Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus.

INTRODUCTION: Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. METHODS: 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. RESULTS: Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. CONCLUSIONS: The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.

Arthroscopically determined degree of injury after shoulder dislocation relates to recurrence rate.

BACKGROUND: The glenohumeral joint is the most mobile articulation in the body and the most commonly dislocated diarthrodial joint with peaks in the incidence of dislocation occurring during the second and sixth decades. Age at the time of the initial dislocation is inversely related to the recurrence rate. Traumatic anterior instability is often associated with intraarticular injuries. The frequency of injuries may increase with dislocation or subluxation episodes. QUESTIONS/PURPOSES: We compared the frequency of lesions associated with traumatic anterior instability in patients with primary and recurrent instability. METHODS: We retrospectively reviewed 96 selected patients with traumatic anterior instability treated arthroscopically between 2005 and 2008. Forty-five had arthroscopy after a first episode of dislocation (Group I) and 51 had two or more episodes of instability (Group II). We compared the frequencies and percentage of intraarticular lesions in both groups. RESULTS: We observed a Bankart lesion in all patients of both groups. The posterior Bankart lesion was observed more frequently in Group II than in Group I: 47% versus 28%. SLAP lesions were observed in 12% in Group I and 24% in Group II. In 10 patients in Group II, there was an associated rotator cuff tear. CONCLUSIONS: Patients with recurrent shoulder dislocation had a higher arthroscopic degree of injury. These patients presented more posterior labral lesions, SLAP tears, and rotator cuff pathology than patients with a first episode of shoulder dislocation. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Longitudinal tears of peroneus longus and brevis tendons: a gouty infiltration.

The natural history of recurrent uric acid deposition includes joint destruction, as well as tendon weakening and rupture. Simultaneous rupture of the peroneus longus and brevis tendons secondary to tophaceous gout is very rare. In the present report, we describe the case of a 37-year-old man who had a history of recurrent ankle pain and 4 previous episodes of acute gout localized to his ipsilateral first metatarsophalangeal joint. The physical examination revealed the ankle pain to actually be localized to the peroneal tendons immediately distal to the fibular malleolar groove. Magnetic resonance imaging showed longitudinal tears in the peroneus longus and brevis. Surgical exploration and repair of the ruptured tendons revealed the presence of monosodium urate deposition within the substance of the tendons at the rupture sites. The tendons were debrided and repaired using longus to brevis tenodesis. The postoperative course was unremarkable and entailed referral to a rheumatologist for metabolic management. After more than a 1-year period of follow-up, the patient was ambulating without difficulties wearing regular shoe gear.

Retorno deportivo en atletas de alto rendimiento después de reconstrucción de ligamento cruzado anterior de rodilla: análisis de factores y estrategias / Return to sport on high demand athletes before anterior cruciate ligament reconstruction: analysis of factors and strategies

Nuestro equipo de trabajo piensa que el éxito en la obtención del retorno deportivo pre lesión se basa no solo en la habilidad del cirujano y la técnica empleada. Definimos tres factores claves para lograr el retorno al deporte en forma satisfactoria: 1- Cirugía: con una adecuada selección de la técnica empleada, el tipo de injerto y los métodos de fijación y la aplicación de estimuladores biológicos a la cicatrización: Concentrado Plaquetario Autólogo con sus respectivos factores de crecimiento. Todo esto definido en base al paciente, su edad, sexo, tipo de deporte y nivel de competencia. 2- Rehabilitación acelerada: en esta etapa el kinesiólogo y fisioterapeuta recuperan la función de la rodilla operada y su capacidad funcional preparando al paciente para su entrenamiento funcional. 3- Entrenamiento funcional: fase en la cual se trabaja intensamente la neuro propiocepción, lo automatización de los gestos técnicos según cada deporte. Objetivo Describir los factores críticos involucrados en la obtención de una exitosa reconstrucción de ligamento cruzado anterior en deportistas de alto rendimiento Material y Método: Se analiza en forma retrospectiva 212 deportistas de alto rendimiento, 152 hombres y 60 mujeres, con un rango de edad de 15 a 28 años. Previo a autorizar el retorno al deporte se evalúa con resonancia magnética, evaluación isocinetica y pruebas funcionales según deporte. Resultados: Con esta evaluación integral el retorno deportivo fue de 94,5 por ciento en forma global, siendo en hombres un 97 por ciento y en mujeres 88 por ciento, en un plazo promedio de 7 meses. El retorno al entrenamiento se inicia en promedio a partir del 4 mes, con un rango entre el 4° Y 5° mes dependiendo del deporte. El 54 por ciento de los pacientes se reconstruyó utilizando tendón patelar y el 46 por ciento empleando isquiotibiales (semitendinoso/gráciles) Conclusiones: La reconstrucción de LCA en deportistas de alto rendimiento debe considerar una serie de factores en la toma de decisiones, ya que lograr un retorno al deporte al mismo nivel pre lesional no solo depende de una adecuada técnica quirúrgica.

