Revistas
Revista:
JOURNAL OF KNEE SURGERY
ISSN:
1538-8506
Año:
2023
Vol.:
36
N°:
1
Págs.:
79 - 86
The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p =0.897; sidewalk invasions, p =0.749; pedestrian impact, p =0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right-left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries.
Autores:
Perelli, S. (Autor de correspondencia); Costa, G. G.; Montiel, Veronica; et al.
Revista:
AMERICAN JOURNAL OF SPORTS MEDICINE
ISSN:
0363-5465
Año:
2022
Vol.:
50
N°:
14
Págs.:
3778 - 3785
Background: The increase in anterior cruciate ligament (ACL) injuries in pediatric patients and the high failure rate reported in the literature in this population are driving surgeons to search for specific techniques to better restore knee stability. Recent literature has reported that the combination of lateral extra-articular tenodesis (LET) and ACL reconstruction improves outcomes in high-risk patients. However, such advantages in pediatric patients have been infrequently evaluated. Purpose: To assess whether adding LET to ACL reconstruction can significantly improve knee stability, clinical outcomes, and failure rates in pediatric patients. Study Design: Cohort study; Level of evidence, 3. Methods: A multicentric study involving 3 orthopaedic teaching centers was conducted to evaluate pediatric patients aged between 12 and 16 years who had undergone primary ACL reconstruction using a physeal-sparing femoral tunnel drilling technique. A minimum 2-year follow-up evaluation was required. Based on the surgical technique performed, the patients were divided into 2 group. The patients in group 1 underwent an isolated arthroscopic ACL reconstruction, while the patients in group 2 had an arthroscopic ACL reconstruction in combination with a modified Lemaire LET procedure. Group 1 was a historical control cohort of patients, whereas group 2 was prospectively enrolled. All the patients included in the present study were clinically evaluated using the Pediatric International Knee Documentation Committee (Pedi-IKDC) subjective score and the Pediatric Functional Activity Brief Scale (Pedi-FABS) score. Anteroposterior knee stability was measured using the KT-1000 knee ligament arthrometer, and the objective pivot-shift evaluation was documented using a triaxial accelerometer (Kinematic Rapid Assessment [KiRA]). The included patients also underwent a standardized radiological protocol to evaluate leg-length discrepancies, axial deviation, and degenerative signs preoperatively and at last follow-up. Results: This study included 66 pediatric patients with an anatomic hybrid ACL reconstruction using an autologous 4-strand hamstring graft. In group 1, there were 34 patients (mean age, 13.5 +/- 1.2 years), while 32 patients (mean age, 13.8 +/- 1.4 years) were included in group 2. The clinical outcome scores showed no difference between the 2 groups (Pedi-IKDC, P = .072; Pedi-FABS, P = .180). Nevertheless, the patients in group 2 had better anteroposterior stability measured using a KT-1000 arthrometer (1.9 +/- 1.1 mm in group 1 vs 0.8 +/- 0.8 mm in group 2; P = .031), as well as better rotational stability measured using the KiRA (-0.59 +/- 1.05 m/s(2) in group 2 vs 0.98 +/- 1.12 m/s(2) in group 1; P = .012). The patients in group 1 returned to sports at the same competitive level at a rate of 82.4%, while patients included in group 2 returned at the same competitive level in 90.6% of the cases without a significant difference between the 2 groups (P = .059). No leg-length discrepancies were found between the 2 groups at last follow-up (P = .881). Two patients displayed an increased valgus deformity of 3 degrees on the operated limb at last follow-up (1 patient in group 1 and 1 patient in group 2). Group 1 had a significatively higher cumulative failure rate (14.7% vs 6.3%; P = .021). No intra- or postoperative complications was observed between the 2 groups. Conclusion: Performing a modified Lemaire LET along with an ACL reconstruction with hamstring graft in pediatric patients reduced the cumulative failure rate and improved objective stability with no increase in intra- or postoperative complications. No significant difference was found between the 2 groups in terms of patient-reported outcomes or in the return-to-sports activity.
