[Effect of asymptomatic chodral on the recovery of the working patient after a traumatic injury of the knee]. / Efecto de las lesiones condrales asintomáticas en la recuperación del paciente laboral tras una lesión traumática de rodilla.

The objective of this study was to investigate the prevalence and epidemiology of knee cartilage lesions in the work environment, and to assess whether they increase the patient's work leave and thus also cost. We also analyzed the prevalence of concomitant pathology and how it affected recovery and final outcome. MATERIAL AND METHODS: Monocentric retrospective cohort of patients with occupational injuries who underwent knee arthroscopy during 2018. Demographic data, diagnosis, concomitant chondral pathology, treatment, symptoms and signs at discharge, work leave and total cost were collected. RESULTS: 123 patients were analyzed, with a mean age of 47 years. No differences were found between sexes or with respect to obesity. Asymptomatic chondral lesions were found in 35.25% of the patients, primarily the older ones (48-53 years). The presence of cartilaginous pathology did not increase days of work leave or total cost (p > 0.05). In patients with meniscopathy in whom meniscectomy is performed, the chondral lesion increased the number of days of work leave (p = 0.03). There were no differences in the number of days of work leave nor total cost for different treatments of chondral pathology. CONCLUSION: The management of a concomitant chondral knee lesion is still controversial. These lesions might convey poorer functional prognosis in patients with meniscopathy. Current therapies have not shown a clear benefit in work injuries.

El objetivo principal del estudio fue analizar la asociación entre la presencia de lesiones cartilaginosas asintomáticas en pacientes con lesiones traumáticas de rodilla y su tiempo de baja y gasto mutual. Los objetivos secundarios fueron describir la prevalencia y epidemiología de estas lesiones y analizar si se asocian con la presencia de obesidad y un peor resultado final. Material y métodos: Revisión retrospectiva de una cohorte de todos los pacientes a los que se les realizó una artroscopía de rodilla tras una lesión traumática en un centro mutual en el año 2018. Se recogieron datos demográficos, diagnóstico, patología condral concomitante, tratamiento, clínica al alta, tiempo total de baja y el gasto derivado de ésta. Resultados: Fueron analizados 123 pacientes con una media de edad de 47 años, no se encontraron diferencias entre sexos ni respecto a la obesidad entre los grupos con y sin lesión condral. Las lesiones cartilaginosas fueron diagnosticadas en más de un tercio de los pacientes valorados (35.25%), la mayoría entre 48 y 53 años. La presencia de patología condral no fue un condicionante que aumentara los días de baja o el gasto total (p > 0.05). En pacientes con meniscectomía, la lesión condral aumenta el tiempo de baja (p = 0.03). Los tratamientos enfocados en la lesión condral no produjeron diferencias en cuanto a la duración de la baja ni en el gasto. Conclusión: El manejo de una lesión condral concomitante a nivel de la rodilla sigue presentando controversia. Podría implicar un factor de mal pronóstico de recuperación en pacientes con meniscopatía y las terapias actuales no han mostrado un beneficio claro en estos pacientes del entorno laboral.

Efecto de las lesiones condrales asintomáticas en la recuperación del paciente laboral tras una lesión traumática de rodilla / Effect of asymptomatic chodral on the recovery of the working patient after a traumatic injury of the knee

Resumen: El objetivo principal del estudio fue analizar la asociación entre la presencia de lesiones cartilaginosas asintomáticas en pacientes con lesiones traumáticas de rodilla y su tiempo de baja y gasto mutual. Los objetivos secundarios fueron describir la prevalencia y epidemiología de estas lesiones y analizar si se asocian con la presencia de obesidad y un peor resultado final. Material y métodos: Revisión retrospectiva de una cohorte de todos los pacientes a los que se les realizó una artroscopía de rodilla tras una lesión traumática en un centro mutual en el año 2018. Se recogieron datos demográficos, diagnóstico, patología condral concomitante, tratamiento, clínica al alta, tiempo total de baja y el gasto derivado de ésta. Resultados: Fueron analizados 123 pacientes con una media de edad de 47 años, no se encontraron diferencias entre sexos ni respecto a la obesidad entre los grupos con y sin lesión condral. Las lesiones cartilaginosas fueron diagnosticadas en más de un tercio de los pacientes valorados (35.25%), la mayoría entre 48 y 53 años. La presencia de patología condral no fue un condicionante que aumentara los días de baja o el gasto total (p > 0.05). En pacientes con meniscectomía, la lesión condral aumenta el tiempo de baja (p = 0.03). Los tratamientos enfocados en la lesión condral no produjeron diferencias en cuanto a la duración de la baja ni en el gasto. Conclusión: El manejo de una lesión condral concomitante a nivel de la rodilla sigue presentando controversia. Podría implicar un factor de mal pronóstico de recuperación en pacientes con meniscopatía y las terapias actuales no han mostrado un beneficio claro en estos pacientes del entorno laboral.

