Tratamiento de las lesiones del ligamento cruzado anterior y meniscales en adolescentes: reporte de un caso / Treatment for anterior cruciate ligament and meniscal tears in adolescents: a case report / Tratamento das lesões do ligamento cruzado anterior e meniscais em adolescentes: relatório de um caso

Dada la creciente popularidad de las actividades deportivas, el número de roturas del ligamento cruzado anterior (LCA) y lesiones meniscales ha aumentado en particular en niños y adolescentes. El manejo de estas lesiones es desafiante debido las fisis abiertas. Por un lado las opciones de reconstrucción del LCA incluyen técnicas: transfisarias, extra-articulares y intraepifisarias. Por otro lado se han descrito diferentes técnicas de reparación meniscal: "all-inside", "inside-out" y "outside-in". Estas tiene como objetivo lograr la cicatrización meniscal, evitando los efectos adversos de la meniscectomía. Presentamos un reporte de caso de un adolescente de 14 años con una rotura completa del LCA y una lesión del cuerno posterior del menisco interno que fue sometido a una reconstrucción transfisaria del LCA y a una reparación meniscal "inside-out".

With the raising popularity of sporting activity, the number of anterior cruciate ligament (ACL) ruptures and meniscal tears has increased in particular in children and adolescents. Management of these injuries is challenging due to open growth plates. On the one hand the ACL reconstructions options includes: transphyseal, extra-articular and epiphyseal-only techniques. On the other hand there have been described different meniscal repair techniques: "all-inside", "inside-out" and "outside-in". These aim to achieve meniscal healing, avoiding the adverse effects of meniscectomy. We present a case report of a 14-year adolescent with an ACL complete rupture and a posterior horn tear of the medial meniscus who underwent an ACL transphyseal reconstruction and a "inside-out" meniscal repair.

Dada a crescente popularidade das atividades esportivas, o número de rupturas do ligamento cruzado anterior (LCA) e lesões meniscais aumentou especialmente em crianças e adolescentes. O manejo destas lesões é desafiador devido às fissuras abertas. Por um lado as opções de reconstrução do LCA incluem técnicas: transfisárias, extra-articulares e intraepifisárias. Por outro lado, foram descritas diferentes técnicas de reparação meniscal: "all-inside", "inside-out" e "outside-in". Estes têm como objetivo alcançar a cicatrização meniscal, evitando os efeitos adversos da meniscectomia. Apresentamos um relatório de caso de um adolescente de 14 anos com uma ruptura completa do LCA e uma lesão do corno posterior do menisco interno que foi submetido a uma reconstrução transfisária do LCA e a uma reparação meniscal "inside-out".

Diagnostic value of MRI in the knee anterior cruciate ligament tear / 中国医学装备

Objective:To investigate the diagnostic value of MRI in the knee anterior cruciate ligament tear.Methods: retrospective analysis for treatment of 40 patients with anterior cruciate ligament tear by observation group, by analyzing the clinical data and image, and selected the same period for treatment of 20 cases of patients with knee joint other lesions but ACL normal MRI data comparison by Control group, The form characteristics of ACL and abnormal signal strength, whether there is a line or an ACL tear with signs were analyzed.Results:The MRI diagnosis of ACL tear completely is higher for the sensitivity and specificity (87.5%, 90%; Diagnosis of ACL partial tear, and arthroscopy and surgery results in 8 cases, the rest 4 cases of complete tear, 4 cases of false negative; ACL tear with signs including abnormal curvature of bone contusion, photo, or meniscus has obvious lateral collateral ligament damage, tibia forward, etc. ACL tear group and normal group average photo Angle, PCLS L/H mean significant difference.Conclusion: through analysis of MRI diagnosis torn ACL completeness, has high accuracy, but the part in the ACL tear or chronic tear diagnosis, accurate rate is relatively low.

Study on Recovery of Range of Motion Following Arthroscopic Anterior Cruciate Ligament Reconstruction using Autologous Bone / 대한정형외과학회잡지

