Factores de riesgo relacionados a la falla de la sutura meniscal en niños y adolescentes / Risk factors related to meniscal suture failure in children and adolescents

Las lesiones meniscales en niños son cada día más frecuentes. La preservación meniscal es una prioridad en este grupo de pacientes, sin embargo, existen pocos artículos que muestran los resultados de suturas meniscales en niños. OBJETIVO: El objetivo de este estudio es identificar factores de riesgo de falla en pacientes sometidos a una sutura meniscal en niños menores de 18 años. MÉTODO: Estudio retrospectivo de 35 pacientes sometidos a una sutura meniscal, con una edad promedio de 16 años (13­18) y un seguimiento de 71 meses de media (16­115). Se evaluaron 6 variables: tipo, localización y tamaño de la lesión, edad, técnica quirúrgica y asociación a rotura de ligamento cruzado anterior (LCA). Los pacientes que presentaron falla de la sutura meniscal fueron identificados y sometidos a una regresión logística usando un modelo Stata V.14.0. RESULTADOS: 9 pacientes (24.3%) presentaron una falla en su cirugía durante el seguimiento. Lesiones iniciales mayores a 16 mm mostraron una tasa de re-rotura de un 73% independiente de la técnica quirúrgica. En lesiones menores a 16 mm, se obtuvo un 78% de reparaciones exitosas. No se encontró relación entre la re-rotura meniscal y lesión de LCA, tipo y localización de la lesión, técnica quirúrgica y edad de los pacientes. CONCLUSIÓN: Este estudio muestra que la reparación meniscal en niños tiene buenos resultados con una tasa de éxito promedio de un 75%. El riesgo de falla de sutura meniscal se correlacionó con el tamaño inicial de la lesión con un 73% de fallo en lesiones mayores a 16 mm independientemente del tipo de cirugía.

Meniscal tears are uncommon in the pediatric population, with an increasing number. Currently meniscal preservation is a priority when treating these injuries. However, only a few studies have reported the clinical outcomes of arthroscopic meniscal repair in children and its risk factors of failure. OBJECTIVE: Identify risk factors related to meniscal suture failure in patients under 18 years who underwent a meniscal repair. METHODS: Retrospective study of 35 patients with an average age of 16 years (13 - 18) who underwent arthroscopic meniscal repair with a mean follow up of 71.1 months (16­115). We evaluate 6 variables: type, location and size of meniscal tear, age, surgical technique and anterior cruciate ligament (ACL) association. Patients with re-rupture were identified and statistical analysis was performed through a logistic regression model using Stata V.14.0. RESULTS: 9 patients (24.3%) presented a suture failure during follow-up. Average time for re-rupture was 16 months (4­60 months). With an initial tear size of 16 mm or bigger, 73% of the meniscal repair will fail despite surgery technique. With an initial tear size smaller than 16 mm, 78% of will heal. No association was found between meniscal re-rupture and ACL rupture, type and location of tear, surgical technique and age. Conclusion: In our study meniscal repairs in pediatric population had good overall results with a global healing rate of 75.7%. The risk of suture failure was related to the initial size of meniscal tear: when meniscal tear is bigger than 16 mm, 73% of them will fail despite surgery.

Experiencia y manejo en artritis séptica (AS) en cirugía de reconstrucción de ligamento cruzado anterior (LCA) / Septic arthritis after anterior cruciate ligament reconstruction

Objetivo: Identificar la incidencia, factores de riesgo asociados y resultados funcionales en un grupo de pacientes que presentaron una artritis séptica luego de la reconstrucción primaria de ligamento cruzado anterior. Materiales y Métodos: Estudio retrospectivo de una serie de pacientes sometidos a reconstrucción primaria del ligamento cruzado anterior, entre enero del 2000 y mayo del 2011. Se revisaron las fichas clínicas y protocolos operatorios analizando incidencia, presentación, gérmenes involucrados, factores de riesgo, tratamiento y resultados funcionales. Resultados: Analizamos 1.796 casos de reconstrucciones primarias del ligamento cruzado anterior, edad promedio de 26.5 años, identificando 9 casos de infecciones articulares y con una incidencia global de 0,5 %. Siete se presentaron en pacientes con autoinjerto de isquiotibiales, 2 en aloinjerto y ninguna en autoinjerto HTH. Entre los factores de riesgo intraoperatorios evaluados no se encontró correlación significativa. En todos los pacientes se realizó aseo quirúrgico artroscópico, preservando el injerto en el 67% de los casos. El score de Lysholm promedio fue 95 puntos. Conclusiones: La artritis séptica luego de la reconstrucción de ligamento cruzado anterior es una complicación de baja frecuencia. El manejo precoz es fundamental para obtener buenos resultados funcionales, no siendo necesaria la remoción del injerto en la mayoría de los casos. Nivel de Evidencia: IV

