Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients Using Quadriceps Tendon Autograft.

Many techniques for reconstruction of pediatric and adolescent anterior cruciate ligament (ACL) ruptures have been described, yet the best technique to reproduce normal kinematics of the knee while causing minimal growth disturbance is not definitively determined. We describe a technique which adapts the Allen Anderson technique for all-inside, all-epiphyseal, anatomic ACL reconstruction. However, this technique uses a novel quadriceps tendon-patellar bone-autograft to provide the best-possible patient outcomes. ACL reconstruction advancement in pediatrics is important as an increasing number of adolescent athletes experience ACL rupture and desire to return to sport.

Transplante osteocondral autólogo no tratamento de lesões condrais na patela / Osteochondral autologous transplantation for treating chondral lesions in the patella

OBJETIVO: O objetivo primário deste estudo é avaliar a evolução clínica e funcional dos pacientes com lesão cartilaginosa de espessura total, sintomática da superfície articular da patela tratados com transplante osteocondral autólogo. MÉTODOS: Este estudo prospectivo envolveu 17 pacientes, sendo realizado no período de junho de 2008 a março de 2011. Foram preenchidos no pré-operatório e com um ano de pós-operatório, os questionários específicos de Lysholm, Kujala e Fulkerson para avaliação do joelho acometido e o SF-36 para avaliação da qualidade de vida geral dos pacientes. Foi utilizado o teste não paramétrico pareado de Wilcoxon na análise estatística dos valores pré e pós-operatórios dos questionários e os dados foram analisados no programa SPSS for Windows versão 16.0 e uma significância de 5% foi adotada. RESULTADOS: O Lysholm pré e pós-operatório médio foi de 54,59 e 75,76 pontos (p < 0,05). A pontuação do Fulkerson pré e pós-operatório médio foi de 52,53 e 78,41 pontos (p < 0,05). CONCLUSÕES: Consideramos o transplante osteocondral autólogo um bom método de tratamento para as lesões condrais de espessura total sintomáticas da superfície articular da patela.

OBJECTIVE: The primary aim of this study was to assess the clinical and functional evolution of patients with total-thickness symptomatic cartilaginous injury of the patellar joint surface, treated by means of osteochondral autologous transplantation. METHODS: This prospective study was conducted from June 2008 to March 2011 and involved 17 patients. The specific questionnaires of Lysholm, Kujala and Fulkerson were completed preoperatively and one year postoperatively in order to assess the affected knee, and SF-36 was used to assess these patients' general quality of life. The nonparametric paired Wilcoxon test was used for statistical analysis on the pre and postoperative questionnaires. The data were analyzed using the SPSS for Windows software, version 16.0, and a significance level of 5% was used. RESULTS: The Lysholm preoperative and postoperative average scores were 54.59 and 75.76 points (p < 0.05). The Fulkerson pre and postoperative average scores were 52.53 and 78.41 points (p < 0.05). CONCLUSIONS: We believe that autologous osteochondral transplantation is a good treatment method for total-thickness symptomatic chondral lesions of the joint surface of the patella.

Histochemical and ultrastructural study of the extracellular matrix fibers in patellar tendon donor site scars and normal controls.

Lesions of the anterior cruciate ligament are extremely common and frequently demand surgical treatment in order to avoid disabling sequels. The use of a central one-third of the patellar tendon as an autograft for surgical reconstruction of a damaged cruciate ligament is common. Although several investigations in human and animal models have demonstrated long-term graft viability, there have been cases of loosening and rupture of the graft. In these occasions, a new substitute for the torn structure must be found. Owing to its inherent accessibility, the patellar tendon has been elected one of the choices of donor tissue. In order to evaluate the characteristics of the remaining scar, we performed a histochemical and ultrastructural study using biopsy material obtained from the central one-third of the donor tendon of 8 patients. This material was analyzed by comparing the ultrastructural picture with the results obtained using the specific method for collagen-containing fibers (Picrosirius-polarization) by light microscopy; four normal patellar tendons were used as controls. Despite the resemblance with the normal tissue, our results show that the healed tissue does not restore the tendon ad integrum, neither at the light microscopic nor at the electron microscopic levels. Structural differences can be responsible for biomechanical alterations. Impaired biomechanical properties can, at least partly, explain some of the clinical complications observed in patients submitted to this surgical technique. However, without performing biomechanical studies in this kind of tendons, we are neither allowed to encourage nor to reject the use of scars as donor tissue for a second surgery.

Artroplastía total de rodilla sin componente rotuliano / Total knee replacement with preservation of the patient's patella

Se estudiaron 83 pacientes a los que se les realizó un total de 89 artroplastías de rodilla, evaluándose las ventajas y desventajas de no realizar la colocación del implante rotuliano. Solamente se incluyeron en el estudio pacientes con diagnóstico de gonartrosis degenerativa. Los pacientes se evaluaron con el sistema propuesto por the Knee Society antes y después de la cirugía, agregándose las complicaciones rotulianas como son luxación, subluxación y fractura patelar. Los resultados demostraron fractura de rótula en cinco pacientes (5.61 por ciento), dolor rotuliano en 15 (16.85 por ciento), y rigidez de rodilla en cinco (5.61 por ciento). No se presentaron casos de luxación o subluxación rotuliana. Al no colocar el botón rotuliano se disminuyen aún más las posibles complicaciones propias del implante en forma significativa