Valoración funcional y de calidad de vida en pacientes tratados con artrodesis de tobillo / Functional results and quality of live in patients with ankle arthrodesis

Objetivo: analizar los resultados funcionales y de calidad de vida en pacientes con artrodesis de tobillo con un tiempo de evolución medio. Pacientes y metodología: se analizaron 20 pacientes laborales (18 hombres y 2 mujeres) intervenidos con una artrodesis de tobillo,16 del lado derecho y 4 del izquierdo, de causa postraumática, por fracturas del pilón tibial o graves de los huesos proximales del tarso y sin otras patologías en miembros inferiores. La edad media fue de 40 años (26-54) y el peso medio de 89 kg (54-117 kg). Se realizaron dos valoraciones funcionales (Mazur, AOFAS) y otro de calidad de vida (SF-36), después de un mínimo de 3 años de evolución. Resultados: la puntuación con la escala de Mazur fue 49,26 puntos, con la AOFAS, 49,89 y con el SF-36, 43,3 puntos. Sin embargo, un 80% de los pacientes mostraron buenos resultados. No encontramos una relación entre las escalas funcionales y la de calidad de vida, donde las respuestas tendieron a lo negativo. Conclusión: aunque la valoración global es baja, los pacientes mantienen en su mayoría una actividad de vida normal (AU)

Objetive: Compare and analyze the functional results of large outcome ankle arthrodesis through both kinetic and kinematical motion study and plantar support study. Patients and methodogy: We studied 20 patients (18 males and 2 females) with post-traumatic ankle arthrodesis (16 right side and 4 left side) with a minimum follow up of three years (3-9 years). No other lower extremity pathologies were associated. Average age was 37 years (23-56 y.o) and average weight 84,5 kg (54- 117 Kg). In order to objectify the results we used two functional scores, AOFAS score (max 90 points) and Mazur score (max 97 points) and a quality life scale SF-36 (max 100 points), with a minimum follow up of three years. Results: The results obtained with Mazur scale were 49,26 points (14 – 83), 49,89 points AOFAS scale (22- 84), 43,3 points SF-36 (29-68). Nearly 80% of patients showed a good result in the functional scales. We did not find a relationship between the functional scales and the quality of live scale. Conclusion: Patients with ankle arthrodesis show a low subjective outcome in the quality life scales although most of them perform a normal daily live activities (AU)

Artrodesis subastragalina secundaria mediante el sistema Vira® en el tratamiento de las secuelas de las fracturas de calcáneo / Secondary subtalar arthrodesis using the Vira system for treating the sequelae of calcaneus fractures

Objetivo: Evaluar la eficacia del sistema Vira(R) en el tratamiento de las secuelas de las fracturas de calcáneo mediante artrodesis subastragalina secundaria. Material y métodos: Evaluamos prospectivamente 23 artrodesis subastragalinas secundarias. Dieciocho casos fueron artrodesis in situ; 4 de ellas asociaron descompresión lateral y 5 fueron correcciones de consolidación viciosa mediante osteotomía de calcáneo. En todos los casos, la fijación se realizó con el sistema Vira(R) sin injerto. El tiempo medio de evolución desde la fractura fue de 22 meses. Se realizó una evaluación clínica mediante la escala AOFAS y una evaluación radiográfica y de TAC. Resultados: La puntuación media en la escala AOFAS previa a la cirugía fue de 41,1 puntos y se alcanzaron 71,6 puntos al final del seguimiento. De los 11 pacientes sin incapacidad volvieron a su ocupación habitual todos, salvo 3. La media de incapacidad temporal en los pacientes a los que se les dio el alta fue de 123 días Dos casos presentaron retardo de consolidación de la artrodesis subastragalina y precisaron reintervención con injerto autógeno. No se registraron complicaciones quirúrgicas ni posquirúrgicas. Conclusión: El sistema Vira(R) es eficaz en la artrodesis secundaria y aporta estabilidad suficiente para permitir el apoyo y la rehabilitación precoces, con una elevada tasa de fusión, sin necesidad de injerto óseo adicional (AU)

