histological evaluation, among the most relevant variables evaluated by the Bonar score, the cell morphology score in the proximal area was significantly higher than in the distal area (p <0.0001). Conclusion: Our findings showed higher levels of pathology within the proximal biceps, supporting the elimination of this segment for chronic biceps tendinopathy, which can be accomplished through subpectoral tenodesis. Level of Evidence: IV


Subject(s)
Adult , Middle Aged , Shoulder/anatomy & histology , Chronic Disease , Tendinopathy , Tenodesis
4.
Artrosc. (B. Aires) ; 28(2): 149-156, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1282680

ABSTRACT

Introducción: El objetivo primario de nuestro trabajo es analizar los resultados funcionales y retorno deportivo de una serie de pacientes operados de revisión de LCA aislado y aquellos en quien se asoció una plástica extraarticular lateral (PEAL). Como objetivo secundario analizamos la tasa de re-ruptura en ambos grupos. Materiales y métodos: cohorte retrospectiva con recolección de datos prospectivo. Se evaluaron pacientes consecutivos operados de revisión de LCA aislado entre 2014 y 2015 (Grupo 1), y en quienes se asoció una plástica extraarticular lateral (PEAL) entre 2015 y 2016 (Grupo 2). Fueron estudiados a través de un examen clínico, escalas subjetivas de Lysholm, IKDC, evaluación artrométrica con KT-1000, retorno deportivo y una resonancia magnética (RM) al año. Analizamos la tasa de re-ruptura.Resultados: treinta y seis pacientes, dieciocho en cada grupo con un seguimiento promedio de cincuenta y tres meses (rango 37-73). Para la PEAL se realizó una tenodesis extraarticular lateral con fascia lata en trece casos y una reconstrucción con aloinjerto en cinco casos. La mediana de edad fue de 30.5 (RIC 27-36 años) en el Grupo 1 y 26.5 (RIC 24-33 años) en el Grupo 2. La mediana de la escala de Lysholm pre y postoperatoria fue 65 (RIC 61-72) y 91 (RIC 87-98) en el Grupo 1, y 72 (RIC 53-75) y 90 (RIC 79-95) en el Grupo 2 (p 0.1). La mediana de la escala de IKDC pre y postoperatoria fue 55 (RIC 45-65) y 80 (RIC 75-94) en el Grupo 1, y 56 (RIC 48-67) y 76 (RIC 68-84) en el Grupo 2 (p 0.11). Dieciséis (89%) pacientes en cada grupo retornaron al deporte. La tasa de re-ruptura fue 17% (n = 3) para el Grupo 1 y 5.5% (n = 1) para el Grupo 2 (p >0.6) en un promedio de veinticuatro meses. Conclusión: los resultados clínicos y de retorno al deporte han demostrado ser satisfactorios ambos grupos. Si bien la tasa de re-ruptura fue tres veces menor en el Grupo 2, esta diferencia no fue significativa. Se requiere mayor número de pacientes y tiempo para establecer una conclusión.Tipo de estudio: Cohorte retrospectiva. Nivel de evidencia: III


Introduction: The aim of this study is to compare the clinical outcomes and return to sports of a consecutive series of patients treated for revision ACL with and without a lateral extra-articular reconstruction. The secondary objective was to analyze the failure rate in both groups.Materials and methods: we retrospectively evaluated a series of patients treated for isolated revision ACL between 2014 and 2015 (Group 1) and revision ACL associated with a lateral extra-articular plasty from 2015 to 2016 (Group 2). All patients were evaluated with clinical examination, subjective scales of Lysholm and IKDC, return to sports, arthrometric KT-1000 evaluation, magnetic resonance (MR) at one-year follow-up and failure rate.Results: thirty-six patients were evaluated, eighteen in each Group with a mean follow-up of fifty-three months (range 37-73). For the LEAP, in thirteen cases we performed a lateral tenodesis with ilio-tibial band and in five cases a reconstruction using allograft. The median age was 30.5 (IQR 27-36 years) for Group 1 and 26.5 (IQR 24-33 years) for Group 2. The median pre and postoperative Lysholm score was 65 (IQR 61-72) and 91 (IQR 87-98) in Group 1, and 72 (IQR 53-75) and 90 (IQR 79-95) in Group 2 (p 0.1). The median pre and postoperative IKDC score was 55 (IQR 45-65) and 80 (IQR 74-94) in Group 1, and 56 (IQR 48-67) and 76 (IQR 68-84) in Group 2 (p 0.11). Sixteen (89%) patients return to sports in each Group. The failure rate was 17% (n = 3) for Group 1 and 5.5% (n = 1) for Group 2 (p >0.6) at a mean of twenty-four months.Conclusion: clinical outcomes and return to sports were similar for both groups. Even though the failure rate was three times less in Group 2, this difference was not statistically significant. Greater number of patients and more follow-up is necessary to establish any conclusion.Type of study: Retrospective cohort . Level of evidence: III


