RESUMEN
Arthrosis following rupture of the anterior cruciate ligament has been analysed in two series. The first series was derived from a review of 150 cases of reconstruction of the anterior cruciate ligament with a follow-up of 3 years or more. Arthrosis was seen to have developed in 13.3%. The second series was concerned with 64 cases of unilateral arthrosis treated by upper tibial valgus osteotomy in whom there had been a previous rupture of the anterior cruciate ligament. The 'tolerance interval'--that is the time between the original ligamentous injury and the time of osteotomy--for the development of arthrosis was very variable, ranging in the natural-history cases from 10 to 50 years, with a mean of 35 years. It is important to recognise the radiological signs of the onset of arthrosis. These are osteophytosis of the intercondylar notch, osteophyte formation at the posterior part of the medial tibial plateau, and, in particular, narrowing of the medial joint line with posterior subluxation of the medial femoral condyle, well seen in lateral radiographs whilst standing on one lower limb. Early arthroses, appearing after 10 years, may occur as a 'natural arthrosis', but it develops much more frequently after surgical treatment that had failed to correct anterior laxity and particularly when it had been performed on knees that were already pre-arthrotic. The main factor in arthrosis is anterior laxity measured radiologically by an 'active Lachman' radiograph. Removal of the medial meniscus which in itself, is liable to produce arthrosis, is even more harmful in anterior cruciate laxity since it doubles the degree of anterior subluxation of the tibia seen on unilateral weight-bearing. The development of varus deformity, which characterises progressive arthrosis, has its origin in wear of the posterior part of the medial tibial plateau caused by anterior cruciate laxity. Other factors play an important part such as associated lateral laxity, constitutional genu varum and weakness of the hamstring muscles, which oppose the subluxating action of the quadriceps.
Asunto(s)
Inestabilidad de la Articulación/complicaciones , Articulación de la Rodilla , Osteoartritis de la Rodilla/etiología , Adulto , Enfermedad Crónica , Femenino , Humanos , Inestabilidad de la Articulación/cirugía , Masculino , Osteoartritis de la Rodilla/cirugía , Estudios Retrospectivos , Adulto JovenRESUMEN
A retrospective review of 29 patients (30 knees) was carried out who had previously undergone a single-stage combined ACL reconstruction with valgus upper tibial osteotomy for chronic ACL rupture coupled with early medial tibio-femoral arthritis. Of the 30 knees, 19 (63%) had had a previous medial meniscectomy. Major complications occurred in two knees resulting in stiffness. At a mean of 12 years follow-up (6-16 years) only five knees (17%) had progressed one arthritis grade. Fourteen patients (47%) returned to intensive sports, and a further 11 (37%) played moderate sports. The mean difference in anterior tibial translation with the opposite normal knee was 3 mm at review. It was concluded that the combined operation has a low morbidity, controls anterior laxity, allows many patients to return to sports, and does not result in a rapid progression of osteoarthritis.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Tibia/cirugía , Adolescente , Adulto , Ligamento Cruzado Anterior/fisiopatología , Lesiones del Ligamento Cruzado Anterior , Niño , Enfermedad Crónica , Terapia Combinada , Femenino , Fémur/cirugía , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Ligamentos Articulares/trasplante , Masculino , Osteoartritis de la Rodilla/clasificación , Osteoartritis de la Rodilla/fisiopatología , Osteotomía/efectos adversos , Radiografía , Estudios Retrospectivos , Rotura/cirugía , Resultado del TratamientoRESUMEN
Two series of consecutive total knee replacements were compared retrospectively: 118 HLS II posterior stabilized prostheses (Group 1) versus 138 HLS CP posterior cruciate ligament sparing prostheses (Group 2). Both implants were made by the same manufacturer. The prostheses had been inserted between 1989 and 1992. Mean followup was 4 years. The authors looked for evidence of laxity in the coronal and the sagittal planes, the correlation of laxity with other factors, and the effect of laxity on the objective and subjective outcome as measured with the Knee Society score. Group 2 had significantly more clinical and radiologic laxity. There was little difference between the two groups regarding the overall objective and subjective outcome; however, there was a significantly higher rate of excellent results in Group 1. Longer followup will be required to see whether the implants with laxity are at heightened risk for tibial component wear.