Reconstrucción de ligamento cruzado posterior con técnica de doble banda en 100 pacientes con una media de 3 años de seguimiento / Outcomes after double-bundle PCL reconstruction

INTRODUCCIÓN: El objetivo de este trabajo fue determinar los resultados luego de una reconstrucción de doble banda del LCP (RLCP DB). MATERIALES Y MÉTODOS: Se incluyeron todos los pacientes sometidos a una RLCP DB artroscópica primaria para las lesiones completas de LCP (Grado III), entre mayo de 2010 y marzo de 2015. Se realizaron valoraciones funcionales (Tegner, Lysholm, WOMAC, SF-12) y objetivas (radiografías de estrés tibial posterior) antes y a un mínimo de dos años después de la operación. RESULTADOS: Cien pacientes que se sometieron a RLCP DB se incluyeron en este estudio. El promedio de seguimiento para la cohorte de RLCP DB fue de 2.9 años (rango, 2- 6 años). Hubo una mejoría significativa de todos los parámetros funcionales (todos los valores p <0,001). La diferencia media de lado a lado (DLL) en la traslación tibial posterior en radiografías de estrés mejoró de 11,0 ± 3,5 mm antes de la cirugía a 1,6 ± 2,0 mm después de la operación (p <0,001). CONCLUSIÓN: Se observaron resultados funcionales y objetivos significativamente mejores después de una RLCP DB en un seguimiento promedio de 3 años, con bajas tasas de complicaciones, independientemente de la patología ligamentaria concomitante o el momento de la cirugía (agudo o crónico). Además, se obtuvieron resultados clínicos subjetivos y funcionales similares en comparación con las reconstrucciones aisladas del LCA. Tipo de estudio: Serie de Casos. Nivel de evidencia: II.

BACKGROUND: to report on the outcomes after double-bundle PCL reconstructions in isolated versus combined injuries and acute versus chronic PCL reconstructions. METHODS: All patients who underwent a primary endoscopic RPCL DB for complete PCL tears (Grade III) PCL tears between May 2010 and March 2015 were reviewed. Patient reported outcome scores (Tegner, Lysholm, WOMAC, SF-12) and objective posterior stress radiographs were collected preoperatively and at a minimum two-years postoperatively. RESULTS: One hundred patients who underwent RPCL DB were included in this study. The mean follow-up for the PCL cohort was 2.9 years (range, 2-6 years). All functional scores improved at last follow up (all p values <0.001). The mean side-to-side difference (DLL) in posterior tibial translation on kneeling stress radiographs improved from 11.0 ± 3.5 mm preoperatively to 1.6 ± 2.0 mm postoperatively (p<0.001). CONCLUSION: Significantly, improved functional and objective outcomes were observed after anatomic-based RPCL DB at a mean 3 years follow-up, with low complication rates, regardless of concomitant ligamentous pathology or timing to surgery. Additionally, contrary to previous reports, comparable subjective and functional clinical outcome were achieved compared to an isolated ACL reconstruction control cohort. Type Study: Case report. Level of evidence: II.

Diagnosis and Treatment of Occult Lisfranc Injury / 대한족부족관절학회지

PURPOSE: To evaluate the effectiveness of intraoperative stress test for diagnosis of occult Lisfranc injury. MATERIALS AND METHODS: Between April 2009 and October 2012, 21 patients with occult Lisfranc injuries underwent intraoperative stress test and internal fixation. There were 11 males and 10 females with an average age of 45.3 years (range, 23~79 years). Injuries were caused by traffic accident in 10 cases, indirect force (twisting injury) in 8 cases, and crush in 2 cases, falling from a height in 1 case. Unstable injuries on stress radiograph in occult injury of Lisfranc joint were treated by open reduction or closed reduction and fixation with cannulated screw or K-wire. Radiological evaluation was assessed according to preoperative and postoperative diastasis between 1st and 2nd metatarsal base. RESULTS: Assoicated injuries were 9 cases of metatarsal fractures, 6 cases of cuneiform fractures and 6 cases of both metatarsal and cuneiform fractures. Medial and middle column fixation was in 13 cases, and three columns fixation was in 8 cases. Initial diastasis between 1st and 2nd metatarsal base was 2.8 mm (1.3~4.7 mm) on AP radiograph and postoperative diastasis between 1st and 2nd metatarsal base was 1.2 mm (0.5~2.4 mm) on AP radiograph. CONCLUSION: Even there is no sign of clear Lisfranc injury, it is necessary to pay attention and give evaluation on circumstances of occult Lisfranc injuries with metatarsal or cuneiform fractures. Intraoperative stress test is helpful to diagnose an occult Lisfranc injury. For unstable injuries on stress radiographs of occult Lisfranc joint injury, operative treatment with open or closed reduction and internal fixation is useful method.

Clinical Results after Closed Reduction and Internal Fixation for Unstable Subtle Injuries of Lisfranc Joint / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate retrospectively the clinical results of closed reduction and percutaneous screw fixation for unstable injuries on stress radiographs in subtle injuries of Lisfranc joint. MATERIALS AND METHODS: From June 1997 to March 2003, 6 cases of unstable injuries on stress radiograph in subtle injuries of Lisfranc joint were treated by percutaneous cannulated screw fixation after closed reduction. All cases were injuried by indirect force (twisting injury). The average diastasis between the 1st and 2nd metatarsal base was 3 mm (2-4 mm) on initial nonweight bearing AP radiograph. The average follow-up period was 20 months. Clinical evaluation was assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score. RESULTS: The AOFAS midfoot score was average 86 (80-90) points. The average diastasis between 1st and 2nd metatarsal base was 2 mm (1-3 mm) on weight bearing AP radiograph in final follow up. The final diastasis was increased slightly than diastasis in initial postoperative radiographs. But the clinical results were good. There was no correlation between the degree of diastasis and the clinical results. On weight bearing lateral radiograph, the average difference with normal foot in the distance between plantar aspect of 5th metatarsus and medial cuneiform was 2 mm (0-3 mm). One case had mild arthritic change on the radiographs CONCLUSION: When the Lisfranc injuries, especially in the subtle injuries were suspicious, the stress views are helpful to assess stability of the Lisfranc injuries and planning of treatment. For unstable injuries on stress radiographs in subtle injuries of Lisfranc joint, closed reduction and percutaneous screw fixation is useful method to expect good clinical results.