Subject(s)
Adult , Middle Aged , Arthroscopy/methods , Reoperation , Tenodesis , Anterior Cruciate Ligament Reconstruction , Return to Sport
5.
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
6.
Article in English | WPRIM | ID: wpr-764836

ABSTRACT

PURPOSE: This study examined the clinical outcomes and assessed the average time to return to play following a peroneal tendon repair in Korean athletes. MATERIALS AND METHODS: Between March 2004 and February 2017, a total of 30 athletes underwent peroneal tendon repair for a peroneal tendon tear. The indications of surgical treatment were chronic pain or intractable symptoms after a previous ankle sprain affecting sports activity refractory to conservative treatment for at least six months. The patient underwent tubulization for a longitudinal tendon rupture. Peroneus longus to peroneus brevis tenodesis was performed when tendon repair was impossible due to total rupture or multiple longitudinal rupture. RESULTS: Twenty patients not included in this study were as follows: insufficient follow-up, previous surgery, and additional bone surgery. All 10 patients had a previous ankle sprain history, tenderness and swelling on the retromalleolar area. In the 10 patient population, there were five peroneus brevis tendon tears, three peroneus longus tendon tears, one peroneus longus and brevis tendon tear, and one peroneus brevis and superior peroneal retinaculum tear. In the 10 patients, six cases of peroneal brevis tendon repair and four cases of peroneal longus to brevis tenodesis were performed. The preoperative American Orthopaedic Foot and Ankle Society score was improved from a mean of 60.6 (standard deviation [SD], 8.64) to a mean of 90.2, postoperatively (SD, 4.4; p<0.012). The preoperative visual analogue scale was improved from a mean of 5.43 (SD, 1.2) to 0.5 (SD, 0.16), postoperatively (p<0.023). The mean length of time to return to play was 12.2 weeks (range, 8~16 weeks). CONCLUSION: Peroneal tendon tear can occur due to sports injuries. If there is tenderness at the retromalleolar area, the surgeon should consider a peroneal tendon lesion. Surgical repair of the peroneal tendon can be an effective treatment to help athletes to return to play.


Subject(s)
Ankle , Ankle Injuries , Athletes , Athletic Injuries , Chronic Pain , Follow-Up Studies , Foot , Humans , Return to Sport , Rupture , Sports , Tears , Tendon Injuries , Tendons , Tenodesis
7.
Article in Chinese | WPRIM | ID: wpr-773851

ABSTRACT

OBJECTIVE@#To compare clinical efficacy of arthroscopic tenodesis and tenotomy in treating biceps long head tendinitis.@*METHODS@#From January 2015 to January 2017, 40 patients with long head of the biceps tendinitis were randomly divided into tenotomy group (18 patients) and tenodesis group(22 patients). In tenotomy group, there were 6 males and 12 females with an average age of (62.2±6.1) yeas old, and the average course of disease was (8.5±2.2) months; while in tenodesis group, there were 8 males and 14 females with an average age of(60.5±6.3) years old, and the average course of disease was (8.1±2.3) months. Operative time and deformity of Popeye were compared between two groups, VAS score was used to evaluate degree of pain, and UCLA score was used to assess clinical effects before operation, 3, 6 and 12 months after operation.@*RESULTS@#Forty patients were followed up for 12 to 17 months with an average of(14.3±2.1) months. Eight patients occurred Popeye deformity in tenotomy group, and nobody in tenodesis group. There was significant difference between tenotomy group(40.55±7.51) min and tenodesis group(75.33±9.45) min. VAS score after operation at 3, 6 and 12 months were decreased than that of before operation, and VAS score in tenotomy group was lower than that of in tenodesis group at 3 months after operation(0.05). UCLA score at at 3, 6 and 12 months after operation in tenodesis group were increased than that of before operation, and UCLA score in tenotomy group was lower than that of in tenodesis group at 3 months after operation(0.05). According to UCLA score, 5 got excellent results, 10 moderate and 3 poor in tenotomy group, while 8 got excellent results, 12 moderate and 2 poor in tenodesis group, but without difference between two groups(χ² =0.057, =0.81).@*CONCLUSIONS@#Both of arthroscopic tenotomy and tenodesis in treating long head of the biceps tendinitis could receive good clinical effects, and early functional outcomes by arthroscopic tenotomy was better than that of tenodesis, but no difference in later period.