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Prótesis de la Rodilla/efectos adversos , Osteoartritis de la Rodilla/cirugía , Ligamento Cruzado Posterior/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/métodos , Fenómenos Biomecánicos , Femenino , Humanos , Inestabilidad de la Articulación/clasificación , Inestabilidad de la Articulación/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/clasificación , Osteoartritis de la Rodilla/diagnóstico por imagen , Diseño de Prótesis , Falla de Prótesis , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
PURPOSE OF THE STUDY: Assess long-term subjective, functional and radiographic outcome after free patellar graft and extra-articular lateral plasty for chronic anterior laxity of the knee. PATIENTS AND METHODS: 148 cases of chronic anterior laxity of the knee treated by free patellar graft and extra-articular lateral Lemaire plasy were reviewed after a mean follow-up of 11.5 years (range 10-15 years). A complete work-up was performed in all cases at 4 years postsurgery to assess objective, sport, function and radiographic outcome (objective laxity and osteoarthritic status). RESULTS: Subjectively, 65 p. 100 of the patients were very satisfied and 24 p. 100 were satisfied. According to the IKDC classification, functional outcome was in class A in 22 p. 100 and in class B in 49 p. 100. All failures (14 p. 100) except one occurred during the first year. When the meniscus was healthy or repaired, the failure rate was only 4 p. 100. Two principal factors favoring failure were severe laxity (meniscectomy) and poor femoral position. Residual laxity measured on the lateral view in the one-leg weight bearing position was 3.3 mm in the overall series, 2.4 mm for cases with isolated anterior laxity, and 4 mm for chronic laxities. Residual laxity was higher if the medial meniscus was totally or partially removed. There was no change between the 4th and 11th year of follow-up. A secondary meniscectomy was performed in 5 p. 100 of the cases despite renewed sports activity in 80 p. 100 of the cases. Osteoarthritic degeneration was the most important factor for less favorable outcome: 42 p. 100 of the cases developed preosteoarthitis or osteoarthritis. Joint degeneration occurred almost exclusively in patients who had undergone medial meniscectomy. Only 2 p. 100 of the patients with a healthy or repaired meniscus developed osteoarthritis. When the anterior laxity was the only anomaly, the functional result was very excellent, with renewed sports activity. Even in cases with persistent residual laxity, there were almost no failures or secondary meniscal lesions if the femoral position was correct. DISCUSSION: For chronic laxity, free patellar graft alone cannot avoid a high rate of failure and/or joint degeneration, particularly favored by an incorrect femoral position. Improved results can only be achieved by preserving the meniscus and possibly associating a lateral or medial plasty whose effect remains to be evaluated.
Asunto(s)
Artroplastia/métodos , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Tendones/trasplante , Adolescente , Adulto , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Rótula , Complicaciones Posoperatorias/cirugía , Radiografía , Reoperación , Factores de TiempoRESUMEN
Unilateral weight bearing was simulated on 12 cadaver knees to quantitate anterior tibial translation (ATT) after anterior cruciate ligament (ACL) transection and to asses the role of the posteromedial structure and the hamstrings in controlling laxity. With the ACL intact, ATT was 3.5 +/- 2.8 mm in extension and 4.3 +/- 3.6 mm at 60 degrees flexion. After sectioning the ACL, ATT was 6.5 +/- 4.7 mm in extension and 17.5 +/- 10 mm at 60 degrees flexion (P = 0.001). Applying a force in the hamstrings was unable to correct the pathological ATT observed after ACL section. Partial medial meniscectomy did not increase ATT after the ACL section. Disinsertion of the posterior horn of the medial meniscus and total medial meniscectomy increased ATT significantly compared to isolated ACL section. After ACL transection, sectioning the meniscotibial fibers or posteromedial capsule significantly increased ATT (6.5 +/- 0.5 mm in extension). Section of the postero-oblique ligament or popliteus tendon had no effect on ATT.
