Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results. / Artroplastia total de cadera con sistema de doble movilidad de segunda generación como tratamiento de coxartrosis primaria, resultados a mediano plazo.

INTRODUCTION: Osteoarthritis is a disabling pathology characterized by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. MATERIALS AND METHODS: A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. RESULTS: The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. CONCLUSION: The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. Evidence level IV. Retrospective observational case series study.

Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results. / Artroplastia total de cadera con sistema de doble movilidad de segunda generación como tratamiento de coxartrosis primaria, resultados a mediano plazo.

INTRODUCTION: Osteoarthritis is a disabling pathology characterized by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. MATERIALS AND METHODS: A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. RESULTS: The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. CONCLUSION: The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. EVIDENCE LEVEL: IV. Retrospective observational case series study.

Reinsertion of Posterior Meniscal Root for Management of Hypermobile Lateral Meniscus: Description of a Surgical Technique.

Lateral meniscus hypermobility is a special condition in which the posterior horn of the lateral meniscus exhibits excessive mobility. This condition can cause pain and locking in the knee, especially during kneeling, deep flexion, or squatting. In this article, we present a surgical technique for the reinsertion of the posterior root of the external meniscus in cases of hypermobility without detachment. The objective is to increase the tension of the meniscotibial and meniscal popliteal ligaments to achieve meniscal stability. The procedure involves suturing the meniscal root and fixation using a knotless implant through a transosseous tunnel. This technique has proven to be effective in stabilizing the lateral meniscus in patients with hypermobility.

Hipermovilidad del tercio posterior del menisco lateral secundario a lesión de los ligamentos meniscotibiales. Estudio cadavérico / Hypermobility of the posterior third of the lateral meniscus secondary to injury to the meniscotibial ligaments. Cadaveric study

Introducción: Los meniscos son estructuras semilunares formadas por fibrocartílagos, localizadas entre el fémur y la tibia. El menisco externo es más móvil, debido a sus inserciones a través de los ligamentos meniscotibiales y poplíteomeniscales. El menisco interno tiene un desplazamiento de 2-3 mm comparado con un desplazamiento de 9-10 mm del menisco externo. Se ha descripto en la literatura mundial que la hipermovilidad meniscal es secundaria a lesión de ligamentos poplíteomeniscales (principales estabilizadores), sin embargo, se realizó un estudio cadavérico donde se evidenció que los ligamentos poplíteomeniscales desempeñan un papel secundario. El objetivo de este estudio es demostrar que la lesión de los ligamentos meniscotibiales es la causante de la hipermovilidad meniscal externa.Materiales y métodos: se realizó un estudio cadavérico en 2022 en Arthrex, Naples, Florida, Estados Unidos. Previo a la valoración artroscópica se efectuó la sección de ligamentos meniscotibiales en el tercio posterior del menisco externo, manteniendo los ligamentos poplíteomeniscales y la inserción de la raíz posterior. Posteriormente, se efectuó la valoración artroscópica en la que se vio traslación anterior y superior del tercio posterior del menisco externo y se realizó la fijación meniscal.Resultados: mediante la fijación del tercio posterior del menisco lateral con técnica transósea, en una falla o insuficiencia de los ligamentos meniscotibiales, se logra estabilidad completa del menisco.Conclusión: la estabilidad principal del tercio posterior del menisco lateral está dada por la inserción periférica de los ligamentos meniscotibiales, por lo que la hipermovilidad meniscal externa no se debe a lesión de los ligamentos poplíteomeniscales. Nivel de Evidencia: IV

Introduction: The menisci are semilunar structures formed by fibrocartilage, located between the femur and the tibia. The lateral meniscus is more mobile due to its insertions through the tibial meniscus and popliteal meniscal ligaments. The medial meniscus has a displacement of 2-3 mm compared to a displacement of 9-10 mm for the external meniscus. It has been described in the world literature that meniscal hypermobility is secondary to injury to the popliteal meniscal ligaments (main stabilizers), however a cadaveric study was carried out where it was shown that the meniscal popliteal ligaments play a secondary role. The objective of this study is to demonstrate that injury to the meniscotibial ligaments is the cause of external meniscal hypermobility.Materials and methods: the cadaveric study was carried out in 2022 at Arthrex, Naples, Florida, United States. Prior to the arthroscopic evaluation, section of the meniscotibial ligaments was performed in the posterior third of the lateral meniscus, maintaining the popliteal meniscal ligaments and the posterior root insertion. Subsequently, the arthroscopic assessment is performed, showing anterior and superior translation of the posterior third of the external meniscus, and meniscal fixation is performed.Results: by fixing the posterior third of the lateral meniscus with a transosseous technique, in a failure or insufficiency of the meniscotibial ligaments, complete stability of the meniscus is achieved. Conclusion: the main stability of the posterior third of the lateral meniscus is given by the peripheral insertion of the meniscotibial ligaments, so external meniscal hypermobility is not due to injury to the popliteal meniscal ligaments. Level of Evidence: IV

Reconstrucción de labrum acetabular bilateral en hipoplasia labral con aloinjerto cadavérico / Bilateral acetabular labrum reconstruction in hypoplastic labrum with cadaveric allograft

