[Comparative study of the repair of full thickness tear of the supraspinatus by means of "single row" or "suture bridge" techniques]. / Estudio comparativo de la reparación de la rotura de espesor completo del supraespinoso mediante técnica "hilera simple" o "suture bridge".

PURPOSE: The purpose of this study is to analyze if there is any difference between the arthroscopic reparation of full-thickness supraspinatus tears with simple row technique versus suture bridge technique. MATERIAL AND METHODS: We accomplished a retrospective study of 123 patients with full-thickness supraspinatus tears between January 2009 and January 2013 in our hospital. There were 60 simple row reparations, and 63 suture bridge ones. RESULTS: The mean age in the simple row group was 62.9, and in the suture bridge group was 63.3 years old. There were more women than men in both groups (67%). All patients were studied using the Constant test. The mean Constant test in the suture bridge group was 76.7, and in the simple row group was 72.4. We have also accomplished a statistical analysis of each Constant item. Strength was higher in the suture bridge group, with a significant statistical difference (p 0.04). The range of movement was also greater in the suture bridge group, but was not statistically significant. CONCLUSIONS: Suture bridge technique has better clinical results than single row reparations, but the difference is not statistically significant (p = 0.298).

OBJETIVO: Analizar si existen diferencias clínicas entre las técnicas «hilera simple¼; versus «. MATERIAL Y MÉTODOS: suture bridge¼; en la reparación artroscópica de roturas de espesor completo del supraespinoso. Estudio retrospectivo de 123 pacientes con rotura de espesor completo del supraespinoso, intervenidos entre Enero de 2009 y Enero de 2013 (60 hilera simple y 63. RESULTADOS: suture bridge). La edad media en el grupo suture bridge fue 63.3 años y en el grupo hilera simple, 62.9. Predominio de mujeres (67%) en ambos grupos. En todos los casos, se reparó la hilera medial con anclajes Bio-Corkscrew y la hilera lateral con implantes Bio-PushLock (Arthrex, Naples, FL). El valor del test de Constant medio en individuos intervenidos mediante. CONCLUSIONES: suture bridge fue 76.7 (ponderado 96.5). En hilera simple, fue 72.4 (ponderado 92.8). Se realizó también un análisis estadístico comparativo de cada ítem del test de Constant por separado. La fuerza es el único parámetro del test de Constant estadísticamente significativo y es mayor en el grupo suture bridge. La reparación de las roturas de espesor completo del supraespinoso mediante.

[Arthroscopic repair of anterior relapsing shoulder dislocation. Is there a learning curve?]. / Reparación artroscópica de la luxación anterior recidivante de hombro. Existe la curva de aprendizaje?

OBJECTIVE: We reviewed the first cases that underwent arthroscopic surgery at our center due to relapsing glenohumeral stability of the shoulder. The objective of this paper is to analyze the influence of the learning curve on the results obtained. MATERIAL AND METHODS: We analyzed 137 patients who underwent surgery at Hospital 12 de Octubre in Madrid, Spain between.February 1999 and March 2010. A total of 101 patients met the inclusion criteria, and these patients were divided into two groups using a chronological order, the first 50 patients and the second 50 patients. There were no statistically significant differences in sex, age and laterality between both groups (p = 0.51, p = 0.15 and p = 0.23, respectively), so the groups were comparable. We compared the following between both groups: clinical outcomes, number of dislocations, reoperations and complications, i.e., implant migration, arthrosis and axillary nerve neuropathy. We also compared the functional results, which were measured using the Constant and Rowe scales. RESULTS: Four episodes of redislocation occurred in group 1 and 6 in group 2. Three reoperations were performed in group 1 and 6 in group 2. No statistically significant differences were found in the number of redislocations and reoperations (p = 50 and p = 0.48, respectively).

[Arthroscopic treatment of talus osteochondral lesions: study of 73 cases]. / Tratamiento artroscópico de las lesiones osteocondrales de astrágalo: estudio de 73 casos.