Asunto(s)
Ligamento Cruzado Anterior/fisiopatología , Ligamento Cruzado Anterior/cirugía , Artroplastia/efectos adversos , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiopatología , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Traumatismos de la Rodilla/cirugía , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/cirugía , Persona de Mediana Edad , Modelos Anatómicos , Músculo Esquelético/fisiopatología , Soporte de PesoRESUMEN
PURPOSE OF THE STUDY: Patella infera is a post operative complication that can be prevented in most cases. This study was undertaken to determine etiological factors and to determine the means to avoid patella infera following knee surgery. The authors describe a new surgical technic to correct this complication and describe prognostic factors for achieving good results. MATERIAL AND METHODS: From 1985 to 1991, 35 patellar tendon lengthenings were performed in 35 patients. There were 28 female and 7 male patients with an average age of 37 years (21 to 72). Follow-up averaged 27 months and all patients had radiographic follow-ups. All patients had previous knee surgery: 21 for patellar pain (= patellar pain), 9 ACL reconstructions, 5 traumatic lesions. The range of motion of the knee was between 5 and 120 degrees. Patients complained of a burning pain in the patellar region and the sensation that the knee was held in a vice. The average Insall index was 0.55 (0.3 to 0.87). 25 patients had osteoporosis of the patella and 31 patients had a typical "sunrise" aspect on axial radiographs in 30 degrees of flexion. The usual diagnosis was that of algodystrophy. All patients underwent patellar tendon lengthening. RESULTS: Intra operative findings showed transverse retractions leading to resection of the medial and lateral retinaculum. The patellar tendon was short but its histological structure was normal. 15 patients had excellent results with no residual pain and were able to resume sports activities. 11 had good results with residual pain in hyperflexion and 9 had poor functional results, however nocturnal pain disappeared. Range of motion was between 0 and 130 degrees. Radiographic results were excellent since the preoperative average Insall score of 0.55 increased to 1.02 at follow-up. DISCUSSION: Patella infera is caused by combination of two factors: patellar surgery (painful patellar syndrome, patellar instability, ACL reconstruction using the mid third of the patellar tendon) and painful post operative rehabilitation with no active quadriceps contractions. To avoid this complication, the knee should be braced in 20 degrees of flexion to tense the patellar tendon and rehabilitation should be undertaken with active quadriceps contractions. Patellar lengthening is a successful procedure with the results being dependent upon number of previous surgeries, cartilage damage and, most importantly, the patellar index: between 0.8 and 0.65 the results are uncertain, < 0.6, the results are usually good. CONCLUSION: Patella infera is not a frequent complication of knee surgery. It is important to diagnose it early in order to prevent it. For chronic cases, surgical criteria should be strict: sensation of burning pain, lack of motion, unstable flexed monopodal stance, "sunrise" aspect on axial radiographs and a patellar index < 0.6. Patella infera differs from algodystrophy and re operation by retinacular release is indicated if the delay from previous surgery is < 2 months. In older cases, patellar tendon lengthening should be undertaken.
Asunto(s)
Rótula/cirugía , Complicaciones Posoperatorias , Tendones/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Rótula/diagnóstico por imagen , Pronóstico , Radiografía , Rango del Movimiento ArticularRESUMEN
Anterior tibial translation was measured in both knees using the radiological Lachman test and the lateral monopodal stance tests in 281 patients with unilateral anterior cruciate ligament (ACL) rupture. Measurements of translation in the medial compartment were more useful than those in the lateral compartment. Measurement of anterior tibial translation in the medial compartment using the radiological Lachman test showed ACL rupture in 92% of cases compared with 70% for the lateral monopodal stance test. In normal and in ACL-ruptured knees the monopodal stance test showed that every 10 degrees increase in posterior inclination of the tibial plateau was associated with a 6 mm increase in anterior tibial translation; the radiological Lachman test showed a 3 mm increase for every 10 degrees increase in tibial slope.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/diagnóstico por imagen , Tibia/diagnóstico por imagen , Adolescente , Adulto , Ligamento Cruzado Anterior/fisiopatología , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Postura , Radiografía , Rango del Movimiento Articular , Análisis de Regresión , Rotura , Tibia/fisiopatología , Soporte de PesoRESUMEN