Subject(s)
Aged , Arthroscopy , Female , Humans , Male , Middle Aged , Rotator Cuff , Rotator Cuff Injuries , Tendinopathy , Tenodesis
8.
Artrosc. (B. Aires) ; 25(3): 87-91, 2018. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-972517

ABSTRACT

INTRODUCCIÓN: La ruptura del ligamento cruzado anterior (LCA) es una de las lesiones más frecuentes de la rodilla. La persistencia de inestabilidad rotacional residual después de una reconstrucción del LCA, ha llevado a cirujanos de rodilla a realizar procedimientos adicionales para mejorar dicha estabilidad como lo es la tenodesis extraarticular lateral. OBJETIVO: Describir resultados clínicos de estabilidad rotacional en la reconstrucción del LCA junto con la tenodesis extraarticular lateral en pacientes con inestabilidad anterolateral intervenidos quirúrgicamente en el Hospital de San José, además conocer y extrapolar nuestra experiencia a nivel nacional. MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo se incluyeron pacientes con inestabilidad anterolateral de rodilla identificados con prueba de pivot shift grado II o III, intervenidos quirúrgicamente para reconstrucción de LCA más tenodesis extraarticular lateral en el Hospital de San José, durante el periodo comprendido entre enero de 2014 y junio de 2016. RESULTADOS: Se identificaron un total de 30 pacientes a los cuales se les realizó reconstrucción del LCA más tenodesis extraarticular lateral. El resultado clínico de los pacientes, evaluado con la escala IKDC (Comité Internacional de Documentación sobre la Rodilla), evidenció un 60% de resultados normales, 33% de resultados casi normales y 7% de resultados anormales. La estabilidad rotacional postquirúrgica se logró en el 100% de los pacientes con la prueba de pivot shift sin importar el resultado de IKDC. CONCLUSIONES: La reconstrucción del LCA más tenodesis extraarticular lateral como técnica de recuperación de la función en pacientes con inestabilidad anterolateral grado II o III, es reproducible y segura para mejorar la inestabilidad rotacional de la rodilla. Tipo de estudio: Serie de casos. Nivel de evidencia: IV.


INTRODUCTION: The rupture of the anterior cruciate ligament (ACL) is one of the most frequent injuries of the knee. The persistence of residual rotational instability after an ACL reconstruction has led knee surgeons to perform additional procedures to improve tension stability such as extra-articular lateral tenodesis. OBJECTIVE: To describe the clinical results of rotational stability in the reconstruction of the ACL along with the extra-articular lateral tenodesis in patients with anterolateral instability surgically operated in the Hospital of San José. METHODOLOGY: A descriptive study was carried out with patients with anterolateral knee instability identified with pivot shift grade II or III, who underwent surgery for reconstruction of ACL plus extra-articular lateral tenodesis at the Hospital of San José during the period between January 2014 and June 2016. RESULTS: A total of 30 patients were identified who underwent LCA reconstruction plus extra-articular lateral tenodesis. The clinical outcome of the patients, evaluated with IKDC (International Knee Documentation Committee), evidence of 60% of normal results, 33% of almost normal results and 7% of abnormal results. Post-surgical rotational stability was achieved in 100% of the patients with the pivot shift test regardless of the IKDC result. CONCLUSIONS: The reconstruction of the LCA plus lateral extraarticular tenodesis as a technique of recovery of function in patients with anterolateral instability grade II or III with absence of associated lesions is a reproducible technique. This approach would improve rotational stability of the knee, recover function and the perception of a return close or equal to the activities prior to injury, however, it is necessary to perform comparative studies with the largest follow-up to assess the presence of early osteoarthrosis and determine residual instability. Type study: Case series. Level of evidence: IV.


Subject(s)
Adult , Anterior Cruciate Ligament Reconstruction/methods , Anterior Cruciate Ligament/surgery , Knee Injuries/surgery , Reconstructive Surgical Procedures/methods , Tenodesis/methods , Follow-Up Studies , Treatment Outcome
9.
Artrosc. (B. Aires) ; 25(2): 63-69, 2018. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-972512