Revista:
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN:
0936-8051
Año:
2022
Vol.:
142
N°:
8
Págs.:
1793 - 1800
Purpose A question still remains as to whether constrictive toe-box shoes (TBS) cause disability only due to pain on pressure points or if they can cause permanent changes in the hallux anatomy. The aim of this study is to compare the hallux morphology in 3 groups classified according to their use of constrictive or open TBS. Methods 424 patients were classified into 3 groups: group A used open TBS daily; group B used constrictive TBS daily; group C used both open and constrictive TBS. Hallux's angles, presence of exostoses and shape of the distal phalanx (DP) were analyzed on dorsoplantar weight-bearing radiographs and compared amongst groups. Results The intermetatarsal (IMA), metatarsophalangeal (MTPA), DASA, PASA, interphalangeal (IPA), obliquity (AP1), asymmetry (AP2) and joint deviation (JDA) angles for group A were 10 degrees, 8 degrees, 5 degrees, 4 degrees, 9 degrees, 3 degrees, 5 degrees, 3 degrees; for group B were 9 degrees, 19 degrees, 5 degrees, 6 degrees, 12 degrees, 2 degrees, 8 degrees, 2 degrees; and for group C were 10 degrees, 10 degrees, 4 degrees, 4 degrees, 12 degrees, 3 degrees, 8 degrees, 1 degrees. Only the differences in the MTPA, IPA and AP2 were statistically significant (p < 0.05). The prevalence of exostoses on the tibial side of the DP was 22, 36, and 29% in groups A, B and C, respectively (p < 0.05). We found similar distributions of the different DP shapes in the three groups. Conclusions Our results suggest that the use of constrictive TBS, even if used only occasionally, could change hallux anatomy from a young age increasing MTPA, IPA and AP2. Moreover, we have found that DP exostoses are present as a "normal variation" in patients who wear an open TBS, but their prevalence is higher in those wearing constrictive toe-box shoes. This could be due to a reactive bone formation secondary to the friction caused by the inner border of the shoe. Level of clinical evidence 3.
Autores:
Gil-Melgosa, L.; Grasa, J.; Urbiola, A.; et al.
Revista:
BIOMEDICINES
ISSN:
2227-9059
Año:
2022
Vol.:
10
N°:
1
Págs.:
19
Achilles tendon rupture is a frequent injury with an increasing incidence. After clinical surgical repair, aimed at suturing the tendon stumps back into their original position, the repaired Achilles tendon is often plastically deformed and mechanically less strong than the pre-injured tissue, with muscle fatty degeneration contributing to function loss. Despite clinical outcomes, pre-clinical research has mainly focused on tendon structural repair, with a lack of knowledge regarding injury progression from tendon to muscle and its consequences on muscle degenerative/regenerative processes and function. Here, we characterize the morphological changes in the tendon, the myotendinous junction and muscle belly in a mouse model of Achilles tendon complete rupture, finding cellular and fatty infiltration, fibrotic tissue accumulation, muscle stem cell decline and collagen fiber disorganization. We use novel imaging technologies to accurately relate structural alterations in tendon fibers to pathological changes, which further explain the loss of muscle mechanical function after tendon rupture. The treatment of tendon injuries remains a challenge for orthopedics. Thus, the main goal of this study is to bridge the gap between clinicians' knowledge and research to address the underlying pathophysiology of ruptured Achilles tendon and its consequences in the gastrocnemius. Such studies are necessary if current practices in regenerative medicine for Achilles tendon ruptures are to be improved.
Revista:
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN:
1434-3916
Año:
2021
Vol.:
141
N°:
2
Págs.:
313 - 319
Introduction The knee in Parkinson's disease (PD) patients is a problematic joint due to pain, stiffness and gait instability. The aim of this study is to evaluate the functional outcome and degree of pain relief achieved after total knee arthroplasty (TKA) in PD patients. Materials and methods This is a retrospective review of 26 PD patients (32 knees) with osteoarthritis who underwent a TKA between 1994 and 2013. Comorbidities, anesthetic procedures and complications were recorded. Patient functional status was assessed with the Knee Society Function Score (KFS) and the Knee Society Score (KSS). PD stage was classified with the Hoehn and Yahr Scale. Results The mean follow-up was 3.5 years (range 2-9). The mean age was 71 years (range 61-83) with a mean time since PD diagnosis of 11.8 years (range 4-24). PD severity on the Hoehn and Yahr Scale was 1.5 points before surgery and 2 points postoperatively. Pain on the visual analogic scale improved from 8 points preoperatively to 5 points at 1-year follow-up; function improved from 32 (range 20-45) to 71 (range 50-81) and from 34 (range 28-52) to 59 (range 25-76) on the KSS and KFS, respectively. The mean postoperative hospital stay was 9.8 days (range 5-21). Confusion and flexion contracture were the most frequent perioperative complications. Conclusion TKA successfully provided pain relief in PD patients. However, the functional outcome is related to disease progression and, therefore, variable. Perioperative complications are difficult to avoid and manage.