For prevention of limitation of range of motion due to arthrofibrosis of the knee joint after anterior cruciate ligament reconstruction, it is accepted in general that the operation should be delayed for about three weeks after injury. We studied the duration form operation to time of full range of motion, and analized the results in forty-eight patients who had undergone arthroscopic anterior cruciate ligament recostruction using the autologous bone-patella tendon-bone graft and early CPM, range of motion exercise during Feb. 1991 and June 1994. The results were as follows: 1. The average interval from injury to operation were 1.3 weeks in acute injury group, 6 weeks in subacute injury group and 20.7 months in chronic group. The average interval from operation to full range of motion were 7.1 weeks in acute injury group, 5.7 weeks in subacute injury group and 3.0 weeks in chronic group. 2. In acute injury group, 14(93.3%) of 15 cases showed full extesion and only 1 case(6.7%) showed the limitation of extension less than 5 degrees. In subacute injury group, 6(85.7%) of 7 cases showed full extension but1 case(14.3%) showed the limitation of extension less than 5 degrees. On the other hand in the chronic injury group, all the 26 cases(100%) of the patients showed full extension. 3. In acute injury group, 14(93.3%) of 15 cases showed full flexion and only 1 cases(6.7%) showed the limitatin of flexion less than 5 degrees. In subacute injury group, 6(85.7%) of 7 cases showed full flexion but 1 case(14.3%) showed the limitation of flexion less than 5 degrees. On the other hand in the chronic injury group, 23(88.5%) of 26 cases could flex to full range of flexion, and 3 cases(11.5%) revealed limitation of flexion less than 5 degrees. 4. The limitation of ROM mainly due to arthrofibrosis can be prevented by early range of motion execise and active rehabilitation in the acute or chronic anterior cruciate ligament reconstruction using the autograft bone-patella-bone graft. Although in acute patients the interval from operation to full ROM can be prolonged, the full ROM can be achieved after all.

Cybex Evaluation of Muscle Strength Following Arthroscopic Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

Cybex evaluation of muscle strength was performed on 15 patients with chronic anterior cruciate ligament tears following arthroscopic reconstruction using central one-third patella tendon autograft. Cybex testing was done preoperatively and at 3, 6, 9, and 12 months postoperatively. Peak torque and total work of the quadriceps and hamstrings at the angular velocity of 60 degree/sec and 180 degree/sec were measured and analyzed. The results were as follows: l. At the angular velocity of 60 degree/sec, the muscle strength of the quadriceps showed 45.4% deficit in peak torque and 50.9% deficit in total work compared to the contralateral normal knee preoperatively, 48.2% and 49.0% deficit respectively at 3 months after operation, 40.3% and 37.7% deficit at 6 months, 30.6% and 32.5% deficit at 9 months and 23.4% and 24.7% deficit at 1 year after operation. 2. At the angular velocity of 60 degree/sec, the muscle strenggth of the hamstrings showed 32.3% deficit in peak torque and 42.9% deficit in total work compared to the contralateral normal knee preoperatively, 39.3% and 42.4% deficit respectively at 3 months after operation, 27.3% and 32.3% deficit at 6 months, 21.2% and 22.3% deficit at 9 months and 17.9% and 18.4% deficit at 1 year after operation. 3. At the angular velocity of 180 degree/sec, the muscle strength of the quadriceps showed 38.4% deficit in peak torque and 42.0% deficit in total work compared to the contralateral normal knee preoperatively, 41.1% and 47.54% deficit respectively at 3 months after operation, 34.4% and 33.7% deficit at 6 months, 28.5% and 28.6% deficit at 9 months and 21.0% and 22.1% at 1 year after operation. 4. At the angular velocity of 180 degree/sec, the muscle strength of the hamstrings showed 26.9% deficit in peak torque and 31.8% deficit in total work compared to the contralateral normal knee preoperatively, 41.2% and 45.2% deficit respectively at 3 months after operation, 32.3% and 36.0% deficit at 6 months, 21.4% and 25.1% deficit at 9 months and 16.1% and 15.7% at 1 year after operation.

The Occult Osseous Lesions on Magnetic Resonance Imaging Associated with Acute Anterior Cruciate Ligament Tears / 대한정형외과학회잡지

Magnetic resonance imaging(MRI) is accepted as a useful tool for the diagnosis of injury of the knee recently. The anterior cruciate ligament tear is accompanied by the damage of the osseous and soft tissue of the knee. The occult osseous lesion is found on magnetic resonance imaging as bone density change that is not found on the simple radiograph. From Jan. 1992 to Apr. 1994, magnetic resonance imaging was performed on 44 patients with acute anterior cruciate ligament tears. MRI was done within 6 weeks of the index anterior cruciate ligament injury. The criteria of decreased signal intensity on the Tl weighted image and increased signal intensity on the T2 weighted image was applied for the incidence assessment of the occult osseous lesion. After arthroscopy with or without ACL reconstruction, follow-up simple radiograph was checked every 3 months. Occult osseous lesions were documented in 32(73%) of the 44 patients. Of the 32 patients with bony lesion, 81% had lesions of the lateral compartment. Lateral femoral condyle was involved in 15 cases(46.9%), and lateral tibial plateau in 22 cases (68.8%). Follow-up X-ray revealed no joint deperession in all of the 32 patients with the occult osseous lesion. This result suggests that there is a high correlation between the occult osseous lesion of lateral compartment of the knee on magnetic resonance imaging and anterior cruciate ligament tear. The presence of the occult osseous lesion in the patient with acute anterior cruciate ligament tear did not affect rehabilitation and weight bearing.