Influence of hip restriction on noncontact ACL rerupture.

PURPOSE: This study investigated variables associated with hip restriction (reduced range of motion) in a group of soccer players presenting with noncontact rerupture of the anterior cruciate ligament (ACL) and compared results with a group of sport-matched healthy professional athletes. METHODS: In this case series, 28 male soccer players with noncontact ACL rerupture were examined for clinical hip range of motion findings potentially associated with ACL rerupture, namely anterior knee displacement, internal-external hip rotation, and cruciate ligament insufficiency. Results were compared with data obtained from 27 healthy professional players. Patients presenting gross surgical errors (e.g. poorly positioned tunnel) or reporting major accidents affecting the lower limbs, such as leg or ankle fractures, were excluded from analysis. Internal-external rotation was measured in the supine position, with knee and hip at 90° of flexion. ACL insufficiency was assessed using the Pivot Shift test and the Lachman's test with the aid of a Rolimeter RM(®) arthrometer and confirmed by magnetic resonance imaging. RESULTS: The most prevalent finding was a significantly lower mean internal-external hip rotation in the rerupture group (45.0°) when compared with healthy professional soccer players (56.2°). CONCLUSION: Assessing hip restriction in patients presenting noncontact ACL rerupture showed to be extremely important during ACL reconstruction planning.

Femoral pseudoarthrosis and knee stiffness: long-term results of a one-stage surgical approach.

INTRODUCTION: The objective of this study was to analyze the surgical results of the simultaneous treatment of femoral pseudoarthrosis and knee stiffness using a combined one-stage approach (quadricepsplasty + osteoperiosteal decortications + bone autografting + fracture stabilization). PATIENTS AND METHOD: Twelve patients (six men) followed up for a minimum of 10 years and who had undergone surgery for these combined procedures were contacted for evaluation. Their mean age at the time of the surgery was 30 years (standard deviation, SD 15; range 22-65 years), and mean time from initial trauma was 16 months (SD 6, range 10-32 months). RESULTS: Mean range of motion improved from 10 degrees (SD 9) to 112 degrees (SD 13) postoperatively. Fractures healed in all patients, and improvement in their range of motion was statistically significant (Student's t-test = 31; P

Arthroscopic protocol for treatment of knee extension block after patellar ACL reconstruction.

This study presents a new protocol for arthroscopic approach based on the treatment of 36 patients with extension block of the knee as a result of intra-articular reconstruction of the anterior cruciate ligament (ACL) using the patellar tendon. Arthroscopy not only allowed the identification of the active mechanical extension block of the knee, but also the passive mechanical block that can occur with a functional or loose ligament. This protocol can be useful in the treatment of postoperative extension block of the knee as a complication of ACL reconstruction.

Osteotomia valgizante de tíbia com placa "calço" de Puddu: apresentação da técnica / Valgus tibial with \"wedge\" plate of Puddu: technique presentation

O objetivo do presente trabalho é apresentar os resultados iniciais, obtidos com a osteotomia valgizante de adição de tíbia, fixada com placa calço descrita por Puddu. Foram operados 29 joelhos em 27 pacientes para correção de geno-varo, sendo que, em apenas um paciente o procedimento bilateral teve objetivo profilático. A osteotomia proximal de tíbia foi feita de forma oblíqua iniciando na inserção distal do ligamento colateral medial em direção ao tubérculo de Gerdy. A osteotomia foi aberta e fixada com uma placa de calço Puddu. O espaço aberto da osteotomia foi preenchido por enxerto autólogo de ilíaco. A carga total era dada com 45 dias de pós-operatório. Os resultados obtidos mostraram que entre 4 a 6 meses os pacientes tiveram uma significativa melhora na sintomatologia indutora do procedimento cirúrgico. A avaliação final mostrou 27 resultados satisfatórios e apenas 2 regulares. Como conclusão essa técnica tornou a osteotomia de tíbia um procedimento reprodutível com resultados previsíveis com excelente manutenção no pós-operatório da correção obtida no trans-operatório.

Protocolo de tratamento artroscópico do bloqueio da extensäo após reconstruçäo do ligamento cruzado anterior / Protocol for arthroscopic treatment of extension block after reconstruction of the anterior cruciate ligament

É proposto um protocolo para o tratamento artroscópico baseado nos procedimentos realizados em 36 pacientes portadores de bloqueio da extensäo do joelho pós-reconstruçäo intra-articular do ligamento cruzado anterior com tendÒo patelar. Os achados artroscópicos permitiram a identificaçäo do bloqueio mecânico ativo da extensäo do joelho, bem como do bloqueio mecânico passivo, que pode ocorrer com ligamento funcionante ou com um ligamento frouxo. Acreditamos que esses nossos conceitos possam ser de grande importância no tratamento do bloqueio pós-operatório da extensäo do joelho que podem ocorrer nas reconstruçöes do ligamento cruzado anterior.