Purpose: To assess the efficacy of the Vira(R) system for the treatment of calcaneal fractures by means of a secondary subtalar arthrodesis. Materials and methods: We prospectively assessed 23 secondary subtalar arthrodeses. Eighteen cases were "in situ" arthrodeses, 4 of which were combined with a lateral decompression and 5 were corrections of malunions by means of calcaneus osteotomies. All cases were addressed with the Vira(R) system, without bone grafting. Mean time to surgery was 22 months. A clinical assessment using the AOFAS scale and a radiographic and CT-evaluation were performed. Results: Mean preoperative AOFAS scale was 41.1 points, with a score of 71.6 points being reached at the end of follow-up. All but 3 of the 11 patients without disability returned to their usual occupations. Mean temporary disability in the patients that were discharged was 123 days There were 2 cases of delayed healing of the subtalar arthrodesis; these had to be reoperated with an autologous graft. There were no surgical or postsurgical complications. Conclusion: The Vira(R) system is efficient for secondary arthrodesis, providing the patient with enough stability to permit early weightbearing and rehabilitation, with a high healing rate and with no need for additional bone grafting (AU)

Valoración clínica y radiográfica de la meniscectomía y reparación de la rotura del ligamento cruzado anterior con 10 años de evolución / Clinical and radiographic assessment of meniscectomy and repair of the anterior cruciate ligament rupture ten years after surgery

Objetivo: valorar la situación funcional y radiográfica de los pacientes que fueron intervenidos de meniscectomía, ligamentoplastia de LCA o ambas 10 años después de las cirugías. Material y Método: revisamos 35 pacientes intervenidos de meniscectomía parcial, ligamentoplastia con tendones de la pata de ganso por rotura del LCA, o ambas técnicas conjuntas, en 1997. Evaluamos el índice de satisfacción (escala 1-10), cuestionario KOOS (Knee Osteoarthritis Outcome Score) y el grado de gonartrosis en radiografía antero- posterior y lateral en carga, siguiendo la escala de Kellgren-Lawrence. Se efectuó un análisis de los datos obtenidos en cada grupo para efectuar un estudio descriptivo de los mismos. Resultados: la meniscectomía fue un factor de riesgo para el desarrollo de artrosis, no hemos demostrado que la reconstrucción del LCA con tendones de pata de ganso favorezca la gonartrosis a medio plazo, casi el 70% de los pacientes no tenía signos degenerativos y los que los presentaron se encuadraron en un grado I. Tampoco establecimos una relación entre la presencia de signos de artrosis radiográfica y la percepción de calidad de vida. En nuestros casos, ambas cirugías tienen una evolución clínica a medio plazo que permite al paciente una buena calidad de vida y una actividad laboral normal, si bien la ligamentoplastia aislada de LCA obtiene mejores puntuaciones en el cuestionario KOOS con menor incidencia de artrosis en la imagen (AU)

Objective: To assess the functional and radiographic status of patients operated upon for meniscectomy and/or ligamentoplasty of the anterior cruciate ligament (ACL) 10 years after surgery. Material and method: We reviewed 35 patients operated upon in 1997 for partial meniscectomy, ligamentoplasty with goosefoot tendons for rupture of the ACL, or both techniques in combination. We evaluated the satisfaction index (1-10 scale), KOOS questionnaire (Knee Osteoarthritis Outcome Score) and the degree of gonarthrosis in antero-posterior and lateral weight-bearing radiography, following the Kellgren-Lawrence scale. The data obtained from each group were analyzed and subjected to descriptive study. Results: Meniscectomy was a risk factor for the development of osteoarthritis. We have not shown reconstruction of the ACL with goosefoot tendons to enhance gonarthrosis over the middle term; almost 70% of all patients had no degenerative signs, and those who did were rated as grade I. Likewise, no relationship was established between the presence of signs of radiographic osteoarthritis and patient perceived quality of life. In our cases, both surgical interventions offer middle term clinical results affording patients a good quality of life and normal working activity, though ACL ligamentoplasty alone obtains better scores according to the KOOS questionnaire, with a lesser incidence of osteoarthritis as determined by imaging techniques (AU)