Abstract: The objective of this study was to investigate the prevalence and epidemiology of knee cartilage lesions in the work environment, and to assess whether they increase the patient's work leave and thus also cost. We also analyzed the prevalence of concomitant pathology and how it affected recovery and final outcome. Material and methods: Monocentric retrospective cohort of patients with occupational injuries who underwent knee arthroscopy during 2018. Demographic data, diagnosis, concomitant chondral pathology, treatment, symptoms and signs at discharge, work leave and total cost were collected. Results: 123 patients were analyzed, with a mean age of 47 years. No differences were found between sexes or with respect to obesity. Asymptomatic chondral lesions were found in 35.25% of the patients, primarily the older ones (48-53 years). The presence of cartilaginous pathology did not increase days of work leave or total cost (p > 0.05). In patients with meniscopathy in whom meniscectomy is performed, the chondral lesion increased the number of days of work leave (p = 0.03). There were no differences in the number of days of work leave nor total cost for different treatments of chondral pathology. Conclusion: The management of a concomitant chondral knee lesion is still controversial. These lesions might convey poorer functional prognosis in patients with meniscopathy. Current therapies have not shown a clear benefit in work injuries.

Evaluación funcional de los pacientes con rotura del ligamento cruzado anterior. Estudio analítico transversal / Functional evaluation of patients with anterior cruciate ligament injury. A transversal analytical study

OBJETIVO: Evaluar, mediante un análisis biomecánico, la alteración funcional de la marcha y del equilibrio de pacientes con rotura del ligamento cruzado anterior (LCA). MATERIAL Y MÉTODO: Estudio analítico transversal en 64 sujetos, 27 sujetos sanos y 37 pacientes con lesión de LCA. A todos los sujetos se les realizó un análisis biomecánico de la marcha mediante 4 pruebas: 1) prueba cinemática de la marcha, para caracterizar el patrón de marcha; 2) prueba de análisis cinético de la marcha, para analizar las características de las fuerzas ejercidas contra el suelo, la duración de las pisadas, la simetría entre ambas extremidades y la repetitividad del gesto analizado; 3) prueba de la marcha con pívot, para valorar la estabilidad rotacional de la rodilla alrededor del eje sagital; y 4) prueba de equilibrio. RESULTADOS: Se han encontrado alteraciones en el análisis cinemático y cinético tanto en la rodilla lesionada como en la sana respecto al grupo control. En la prueba de la marcha con pívot hay una tendencia al aumento de las fuerzas en los 3 ejes, tanto en la pierna de apoyo como en la pierna de salida en los pacientes con rotura de LCA, en comparación con los sujetos sanos. CONCLUSIÓN: La rotura del LCA produjo alteración del patrón de marcha, alteración de las fuerzas ejercidas contra el suelo, de la duración de las pisadas, de la simetría entre ambas extremidades y de la repetitividad del gesto durante la marcha y alteración de la estabilidad rotacional de la rodilla en el eje sagital

OBJECTIVE: To evaluate, by means of biomechanical analysis, functional alterations of gait and balance of patients with anterior cruciate ligament (ACL) injury. MATERIAL AND METHODS: Transversal analytical study on 64 people, 27 health subjects and 37 patients with ACL injury. Biomechanical analysis of gait in all individuals was performed by means of four tests: 1) kinematic test, to characterize gait pattern; 2) kinetic test, to characterize forces against the floor, duration of treads, symmetry of both legs, and the reproducibility of the gait; 3) pivot-shift test, to analyze the rotational stability of the knee on the sagittal axis; and 4) equilibrium test. RESULTS: Alterations in kinematic and kinetic analysis were found in both the injured knee and the healthy knee compared to the control group. In the pivot-shift gait test there is a tendency to increase the forces on the three axes, both in the support leg and in the exit leg in patients with ACL injury, in comparison with healthy subjects. CONCLUSION: ACL injury-induced changes in gait pattern, changes in forces against the floor, duration of treads, symmetry of both legs, and the reproducibility of gait and changes in rotational stability of the knee on the sagittal axis