BACKGROUND AND AIM: The aim of our study is to analyze the different techniques used in arthroscopic treatment of talus osteochondral lesions. MATERIAL AND METHOD: We retrospectively analyzed 73 patients who underwent surgery between 2000 and 2011. Patients were divided in two groups: group A (51 patients), those treated with osteochondral stimulation techniques, and group B (32 patients), that were treated by repair techniques. The mean age was 32.58 (19-73) years in group A and 36.50 (19-58) in group B. It is identified male predominance and medial lesions in both groups. RESULTS: Were evaluated according to the AOFAS ankle scoring scale, it is observed a statistically significant clinical improvement (P<.001). Preoperative values were 48.77 (31-67) in group A and 58.08 (41-75) in group B. After surgery scores amounted to 85.19 (60-100) in group A and 93.60 (80-100) in group B. CONCLUSIONS: Ankle arthroscopy is an excellent technique for the accurate staging of osteochondral lesions, and diagnosis and treatment of associated injuries. The arthroscopic treatment of lesions grade i, ii and sometimes iii, by stimulation techniques and chondral lesions grade iii and iv by replacement techniques, gives good results with few complications.

Tratamiento artroscópico de las lesiones osteocondrales de astrágalo: estudio de 73 casos / Arthroscopic treatment of talus osteochondral lesions: study of 73 cases

Introducción y objetivo. El objetivo de nuestro estudio es analizar las distintas técnicas artroscópicas empleadas en el tratamiento de las lesiones osteocondrales de astrágalo. Material y método. Realizamos un estudio retrospectivo de 73 casos, intervenidos entre los años 2000 y 2011. Los pacientes se dividieron en 2 grupos: grupo A (51 pacientes), aquellos tratados mediante técnicas de estimulación osteocondral; grupo B (32 pacientes), tratados mediante técnicas de reparación. La edad media fue de 32,58 años (19-73) en el grupo A, y 36,50 años (19-58) en el grupo B. Se identifica predominio del sexo masculino y de lesiones mediales en ambos grupos. Resultados. Se evaluaron los resultados siguiendo la escala de la AOFAS de retropié, observando una mejoría clínica estadísticamente significativa (p < 0,001). Los valores preoperatorios fueron 48,77 (31-67) en el grupo A, y 58,08 (41-75) en el grupo B. Después de la intervención quirúrgica las puntuaciones ascendieron a 85,19 (60-100) en el grupo A, y 93,60 (80-100) en el grupo B. Conclusiones. La cirugía artroscópica es la técnica de elección en el tratamiento de las lesiones osteocondrales de tobillo, permite una correcta estadificación y tratamiento de las lesiones asociadas. El tratamiento artroscópico de las lesiones grado i , ii y, en ocasiones iii mediante técnicas de estimulación condral, y de lesiones grado iii y iv mediante técnicas de reparación ofrece buenos resultados con escasas complicaciones (11%) (AU)

Background and aim. The aim of our study is to analyze the different techniques used in arthroscopic treatment of talus osteochondral lesions. Material and method. We retrospectively analyzed 73 patients who underwent surgery between 2000 and 2011. Patients were divided in two groups: group A (51 patients), those treated with osteochondral stimulation techniques, and group B (32 patients), that were treated by repair techniques. The mean age was 32.58 (19-73) years in group A and 36.50 (19-58) in group B. It is identified male predominance and medial lesions in both groups. Results. Were evaluated according to the AOFAS ankle scoring scale, it is observed a statistically significant clinical improvement (P<.001). Preoperative values were 48.77 (31-67) in group A and 58.08 (41-75) in group B. After surgery scores amounted to 85.19 (60-100) in group A and 93.60 (80-100) in group B. Conclusions. Ankle arthroscopy is an excellent technique for the accurate staging of osteochondral lesions, and diagnosis and treatment of associated injuries. The arthroscopic treatment of lesions grade i , ii and sometimes iii , by stimulation techniques and chondral lesions grade iii and iv by replacement techniques, gives good results with few complications (AU)

[Medium-term results of arthroscopic repair of relapsing anteroinferior glenohumeral instability]. / Resultados a mediano plazo de la reparación artroscópica en la inestabilidad recidivante glenohumeral anteroinferior.

