Luxaciones complejas de codo con inestabilidad póstero-lateral: ¿cuáles son las mejores opciones de tratamiento? revisión bibliográfica sistematizada / Complex elbow dislocations with postero-lateral instability: what are the best treatment options? systematized bibliographic review / Luxações complexas do cotovelo com instabilidade póstero-lateral: quais são as melhores opções de tratamento? revisão bibliográfica sistematizada

Introducción: El 25% de las luxaciones de codo corresponden a luxaciones complejas, que se definen como aquellas luxaciones que se acompañan de lesiones óseas, siendo las mismas más inestables que la luxaciones puras o simples. Estas lesiones han planteado un importante desafío terapéutico, ya que históricamente se han obtenido pobres resultados funcionales. El objetivo de este trabajo es revisar la bibliografía acerca del tratamiento de las luxaciones complejas de codo con inestabilidad posterolateral, y valorar los resultados de las múltiples opciones terapéuticas. Materiales y Métodos: Se realizó la búsqueda sistematizada utilizando el buscador PubMed, obteniéndose un total de 1450 artículos, de los cuales 32 cumplieron con los criterios de inclusión y exclusión establecidos. Resultados: Los estudios analizados fueron de bajo nivel de evidencia, III o IV, correspondiendo en su mayoría a series de casos retrospectivos. Destaca la gran cantidad de variantes terapúticas existentes, con diferentes protocolos terapéuticos, que arrojan resultados funcionales similares. Conclusiones: Las luxaciones complejas del codo corresponden a lesiones complejas, capaces de causar secuelas funcionales importantes en los pacientes. El establecimiento de protocolos terapéuticos es clave para obtener mejores resultados funcionales.

Introduction: 25% of elbow dislocations correspond to complex dislocations, which are defined as those dislocations that are accompanied by bone injuries, being more unstable than pure or simple dislocations. These lesions have set an important therapeutic challenge, since historically poor functional results have been obtained. The objective of this study is to review the literature on the treatment of complex elbow dislocations with posterolateral instability, and to assess the results of the multiple therapeutic options. Materials and Methods: The systematized search was carried out using the Pubmed search engine, obtaining a total of 1450 articles, of which 32 met the established inclusion and exclusion criteria. Results: The studies analyzed were of a low level of evidence, III or IV, corresponding mostly to retrospective case series. The large number of existing therapeutic variants stands out, with different therapeutic protocols, which yield similar functional results. Conclusions: Complex elbow dislocations correspond to complex injuries, capable of causing important functional sequelae in patients. The establishment of therapeutic protocols is key to obtaining better functional results.

Introdução: 25% das luxações do cotovelo correspondem a luxações complexas, que são definidas como aquelas luxações acompanhadas de lesões ósseas, sendo as mesmas mais instáveis ​​que as luxações puras ou simples. Essas lesões representam um importante desafio terapêutico, uma vez que resultados funcionais historicamente ruins têm sido obtidos. O objetivo deste trabalho é revisar a literatura sobre o tratamento das luxações complexas do cotovelo com instabilidade póstero-lateral e avaliar os resultados das múltiplas opções terapêuticas. Materiais e Métodos: Foi realizada uma busca sistematizada por meio do mecanismo de busca PubMed, obtendo-se um total de 1450 artigos, dos quais 32 atenderam aos critérios de inclusão e exclusão estabelecidos. Resultados: Os estudos analisados ​​foram de baixo nível de evidência, III ou IV, correspondendo em sua maioria a séries de casos retrospectivas. Destaca-se o grande número de variantes terapêuticas existentes, com diferentes protocolos terapêuticos, que apresentam resultados funcionais semelhantes. Conclusões: As luxações complexas do cotovelo correspondem a lesões complexas, capazes de causar sequelas funcionais importantes nos pacientes. O estabelecimento de protocolos terapêuticos é fundamental para obter melhores resultados funcionais.

Inestabilidad posterolateral cronica de codo. reconstruccion ligamentaria / Chronic posterolateral elbow instability. ligament reconstruction

Introducción: El objetivo de este trabajo es evaluar los resultados de una serie de pacientes con inestabilidad posterolateral crónica de codo, tratados con reconstrucción del ligamento colateral cubital con injerto tendinoso. Materiales y Métodos: Se presentan 10 pacientes, con una edad promedio de 47 años. El tiempo entre la luxación y la cirugía fue de 16 meses. El pivot shift test bajo anestesia fue positivo en todos los casos. Bajo control radioscópico, siete pacientes tenían un estadio 1 de Horii; dos, estadio 3 y uno tenía un estadio 2. En la mayoría de los casos, se utilizó el tendón del palmar menor. El seguimiento promedio fue de 21 meses. Resultados: La flexo-extensión fue de 126-3º. El dolor fue 0 en reposo y 1 en actividad, según la escala analógica visual. El puntaje DASH promedio fue 12 y el de la Clínica Mayo de 95. Ningún paciente reportó sensación de inestabilidad. El pivot shift test con el paciente despierto fue negativo en todos los casos. Conclusiones: La reconstrucción del ligamento lateral del codo con injerto tendinoso en pacientes con inestabilidad posterolateral crónica es eficaz para lograr la estabilidad articular. Los mejores resultados se observaron en pacientes con estadios 1 y 2 de inestabilidad. No hubo casos de inestabilidad residual.