Utilización del ácido tranexámico tópico en la artroplastia total primaria de cadera. Eficacia y seguridad. Nuestra experiencia / Use of topical tranexamic acid in primary total hip arthroplasty. Efficiency and safety. Our experience

ANTECEDENTES Y OBJETIVO: El ácido tranexámico por vía intravenosa ha demostrado que disminuye el sangrado y la necesidad de transfusiones en la artroplastia total de cadera, aunque tiene un riesgo teórico de producir fenómenos tromboembólicos. Recientemente, se han publicado algunos trabajos con la aplicación del ácido tranexámico tópico, sin haberse definido todavía cuál es el protocolo de administración ideal. El objetivo de este trabajo fue demostrar que nuestro protocolo de administración tópica de ácido tranexámico es eficaz y seguro. MATERIALES Y MÉTODOS: Recogida de datos de una serie prospectiva de 80 artroplastias primarias de cadera, en las que se utilizó un protocolo de ácido tranexámico tópico: se prepararon 1,5 g diluidos en un volumen total de 60ml, administrando 20ml tras fresar el cotilo, 20ml en el canal femoral y 20ml a través del redón, manteniéndolo cerrado durante 20 min. RESULTADOS: Se intervino a 80 pacientes. Hemoglobina preoperatoria 14,26g/dl; hematocrito preoperatorio 42,39%. Se observó una pérdida media de 2,74g/dl de hemoglobina y del 8% de hematocrito. Precisaron transfusión el 11% de los pacientes, de los cuales el 67% tenía una anemia previa conocida; solo 3 pacientes sin anemia previa precisaron transfusión (4%). No hubo ninguna complicación tromboembólica en nuestra serie. CONCLUSIONES: La utilización de ácido tranexámico tópico fue eficaz y segura en la artroplastia total primaria de cadera, reduciendo la necesidad de transfusión sanguínea respecto a lo descrito en la literatura en pacientes no tratados

BACKGROUND AND AIM: Intravenous tranexamic acid has been shown to reduce bleeding and the need for transfusions in total hip arthroplasty, although it has a theoretical risk of producing thromboembolic phenomena. Recently some papers have been published using the topical application of tranexamic acid, but the ideal administration protocol has not yet been clearly defined. The aim of this paper was to demonstrate that our protocol of topical tranexamic acid is effective and safe. MATERIALS AND METHODS: Prospective data collection from a case series of 80 primary hip arthroplasties, in which the following topical tranexamic acid protocol is used: 1.5 grams diluted to a total volume of 60ml were administered, applying 20ml in the acetabular bed, 20ml in the femoral canal and 20ml through the Redon drain, keeping it closed for 20minutes. RESULTS: Eighty patients were operated. Preoperative haemoglobin 14.26g / dL; preoperative haematocrit 42.39%. An average loss of 2.74g / dL of haemoglobin and 8% of haematocrit was obtained. Eleven percent of the patients required transfusion, of whom 67% had known previous anaemia; only 3 patients without prior anaemia required transfusion (4%). There were no thromboembolic complications in our series. CONCLUSIONS: The use of topical tranexamic acid was safe and effective in primary total hip arthroplasty, reducing the need for blood transfusion compared to that described in the literature in untreated patients

Tendinitis calcificante de hombro con extensión intraósea: experiencia con el tratamiento artroscópico y revisión de la literatura / Calcific tendinopathy of the shoulder with intraosseous extension: experience with arthroscopic treatment and review of the literature

