RESUMO

Lack of full extension of the knee is a disabling condition that sometimes needs to be treated by a posterior capsulotomy of the knee. However, it is not clear if the full extension acquired can be kept throughout long-time follow-up. We conducted a retrospective cohort study of 20 patients diagnosed with minimal flexion contracture of the knee who underwent open posterior capsulotomy between 1990 and 2010. All patients (100%) presented with a preoperative Lysholm's score classified as poor or fair (mean = 58.6 ± 13.8, 95% confidence interval [CI]: 52.3-64.9), but 14 patients (70%) experienced an improvement to good or excellent scores (mean = 87.6 ± 8.8, 95% CI: 83.6-91.6) after the follow-up. The mean preoperative angle of fixed flexion was 25.0 ± 9.1 degrees (95% CI: 20.8-29.2), and it decreased to 4.2 ± 4.1 degrees (95% CI: 2.3-6.1) after the follow-up. We conclude that posterior capsulotomy of the knee proved to be an effective procedure to treat properly patients with painful knees secondary to lack of full extension after 10.3 years of follow-up.

Assuntos

RESUMO

An increasing concern has been given to the rotation stability of the knee in the setting of an anterior cruciate ligament (ACL) reconstruction. This growing interest stems from a better understanding of the rotational stability of the knee afforded by the identification of the anterolateral ligament. Previously, a residual abnormal pivot-shift test had been found after an anatomic single-band reconstruction of the ACL because of a lack of rotational stability, which may lead to the development of osteoarthritis. Residual instability affects function, especially in high-demand athletes who perform many flexion-rotation movements during sporting activity. The purpose of this Technical Note is to describe our preferred method of intra-articular ACL reconstruction using a hamstring tendon autograft in combination with an extra-articular iliotibial band tenodesis for reinforcement of rotational stability.

RESUMO

The loss of knee extension, even if minimal, is disabling and considerably affects the individual's quality of life. This loss of extension can be a consequence of prior surgery, including a previous anterior cruciate ligament reconstruction. Although this loss of extension may be treated through an isolated arthroscopic procedure, a more severe case may warrant an invasive approach. In these cases, a posterior capsulotomy of the knee may be done if all conservative measures have been exhausted. This procedure has been proven to be safe and effective in the re-establishment of full extension in the setting of a minor flexion contracture of the knee. The purpose of this Technical Note was to describe our preferred technique when performing an open posterior capsulotomy of the knee for the treatment of minimal extension deficit.

RESUMO

Introdução: A fratura viciosamente consolidada do calcâneo pode evoluir com artrose e deformidades graves do pé. O objetivo deste estudo é identifi car diferenças na consolidação da artrodese subtalar corretiva, com interposição de enxerto ósseo tricortical autólogo ou com xenoenxerto bovino liofi lizado. Métodos: Foram avaliados prospectivamente 12 pacientes submetidos a artrodese subtalar no Hospital de Clínicas de Porto Alegre. Em 6 pacientes utilizou-se enxerto autólogo e em 6, xenoenxerto bovino liofilizado. Após seguimento médio de 58 semanas, realizou-se a avaliação dos pacientes utilizando a escala AOFAS e a escala visual analógica de dor (VAD). Dois avaliadores cegos avaliaram o tempo para a consolidação da artrodese e a integração do enxerto por exames radiográficos. Resultado: O escore AOFAS melhorou entre o pré e pós-operatório, média de 37 para 64 pontos (p=0,02) no grupo controle e de 38 para 74 pontos (p=0,02) no grupo estudo. Assim como a escala VAD melhorou, média de 4,7 para 1,9 (p=0,028) no grupo controle e de 5,5 para 2,7 (p=0,046) no grupo estudo. Houve consolidação da artrodese em todos os casos do grupo controle em um tempo médio de 5,3 semanas e em 5 casos do grupo estudo, em 8,8 semanas (p=0,077). A integração do enxerto ocorreu após uma média de 10,7 semanas e de 28,8 semanas no grupo controle e estudo, respectivamente (p=0,016). Conclusão: Não observamos diferença estatisticamente significativa no tempo para consolidação da artrodese entre os grupos, embora o tempo para integração do xenoenxerto bovino liofilizado seja estatisticamente maior. Houve melhora clínico-funcional em ambos os grupos.

Introduction: Viciously consolidated fracture of the calcaneus can evolve with osteoarthritis and severe foot deformities. The aim of this study is to identify differences in the consolidation of corrective subtalar arthrodesis with interposition of autologous tricortical bone graft or lyophilized bovine xenograft. Methods: We prospectively evaluated 12 patients undergoing subtalar arthrodesis in the Hospital de Clínicas of Porto Alegre. In 6 patients we used autologous graft and in other 6 lyophilized bovine xenograft. After a mean follow-up of 58 weeks, patients were evaluated using the AOFAS scale and a visual analogue pain scale (VAPS). Two blinded evaluators assessed the time for consolidation of the arthrodesis and integration of the graft for radiographic examinations. Result: The AOFAS score improved between the pre- and postoperative periods, a mean of 37 to 64 points (p = 0.02) in the control group and 38 to 74 points (p = 0.02) in the experimental group. VAPS scores improved as well, from a mean of 4.7 to 1.9 (p = 0.028) in the control group and 5.5 to 2.7 (p = 0.046) in the experimental group. There was consolidation of arthrodesis in all of the cases in the control group at a median time of 5.3 weeks, and in 5 cases in the experimental group, at 8.8 weeks (p = 0.077). Graft integration occurred after a mean of 10.7 weeks and 28.8 weeks in the control and experimental groups, respectively (p = 0.016). Conclusion: We did not fi nd a statistically signifi cant difference in the time for arthrodesis consolidation between the groups, although the time for integration of the lyophilized bovine xenograft is statistically higher. There was clinical and functional improvement in both groups.

Assuntos

RESUMO

BACKGROUND: Calcaneal fracture malunion may evolve into arthrosis and severe foot deformities. The aim of this study was to identify differences in bony union following corrective subtalar arthrodesis with interposition of autologous tricortical bone graft or freeze-dried bovine xenograft. METHODS: We prospectively evaluated 12 patients who underwent subtalar arthrodesis, six patients received autografts and 6 received freeze-dried bovine xenografts. After a mean followup of 58 weeks, the patients were clinical assessed using AOFAS scale and the visual analog scale (VAS) for pain and for final radiographic parameters measurement. Two blind raters evaluated the length of time required for solid union of the arthrodesis and graft integration by retrospective radiographic examination. RESULTS: In the autograft group, AOFAS score improved from a preoperative average of 37 to 64 points postoperatively (p = 0.02) and mean VAS score improved from 4.7 to 1.9 (p = 0.028). In the xenograft group, AOFAS score improved from 38 to 74 points (p = 0.02) and VAS from 5.5 to 2.7 (p = 0.046). Solid union was achieved in all cases in the autograft group at an average of 5.3 weeks and in five cases in the xenograft group at 8.8 weeks (p = 0.077). Graft integration occurred after an average of 10.7 weeks in the autograft group and 28.8 weeks in the xenograft group (p = 0.016). CONCLUSION: With the numbers available, no significant difference could be detected in the length of time required for solid union of subtalar arthrodesis between groups, although time to integration of freeze-dried bovine xenografts was statistically higher. Clinical and functional improvement was observed in both groups.