Revista:
JOURNAL OF BONE AND MINERAL RESEARCH
ISSN:
0884-0431
Año:
2021
Vol.:
36
N°:
11
Págs.:
2203 - 2213
The remodeling of the extracellular matrix is a central function in endochondral ossification and bone homeostasis. During secondary fracture healing, vascular invasion and bone growth requires the removal of the cartilage intermediate and the coordinate action of the collagenase matrix metalloproteinase (MMP)-13, produced by hypertrophic chondrocytes, and the gelatinase MMP-9, produced by cells of hematopoietic lineage. Interfering with these MMP activities results in impaired fracture healing characterized by cartilage accumulation and delayed vascularization. MMP-10, Stromelysin 2, a matrix metalloproteinase with high homology to MMP-3 (Stromelysin 1), presents a wide range of putative substrates identified in vitro, but its targets and functions in vivo and especially during fracture healing and bone homeostasis are not well defined. Here, we investigated the role of MMP-10 through bone regeneration in C57BL/6 mice. During secondary fracture healing, MMP-10 is expressed by hematopoietic cells and its maximum expression peak is associated with cartilage resorption at 14 days post fracture (dpf). In accordance with this expression pattern, when Mmp10 is globally silenced, we observed an impaired fracture-healing phenotype at 14 dpf, characterized by delayed cartilage resorption and TRAP-positive cell accumulation. This phenotype can be rescued by a non-competitive transplant of wild-type bone marrow, indicating that MMP-10 functions are required only in cells of hematopoietic linage. In addition, we found that this phenotype is a consequence of reduced gelatinase activity and the lack of proMMP-9 processing in macrophages. Our data provide evidence of the in vivo function of MMP-10 during endochondral ossification and defines the macrophages as the lead cell population in cartilage removal and vascular invasion. (c) 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Revista:
REVISTA DE LA ASOCIACION ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGIA
ISSN:
1515-1786
Año:
2021
Vol.:
86
N°:
2
Págs.:
139 - 150
Introducción: Las técnicas para corregir las deformidades del hallux incluyen osteotomías metatarsianas y falángicas. Las osteotomías sobre la falange proximal corrigen el DASA y el ángulo interfalángico. Sin embargo, no se han publicado las indicaciones para la osteotomía de la falange distal. El objetivo de este artículo es comunicar la técnica y las indicaciones de la osteotomía percutánea de la falange distal del hallux, y evaluar los resultados de una serie de casos.
Materiales y Métodos: Se analizaron 14 pies en los que se realizó una osteotomía de la falange distal del hallux para corregir una deformidad. Se midieron el DASA, la oblicuidad interfalángica y el ángulo falange distal-interfalángico en las radiografías. La técnica quirúrgica fue percutánea con control fluoroscópico. Los resultados se evaluaron mediante las escalas analógica visual de dolor y AOFAS. Seguimiento medio: 52 meses.
Resultados: 13 pies de mujeres y un pie de hombre. Edad promedio: 58 años. Los resultados clínico y estético fueron excelentes, con alivio del dolor. Mejoría de la escala AOFAS: promedio 37 puntos. Análisis comparativo de ángulos preoperatorios y posoperatorios: DASA (p = 0,01), excepto cuando se aisló de la muestra a los pacientes con osteotomía tipo Akin (p = 0,33); ángulos F2-IF y F2-MTF (p <0,00001). Se registraron las complicaciones.
Conclusiones: En la deformidad en valgo de la falange distal del hallux sintomática, se debe considerar una osteotomía correctora sola o asociada a osteotomía de la falange proximal. La osteotomía percutánea de la falange distal es un método eficaz, seguro y rápido.
Nivel de Evidencia: IV
Autores:
Perez-Prieto, D. (Autor de correspondencia); Perelli, S.; Corcoll, F. ; et al.