OBJECTIVES: Arthroscopic repair of Bankart lesion has become the treatment of choice of anterior shoulder instability. Our objective is to analyze the medium-term results of arthroscopic Bankart repair. MATERIAL AND METHODS: Between January 1999 and November 2007, 86 shoulders of 85 patients with diagnosis of relapsing shoulder dislocation were treated arthroscopically. After a mean 62-month follow-up (minimum 24 months) the results obtained were retrospectively assessed according the Rowe and Constant functional scales. A statistical analysis was done of the relation between functional results and age, sex, the side operated, capsulorrhaphy, rehabilitation and postoperative immobilization in our series. Moreover, the validity of MRI for diagnosing Bankart lesion was assessed. RESULTS: Eighty-five percent of patients had good or excellent results according to the Rowe scale. The mean Constant scale score was 90.6. There-dislocation rate in our series was 9%. The statistical analysis showed that female sex and immobilization time were related with worse results according to the Constant scale. CONCLUSIONS: In our hands, arthroscopic Bankart repair provides results similar to those in other published series. MRI is a useful diagnostic test in our setting, albeit its important implications for the diagnosis of Bankart lesion. Female sex and prolonged immobilization were related with worse functional results.

Artroplastia de cabeza radial mediante prótesis metálicas en fracturas no reconstruibles. Nuestra experiencia / Radial Head Arthroplasty using metallic prosthesis in unreconstructible fractures. Our experience

Objetivo: Analizar los resultados obtenidos con la atroplastia de cabeza radial mediante prótesis metálicas en fracturas no reconstruibles. Material y métodos: Estudio observacional en 9 pacientes con fractura conminuta de la cabeza radial tratadas con prótesis metálicas. Se evaluaron retrospectivamente mediante el Mayo Elbow Performance Index (MEPI) y el cuestionario DASH. También evaluamos la presencia de dolor, los arcos de movilidad, los hallazgos radiográficos y la aparición de complicaciones. El seguimiento medio fue de dieciocho (5-42) meses. Resultados: Tras un seguimiento medio de dieciocho meses (5-42) se obtuvieron cuatro resultados excelentes, tres buenos, uno regular y uno malo según la escala MEPI. El arco de movilidad fue de 110º de flexo-extensión (60º- 145º), 64º de pronación (50º-70º) y 72º de supinación (35º-80º). Aparecen complicaciones en cinco pacientes. Conclusiones: El uso de prótesis metálicas de cabeza radial es una opción terapéutica para casos seleccionados de fracturas conminutas de cabeza radial con una elevada tasa de complicaciones (AU)

Objective: To analyze the outcomes using metallic prosthesis in unreconstructible radial head fractures. Materials and methods: Nine patients with conminuted radial head fractures in which metallic prosthetic arthroplasty was performed were retrospectively evaluated using the Mayo Elbow Performance Index (MEPI) and the DASH questionnaire. The mean follow-up were eighteen (5-42) months. Pain, mobility, X-Rays outcomes and complications were also evaluated. Results: there were four excellent results, three good, one fair and one bad using the MEP score . The average range of motion was 110º of flexo-extension, (60º-145º), 64º of pronation (50º-70º) and 72º of supination (35º-80º). Five complications were observed. Conclusion: The use of radial head metallic prosthesis is an option for the treatment of conminuted radial head fractures in selected cases with a high rate of complications (AU)

Rotura del aparato extensor tras artroplastia total de codo para el tratamiento de una pseudoartrosis de húmero distal / Extensor mechanism rupture after total elbow arthroplasty for the treatment of a distal humerus non-union

Introducción. La artroplastia total de codo es una opción disponible para el tratamiento de diversas patologías del codo. Además de la indicación clásica en la artritis reumatoide, han surgido nuevas indicaciones en fracturas y pseudoartrosis de húmero distal. Sin embargo, no es una técnica exenta de complicaciones. La rotura del aparato extensor es una de ellas. Caso clínico. Mujer de 61 años con fractura conminuta no consolidada supraintercondílea de húmero distal, en un codo con afectación severa por artritis reumatoide, es tratada mediante artroplastia total semiconstreñida de codo tipo Coonrad Morrey. Al mes postoperatorio desarrolló una osificación en el tríceps distal que se extirpó. Varios meses después presenta una lesión del aparato extensor que fue tratada mediante sutura directa. Conclusión. Para casos seleccionados, el empleo de prótesis totales de codo ofrece resultados alentadores. Una correcta indicación y una buena técnica quirúrgica son indispensables para obtener resultados satisfactorios y minimizar la aparición de complicaciones (AU)