ABSTRACT

INTRODUCCIÓN: Los resultados de la reparación de lesiones SLAP en pacientes con compensación laboral son peores que en la población general. El objetivo del presente trabajo es evaluar la evolución postquirúrgica de una serie de pacientes laborales, operados por SLAP, con dos técnicas diferentes: reparación y tenodesis, y comparar dos técnicas de tenodesis. MATERIALES Y MÉTODOS: Se evaluaron retrospectivamente 58 pacientes, con un seguimiento promedio de 18 meses, y edad media de 34 años. El diagnóstico principal en todos los casos fue SLAP. Se formaron dos grupos de tratamiento según la edad y lesiones asociadas: Grupo A- Reparación, 17 casos; Grupo B- Tenodesis, 41 casos. En el grupo B se realizaron dos técnicas: tenodesis suprapectoral artroscópica (23 casos) y subpectoral abierta (18 casos). Se analiza aquí la evolución de ambos grupos de pacientes, y se comparan los resultados de las dos técnicas de tenodesis realizadas. Se utilizó SST, UCLA y Satisfacción personal para evaluar los resultados. RESULTADOS: Los valores medios de SST fueron de 74.5% y 77,8%, y los de UCLA 25.2 y 26.9 puntos para los grupos A y B respectivamente. El porcentaje de pacientes con UCLA satisfactorio fue de 47% en el grupo A y 66% en el grupo B. El porcentaje de pacientes satisfechos con el tratamiento recibido fue: 65% en el grupo reparación y 93% en el grupo tenodesis. La comparación de los resultados de ambas técnicas de tenodesis no encontró diferencias estadísticamente significativas entre los subgrupos. CONCLUSIÓN: El tratamiento quirúrgico de las lesiones SLAP en pacientes con compensación laboral arrojó bajos resultados en los scores de SST y UCLA en esta serie. Hubo mayor porcentaje de pacientes satisfechos en el grupo tenodesis. No encontramos diferencias entre la tenodesis artroscópica y la subpectoral. Tipo de estudio: Serie de casos. Nivel de evidencia: IV.


INTRODUCTION: SLAP lesions in worker´s compensation patients yield worse results than in the general population. The aim of this study was to evaluate the postoperative evolution of a series of worker´s compensation patients operated for SLAP lesions, with two different techniques: repair and tenodesis, and to compare two different types of tenodesis. MATERIAL AND METHODS: 58 patients were retrospectively evaluated with an average follow-up of 18 months, average age of 34 years. The primary diagnosis in all cases was SLAP. Two treatment groups were formed according to age and associated injuries: Group A – Repair, 17 cases; Group B –Tenodesis, 41 cases. Group B was subdivided in Arthroscopic tenodesis (23 cases) and Open subpectoral tenodesis (18 cases). SST, UCLA scores and patient´s satisfaction were used to assess the results of groups A and B. Besides, both groups of tenodesis were compared. RESULTS: SST mean values were 74.5% and 77.8%, and UCLA mean values were 25.2 and 26.9 points respectively for groups A and B. The percentage of patients with satisfactory UCLA was 47% in the Repair group and 66% in the Tenodesis group. The percentage of patients satisfied with the treatment was 65% in the Repair group and 93% in the Tenodesis group. Comparing results of both types of tenodesis found not statistically significant differences between subgroups. CONCLUSION: Surgical treatment of SLAP lesions in worker´s compensation patients showed low results in SST and UCLA scores in this series. There was a higher percentage of satisfied patients in the tenodesis group. We found no differences between arthroscopic and subpectoral tenodesis. Type Study: Case series. Level of Evidence: IV.


Subject(s)
Adult , Arthroscopy/methods , Occupational Diseases , Patient Satisfaction , Shoulder Injuries/surgery , Shoulder Joint/surgery , Tendon Injuries/surgery , Tenodesis/methods
10.
Article in English | WPRIM | ID: wpr-715126

ABSTRACT

Diabetic calcaneal insufficiency avulsion (CIA) fracture are unusual injury. The treatment may be challenging due to the low healing potential from diabetes or Charcot neuroarthropathy, so far. The poor surgical outcomes and surgical failures from treatment of the traumatic calcaneal avulsion fractures were associated with poor bone stock, lack of proper fixation, and the wound problem. Thus, the proper treatment for diabetic CIA fracture was still controversy. This report described two cases of diabetic CIA fracture treated with fixation of fracture fragment and calcaneal tenodesis. In both cases, fracture fragments were re-avulsed despite of fixation. Through investigation for the fate of fracture fragment from these cases, we discussed the proper treatment strategy in diabetic CIA fracture.


Subject(s)
Tenodesis , Wounds and Injuries
11.
Rev. bras. ortop ; 52(3): 291-297, May.-June 2017.
Article in English | LILACS | ID: biblio-1042404

ABSTRACT

ABSTRACT Disorders of the long head of biceps tendon are common in clinical practice. Their causes could be degenerative, inflammatory, instability (subluxation or luxation) or traumatic. They are generally associated to other diseases of the shoulder, mainly rotator cuff injuries. Currently, there is controversy in the literature regarding the indications for surgical treatment and the choice of the best technique for each case, due to the possibility of esthetic deformity, loss of muscle strength, and residual pain. The objective of this study was to identify the indications for surgical treatment, the best surgical technique, and the advantages and disadvantages of each technique described in the orthopedic literature for the treatment of long head of biceps tendon injuries. A revision of the orthopedic medical literature on the following databases: Biblioteca Regional de Medicina (BIREME), Medline, PubMed, Cochrane Library and Google Scholar, comprising articles published in the period from 1991 to 2015.