Objective: To identify the incidence, associated risk factors and functional outcomes of a group of patients who presented septic arthritis after anterior cruciate ligament reconstruction. Materials and Methods: Retrospective study of a series of patients who underwent anterior cruciate ligament reconstruction between January 2000 and May 2011. Medical and operative charts were reviewed to analyze incidence, presentation, involved microorganisms, intraoperative risk factors, treatment and functional results. Results: We analyzed 1.796 cases of primary ACL reconstructions, mean age 26.5 years, identifying 9 cases of joint infections with an overall incidence rate of 0.5 %. Seven occurred in patients with hamstring autograft, 2 in allograft and none in HTH autograft. Among the intraoperative risk factors evaluated, no significant correlation was found. All patients underwent arthroscopic drainage preserving the graft in 67% of the cases. The average Lysholm score was 95 points. Conclusion: Septic arthritis after anterior cruciate ligament reconstruction is a rare complication. Early management is essential to obtain good functional results, not requiring graft removal in most of the cases. Level of Evidence: IV

Experiencia y manejo en artritis séptica (AS) en cirugía de reconstrucción de ligamento cruzado anterior (LCA) / Septic arthritis after anterior cruciate ligament reconstruction

Objetivo: Identificar la incidencia, factores de riesgo asociados y resultados funcionales en un grupo de pacientes que presentaron una artritis séptica luego de la reconstrucción primaria de ligamento cruzado anterior. Materiales y Métodos: Estudio retrospectivo de una serie de pacientes sometidos a reconstrucción primaria del ligamento cruzado anterior, entre enero del 2000 y mayo del 2011. Se revisaron las fichas clínicas y protocolos operatorios analizando incidencia, presentación, gérmenes involucrados, factores de riesgo, tratamiento y resultados funcionales. Resultados: Analizamos 1.796 casos de reconstrucciones primarias del ligamento cruzado anterior, edad promedio de 26.5 años, identificando 9 casos de infecciones articulares y con una incidencia global de 0,5 %. Siete se presentaron en pacientes con autoinjerto de isquiotibiales, 2 en aloinjerto y ninguna en autoinjerto HTH. Entre los factores de riesgo intraoperatorios evaluados no se encontró correlación significativa. En todos los pacientes se realizó aseo quirúrgico artroscópico, preservando el injerto en el 67% de los casos. El score de Lysholm promedio fue 95 puntos. Conclusiones: La artritis séptica luego de la reconstrucción de ligamento cruzado anterior es una complicación de baja frecuencia. El manejo precoz es fundamental para obtener buenos resultados funcionales, no siendo necesaria la remoción del injerto en la mayoría de los casos. Nivel de Evidencia: IV (AU)

Objective: To identify the incidence, associated risk factors and functional outcomes of a group of patients who presented septic arthritis after anterior cruciate ligament reconstruction. Materials and Methods: Retrospective study of a series of patients who underwent anterior cruciate ligament reconstruction between January 2000 and May 2011. Medical and operative charts were reviewed to analyze incidence, presentation, involved microorganisms, intraoperative risk factors, treatment and functional results. Results: We analyzed 1.796 cases of primary ACL reconstructions, mean age 26.5 years, identifying 9 cases of joint infections with an overall incidence rate of 0.5 %. Seven occurred in patients with hamstring autograft, 2 in allograft and none in HTH autograft. Among the intraoperative risk factors evaluated, no significant correlation was found. All patients underwent arthroscopic drainage preserving the graft in 67% of the cases. The average Lysholm score was 95 points. Conclusion: Septic arthritis after anterior cruciate ligament reconstruction is a rare complication. Early management is essential to obtain good functional results, not requiring graft removal in most of the cases. Level of Evidence: IV (AU)

Septic arthritis in ACL reconstruction surgery with hamstring autografts. Eleven years of experience.