ANTECEDENTES Y OBJETIVO: La tendinitis calcificante del manguito de los rotadores es una de las causas frecuentes de dolor en el hombro. El objetivo fue dar a conocer una presentación poco habitual de la tendinitis calcificante de hombro, la expansión intraósea, que en muchos casos puede ser confundida con una lesión tumoral o infecciosa, y de esta manera evitar biopsias o tratamientos innecesarios, y presentar nuestra experiencia con el tratamiento artroscópico. MATERIAL Y MÉTODOS: Se presentan 2 casos clínicos de tendinitis calcificante de hombro con extensión intraósea y una revisión de las series publicadas. RESULTADOS: En ambos casos se observó erosión de la cortical, una lesión osteolítica en la tuberosidad mayor y un edema perilesional. Se obtuvieron buenos resultados con el tratamiento mediante artroscopia de hombro con desbridamiento de la lesión y reinserción del supraespinoso en la tuberosidad mayor mediante un arpón. CONCLUSIONES: Ante una lesión osteolítica con edema perilesional en la tuberosidad mayor, hay que valorar, dentro del diagnóstico diferencial, la expansión intraósea de una tendinitis calcificante. En nuestros casos el tratamiento artroscópico fue eficaz

BACKGROUND AND AIM: Calcific tendinitis of the rotator cuff is a common cause of shoulder pain. The aim of the present study was to show a rare presentation of calcific tendinopathy of the shoulder, the intraosseous extension, which can be mistaken for a bone tumour or an infectious disease. MATERIAL AND METHODS: Two clinical cases of calcific tendinopathy of the shoulder with intraosseous extension and a review of the literature are presented. RESULTS: Cortical erosion, osteolytic lesion in the greater tuberosity and perilesional oedema were observed in both cases. Good results were achieved with shoulder arthroscopy including lesion debridement and reinsertion of the tendon in the greater tuberosity with an anchor. CONCLUSIONS: In the presence of an osteolytic lesion with perilesional oedema in the greater tuberosity, the intraosseous expansion of a calcifying tendinopathy should be included in the differential diagnosis. In our cases the arthroscopic treatment was successful

Use of topical tranexamic acid in primary total hip arthroplasty. Efficiency and safety. Our experience. / Utilización del ácido tranexámico tópico en la artroplastia total primaria de cadera. Eficacia y seguridad. Nuestra experiencia.

BACKGROUND AND AIM: Intravenous tranexamic acid has been shown to reduce bleeding and the need for transfusions in total hip arthroplasty, although it has a theoretical risk of producing thromboembolic phenomena. Recently some papers have been published using the topical application of tranexamic acid, but the ideal administration protocol has not yet been clearly defined. The aim of this paper was to demonstrate that our protocol of topical tranexamic acid is effective and safe. MATERIALS AND METHODS: Prospective data collection from a case series of 80 primary hip arthroplasties, in which the following topical tranexamic acid protocol is used: 1.5 grams diluted to a total volume of 60ml were administered, applying 20ml in the acetabular bed, 20ml in the femoral canal and 20ml through the Redon drain, keeping it closed for 20minutes. RESULTS: Eighty patients were operated. Preoperative haemoglobin 14.26g / dL; preoperative haematocrit 42.39%. An average loss of 2.74g / dL of haemoglobin and 8% of haematocrit was obtained. Eleven percent of the patients required transfusion, of whom 67% had known previous anaemia; only 3 patients without prior anaemia required transfusion (4%). There were no thromboembolic complications in our series. CONCLUSIONS: The use of topical tranexamic acid was safe and effective in primary total hip arthroplasty, reducing the need for blood transfusion compared to that described in the literature in untreated patients.

Functional evaluation of patients with anterior cruciate ligament injury. A transversal analytical study. / Evaluación funcional de los pacientes con rotura del ligamento cruzado anterior. Estudio analítico transversal.

OBJECTIVE: To evaluate, by means of biomechanical analysis, functional alterations of gait and balance of patients with anterior cruciate ligament (ACL) injury. MATERIAL AND METHODS: Transversal analytical study on 64 people, 27 health subjects and 37 patients with ACL injury. Biomechanical analysis of gait in all individuals was performed by means of four tests: 1) kinematic test, to characterize gait pattern; 2) kinetic test, to characterize forces against the floor, duration of treads, symmetry of both legs, and the reproducibility of the gait; 3) pivot-shift test, to analyze the rotational stability of the knee on the sagittal axis; and 4) equilibrium test. RESULTS: alterations in kinematic and kinetic analysis were found in both the injured knee and the healthy knee compared to the control group. In the pivot-shift gait test there is a tendency to increase the forces on the three axes, both in the support leg and in the exit leg in patients with ACL injury, in comparison with healthy subjects. CONCLUSION: ACL injury-induced changes in gait pattern, changes in forces against the floor, duration of treads, symmetry of both legs, and the reproducibility of gait and changes in rotational stability of the knee on the sagittal axis.