Reinserción de la avulsión distal del músculo biceps braquial con técnica de Endobutton® / Endobutton-assisted repair of distal biceps brachii tendon ruptures

Objetivo: analizar los resultados del tratamiento quirúrgico de las avulsiones distales del bíceps con técnica de Endobutton ® y presentar detalles técnicos que simplifican la cirugía.Pacientes y metodologá: utilizamos el implante Endobutton ® para reanclar 8 avulsiones distales del tendón del bíceps. Todos los pacientes eran varones y la edad media de 42 años (rango de 35 a 56 años).La movilidad completa se permitió a la semana de la cirugía. El seguimiento mínimo fue de 12 meses.Resultados: Todos los pacientes estaban satisfechos conel resultado final. La movilidad media fue de 3 a 140º,con 80º de supinación y 75º de pronación. Todos los pacientes recuperaron su nivel de actividad previo a la lesión. No tuvimos ninguna complicación neurológica ni sinostosis radio-cubital.Conclusiones: la reparación de las roturas del bíceps distal con técnica de Endobutton es una técnica sencilla y segura. La fuerte fijación inicial permite una rehabilitación postoperatoria agresiva que mejora los resultados de movilidad y fuerza

Objective: the purpose of this study was to analyze theresults of EndoButton- assisted repair of distal biceps tendon ruptures and present technical tips that simplify the technique.Patients and methods: we used the Endobutton™ to repair8 distal biceps avulsions. All patients were male, average age was 42 (range 35-56). Full range of motion astolerated was allowed one week after surgery. The minimumfollow up was 12 months All patients were satisfied with their final result. Average range of motion was 3 to 140º with 80º supination and 75º pronation. All patients returned to their pre-injury activity level. There were no neural injuries and no radio-ulnar synostosis.Conclusion: the repair of distal biceps tendon ruptureusing the Endobutton™ is a simple and safe technique.The strong fixation allows aggressive postoperative rehabilitation and provides excellent results both in motion and strength

[Anterior cervical fusion with tantalum interbody implants. Clinical and radiological results in a prospective study]. / Artrodesis cervical anterior mediante implante de tantalio. Resultados clínicos y radiológicos.

Anterior cervical discectomy and interbody fusion (ACDF) is a widely accepted surgical technique in the treatment of cervical disc disease. Tantalum cages have been recently introduced in spine surgery for interbody fusion because of the advantages of their mechanical properties. We present the results of a prospective clinical and radiological study on 24 consecutive patients who underwent an ACDF with tantalum cages. Clinical evaluation was assessed preoperatively and after surgery by a questionnaire that included a Visual Analogic Scale (VAS) of neck and arm pain, the Oswestry Disability Index and the Zung Depression Scale. Results were classified by Odom's criteria. Radiological evaluation included flexion-extension X-rays, and changes in distance between spinous processes and Cobb angle were measured. Postoperatively patients were reviewed 3 and 12 months after surgery. A statistical significative improvement in all clinical data was reported. According to Odom's criteria in 75% of patients the results were considered like excellent or good. Only one case of radiological and clinical pseudoarthrosis was confirmed. No significative differences were reported 3 and 12 months after surgery. Tantalum cages are a very promising and usefull alternative among implants available for ACDF. Compatibility with MRI postoperative studies and the unnecessariness of autograft are some of their advantages.

