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Background: The purpsose of this study was to evaluate the biomechanical outcomes of patients who underwent ACL reconstruction either with the DB or SB technique. We hypothesized that the DB technique would provide better rotation control of the knee following ACL reconstruction. Methods: The study included seventy-five participants (26 DB, 22 SB, and 27 healthy volunteers). Only cases with at least one year of postoperative follow-up were included. The participants performed three different demand tasks: walk task, walk and change direction, and stair descent and change direction, which was tracked using a three-dimensional 4-camera optoelectronic system. The following kinematic data were analyzed: tibial rotation amplitude and maximal internal and external rotation. Knees with ACL reconstruction were compared to contralateral knees with intact ACL and healthy knees. Clinical outcomes were determined using the subjective and objective International Knee Documentation Committee (IKDC) questionnaire and a manual arthrometer (KT 1000). Results: Both surgical groups exhibited similar clinical outcomes (mean subjective IKDC 91 SB vs. 90 DB, P=0.815; KT 1000 difference: 2mm in both groups, P=0.772). The vertical component of the ground force reaction revealed no differences between the surgical and control groups (P>0.05). Tibial rotation amplitude and maximal internal and external rotation were similar between the control, SB, and DB groups in all three different demand tasks (P>0.05). Conclusion: ACL reconstruction using either the SB or DB technique can restore rotational control to the level of a healthy knee. No clinical or functional differences were found between the SB and DB surgical options.

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BACKGROUND: This study retrospectively evaluated the medium- and long-term results of patients submitted to double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. METHODS: A retrospective study of case series at a single center. Cases submitted to isolated ACL reconstruction with at least five years of follow-up were included. The following data were collected: demographic data; practice of competitive sport before the injury; previous surgery; injury/surgery in the contralateral knee; return to the practices of sports and level; re-injury (postoperative time; mechanism; need for surgery); and symptoms at the last clinical follow-up visit. Descriptive and sub-group analyses were performed. RESULTS: Sixty-nine patients were included; 52 men (75%), 49 athletes (71%), 47 (68%) with primary injury, mean age of 30 years (SD 10). The patients were followed up for an average of 8.7 years (minimum 5, maximum 11.8) after surgery. After the reconstruction, 67 (97%) returned to the sport; 75% at the same level as before the injury. Ten patients (14%) suffered re-injury after an average of 32 months (between 9 and 50 months). Regarding the outcome of re-injury, no statistically significant differences were found between subgroups of athletes vs non-athletes or primary injury vs revision surgery, despite a significant tendency towards increased re-injury levels in athletes. However, this tendency was not statistically significant. CONCLUSION: In our series of patients operated on with the double-bundle technique and with a long follow-up time, 14% presented re-injury, with no differences between primary and revision cases, and with a trend towards higher re-injury levels among the athletes in relation to the non-athletes. The rate of return to sport was satisfactory, with 97%, of which 75% were playing at the same level as before the injury.

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INTRODUCTION: We attended three skeletally immature patients with Down syndrome (DS) with complaints of severe patellofemoral instability and dislocated patella (preoperatively, Dugdale classification IV or V), in addition to low functional capacity, with falls during gait. The technique (lateral release, medial capsulectomy, reconstruction of the medial patellofemoral ligament (MPFL) with the patellar ligament and associated techniques, and some knees) and results in three children with DS and bilaterally dislocated patella were revealed. CASE REPORT: Our minimum follow-up was 27 months and maximum was 105 months (average of 64 months). All children improved gait, patellar stability, Kujala (58.13%), and subjective IDKC (40.55%) scores and improved the congruence and the trochlea groove angles. CONCLUSION: The patellofemoral instability in children with DS is a challenge. We should use an arsenal of surgical techniques in this complex problem. We believe in early surgery to improve the formation of structures, especially in patients with gross instabilities and frequent falls. In all cases, we detected a weakness of medial components and lateral contracture, reconstructed the MPFL (we were the first researchers to describe this procedure for this group of patients), and performed a medial capsulectomy and lateral release. In some knees, intraoperatively, it was necessary to associate the reconstruction of the medial patellotibial ligament to improve instability. We consider fundamental analysis of the axis with panoramic radiographs and hemiepiphysiodes is in cases of asymmetric or severe valgus.