Calcific tendinopathy of the shoulder with intraosseous extension: experience with arthroscopic treatment and review of the literature. / Tendinitis calcificante de hombro con extensión intraósea: experiencia con el tratamiento artroscópico y revisión de la literatura.

BACKGROUND AND AIM: Calcific tendinitis of the rotator cuff is a common cause of shoulder pain. The aim of the present study was to show a rare presentation of calcific tendinopathy of the shoulder, the intraosseous extension, which can be mistaken for a bone tumour or an infectious disease. MATERIAL AND METHODS: Two clinical cases of calcific tendinopathy of the shoulder with intraosseous extension and a review of the literature are presented. RESULTS: Cortical erosion, osteolytic lesion in the greater tuberosity and perilesional oedema were observed in both cases. Good results were achieved with shoulder arthroscopy including lesion debridement and reinsertion of the tendon in the greater tuberosity with an anchor. CONCLUSIONS: In the presence of an osteolytic lesion with perilesional oedema in the greater tuberosity, the intraosseous expansion of a calcifying tendinopathy should be included in the differential diagnosis. In our cases the arthroscopic treatment was successful.

Lesión del labrum superior anteroposterior (SLAP) en el entorno laboral / Superior labral anterior to posterior (SLAP) injury in the workplace

Antecedentes y objetivo: La lesión del labrum superior anteroposterior (SLAP) es una conocida causa de dolor y disfunción del hombro en pacientes activos. El objetivo fue estudiar las lesiones de SLAP en población laboral y valorar la fiabilidad de la exploración física y las técnicas de imagen en el diagnóstico de las lesiones de SLAP en el entorno laboral. Material y métodos: Revisión retrospectiva de 58 lesiones de SLAP tratadas en nuestra mutua laboral desde 2005 hasta 2015 en 815 pacientes en los que se realizó una artroscopia de hombro. Se han recogido datos del mecanismo lesional, datos clínicos, pruebas complementarias (comparando el informe radiológico inicial con el de un radiólogo especializado en musculoesquelético), hallazgos artroscópicos y tratamiento realizado. Resultados: El mecanismo lesional más frecuente ha sido la lesión aguda levantando peso, en la mayoría de casos, por encima de la cabeza. La lesión de SLAP se sospechó en el 41% con anamnesis y exploración física, en el 29% de los informes radiológicos iniciales y en el 52% en los informes del radiólogo especialista en musculoesquelético. Presentaron lesiones asociadas el 78%, la mayoría lesiones del manguito rotador. Conclusión: La lesión de SLAP en el entorno laboral es infrecuente y muchas veces se diagnostica durante una artroscopia realizada por otra lesión. La artrorresonancia magnética y la resonancia magnética tienen menos fiabilidad que la evaluación clínica para su diagnóstico. Un radiólogo especializado en musculoesquelético podría mejorar la rentabilidad de las pruebas de imagen en el diagnóstico de estas lesiones

Background and objective: Superior labral anterior to posterior (SLAP) injuries are widely recognised as a cause of pain and dysfunction in the shoulders of active patients. The aims of the present study were to analyze SLAP injuries in the workplace, and to evaluate the reliability of physical examination and imaging techniques for the diagnosis of work-related SLAP injuries. Material and methods: Retrospective chart review of 58 SLAP injuries treated in our occupational health centre from 2005 to 2015 in 815 patients undergoing shoulder arthroscopy. Data were collected on mechanism of injury, clinical proceedings, complementary tests (contrasting the initial magnetic resonance imaging report with that of a radiologist specializing in musculoskeletal pathology), arthroscopy findings and treatments performed. Results: The most common mechanism of injury was acute injury while handling weight, in the majority of cases, above the head. SLAP injury was suspected in 41% of cases through anamnesis and physical exam, in 29% through the initial magnetic resonance imaging report, and in 52% through the specialised radiologist's report. In 78%, associated injuries were present, the most common being rotator cuff injuries. Conclusions: SLAP injuries in the workplace are rare and are often a diagnostic finding during surgical intervention performed for a different associated injury. Arthro-magnetic resonance imaging and magnetic resonance imaging have lower reliability than physical exams in the diagnosis of work-related SLAP injuries. A radiologist specializing in musculoskeletal pathology could probably improve the reliability of imaging test interpretation in work-related SLAP injuries

Superior labral anterior to posterior (SLAP) injury in the workplace. / Lesión del labrum superior anteroposterior (SLAP) en el entorno laboral.