RESUMO As lesões da cabeça longa do tendão bicipital (CLB) são comuns na prática clínica e podem ter causas degenerativas, inflamatórias, instabilidades (subluxação ou luxação) ou traumáticas. Geralmente, elas estão associadas a outras doenças do ombro, principalmente a lesões do manguito rotador. Atualmente, existem controvérsias quanto às indicações dos tratamentos cirúrgicos e à escolha da melhor técnica para cada caso, devido à possibilidade de deformidade estética, perda da força muscular e dor residual. O objetivo deste estudo foi identificar as indicações do tratamento cirúrgico, a melhor técnica cirúrgica e as vantagens e desvantagens de cada técnica descritas na literatura médica ortopédica no tratamento das lesões da CLB. Foi realizada revisão da literatura médica ortopédica disponível na base de dados da Biblioteca Regional de Medicina (BIREME), Medline, PubMed, Cochrane Library e Google Scholar, incluindo artigos publicados no período de 1991 a 2015.


Subject(s)
Rotator Cuff , Shoulder Impingement Syndrome , Shoulder Pain , Tenodesis , Tenotomy
12.
Artrosc. (B. Aires) ; 24(2): 75-81, 2017.
Article in Spanish | LILACS, BINACIS | ID: biblio-868731

ABSTRACT

Las biotenodesis con tensor de fascia lata para el tratamiento de las inestabilidades por insuficiencia del ligamento cruzado anterior han sido utilizadas con muy buenos resultados durante muchísimos años. Tuvieron su máximo apogeo entre los años 1975 y 1985, siendo prácticamente olvidadas por la mayoría de los cirujanos con la llegada de las técnicas de reconstrucción intraarticulares artroscópicas. En los últimos años luego de la descripción de un “viejo-nuevo” ligamento anterolateral de la rodilla, han tenido un nuevo auge si bien debe mencionarse claramente que la técnica de Lemaire no reconstruye este ligamento. Esta técnica resulta sumamente útil cuando se la asocia con plásticas intraarticulares en revisiones o insuficiencias luego de una plástica primaria del LCA, o como procedimiento único en pacientes de más de 50 años con bajo nivel de exigencia física, en virtud que presentan una muy baja morbilidad y una rehabilitación más rápida en relación a las plásticas intraarticulares. Tipo de estudio: Técnica Quirúrgica. Nivel de evidencia: V.


The biotenodesis with fascia lata tensor for the treatment of instabilities due to insufficiency of the anterior cruciate ligament have been used with very good results for many years. In recent years after the description of an “old-new” anterolateral ligament of the knee have had a new boom although it should be clearly stated that the technique of Lemaire does not reconstruct this ligament. Anatomical repairs and details of surgical technique are described. This technique is extremely useful when it is associated with intraarticular plastics in revisions or insufficiencies after primary plastic surgery of the ACL or as a single procedure in patients over 50 years of age with a low level of physical requirement because they present a very low morbidity and one Rehabilitation in relation to intra-articular plastic. Type of study: Surgical Technique. Level of Evidence: V.


Subject(s)
Humans , Knee Joint/anatomy & histology , Knee Joint/surgery , Arthroscopy/methods , Fascia Lata/surgery , Joint Instability , Anterior Cruciate Ligament/surgery , Tenodesis/methods
13.
Article in English | WPRIM | ID: wpr-64553

ABSTRACT

BACKGROUND: The purpose of this study was to compare the clinical outcome in patients aged less than 55 years who underwent arthroscopic tenodesis and arthroscopic repair for type 2 superior labrum anterior and posterior (SLAP) lesions. METHODS: Between April 2008 and December 2014, surgery was performed on a total of 45 patients with isolated type 2 SLAP lesions. Arthroscopic repair was performed in 22 patients and arthroscopic tenodesis was performed in 23 patients. In both groups, the clinical outcomes at follow-ups were evaluated using the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) score. RESULTS: In both groups, the VAS scores for pain had improved significantly throughout the postoperative follow-up period. The VAS score showed a statistically significant difference at postoperative 3 and 6 months (p0.05). In both groups, the functional outcome was statistically improved postoperatively. In a comparison of the UCLA and ASES scores between the two groups, there was a statistically significant difference at postoperative 3 and 6 months (p0.05). CONCLUSIONS: Based on the results of this and other studies, patients with isolated type 2 SLAP lesions showed better short-term clinical outcome with tenodesis than with repair. However, there was no difference between the two groups at the final follow-up.