Artrodesis cervical anterior mediante implante de tantalio. Resultados clínicos y radiológicos / Anterior cervical fusion with tantalum interbody implants. Clinical and radiological results in a prospective study

La discectomía cervical anterior con artrodesisintersomática (DCAA) es una técnica quirúrgica ampliamente aceptada en el tratamiento de la enfermedad discal cervical. Recientemente se han introducido con esta indicación las cajas de tantalio debido a sus excelentes propiedades mecánicas y biológicas. Presentamos los resultados iniciales clínicos y radiológicos de un estudio prospectivo de 24 pacientes intervenidos en nuestro servicio tras el empleo de cajas de tantalio en la DCAA. La evaluación clínica pre y postoperatoria se realizó mediante cuestionario que incluía una Escala Visual Analógica de dolor, el Índice de Oswestry, y la Escala de Zung. Los resultados fueron clasificados mediante los criterios de Odom. La evaluación radiológica incluyó radiografías dinámicas en las que se midieron las variaciones del ángulo de Cobb y la distancia interespinosa. Postoperatoriamente los pacientes fueron revisados en el tercer mes y al año dela intervención. Todos los parámetros clínicos mejoraron de forma estadísticamente significativa. Según con los criterios de Odom, el 75% de los casos fueron considerados como excelentes o buenos. Sólo se confirmó clínica y radiológicamente un caso de pseudo-artrosis. No se observaron diferencias significativas en las revisiones al año y a los 3 meses. Conclusión: Las cajas de tantalio constituyen un implante prometedor y pensamos que útil entre las diversas opciones quirúrgicas para la DCAA, por sus buenos resultados clínicos, por la no necesidad de autoinjerto, y por su excelente compatibilidad con la resonancia nuclear magnética

Anterior cervical discectomy and interbody fusión (ACDF) is a widely accepted surgical technique in the treatment of cervical disc disease. Tantalum cages have been recently introduced in spine surgery for interbody fusion because of the advantages of their mechanical properties. We present the results of a prospective clinical and radiological study on 24 consecutive patients whounder went an ACDF with tantalum cages. Clinical evaluation was assessed preoperatively and after surgery by a questionnaire that included a Visual Analogic Scale(VAS) of neck and arm pain, the Os westry Dissability Index and the Zung Depression Scale. Results were classified by Odom’s criteria. Radiological evaluation included flexion-extension X-rays, and changes in distance between spinous processes and Cobb angle were measured. Postoperatively patients were reviewed 3and 12 months after surgery. A statisitical significative improvement in all clinical data was reported. According to Odom’s criteria in75% of patients the results were considered like excellent or good. Only one case of radiological and clinical pseudoarthrosis was confirmed. No significative differences were reported 3 and 12 months after surgery. Tantalum cages are a very promising and usefull alternative among implants available for ACDF. Compatibility with MRI postoperative studies and the unnecessariness of autograft are some of their advantages

Osteochondral allografts for osteochondritis dissecans and osteonecrosis of the femoral condyles.

Osteochondral allografts were used in 11 patients with osteochondritis dissecans and 4 with osteonecrosis of the femoral condyles. The lesions were mainly in the medial condyle in 13 cases, and in the weightbearing area in 10. The grafts had a mean size of 6 cm2; 8 were kept in hypothermia at 4 degrees C for less than 24 h and 7 were stored at -80 degrees C with cryoprotection. After an average follow up of 3.2 years, only 2 patients needed a further operation, one for nonunion and the other for a fracture of the graft. The others had improved clinically and showed radiological union of the graft with preservation of the joint space.

Intact articular cartilage cryopreservation. In vivo evaluation.

By varying the parameters that determine the cryopreservation process (freezing rate, storage temperature, cryoprotective agents, storage time), various protocols have been designed for preservation of osteochondral allografts of rabbit femoral condyles. The grafts were implanted orthotopically for three months. After harvesting, the results were evaluated by optical microscopy, histochemistry, and electron microscopy (scanning and transmission). A quantitative study and statistical analysis was performed using a gradation scale of chondral degeneration. Synovial reaction was higher in the fresh allograft than in the cryopreservation groups. Glycerol yielded better results than DMSO as a cryoprotective agent. No cryopreservation protocols produced the results equal to the control groups of either fresh auto- or allografts. Optimal preservation was achieved with either the group with hypothermic storage at 4 degrees for no more than 48 hours or the group with slow freezing to -80 degrees and preparative exposure to 15% glycerol at 4 degrees for 60 minutes. No statistically significant differences were found in these two groups.