The development of the anterior cruciate ligament in the paediatric population.

PURPOSE: The aim of this study was to retrospectively compile normative data on the anterior cruciate ligament (ACL) in the paediatric population with magnetic resonance imaging, emphasizing the differences between men and women. METHODS: In this retrospective study, musculoskeletal radiologists evaluated length, area, coronal and sagittal inclination of the ACL and inclination of the intercondylar notch. A total of 253 MR examinations (130 males and 123 females between 6 and 18 years of age) were included. The association between measurements, sex and age was considered. Linear and fractional polynomial regression models were used to evaluate the relationships between measurements. RESULTS: ACL length showed significant progressive growth (p < 0.001) with age in men and women, without characterization of growth peaks. ACL area in women showed more pronounced growth up to 11 years, stabilized from 11 to 14 years and then sustained a slight reduction. In men, ACL area showed more pronounced growth up to 12 years, stabilized from 12 to 15 years and then sustained slight reduction. Coronal and sagittal inclination of the ACL showed a significant progressive increase (p < 0.001) with age in both sexes, progressively verticalizing. The intercondylar roof inclination angle showed significant progressive reduction (p < 0.001) with age in both sexes. CONCLUSION: The area of the ACL does not accompany skeletal maturation, interrupting its growth around 11-12 years. Progressive verticalization of the ACL as well as of the intercondylar notch roof in the evaluated ages was also observed. The clinical relevance of this study is that the ACL presents different angular and morphologic changes during growth in the paediatric population. Since ACL repair is now being performed on younger children, recognition of the normal developmental changes of the ACL is of utmost importance for successful ACL graft placement. LEVEL OF EVIDENCE: III.

Femoral Component Axial Rotation in the Gap-Balancing Approach to Total Knee Arthroplasty: Measurement by Computed Tomography.

BACKGROUND: Rotational malalignment of total knee arthroplasty (TKA) is a potential cause for revision surgery; therefore, it is important to have valid criteria for evaluation of normal component rotational alignment. Because computed tomography (CT) is considered the most accurate method to assess the rotational alignment of prosthetic components, the objectives in this study were define the femoral component (FC) rotation by measuring the posterior condylar angle (PCA) and the condylar twist angle (CTA) in a patient population that underwent gap-balancing TKA; determine the reliability of the FC rotation by using these measurements; evaluate the inter-relationship between the PCA and CTA; and finally evaluate the frequency and agreement in identification of the medial epicondyle sulcus (MES). METHODS AND RESULTS: In this retrospective study, 2 radiologists examined 50 CT scans. Mean PCA values of -2.26° and -2.56° (internal rotation) and CTA values of -5.54° and -6.28° (internal rotation) were attained by 2 observers with a higher interobserver concordance for the PCA. Both measurements were considered to be reliable. There was moderate interobserver agreement for MES identification, with the MES present in 64% and 78% of patients, as identified by 2 observers. CONCLUSION: Mean FC rotation values as evaluated by PCA were -2.26° and -2.56° and as evaluated by CTA were -5.54° and -6.28°. PCA and CTA measurement by CT is reliable; however, the use of PCA is preferable because of the higher observer concordance. PCA can be inferred by subtracting 3° or 4° from the CTA. MES was identified in 64% and 78% of patients, with only moderate interobserver agreement.

Artroplastia total do joelho "Whiteside Ortholoc II" sem cimento. Avaliaçäo clínica e radiográfica após dois anos de seguimento / Ortholoc II whiteside cementless total knee arthroplasthy. Clinical and radiologic evaluation after two years of follow-up

Os autores apresentam a técnica cirúrgica bem como os resultados da avaliaçäo clínica e radiológica da artroplastia total do joelho sem cimento, do tipo Ortholoc II Whiteside (porous coated). A prótese utilizada é do tipo condilar total com preservaçäo do ligamento cruzado posterior. Os componentes femoral e tibial sao fixados biologicamente por crescimento ósseo em superfície porosa adequada. O componente patelar, totalmente de polietileno, teve sua fixaçäo com cimento. O material é constituído de 34 pacientes (33 com osteoartrose primária e 1 com artrite reumatóide) submetidos a 34 artroplastias. O tempo de seguimento variou de 20 a 28 meses, com média de 24,02 meses. A idade variou de 35 a 83 anos, com média de 67,08 anos. Foi utilizado o protocolo de avaliaçäo clínica e radiológica da Knee Society(5,14) e obtida pontuaçäo articular final média de 85,42 (38,21 no pré-operatório) e pontuaçäo funcional final média de 64,24 (48,33 no pré-operatório). Os resultados foram considerados plenamente satisfatórios e compatíveis com a literatura.

Tratamento em dois tempos das infecçöes nas artroplastias totais do joelho / Two-stage technique to treat infected total knee arthroplasties

Os autores apresentam a técnica de tratamento em dois tempos para as artroplastias totais de joelho infectadas e os resultados a curto prazo. Foram protocolados seis pacientes (seis joelhos) que apresentavam infecção profunda pós-artroplastia total. No primeiro tempo é feita a resecção da artroplastia primária com desbridamento e colocação de espaçador de cimento com gentamicina, permanecendo seis semanas com antibioticoterapia endovenosa. No segundo tempo é feita a artroplastia total de revisão. Apesar do curto tempo de seguimento, os resultados têm sido promissores, não havendo recidiva da infecção em nenhumcaso.

Tratamento das infecçöes nas artroplastias totais de joelho / Management of infections on total knee arthroplasties

Os autores apresentam os resultados no tratamento das infecçoes profundas nas artroplastias totais de joelho. Em 250 atroplastias totais de joelhos, 15 (6 por cento) sofreram infecçao profunda, precocemente em 12 (80 por cento) e tardiamente em três (20 por cento). A infecçao foi diagnosticada por meio do quadro clínico, radiológico e artrocentese com cultura do material. O agente predominante foi o Staphylococcus aureus (cinco pacientes - 33,33 por cento). Em três pacientes o tratamento foi a artrotomia com desbridamento, ressecçao da prótese e colocaçao de cimento com gentamicina por seis semanas, e novo implante da prótese. Um desses pacientes submetidos a revisao em dois tempos permaneceu com infecçao. Dos 12 pacientes submetidos a desbridamento e manutençao da prótese, dez nao obtiveram êxito e evoluíram para a artrodese e dois, para a cura.