BACKGROUND AND OBJECTIVE: Superior labral anterior to posterior (SLAP) injuries are widely recognised as a cause of pain and dysfunction in the shoulders of active patients. The aims of the present study were to analyze SLAP injuries in the workplace, and to evaluate the reliability of physical examination and imaging techniques for the diagnosis of work-related SLAP injuries. MATERIAL AND METHODS: Retrospective chart review of 58 SLAP injuries treated in our occupational health centre from 2005 to 2015 in 815 patients undergoing shoulder arthroscopy. Data were collected on mechanism of injury, clinical proceedings, complementary tests (contrasting the initial magnetic resonance imaging report with that of a radiologist specializing in musculoskeletal pathology), arthroscopy findings and treatments performed. RESULTS: The most common mechanism of injury was acute injury while handling weight, in the majority of cases, above the head. SLAP injury was suspected in 41% of cases through anamnesis and physical exam, in 29% through the initial magnetic resonance imaging report, and in 52% through the specialised radiologist's report. In 78%, associated injuries were present, the most common being rotator cuff injuries. CONCLUSIONS: SLAP injuries in the workplace are rare and are often a diagnostic finding during surgical intervention performed for a different associated injury. Arthro-magnetic resonance imaging and magnetic resonance imaging have lower reliability than physical exams in the diagnosis of work-related SLAP injuries. A radiologist specializing in musculoskeletal pathology could probably improve the reliability of imaging test interpretation in work-related SLAP injuries.

Utilización del plasma rico en plaquetas en el tratamiento de la patología del manguito de los rotadores. ¿Qué hay demostrado científicamente? / Use of platelet-rich plasma in the treatment of rotator cuff pathology. What has been scientifically proven?

Objetivo. Obtener una visión objetiva de las evidencias científicas y/o clínicas actuales sobre el uso de plasma rico en plaquetas (PRP) en el tratamiento de la patología del manguito de los rotadores. Método. Revisión sistemática en Pubmed e identificación de estudios que evalúen la eficacia de PRP en el tratamiento de la patología del manguito de los rotadores desde 2013 hasta la actualidad. Los datos se agrupan según el tipo de estudio (laboratorio, clínico o metaanálisis); se obtienen datos sobre el diseño del estudio, la patología tratada y los resultados clínicos. Resultados. Se han analizado 35 artículos: 10 estudios de laboratorio, 17 estudios clínicos y 8 metaanálisis. Mientras que los estudios de laboratorio observan resultados positivos o parcialmente positivos para el uso de PRP, el 70,6% de los estudios clínicos y el 75% de los metaanálisis no encuentran diferencias estadísticamente significativas entre el grupo con PRP y el grupo control. Discusión. Los resultados positivos de los estudios de laboratorio tienen una baja traslación a los estudios clínicos. No hay concordancia entre los escasos resultados positivos observados en los diferentes estudios clínicos, habiéndose observado incluso resultados contradictorios. Conclusiones. No existen evidencias científicas y/o clínicas sólidas para el uso de PRP en el tratamiento de la patología del manguito de los rotadores en la práctica clínica habitual (AU)

Purpose. To analyze the current scientific and/or clinical evidence supporting the use of platelet-rich plasma (PRP) in the treatment of rotator cuff pathology. Methods. After a systematic review in PubMed, studies assessing PRP efficacy in the treatment of rotator cuff pathology published since 2013 to date were identified. Data were grouped based on type of study (laboratory, clinical or meta-analysis); accordingly study design, pathology treated and clinical outcomes were summarized. Results. Thirty five articles have been analyzed: 10 laboratory studies, 17 clinical assays and 8 meta-analyses. While laboratory studies report positive or partially positive results for the use of PRP, 70.6% of clinical studies and 75% of meta-analysis found no statistically significant differences between the PRP group and the control group. Discussion. The positive results of laboratory studies do not translate well to clinical practice. There is no concordance among the few positive results reported in the clinical studies, and even some contradictory effects have been reported. Conclusions. There is no solid scientific and/or clinical evidence supporting the use of PRP in the treatment of rotator cuff pathology in routine clinical practice (AU)

Use of platelet-rich plasma in the treatment of rotator cuff pathology. What has been scientifically proven? / Utilización del plasma rico en plaquetas en el tratamiento de la patología del manguito de los rotadores. ¿Qué hay demostrado científicamente?