Subject(s)
California , Elbow , Follow-Up Studies , Humans , Shoulder , Surgeons , Tenodesis
14.
Article in English | WPRIM | ID: wpr-770790

ABSTRACT

BACKGROUND: The purpose of this study was to compare the clinical outcome in patients aged less than 55 years who underwent arthroscopic tenodesis and arthroscopic repair for type 2 superior labrum anterior and posterior (SLAP) lesions. METHODS: Between April 2008 and December 2014, surgery was performed on a total of 45 patients with isolated type 2 SLAP lesions. Arthroscopic repair was performed in 22 patients and arthroscopic tenodesis was performed in 23 patients. In both groups, the clinical outcomes at follow-ups were evaluated using the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) score. RESULTS: In both groups, the VAS scores for pain had improved significantly throughout the postoperative follow-up period. The VAS score showed a statistically significant difference at postoperative 3 and 6 months (p0.05). In both groups, the functional outcome was statistically improved postoperatively. In a comparison of the UCLA and ASES scores between the two groups, there was a statistically significant difference at postoperative 3 and 6 months (p0.05). CONCLUSIONS: Based on the results of this and other studies, patients with isolated type 2 SLAP lesions showed better short-term clinical outcome with tenodesis than with repair. However, there was no difference between the two groups at the final follow-up.


Subject(s)
California , Elbow , Follow-Up Studies , Humans , Shoulder , Surgeons , Tenodesis
15.
Article in Korean | WPRIM | ID: wpr-655107

ABSTRACT

Stiffness and pain are major causes of failed superior labral anterior to posterior (SLAP) repair. The term, ‘failed SLAP repair’, can be defined as stiffness or pain without rotator cuff tears, acromio-clavicular pathology, arthritis, impingement syndrome, and other shoulder diseases. Moreover, it does not respond to conservative management. Generally, for failed SLAP repair, the initial conservative management includes physical therapy, strengthening exercise, oral medications, and injections. In addition, with failed conservative treatment, surgical intervention can be carried out. Surgical indications must be in consideration with patients' age, mechanism of injury, stability of the lesion, activity, former history of sports activity, and types of sports. Surgical treatments include debridement, SLAP repair, biceps tenodesis and tenotomy. However, each type of surgical method is controversial on both indications and prognosis. Surgical treatment on SLAP lesion is increasing, and studies on failed SLAP repair are expanding. The recommended first line therapy for failed SLAP lesion is conservative management, and with limited and thorough indications, surgical treatment yields good results, depending on concurrent lesions. However, authors recommend that it is important to seek for adjacent lesions prior to the initial SLAP repair to decrease failed SLAP repair.


Subject(s)
Arthritis , Debridement , Methods , Pathology , Problem Solving , Prognosis , Rotator Cuff , Shoulder , Sports , Tears , Tenodesis , Tenotomy
16.
Article in Korean | WPRIM | ID: wpr-211698

ABSTRACT

The pathophysiology of impingement syndrome and labral tear was variable and not clear. In general populations, lesions occur mainly in acute cases. But in athletes, lesions are caused by repetitive exposure to excessive force, resulting in different patterns. For diagnosis, thorough physical examinations and radiologic findings should be combined. In athletes, conservative treatment including posterior capsular stretching and periscapular muscle strengthening is recommended as the first choice of treatment considering chronic progression and adaptive change. When choosing surgical treatment because of failure of conservative treatment, careful attention should be paid to the choice of repair or debridement of the rotator cuff partial tear, and the choice of the labral repair or biceps tenodesis.


Subject(s)
Athletes , Debridement , Diagnosis , Humans , Physical Examination , Rotator Cuff , Shoulder Impingement Syndrome , Tears , Tenodesis
17.
Rev. chil. ortop. traumatol ; 57(2): 36-41, mayo-ago. 2016.
Article in Spanish | LILACS | ID: biblio-909688

ABSTRACT

INTRODUCCIÓN: La inestabilidad anteroposterior y la laxitud rotatoria demostrada mediante test de pivot-shift severo podría estar causada por la combinación de lesión de ligamento cruzado anterior (LCA) y de estructuras laterales de la rodilla, particularmente del ligamento anterolateral (LAL). Este último actúa como estabilizador secundario, restringiendo la rotación interna y complementando el rol primario de estabilización del LCA. MATERIAL Y MÉTODOS: Describir la técnica de reconstrucción mínimamente invasiva del LAL tras realizar una cirugía de revisión del LCA. Además, se ofrece una breve descripción de las indicaciones quirúrgicas, resultados y complicaciones. DISCUSIÓN: La inestabilidad rotatoria persistente tras la reconstrucción de LCA indica que la reconstrucción intraarticular podría no ser suficiente para restaurar la estabilidad rotacional en un subgrupo específico de pacientes. Se han descrito numerosas técnicas de reconstrucción extraarticulares (mencionadas previamente), algunas de ellas con incisiones de gran tamaño, con los consiguientes problemas estéticos. Esta nota describe una técnica simple y mínimamente invasiva de reconstrucción de LAL, realizada tras una revisión del LCA con técnica anatómica, todo en el mismo procedimiento quirúrgico. Esta técnica está indicada en roturas agudas o exploraciones/revisiones del LCA que presenten pivot-shift severo, así como también en pacientes con roturas crónicas del LCA o en pacientes que sean hiperlaxos. A pesar de que esta técnica no ha demostrado ser superior a otras reconstrucciones extraarticulares del LAL, se presenta como una cirugía simple, confiable y rápida, con buenos resultados estéticos.