Revista:
INTERNATIONAL ORTHOPAEDICS
ISSN:
0341-2695
Año:
2021
Vol.:
45
N°:
6
Págs.:
1407 - 1411
Purpose The main aim of this study was to evaluate the re-rupture risk after an anterior cruciate ligament reconstruction (ACL-R) using the vancomycin soaking technique and to compare it with the re-rupture risk in patients on whom this technique was not utilized. The secondary purpose was to compare the functional outcomes of those two subsets of patients operated on for ACL-R. The hypotheses are that the vancomycin soaking technique does not affect the re-rupture risk or the functional outcomes. Material and methods A retrospective historical cohort study was conducted. Two groups were compared in terms of the re-rupture rate (traumatic or atraumatic) and functional outcomes (International Knee Documentation Committee (IKDC), Tegner, and Lysholm). Group 1 consisted of patients that received pre-operative IV antibiotics. In group 2, the patients received pre-operative IV antibiotics along with a graft that had been presoaked in a vancomycin solution. A minimum follow-up of five years was required. Results There were 17 patients that suffered a re-rupture in group 1 (4.7%) and 15 in group 2 (3.9%) (n.s.). IKDC was 82.0 in group 1 and 83.9 in group 2 (p = 0.049); Tegner scored 4 in both groups (n.s.) and Lysholm was 90.3 in group 1 and 92.0 in group 2 (p = 0.015). Conclusion The vancomycin soaking technique for ACL autografts is a safe procedure for the daily clinical practice, in terms of re-ruptures. Moreover, it does not impair functional outcomes after an ACL-R.
Revista:
INTERNATIONAL ORTHOPAEDICS
ISSN:
0341-2695
Año:
2020
Vol.:
44
N°:
7
Págs.:
1435 - 1439
Background: Although different fixation techniques for the Akin osteotomy have been described in the literature, there are no many studies trying to analyze the differences between the types of fixation available. The aim of this study is to analyze if there are any differences between three types of staple fixation available in the market.
Method: We present a retrospective study of 145 cases in which an Akin osteotomy was performed and fixed with three different kinds of implants staple A (28%), staple B (45%), and staple C (27%). Staple A is made out of stainless steel, and the surgeon mechanically controls the compression applied. Staple B increases the compression when heat is applied to it. Staple C has an intrinsic elastic memory that closes the osteotomy. In all cases, distal articular set angle, interphalangeal joint obliquity angle, and metatarsophalangeal angle were measured pre-operatively and 1.5 months post-operatively on dorsoplantar weight-bearing radiographs. Other details such as post-operative complications, implant migration, osteolysis, or fracture of the lateral cortex during surgery were also recorded.
Results: Clinical and radiological results show no relevant differences between the three types of fixation. The mean angular corrections of DASA, interphalangeal joint obliquity angle, and metatarsophalangeal angle were 5, 12, and 21, respectively, for staple A; 4, 10, and 19, respectively, for staple B; and 7, 10, and 23, respectively, for staple C. The rates of intra-operative and post-operative complications were similar for all groups. There was one case of infection per group. We had five cases of delayed union two with staple A and three with staple C. In four cases, there was a loss of correction, two of them fixed with staple A and two with staple C. Seven cases developed a Südeck's syndrome, four of them fixed with staple A and three with staple C. Fifteen patients suffered an uncontrolled fracture of the lateral cortex of the phalanx when performing the osteotomy (3, 8, and 4 cases fixed with staples A, B, and C, respectively), and 87.5% of the patients that developed a plantar displacement of the osteotomy had an uncontrolled fracture of the lateral cortex (p < 0.05). All three staples achieved a rigid internal fixation and minimal periosteum damage and provided a good bone-bone contact.
Conclusions: According to our results, the radiological differences are minimal, and although the thermal compression staple had less complication, clinical differences were also not statistically significant. This means the choice of implant could be left to the surgeon's preferences or made according to cost.
Revista:
REVISTA ESPAÑOLA DE CIRUGIA ORTOPEDICA Y TRAUMATOLOGIA
ISSN:
1888-4415
Año:
2020
Vol.:
64
N°:
5
Págs.:
310-317
BACKGROUND AND OBJECTIVE: Currently, there is no stablished pre-operative model that helps the orthopaedic surgeon predict the final graft diameter in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine whether there is a correlation between semitendinosus (ST) and gracilis (GT) cross-sectional area (CSA) evaluated pre-operatively in mm2 using magnetic resonance imaging (MRI) and the final intra-operative ST-GT autograft diameter in mm2.