Retorno deportivo en atletas de alto rendimiento después de reconstrucción de ligamento cruzado anterior de rodilla. Análisis de factores y estrategias / Return to sport on high demand athletes before anterior cruciate ligament reconstruction. Analysis of factors and strategies

Nuestro equipo de trabajo piensa que el éxito en la obtención del retorno deportivo pre lesión se basa no solo en la habilidad del cirujano y la técnica empleada. Definimos tres factores claves para lograr el retorno al deporte en forma satisfactoria: 1- Cirugía: con una adecuada selección de la técnica empleada, el tipo de injerto y los métodos de fijación y la aplicación de estimuladores biológicos a la cicatrización: Concentrado Plaquetario Autólogo con sus respectivos factores de crecimiento. Todo esto definido en base al paciente, su edad, sexo, tipo de deporte y nivel de competencia. 2- Rehabilitación acelerada: en esta etapa el kinesiólogo y fisioterapeuta recuperan la función de la rodilla operada y su capacidad funcional preparando al paciente para su entrenamiento funcional. 3- Entrenamiento funcional: fase en la cual se trabaja intensamente la neuro propiocepción, lo automatización de los gestos técnicos según cada deporte. Objetivo Describir los factores críticos involucrados en la obtención de una exitosa reconstrucción de ligamento cruzado anterior en deportistas de alto rendimiento Material y Método: Se analiza en forma retrospectiva 212 deportistas de alto rendimiento, 152 hombres y 60 mujeres, con un rango de edad de 15 a 28 años. Previo a autorizar el retorno al deporte se evalúa con resonancia magnética, evaluación isocinetica y pruebas funcionales según deporte. Resultados: Con esta evaluación integral el retorno deportivo fue de 94,5 por ciento en forma global, siendo en hombres un 97 por ciento y en mujeres 88 por ciento, en un plazo promedio de 7 meses. El retorno al entrenamiento se inicia en promedio a partir del 4 mes, con un rango entre el 4° Y 5° mes dependiendo del deporte. El 54 por ciento de los pacientes se reconstruyó utilizando tendón patelar y el 46 por ciento empleando isquiotibiales (semitendinoso/gráciles) Conclusiones: La reconstrucción de LCA en deportistas de alto rendimiento debe considerar una serie de factores en la toma de decisiones, ya que lograr un retorno al deporte al mismo nivel pre lesional no solo depende de una adecuada técnica quirúrgica (AU)

Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors.

PURPOSE: To determine whether the use of platelet-rich plasma gel (PRPG) affects magnetic resonance imaging (MRI) findings in the anterior cruciate ligament (ACL) graft during the first year after reconstruction. METHODS: A prospective single-blinded study of 50 ACL reconstructions in 50 patients was performed. In group A (study group) PRPG was added to the graft with a standardized technique, and in group B (control group) no PRPG was added. An MRI study was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist. RESULTS: The mean heterogeneity score value at the time of MRI, assigned by the radiologist, was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age (P < .05). The mean time to obtain a completely homogeneous intra-articular segment in group A (PRPG added) was 177 days after surgery, and it was 369 days in group B. Using the quadratic predictive model, these findings show that group A (PRPG added) needed only 48% of the time group B required to achieve the same MRI image (P < .001). CONCLUSIONS: ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG.

Late bullet migration into the knee joint.

A 25-year-old active-duty police officer was found to have an intra-articular foreign body on radiographic study of his left knee joint. He had a gunshot wound to the midthigh 54 months prior to the presentation of symptoms. The bullet was lodged in the soft tissue without involving neurovascular structures. The patient complained of limited range of motion of the joint and a "rattle" sensation of the knee. Arthroscopically, a deformed metallic foreign body was found and retrieved. There was no injury inside the joint related to the loose body. These findings were consistent with a migrating bullet from the midthigh to the knee joint. The patient recovered uneventfully and returned to work.