Introduction: The objective of this paper is to evaluate the results of a series of patients with posterolateral elbow instability treated with reconstruction of the ulnar collateral ligament using tendon graft. Methods: We reported 10 patients with a mean age of 47 years. Time from posterolateral dislocation to surgery was 16 months. The pivot shift test under anesthesia was positive in all patients. Seven patients had stage 1 instability according to Horii, one patient with stage 2 and two patients with stage 3 under fluoroscopy. Palmaris minor was the most common tendon used for reconstruction. Follow-up was 21 months. Results: Flexo-extension was 126-3º. Pain according to visual analogue scale was 0 at rest and 1 in activity. DASH score was 12 and Mayo Clinic score was 95. Sensation of instability was not reported by any patient. The pivot shift test in an awake patient was always negative. Conclusions: Ulnar collateral ligament reconstruction with tendon graft in patients with posterolateral elbow instability is useful to restore joint stability. Best results were observed in patients with stage 1 or 2 instability according to Horii. Residual instability was not observed.

Anatomic Reconstructive Surgery of the Posterolateral Instability of the Knee Using Split Acilles Allograft / 대한정형외과학회잡지

PURPOSE: This paper describes a new anatomic reconstructive surgical procedure that simultaneously reconstructs the fibular collateral ligament, popliteal tendon and popliteofibular ligament using a split Achilles allograft and compares the clinical results of this new technique with the posterolateral corner sling procedure used for posterolateral instability of the knee. MATERIALS AND METHODS: Forty-six patients were treated for a posterolateral instability of the knee between 1998 and 2003. The posterolateral corner sling procedure (Group A) was performed in 25 patients and anatomic reconstructive surgery (Group B) in 21 patients. The minimum follow-up was 12 months. An arthroscopic evaluation was performed in all cases. The clinical review included the Lysholm knee scores as well as a lateral instability and tibial external rotation assessment. RESULTS: The mean Lysholm knee scores in groups A and B were 54.8 points and 54.4 points prior to surgery, and 86.9 and 93.6 points at the time of the latest follow-up, respectively (p<0.05). Tibial external rotation of 5 degrees more than the contralateral uninjured knee was noted in 12% of group A and in 5% of group B (p<0.05). Lateral instability of 5 mm greater than the contralateral knee was observed in 28% of group A and in 14% of group B (p<0.05). CONCLUSION: Anatomic reconstruction of the posterolateral corner resulted in less lateral instability and tibial external rotation than did the posterolateral corner sling procedure.

Short Term Clinical Results of Anatomical Reconstruction in the Posterolateral Corner of the Knee using Achilles Tendon Allograft / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the short term clinical results of the new anatomical reconstruction including 3 major posterolateral structures of the knee using a split Achilles allograft. MATERIALS AND METHODS: Eleven knees with posterolateral rotary instability underwent new anatomical posterolateral reconstruction between January 2002 and June 2003. The clinical results were assessed using the Lysholm score and Tegner activity level scales and physical examinations including posterolateral drawer test, dial tests at 30 and 90 degrees of knee flexion, varus stress tests at 0 and 30 degrees of knee flexion. RESULTS: Follow-up averaged 26 months (range, 12 to 29 months). The mean preoperative Lysholm score was 38.6 and at the time of latest follow-up, the mean score was improved to 72.5. The mean preoperative Tegner activity level was improved from 1.6 points to 3.3. Ten out of 11 patients showed negative conversion of the posterolateral drawer test and varus stress test at 30 degrees of flexion postoperatively. All patients, who showed positive signs on the external rotation-dial test at 30 degrees of knee flexion preoperatively, improved postoperatively. In eight patients, preoperative positive signs of varus stress tests at 0 degrees of knee flexion and the external rotation-dial test at 90 degrees of knee flexion disappeared postoperatively. CONCLUSION: This study suggests that the new anatomical reconstruction of posterolateral corner of knee is a reliable method providing excellent stability and satisfactory short term clinical results.

Reconstruction of the Posterolateral Instability of the Knee / 대한정형외과학회잡지

PURPOSE: This study reports the results of a treatment for posterolateral instability of the knee with a modified Muller's method. MATERIALS AND METHODS: Fourteen patients (3 acute and 11 chronic cases) with a modified Muller's method and with a follow-up period of more than 12 months, average follow-up period of 15 months (range, 12 to 22 months) was included. We recorded and analysed the physical findings (reverse Lachmann test and varus stress test at 30 degree knee flexion), stress roentgenograms at preoperative 8 postoperative 12 months, magnetic resonance imagings and Lysholm score at preoperative, postoperative 3, 12 months and the last follow-up. RESULTS: Average Lysholm score was 65A preoperatively and 90.0 at postoperative 12 months. The posterolateral stabilities of the knee were improved in all cases postoperatively, according to the clinical stability tests (reverse Lachmann test and varus stress test at 30 degree knee flexion) and stress roentgenograms. CONCLUSIONS: Modified Muller's technique-the reconstruction of the popliteus tendon using iliotibial band-represents an excellent method to restore tension in the posterolateral complex of the acutely and chronically injured knee.