El labrum acetabular es una estructura fibrocartilaginosa análoga a los meniscos, labrum glenoideo o fibrocartílago triangular. Cumple diferentes funciones biomecánicas como sellado articular, estabilidad articular, resistencia a la traslación, distribución de presiones, etc. En 2003 se describe que el pinzamiento femoroacetabular y la lesión labral son una de las causas de osteoartritis de la cadera. Existen múltiples clasificaciones para lesiones labrales, sin embargo, la de MAHORN incluye en su tipo II al labrum hipoplásico. La literatura define como labrum acetabular hipoplásico cuando el ancho es ≤5 mm, y puede ser de tipo primario (variante anatómica) o secundario (iatrogénica por desbridamiento previo). Existe un amplio espectro en el tratamiento de las lesiones labrales, que dependerá principalmente del tamaño del labrum, el patrón de la lesión, las características del tejido y la zona afectada; desde desbridamiento hasta reconstrucción labral con el fin de preservar la función biomecánica normal de la cadera y evitar el desarrollo de osteoartritis a largo plazo.A continuación, se describe el caso de un paciente de sexo masculino, de veintiocho años, con antecedente de pinzamiento femoroacetabular mixto bilateral y labrum acetabular hipoplásico bilateral, sometido a reconstrucción primaria de labrum derecho con aloinjerto cadavérico de peroneus longus e izquierdo con aloinjerto cadavérico de tendo Achillis, para el que se obtuvo un resultado clínico y funcional favorable. Nivel de Evidencia: IV

The acetabular labrum is a fibrocartilaginous structure analogous to the menisci, glenoid labrum, or triangular fibrocartilage. It fulfills different biomechanical functions, such as: joint sealing, joint stability, resistance to translation, pressure distribution, etc. In 2003 it was described that femoroacetabular impingement and labral injury is one of the causes of hip osteoarthritis. There are multiple classifications for labral lesions, however the MAHORN classification includes the hypoplastic labrum in its type II. The literature defines a hypoplastic acetabular labrum when its width is ≤5 mm, and it can be primary (anatomical variant) or secondary (iatrogenic due to previous debridement).There is a wide spectrum in the treatment of labral lesions, which mainly depends on the size of the labrum, the pattern of the lesion, the characteristics of the tissue and the affected area; from debridement to labral reconstruction in order to preserve the normal biomechanical function of the hip and avoid the development of osteoarthritis in the long term.The case of a 28-year-old male patient is described below, with a history of bilateral mixed-type femoroacetabular impingement and bilateral hypoplastic acetabular labrum, who underwent primary reconstruction of the right labrum with peroneus longus cadaveric allograft and left labrum with Achilles tendon cadaveric allograft, obtaining a favorable clinical and functional outcome. Level of Evidence: IV

Trasplante meniscal con aloinjerto cadavérico en adolescente con meniscopatía por menisco discoideo / Meniscal allograft transplantation in adolescent with meniscectomy

La incidencia de lesiones meniscales en adolescentes ha aumentado debido a la creciente tendencia, en este grupo de edad, de realizar actividades deportivas, una mayor sospecha diagnóstica y mejora en los métodos para su detección. Estas lesiones suelen asociarse a otras patologías, como lesiones de ligamento cruzado anterior o la presencia de menisco discoideo, un factor de riesgo importante. El menisco discoideo fue descripto por primera vez por Young en 1889, es una variación congénita morfológica del menisco lateral o medial, caracterizado por una hipertrofia central y un diámetro mayor de lo normal. Puede ser asintomático o manifestarse con dolor, bloqueo, chasquidos e hinchazón. El tratamiento histórico era la meniscectomía completa, la que se asociaba a cambios degenerativos articulares tempranos, por lo que actualmente se preconiza la saucerización como tratamiento de elección; además, se describe el trasplante meniscal como procedimiento de salvataje, en caso de daño meniscal irreparable. Se presenta el caso de una paciente femenina de doce años sometida a este procedimiento con antecedentes de múltiples intervenciones quirúrgicas en la rodilla izquierda, incluida la meniscectomía parcial, sin resultado clínico favorable. Nivel de Evidencia: IV

The incidence of meniscal injuries in adolescents has increased due to the growing tendency to perform sports activities in this age group, greater diagnostic suspicion, and improvement in diagnostic methods. They are usually associated with other pathologies, such as anterior cruciate ligament injuries and an important risk factor is the presence of a discoid meniscus. The discoid meniscus, first described by Young in 1889, is a congenital morphological variation of the lateral or medial meniscus, characterized by central hypertrophy and a larger diameter than normal meniscus. It can be asymptomatic or manifest with pain, blockage, clicking and swelling. The historical treatment was complete meniscectomy, which was associated with early degenerative joint changes, nowadays saucerization is recommended as the treatment of choice. In addition, the meniscal transplant is described as a salvage procedure, in case of irreparable meniscal damage. We present the case of a twelve-year-old female patient who underwent this procedure with a history of multiple surgical interventions on the left knee, including partial meniscectomy, without a favorable clinical result. Level of Evidence: IV