PURPOSE: To analyze the current scientific and/or clinical evidence supporting the use of platelet-rich plasma (PRP) in the treatment of rotator cuff pathology. METHODS: After a systematic review in PubMed, studies assessing PRP efficacy in the treatment of rotator cuff pathology published since 2013 to date were identified. Data were grouped based on type of study (laboratory, clinical or meta-analysis); accordingly study design, pathology treated and clinical outcomes were summarized. RESULTS: Thirty five articles have been analyzed: 10 laboratory studies, 17 clinical assays and 8 meta-analyses. While laboratory studies report positive or partially positive results for the use of PRP, 70.6% of clinical studies and 75% of meta-analysis found no statistically significant differences between the PRP group and the control group. DISCUSSION: The positive results of laboratory studies do not translate well to clinical practice. There is no concordance among the few positive results reported in the clinical studies, and even some contradictory effects have been reported. CONCLUSIONS: There is no solid scientific and/or clinical evidence supporting the use of PRP in the treatment of rotator cuff pathology in routine clinical practice.

Evaluación de los resultados de la artrodesis tibiotalocalcánea con enclavado retrógrado como técnica de rescate en 15 casos / Evaluation of tibiotalocalcaneal arthrodesis using a retrograde nail as a rescue technique in 15 cases

Evaluar la utilidad de la artrodesis tibiotalocalcánea mediante clavo retrógrado como técnica de rescate en pacientes con deformidad y dolor de las articulaciones tibioastragalina y subastragalina. Material y método. Estudio retrospectivo de 15 casos consecutivos (9 hombres, 5 mujeres), edad media de 46 años, en los que se realizó una artrodesis tibiotalocalcánea con clavo retrógrado. En todos los pacientes habían fracasado otras medidas. Se realizó una anamnesis, exploración y estudio radiográfico detallados previa intervención, valoración funcional mediante la escala AOFAS y el grado de fusión tras la cirugía mediante estudio radiográfico y TC. Resultados. La indicación más frecuente fue la artrosis postraumática en 8 de los 15 casos, seguida en frecuencia por artrosis primaria en 4 casos. Se obtuvo la consolidación en el 93% de los casos (14 de los 15 pacientes) en un tiempo medio aproximado de 20 semanas y un seguimiento medio de 20 meses. El 73% de los pacientes presentaron complicaciones siendo el retardo de consolidación y la pseudoartrosis las más importantes. La mejoría media en la escala AOFAS fue de 43,8 puntos, a expensas fundamentalmente de la mejoría del dolor. Conclusión. Coincidimos con la literatura publicada en considerarla una técnica de rescate útil en pacientes en los que han fracaso cirugías previas y como procedimiento de elección en pacientes con artropatia inflamatoria. Sin embargo, es una técnica exigente, con un alto porcentaje de complicaciones, por lo que requiere una selección cuidadosa de los casos y un diálogo detallado sobre las expectativas de los pacientes (AU)

Objective: To evaluate the usefulness of tibiotalocalcaneal arthrodesis using a retrograde nail as a rescue technique in patients with deformity and pain in the tibia-astragalus and sub-astragalus joints. Material and method: A retrospective study of 15 consecutive cases (9 men, 5 women), with a mean age of 46 years, in whom a tibiotalocalcaneal arthrodesis using a retrograde nail was performed. Other measures had failed in all the patients. An anamnesis, physical and radiographic examination, details of previous treatments were carried out, as well as functional assessment using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the degree of fusion after surgery with x-rays and CT. Results: The most common indication was post-traumatic arthrosis 8 of the 15 cases, followed in frequency by primary arthrosis in 4 cases. Consolidation was achieved in 93% of cases (14 of the 15 patients) in a mean time of approximately 20 weeks and a mean follow up of 20 months. Complications were observed in 73% of patients, with delayed consolidation and pseudoarthrosis being the most important. The mean improvement on the AOFAS scale was 43.8 points, mainly due to the improvement in pain. Conclusion: We agree with that published in the literature in considering this a useful rescue technique in patients where previous surgery has failed, and as a procedure of choice in patients with inflammatory arthritic disease. However, it is a demanding technique, with a high percentage of complications, and requires careful selection of the cases and a detailed dialogue on the expectations of the patients (AU)