Revista:
KNEE
ISSN:
0968-0160
Año:
2020
Vol.:
27
N°:
5
Págs.:
1585 - 1592
Background: There is some controversy about how the proximal tibiofibular joint (PTFJ) capsulotomy changes PTFJ anatomy in closed-wedge high tibial osteotomy (CW-HTO) and about how this affects ankle and knee mobility and the onset of lateral knee pain. The aim of this study is to evaluate changes in PTFJ after CW-HTO, and its possible clinical significance. Methods: This study includes 50 patients who underwent CW-HTO with tibiofibular capsulotomy from 2000 to 2018 in our hospital. A clinical evaluation was conducted to evaluate pain location. The degrees of osteoarthritis and the proximal fibular subluxation were evaluated on radiographs. A dynamic analysis of the PTFJ was also performed comparing proximal fibular head subluxation on anteroposterior knee radiographs with the ankle placed in neutral position and dorsiflexed. Results: The clinical evaluation revealed that two patients had a sore scar, five had pain on the PTFJ with manual compression, and none referred lateral compartment pain. The radiological analysis revealed an average proximal subluxation of the fibular head after the osteotomy of 9.64 (range: 0-29) mm, which was greater in oblique PTFJ (p < 0.05). After the surgery, all the patients developed some degree of PTFJ arthritis. There was no correlation between lateral pain and proximal fibular subluxation, tibiofibular arthritis, or lateral compartment arthritis. The dynamic analysis revealed no significant changes. Conclusions: After CW-HTO all the patients developed proximal subluxation of the fibular head and a variable degree of PTFJ osteoarthritis, but these changes seem to be unrelated with lateral knee pain. (C) 2020 Elsevier B.V. All rights reserved.
Revista:
INDIAN JOURNAL OF ORTHOPAEDICS
ISSN:
0019-5413
Año:
2020
Vol.:
54
N°:
6
Págs.:
840 - 847
Background During the last century, total hip arthroplasties have become more popular. They have had a huge impact on the quality of life, pain, range of motion, social interaction, and psychological well-being. A number of studies have emphasized the importance of using templates to choose the appropriate implant size when planning the surgery. Our aim is to use MediCad(R)software to analyze the ability of the digital template system MediCad(R)to predict the size of the implant needed in total hip arthroplasties. Materials and Methods An arthroplasty preoperative plan was created according to the MediCad(R)software guidelines, on anteroposterior hip X-ray by one junior resident, one senior resident, and three experienced hip surgeons. Results The median size accuracy was 0.7 (range: 0.27-0.87) for the cup, 0.73 (range: 0.36-0.83) for the stem, and 0.28 (range: -0.14-0.69) for the neck. Interobserver reliability was good (kappa > 0.4) and stronger when measuring the stem than when doing so with the cup. Conclusion: Digital preoperative total hip arthroplasty planning is a good method for predicting component size, restoring hip anatomy (vertical offset and horizontal offset), with good interobserver reliability.
Autores:
Mariscal, G. (Autor de correspondencia); Nuñez, J. H.; Figueira, P.; et al.
Revista:
JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE
ISSN:
0974-8237
Año:
2020
Vol.:
11
N°:
1
Págs.:
31
Revista:
THE FOOT
ISSN:
0958-2592
Año:
2019
Vol.:
38
Págs.:
39 - 42
Background: Having had a previous experience of 4 open F2 osteotomies to correct interphalangeal hallux valgus, the aim of this study was to test the efficacy of a percutaneous approach for this correction.
Methods: 3 open and 12 percutaneous F2 osteotomies in 15 cadaver feet were performed. Interphalangeal (IPH), F2 asymmetry (AF2) and joint deviation (JD) angles were measured on radiographs. The operated great toes were anatomically analyzed looking for possible lesions to surrounding tissues.
Results: Mean IPH decreased from 10.7° to 2.9°, AF2 from 7.8° to 1°, and JD from 1.4° to 0.5°. Damage to the hallux extensor tendon was detected in 1 foot and a nail bed lesion was detected in 1 case, both operated percutaneously.
Conclusions: F2 Valgus deformity can be corrected using open or percutaneous osteotomy. The authors consider the open correction worthwhile because percutaneous techniques may damage surrounding tissues and the incision length difference is minor.