RESUMO

Few complications regarding the use of bioabsorbable suture anchors in the shoulder have been reported. What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far. A 53-year old male with previous rotator cuff (RC) repair using bioabsorbable suture anchors presented with pain and weakness after 2 years of surgery. A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint. The complications reported with the use of metallic implants around the shoulder led to the development of bioabsorbable anchors. Advantages are their absorption over time, minimizing the risk of migration or interference with revision surgery, less artifacts with magnetic resonance imaging, and tendon-to-bone repair strength similar to metallic anchors. Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

RESUMO

Em uma tentativa de melhor restabelecer a função normal do ligamento cruzado anterior (LCA), foi proposta a técnica de reconstrução do LCA com feixe duplo (FD). Entretanto, a superioridade desta técnica frente à técnica com feixe simples (FS) ainda não está claramente demonstrada no cenário clínico. O propósito do presente estudo foi avaliar e comparar a amplitude de rotação tibial, o máximo de rotação interna e externa, e a força de reação ao solo de joelhos submetidos à reconstrução anatômica com feixe duplo, a joelhos submetidos à reconstrução com feixe simples, durante a realização de tarefas dinâmicas. Para isso, um total de 75 (setenta e cinco) indivíduos foram avaliados (26 reconstruções feixe duplo, 22 reconstruções feixe simples, 27 indivíduos sem lesão do LCA que formaram um grupo controle). Utilizando um sistema de análise do movimento humano, constituído por 4 câmeras para a análise do movimento, os indivíduos foram avaliados em três tarefas de demandas distintas. Utilizou-se a técnica TSACCAST para o cálculo da rotação interna e externa da tíbia. A média da amplitude de rotação tibial, máximo de rotação interna e externa, foi avaliada para cada joelho em cada um dos três grupos. A avaliação clínica destes pacientes foi realizada utilizando-se questionários subjetivo e objetivo (IKDC), assim como artrometria manual. Estas avaliações revelaram que ambos os grupos operados eram semelhantes no que se refere ao resultado clínico pós-operatório. A avaliação da amplitude de rotação tibial, máximo de rotação interna e externa, demonstrou que o joelho operado era semelhante ao joelho não operado e aos joelhos do grupo controle. Também não se verificou diferença significativa nos valores de amplitude de rotação tibial, máximo de rotação interna e externa, quando se comparou o grupo FS ao grupo FD. Desta forma, concluímos que a reconstrução do LCA com a técnica de FS e com a técnica de FD são similares no que se refere ao restabelecimento do...

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In an attempt to better restore the normal function of the two ACL bundles, the ACL reconstruction with two bundles has been proposed. However, the superiority of the double-bundle technique has not been clearly demonstrated in the clinical setting. The purpose of this study was to compare the tibial rotational range, maximal internal and external rotation and ground reaction force of anatomical double-bundle anterior cruciate ligament reconstructed knees with single-bundle anterior cruciate ligament reconstructed knees during three different demanding tasks. A total of 75 subjects, (26 with double-bundle anterior cruciate ligament reconstruction, 22 with single-bundle anterior cruciate ligament reconstruction, and 27 healthy control individuals) were evaluated in this study. Using a 4-camera motion analysis system, motion subjects were recorded performing during three different tasks. Using the CAST technique, the internal-external tibial rotation of both knees was calculated. The mean tibial rotational range, maximum internal and external rotation, for each knee, was evaluated for the 3 groups (double-bundle group, single-bundle group, and control group). Clinical assessment, including objective and subjective IKDC scores, and knee arthrometric measurement, revealed restoration of the reconstructed knee stability with no differences between the two anterior cruciate ligament reconstruction groups. The results demonstrated that both groups resulted in tibial rotation range values that were similar to those in the non-injured knees and those in the healthy controls. There were also no significant differences in tibial rotational range, maximal internal and external rotation and ground reaction force between the DB group and the SB group. Therefore, anatomical double-bundle and single-bundle reconstruction are able to restore normal tibial rotation.

Assuntos

Humanos , Masculino , Feminino , Anatomia , Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Fenômenos Biomecânicos , Inquéritos e Questionários

RESUMO

BACKGROUND: Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment. PURPOSE: To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Thirty-nine patients (41 knees) (mean age, 24.2 years; range, 12-38 years) with acute patellar dislocation were randomized into 2 groups. One group was treated nonoperatively with immobilization and physiotherapy, the other was treated surgically with MPFL reconstruction; both groups were evaluated with minimum follow-up of 2 years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrence was evaluated. Pearson χ(2) or Fisher exact test was used in the statistical evaluation. RESULTS: The statistical analysis showed that the mean Kujala score was significantly lower in the nonoperative group (70.8), when compared with the mean value of the surgical group (88.9; P = .001). The surgical group presented a higher percentage of "good/excellent" results (71.43%) on the Kujala score when compared with the nonoperative group (25.0%; P = .003). The nonoperative group presented a large number of recurrences and subluxations (7 patients; 35% of cases), whereas there were no reports of recurrences or subluxations in the surgical group. CONCLUSION: Treatment with MPFL reconstruction using the patellar tendon produced better results, based on the analyses of posttreatment recurrences and the better final results of the Kujala questionnaire after a minimum follow-up period of 2 years.