Artrodesis tibiotalocalcánea con clavo retrógrado de reconstrucción / Tibio-talo-calcaneal fusion using a retrograde reconstruction nail

Objetivo. Valorar los resultados con la escala AOFAS (American Orthopaedic Foot and Ankle Society) de los pacientes intervenidos de artrodesis tibiotalocalcánea con clavo retrógrado de reconstrucción. Material y método. Se presentan los resultados de 5 pacientes intervenidos de artrodesis tibiotalocalcánea con clavo retrógrado por lesión grave de las articulaciones tibioastragalina y subastragalina. En todos los casos había importante alteración funcional a la marcha y dolor intenso. Las indicaciones incluyeron artrosis tibioastragalina y subastragalina, artritis destructiva no filiada, pseudoartrosis de una artrodesis primaria del tobillo, necrosis del astrágalo y reconstrucción primaria de una fractura de pilón tibial y astrágalo. La edad media fue de 38,8 años, con un rango entre 24 y 62 años. El tiempo medio de consolidación fue de 20 semanas.La complicación más importante fue una infección de la herida quirúrgica. Resultados. Los resultados funcionales fueron valorados antes y después de la cirugía según los criterios de la AOFAS, siendo en todos los casos muy satisfactorios, con una puntuación media de 70,8 puntos. Conclusiones. La artrodesis tibiotalocalcánea con clavo retrógrado parece ser una técnica excelente en pacientes con afectación grave de las articulaciones tibioastragalina y subastragalina que no respondan a ningún tratamiento no quirúrgico, y como cirugía de rescate en aquellas técnicas de artrodesis que hayan fracasado previamente (AU)

A reinforced rigid fixation device for unstable intertrochanteric fractures.

A 120 degrees blade plate reinforced by a strut is introduced for the treatment of unstable intertrochanteric and proximal subtrochanteric fractures. Mechanical tests showed that the strength of this reinforced resistance device was 11,758 N. This strength is two and three times greater than that of the Gamma nail and sliding hip screw, respectively, and five times greater with the strut than without it. Three hundred fifty-eight patients older than 60 years of age were treated with this method between 1987 and 1991 (mean followup, 16 months). Six months after surgery the fracture had united in 82% of the patients who were walking without aid or using only a cane. Weightbearing began when the patient's general overall condition allowed such activity (average, 5 days; mode, 3 days). A chi squared test showed no difference regarding the results between stable and unstable fractures. Intraoperative and postoperative complication rates were 3% and 7.1%, respectively. The failure of fixation rate was 5.4%. Mechanical tests and clinical results showed that immediate weightbearing can be allowed in all types of intertrochanteric fractures. This reinforced device is effective in treating unstable intertrochanteric fractures and is especially indicated for the most unstable types (Evans' Grades 4 and 5).

Interlocked intramedullary nailing for treatment of open femoral shaft fractures.

Twenty-eight patients with open femoral shaft fractures treated by reamed intramedullary nailing were reviewed retrospectively. Nine patients had Gustilo Grade I injuries; 14, Grade II; and five, Grade IIIA. Twenty cases had static locking, two cases had dynamic locking, and six cases were not locked. Average time to union was 20 weeks. The infection and nonunion rates were 0%. The data suggest that interlocked reamed intramedullary nailing is a safe treatment option for treating open femoral shaft fractures.

Fractures of the central metatarsal.

We reviewed the evolution and final results of 57 patients with central metatarsal fractures treated in Hospital "La Fe" in Valencia between 1982 and 1993. The treatments were nonsurgical in 36 cases and surgical in 21 cases. The most frequent etiologies were traffic accidents, followed by work-related accidents. The fractures were classified according to their anatomic localization and whether they were closed (44 cases) or open (13 cases). Poor functional results manifested by metatarsalgia were present most often when one or two of the following were present: comminution, sagittal plane displacement, open fracture, or severe soft tissue injury. The mean follow-up was 5 years.