Level of clinical evidence: 3.
Revista:
FOOT AND ANKLE SURGERY
ISSN:
1268-7731
Año:
2019
Vol.:
25
N°:
2
Págs.:
158 - 164
Background: Exostoses at the base of the distal phalanx of the great toe are usually asymptomatic. The literature has not generally considered them as the origin of a possible problem resulting from a pressure conflict between hallux and shoe (medial aspect) or second toe (lateral aspect) nor a potential complication of surgical correction of hallux valgus deformity. No studies, to our knowledge, have evaluated its possible correlation with other foot disorders. When one of these neglected exostoses became painful after surgical correction of hallux valgus, we decided to start a study to determine their possible origin, prevalence in daily practice and histo-pathological morphology. Methods: Two hundred and fifty-four feet of patients (average age 41.7. y.) were enrolled in the study from January 2007 to June 2009. Dorsoplantar weight-bearing radiographs were used to analyze the presence of exostoses and their correlation with the distal phalanx morphology, metatarsal formula (or transverse plane orientation of the metatarsal heads parabola) and hallux valgus angles. Patients were classified according to their age and main symptom for consultation. Four exostoses removed from cadaver feet were also analyzed microscopically. Results: Osseous excrescences arising on the medial or lateral aspect at the proximal part of the terminal phalanx of the hallux were observed in 132 feet (51.9%). Thirty-five feet out of these 132 (13.7%) had exostoses on both sides of the phalanx.A statistically significant positive correlation was found between the presence of a medial exostosis of the phalanx and the severity of HVA. Patients with higher IPH and asymmetry angles have a lower prevalence of medial exostoses (p. <. 0.05). Amongst the different morphologies of the second phalanx, exostoses were most likely found in the standard form. Conclusions: Prevalence of exostoses at the base of the distal phalanx is high (51.9% of the studied feet). Histological findings would suggest that these exostoses could be considered a mechanical reactive process, produced by a chronic irritation by shoes. We encourage surgeons to be aware of its potential clinical implications. Direct resection is very simple and the most appropriate treatment for symptomatic cases.
Revista:
REVISTA ESPAÑOLA DE CIRUGIA ORTOPEDICA Y TRAUMATOLOGIA
ISSN:
1888-4415
Año:
2019
Vol.:
63
N°:
4
Págs.:
295 - 299
Objetivo
Conocer los resultados a largo plazo y el pronóstico de los pacientes que han sido intervenidos de resección de la primera fila del carpo (RPFC) en nuestro centro.
Material y método
Realizamos un estudio retrospectivo de 14 pacientes intervenidos de RPFC con un seguimiento de 3 a 16 años. Se evaluaron la movilidad, la capacidad funcional mediante el cuestionario Patient-Rated Wrist Evaluation (PRWE) y la capacidad para realizar las actividades de la vida diaria tras la intervención.
Resultados
El balance articular fue satisfactorio. La puntuación media en la escala PRWE fue de 20,9 ± 17,2 para la subescala de dolor y de 39 ± 35,5 para la subescala de funcionalidad. Ningún paciente había precisado reintervención ni han desarrollado complicaciones. El 80% de los pacientes estuvieron satisfechos o muy satisfechos. El 90% de los pacientes volvería a operarse.
Discusión
El rango de movimiento de la muñeca es similar con las diferentes técnicas de preservación de la movilidad. Los cambios artrósicos en la articulación radio-hueso grande secundarios a esta intervención no producen necesariamente dolor. Algunos autores han descrito que el grado de satisfacción de la RPFC es comparable con el de otros procedimientos, como la artrodesis en 4 esquinas con placa circular o artrodesis mediocarpiana con agujas.
Conclusión
La RPFC tiene alta tasa de satisfacción entre los pacientes con alivio del dolor, buena movilidad y funcionalidad postoperatoria de la muñeca. Además, presenta escasas complicaciones.
Revista:
M.L.T.J. MUSCLES, LIGAMENTS AND TENDONS JOURNAL
ISSN:
2240-4554
Año:
2018
Vol.:
8
N°:
2
Págs.:
261-275
Conclusion: Animal models for muscular degeneration after rotator cuff tears have been well established and described. The next challenge is the achievement of a therapeutic target that could be transferred to the clinical setting.