Assuntos

Instabilidade Articular/terapia , Luxação Patelar/terapia , Ligamento Patelar/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Análise de Variância , Braquetes , Distribuição de Qui-Quadrado , Criança , Crioterapia , Terapia por Estimulação Elétrica , Feminino , Humanos , Imobilização , Instabilidade Articular/cirurgia , Masculino , Luxação Patelar/cirurgia , Ligamento Patelar/lesões , Modalidades de Fisioterapia , Estudos Prospectivos , Amplitude de Movimento Articular , Recidiva , Inquéritos e Questionários , Resultado do Tratamento

RESUMO

BACKGROUND: More than 2 years after undergoing anterior cruciate ligament (ACL) reconstruction, women still present bilateral asymmetries during multijoint movement tasks. Given the well-known ACL-injury gender bias, the goal of this study was to investigate whether males also present such asymmetries more than 2 years after undergoing ACL reconstruction. METHODS: This study involved 12 participants submitted to ACL reconstruction in the ACL group and 17 healthy participants in the control group. The mean postoperative period was 37 months. The participants executed bilateral countermovement jumps and load squat tasks. The kinematics and ground reaction forces on each lower limb and pelvis were recorded, and used to compute bilateral peak vertical ground reaction forces, peak knee and hip joint powers in the sagittal plane, and the ratio between these powers. RESULTS: For the jump task, the groups had the same performance in the jump height, but for the ACL group the peak knee joint power on the operated side was 13% lower than on the non-operated side (p = 0.02). For the squat task, the hip-knee joint power ratio on the operated side of the ACL group was 31% greater than on the non-operated side (p = 0.02). CONCLUSIONS: The ACL group presented a deficit in the operated knee that had its energy generation over time (joint power) partially substituted by the hip joint power of the same side. The fact that, even after more than 2 years following the ACL reconstruction and returning to regular activity, the ACL group still had neuromuscular asymmetries suggests a need for improvement in the ACL reconstruction surgery procedures and/or rehabilitation protocols.

Assuntos

Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Movimento/fisiologia , Adulto , Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Exercício Físico/fisiologia , Feminino , Humanos , Masculino , Procedimentos de Cirurgia Plástica , Ruptura

RESUMO

OBJETIVO: O objetivo deste estudo é descrever a metodologia da análise da rotação do joelho utilizando instrumentos do laboratório de biomecânica e apresentar os resultados preliminares de um estudo comparativo com pacientes submetidos à reconstrução do ligamento cruzado anterior com a técnica de duplo feixe. MÉTODOS: Descreveu-se o protocolo atualmente utilizado em nosso laboratório e realizou-se a análise cinemática tridimensional e medida da amplitude de rotação do joelho de oito pacientes normais (grupo controle) e 12 pacientes operados com a técnica de duplo feixe em três tarefas no laboratório de biomecânica. RESULTADOS: Não indicam diferenças significativas entre os lados operados e não operados em relação às amplitudes médias da marcha, da marcha com mudança de direção ou da marcha com mudança de direção ao descer a escada (p > 0,13). CONCLUSÕES: Os resultados preliminares não demonstraram diferença da técnica de reconstrução de LCA em duplo feixe em relação ao lado contralateral e ao grupo controle.

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OBJECTIVE: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. METHODS: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. RESULTS: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). CONCLUSION: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group.

Assuntos

Humanos , Masculino , Feminino , Adolescente , Adulto , Instabilidade Articular , Traumatismos do Joelho , Ligamento Patelar , Articulação Patelofemoral

RESUMO

OBJECTIVE: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. METHODS: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. RESULTS: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). CONCLUSION: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group.

RESUMO

OBJECTIVE: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL) with non-operative treatment of primary patellar dislocation. METHODS: Thirty-nine patients (41 knees) with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy) and other was treated surgically with reconstruction of the MPFL, and the results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearson's chi-square test and Fisher's exact test were used in the statistical evaluation. RESULTS: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8), compared with the mean value in the surgical group (88.9), with p = 0.001. The surgical group presented a higher percentage of "good/excellent" Kujala score results (71.43%) than in the conservative group (25.0%), with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases), while in the surgical group there were no reports of recurrences and/or subluxation. CONCLUSIONS: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years.