Introduction. Total elbow arthroplasty is an available option for the treatment of many pathologies of the elbow. Apart from the classic indication in rheumatoid arthritis, new indications have arisen in fractures and non-unions of the distal part of the humerus. Many complications have been described with the use of this technique. Extensor mechanism rupture is one of them. Case report. We present the case of a 61-year-old woman with a nonunited comminuted distal humerus fracture in a severely affected rheumatoid elbow who was treated with a Coonrad-Morrey semiconstrained total elbow arthroplasty. One month after the operation she developed a palpable ossification in distal triceps which was extirpated. Some months later she presented an extensor mechanism rupture which was surgically treated using a direct suture. Conclusion. In selected cases, the use of total elbow prosthesis is related to good results. A correct indication and a meticulous surgical technique are essential in order to obtain satisfactory results and to minimise the risk of complications (AU)

Reparación quirúrgica por vía anterior de la rotura distal del tendón del bíceps braquial / Anterior surgical repair of distal ruptures of the brachial biceps tendon

Objetivos. La rotura distal del tendón del bíceps braquial es una lesión poco frecuente. El objetivo de nuestro estudio es evaluar los resultados de las roturas distales de dicho tendón, intervenido quirúrgicamente por vía anterior entre noviembre de 1998 y diciembre de 2003. Material y método. Estudio retrospectivo con 12 pacientes y 13 lesiones, con un seguimiento medio de 37 meses (12-60). La edad media fue de 37,6 años, y todos los pacientes eran del sexo masculino. Todas las lesiones se localizaron en el brazo dominante, excepto un caso de rotura bilateral. Todos fueron intervenidos a través de un abordaje anterior. Diez lesiones (76,9%) se suturaron con arpones, dos (15,4%) con túneles óseos y una (7,7%) se suturó con un anclaje con endobutton. Todos los pacientes, excepto uno, fueron inmovilizados con una férula de escayola braquioantebraquial posterior durante las dos primeras semanas postoperatorias. En cinco pacientes se continuó con esta inmovilización y en seis se sustituyó por una ortesis articulada. Resultados. Se evaluaron los parámetros de: movilidad, fuerza, dolor y satisfacción personal. Todos los pacientes presentaron una movilidad completa. Once pacientes (91,6%) recuperaron la fuerza totalmente. Como complicaciones se encontró una paresia transitoria del nervio radial. La satisfacción personal fue excelente en once pacientes (91,6%) y buena en un paciente (8,4%). No existió ninguna nueva re-ruptura. Conclusiones. Los resultados clínicos y funcionales han sido en la mayoría de los pacientes excelentes, por lo que se recomienda la sutura con arpones por vía anterior (AU)

Purpose. Distal ruptures of the brachial biceps tendon are an infrequent injury. The purpose of this paper is to assess the outcome of distal ruptures of the tendon addressed surgically through an anterior approach between November 1998 and December 2003. Materials and methods. Retrospective study of 12 patients and 13 injuries with a mean follow-up of 37 months (range: 12-60). Mean age was 37.6 years and all patients were male. All injuries were located in the dominant arm, except for one case in which the rupture was bilateral. All were operated with an anterior approach. In ten injuries (76.9%) harpoon sutures were used, in two (15.4%) bone tunnels and in one instance (7.7%) an endobutton anchor. All patients but one were immobilized with a brachioantebrachial plaster splint during the first two weeks post-op. In five patients, this immobilization was continued, whereas in four it was replaced by an articulated brace. Results. Range of movement, strength, pain and personal satisfaction were the parameters assessed. All patients had full mobility. Eleven patients (91.6%) recovered their full strength. As far as complications are concerned, we had a transient radial nerve palsy. Personal satisfaction was excellent in eleven patients (91.6%) and good in one (8.4%). There was no re-rupture. Conclusions. Our clinical and functional results are excellent, for which reason we recommend harpoon suturing with an anterior approach (AU)

Tumor fibroso solitario del adulto en la cadera / Adult solitary fibrous tumor of the hip

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