INTRODUCTION: Anteroposterior instability and rotatory laxity demonstrated by severe pivot-shift test may be caused by combined lesions of the anterior cruciate ligament (ACL) and lateral structures of the knee, particularly the anterolateral ligament (ALL). This ligament acts as a secondary stabiliser that restrains internal rotation and supplements the primary stabilising role of the ACL. MATERIAL AND METHODS: To describe a minimally invasive ALL reconstruction technique following anterior cruciate ligament revision surgery. Brief description of surgical indications, outcomes, and complications. DISCUSSION: Persistent rotatory instability after ACL reconstruction suggests that intra-articular reconstruction may not be sufficient to restore rotational stability in a subgroup of patients. Numerous extra-articular reconstruction techniques have been described with long incisions and cosmetic issues. A description is presented of a simple, minimally invasive ALL reconstruction technique performed after anatomical ACL revision in a single procedure. This technique is indicated in patients with acute ACL injuries and revision ACL associated with a severe pivot-shift, chronic ACL injuries, and joint hyper-laxity. Although this technique has not proven to be superior to any other extra-articular anterolateral ligament reconstructions, it uses simple, reliable and cosmetic surgery, with good early results in a small series of patients.


Subject(s)
Humans , Anterior Cruciate Ligament/surgery , Minimally Invasive Surgical Procedures , Reconstructive Surgical Procedures/methods , Tendons/transplantation , Tibia/surgery , Muscle, Skeletal/transplantation , Tenodesis , Anterior Cruciate Ligament Reconstruction , Allografts
18.
Rev. bras. ortop ; 51(3): 303-312, tab, graf
Article in English | LILACS | ID: lil-787716

ABSTRACT

OBJECTIVE: To present the results from direct tendon repair using EndoButton and interference screws in patients with lesions of the distal biceps that had evolved over a period of more than 28 days. METHODS: Between January 2012 and November 2013, eleven patients (all male) with a torn distal biceps and a time interval between injury and surgery of more than 28 days were evaluated. The patients' mean age was 46 years and the most common mechanism of injury was eccentric loading with the elbow flexed and supinated. RESULTS: A subjective analysis on pain and function was conducted using a visual analog scale of pain (VAS) and the Mayo Elbow Performance Score (MEPS), before and after surgery. The VAS showed a decrease of 5 points to 0.8 points on average. The MEPS improved from 69.3 points before the operation to 97.5 points afterwards. The mean flexion was 133.1° on the operated side, versus 134.3°. The mean extension was -2.5° and 0° (operated side versus non-operated). Supination was 88.2° versus 89.5° and pronation was 82.5° versus 84.1°, comparing the operated side versus the non-operated side. Flexion and supination strengths were evaluated with the aid of a dynamometer, and the mean flexion and supination strengths were found to be respectively 78.57% and 89.65% of the strength of the non-operated limb. CONCLUSION: Use of the technique of direct tendon repair using EndoButton and interference screws was shown to be a safe and effective alternative for repairing chronic lesions of the distal biceps.


OBJETIVO: Apresentar os resultados do reparo direto do tendão com EndoButton e parafuso de interferência nos pacientes com lesão do bíceps distal com evolução maior do que 28 dias. MÉTODOS: Entre janeiro de 2012 e novembro de 2013, 11 pacientes (todos do sexo masculino) com ruptura do bíceps distal com intervalo da lesão e cirurgia maior do que 28 dias. A idade média foi de 46 anos e o mecanismo de trauma mais comum foi uma carga excêntrica com o cotovelo em flexão e supinação. RESULTADOS: Foi feita uma análise subjetiva da dor e função com a Escala Visual Analógica de Dor (EVA) e o Mayo Elbow Performance Score (MEPS) pré e pós-operatório. Houve uma diminuição da EVA de 5 pontos para 0,8 ponto em média. O MEPS melhorou de 69,3 pontos no pré para 97,5 pontos no pós-operatório. A média de flexão foi de 133,1° do lado operado contra 134,3°. A média de extensão foi de -2,5° e 0° (lado operado × não operado). Supinação foi de 88,2° × 89,5° e pronação 82,5° × 84,1° quando comparado o lado operado versus o lado não operado. A força de flexão e supinação foi avaliada com o auxílio de um dinamômetro e verificamos que a força média de flexão e supinação correspondia, respectivamente, a 78,57% e 89,65% a força do membro não operado. CONCLUSÃO: A técnica do reparo direto do tendão com o uso de EndoButton e parafuso de interferência mostra-se como uma opção segura e eficaz para o reparo direto das lesões crônicas do bíceps distal.