BACKGROUND: Knee joint infection after ACL reconstruction is a rare complication with a low reported incidence, but the consequences can be devastating. The purpose of the study was to determine the incidence of septic arthritis after primary ACL reconstruction with hamstring auto-graft and the risk factors that may be associated. METHOD: A retrospective study of all primary ACL reconstruction from January 2000 to May 2011. Electronic medical records were reviewed to determine the number of infections, operating time, associated procedure, time of presentation after surgery, infection treatment, microbiological cultures and graft retention. At the end of the follow-up (18-108months) a functional assessment of all the infected patients was performed using the Lysholm score with the Lysholm score. RESULTS: We analyzed 1564 cases of primary ACL reconstruction with hamstring autograft, of which seven cases were diagnosed with postoperative joint infection (incidence rate of 0.45%). The infectious agent most frequently isolated was a coagulase-negative Staphylococcus. Neither intraoperative factors nor age correlated with the development of the infection. The average Lysholm score was 95 points (range 89-100 points). All but two patients retained their reconstructed ACL. The results of the five patients in which the graft was preserved were significantly better than the two patients that had their grafts removed (p=0.03). CONCLUSION: We conclude that septic arthritis post ACL reconstruction has a low incidence rate, which if handled at an early stage allows the patients a satisfactory return to their previous activities. Graft retention is important to obtain better functional results. LEVEL OF EVIDENCE: IV.

Tratamiento de lesiones del cartílago patelar a través del sistema transferencia osteocondral autólogo / Treatment of patellar cartilage injuries with osteochondral autologous transfer system

Las lesiones osteocondrales en la rodilla representan un problema frecuente en la práctica médica. Estas llevan a la degeneración del cartílago hialino con la consecuente artrosis, causa importante de dolor y discapacidad. En los últimos años se han desarrollado múltiples técnicas para tratar estas lesiones. El sistema de transferencia osteocondral autólogo (OATS) ha sido descrito para el tratamiento de estos defectos focales en los cóndilos femorales; sin embargo, su aplicación real en la patela es todavía un tema de controversia. Una correcta selección de los pacientes en conjunto con una técnica quirúrgica adecuada son fundamentales para el resultado exitoso de esta cirugía. Nuestro objetivo es describir la técnica quirúrgica y los aspectos involucrados en el sistema de transferencia osteocondral autólogo para lesiones condrales focales de la patela.

Osteochondral injuries in the knee are a common problem in medical practice. These lead to the degeneration of the hyaline cartilage and the consequent osteoarthritis, a major cause of pain and disability. In recent years several techniques have been developed to treat these injuries. The osteochondral autologous transfer system (OATS) has been described for the treatment of these defects on the femoral condyles, however its actual implementation in the patella is not yet clear. Patient selection and adequate surgical technique are fundamental to a successful surgery. Our objective is to describe the surgical technique and aspects involved in the osteochondral autograft transfer system for isolated chondral injuries of the patella.

A new elevating metatarsal osteotomy: geometrical design and applications.

For metatarsalgia and lesser toe deformities, a commonly performed procedure is the Weil osteotomy, which inevitably depresses the metatarsal head, changing the intrinsic muscle axis and generating phalanx extension. The objective of this study is to present a new metatarsal osteotomy that shortens or lengthens and elevates the metatarsal head, the elevating metatarsal osteotomy (EMO), with its geometrical analysis and possible applications. A geometrical model was designed, planning an oblique subcapital osteotomy with slice resection and distal displacement. A trigonometric analysis was done to calculate how to shorten, elevate, or lengthen the metatarsal head. The EMO elevates the head in one-third of the width of the resected slice. Distal and dorsal displacement of the metatarsal head results in an elevation and lengthening of the metatarsal bone (60% elevation and 65% lengthening). Performing an elevating metatarsal osteotomy will lengthen and elevate the metatarsal head, which sometimes is necessary when treating toe deformities and instability.