Subject(s)
Humans , Male , Female , Physical and Rehabilitation Medicine , Tendon Injuries , Tendon Transfer , Tenodesis
19.
Rev. bras. ortop ; 51(2): 157-162, Mar.-Apr. 2016. graf
Article in English | LILACS | ID: lil-779988

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the results from arthroscopic tenodesis of the long head of the biceps brachii (LHBB) on the tendon of the subscapularis muscle, with regard to the presence of pain, subscapularis lesion, presence of Popeye's sign and patient satisfaction. METHODS: A prospective cohort study was conducted on 32 patients with LHBB lesions, through preoperative interviews and physical examinations, which were repeated six months after the operation. The main variables studied were the belly press, bear hug and lift-off tests, Popeye's sign, anterior pain and satisfaction. The data were entered into Epi Info 3.5.4 and SPSS 18.0. In order to investigate the variables of interest, the chi-square, Student t and Kruskal-Wallis tests were used. The confidence interval was 95% and p values less than 0.05 were taken to be statistically significant. RESULTS: 32 patients of median age 57.5 years were evaluated. Anterior pain was reported by one interviewee after the operation. The tests for evaluating subscapularis lesions did not show any damage to this musculature after the surgery. Popeye's sign was negative in all the patients. The patient satisfaction rate reached 90.6% of the interviewees. CONCLUSION: This study showed that the new surgical technique described here presented excellent performance, without any subscapularis lesion and without identifying Popeye's sign. Only 3.1% of the patients had complaints of residual pain. The high level of satisfaction among the patients after the surgery confirms the results presented.


OBJETIVOS: Avaliar os resultados da tenodese artroscópica do cabo longo do bíceps braquial (CLB) no tendão do músculo subescapular quanto à presença de dor, lesão do subescapular, presença do sinal de Popeye e satisfação do paciente. MÉTODOS: Foi feita uma coorte prospectiva com 32 pacientes com lesão do CLB, por meio de entrevista e exame físico pré-operatório e também após seis meses do procedimento cirúrgico. As principais variáveis estudadas foram testes Belly Press, Bear Hug e Lift-Off, sinal de Popeye, dor anterior e satisfação. Os dados foram inseridos no Epi Info(tm) 3.5.4 e SPSS 18.0. Para verificar as variáveis de interesse os testes qui-quadrado, t de Student e de Kruskal-Wallis foram usados. O intervalo de confiança foi de 95% e foram considerados estatisticamente significativos valores de p < 0,05. RESULTADOS: Foram avaliados 32 pacientes com mediana de 57,5 anos. A dor anterior pós-operatória foi referida por um entrevistado. Os testes avaliadores de lesão do subescapular não mostraram comprometimento dessa musculatura após a cirurgia. O sinal de Popeye foi negativo em 100% dos pacientes. A porcentagem de satisfação dos pacientes alcançou 90,6% dos entrevistados. CONCLUSÃO: Este estudo apresentou um ótimo desempenho da nova técnica cirúrgica descrita, sem lesão do subescapular e sem identificação de sinal de Popeye. A dor residual foi queixada por apenas 3,1% dos pacientes. A elevada satisfação dos pacientes após a cirurgia confirma os resultados apresentados.


Subject(s)
Humans , Male , Female , Middle Aged , Arthroscopy , Rotator Cuff , Tenodesis
20.
Article in Korean | WPRIM | ID: wpr-202837

ABSTRACT

PURPOSE: The purpose of this study is to review the indications of ankle lateral complex reconstruction using tendon graft. MATERIALS AND METHODS: We searched PubMed using the index, "ankle, instability, lateral ligament, reconstruction" from 1990 to present (September 30, 2015). We excluded 1) modified Brostrom operation (MBO), 2) conventional tenodesis surgery, 3) review article, 4) technical note, and 5) articles written in another foreign language. We reviewed 24 papers through the publication events, operational method, the indications of surgery, and the specific features of the patient group. RESULTS: There were the indications of 1) previous ligament surgery failure, 2) situation when ligament repair is impossible due to the ligament defect, 3) severe instability (preoperative talar tilt >15degrees, anterior draw >10 mm or the difference of contralateral side talar tilt >5degrees, anterior draw >3 mm), and 4) overweight (body mass index >30 kg/m2). Other considerations included 1) generalized joint laxity and 2) workers, highly-demanded or athlete highly-affected by instability. CONCLUSION: The ankle lateral complex reconstruction using tendon graft could be indicated in patients with the possibility of MBO failure with several considerations.


Subject(s)
Ankle , Athletes , Collateral Ligaments , Humans , Joint Instability , Lateral Ligament, Ankle , Ligaments , Overweight , Publications , Tendons , Tenodesis , Transplants
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