Thirty one amateur skiers with 33 knees which had had a symptomatic chronic rupture of the anterior cruciate ligament (ACL) treated with the Lemaire operation were reviewed retrospectively at an average of 4.5 years. Of the patients 23 were women. The operation failed to control symptoms in 17 out of the 33 knees. However the operation did control symptoms in 13 out of 19 knees in patients over 35 years old, compared with only three out of 14 knees in patients under 35 years old. Clinical and objective testing however showed that most knees were still unstable. Despite this 21 patients continued skiing. One patient with a successful result switched to playing tennis. Five patients gave up all sports. Four further patients, all under 35 years old, returned to skiing after an additional intra-articular reconstruction of the anterior cruciate ligament. An isolated extra-articular procedure in amateur skiers under 35 years old with symptomatic chronic ACL rupture is not recommended. They need at least an intra-articular reconstruction to control their symptoms and to stabilize the knee.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Esquí/lesiones , Adolescente , Adulto , Factores de Edad , Ligamento Cruzado Anterior/fisiopatología , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Luxaciones Articulares/fisiopatología , Luxaciones Articulares/cirugía , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/fisiopatología , Masculino , Meniscos Tibiales/cirugía , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Retrospectivos , Carrera/fisiología , Rotura , Esquí/fisiología , Caminata/fisiología , Soporte de Peso/fisiologíaRESUMEN
The relationship between age at meniscectomy and the time to developing OA requiring an operation was studied. A total of 63 patients (7.8% of those presenting for an operation for OA) had had a previous meniscectomy. It was found that there was a strong correlation between the age at meniscectomy and the time delay (r = -0.68, P < 0.0001). The equation for the regression line was y = -0.68x + 41.8, where y = the delay in years between meniscectomy and operation for OA, and x = the age at meniscectomy. It was noted that there were two distinct populations, those < or = 35 yr old with a mean delay of 26 yr (95% CI 20.8-31.4), and those > 35 yr old with a mean delay of 9.8 yr (95% CI 7.5-12.2). The development of OA requiring an operation following meniscectomy depends on the age at meniscectomy and the time delay. To show an increase rate of OA following meniscectomy in a young population would require follow-up of at least 26 yr.
Asunto(s)
Articulación de la Rodilla , Meniscos Tibiales/cirugía , Osteoartritis/etiología , Adulto , Envejecimiento/fisiología , Humanos , Articulación de la Rodilla/fisiología , Persona de Mediana Edad , Osteoartritis/cirugía , Factores de TiempoRESUMEN
Forty-four of the first 50 knees to undergo anterior cruciate ligament (ACL) reconstruction combined with a valgus tibial osteotomy were reviewed retrospectively at an average of three and a half years later. The combined operation was performed on patients with symptomatic chronic ACL rupture who also had varus malalignment on unilateral weight bearing, usually secondary to a previous medial meniscectomy. All patients originally played regular sports, but before the combined operation, 31 did not play at all. The operation had a low morbidity, and significantly improved clinical symptoms, clinical stability, and functional stability. Postoperatively only one patient could play competitive sports, although a further 26 could play leisure sports. At review there was no radiological progression of osteoarthrosis, and 37 patients (91%) were satisfied or very satisfied with the operation. Performing a valgus tibial osteotomy improved the results of ACL reconstruction in patients with acquired varus malalignment and extended the indications of ACL reconstruction to include patients younger than 40 years of age with early medial compartment osteoarthrosis.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Traumatismos en Atletas/cirugía , Traumatismos de la Rodilla/cirugía , Osteotomía , Tibia/cirugía , Adolescente , Adulto , Lesiones del Ligamento Cruzado Anterior , Traumatismos en Atletas/epidemiología , Niño , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Traumatismos de la Rodilla/epidemiología , Masculino , Osteotomía/estadística & datos numéricos , Ligamento Rotuliano/trasplante , Complicaciones Posoperatorias/epidemiología , Rotura , Factores de TiempoRESUMEN
We analyzed the radiographs and computed tomography (CT) scans of 143 knees operated on for symptomatic patellar instability and 67 contralateral asymptomatic knees, together with 190 control knee radiographs and 27 control knee scans, to determine the factors affecting patellar instability. Four factors were relevant in knees with symptomatic patellar instability: (1) Trochlear dysplasia (85%), as defined by the crossing sign (96%) and quantitatively expressed by the trochlear bump, pathological above 3 mm or more (66%), and the trochlear depth, pathologic at 4 mm or less. (2) Quadriceps dysplasia (83%), defined a present when the patellar tilt in extension is more than 20% on the CT scans. (3) Patella alta (Caton-Deschamps) index greater than or equal to 1.2 (24%). (4) Tibial tuberosity-trochlear groove, pathological when greater than or equal to 20 mm (56%). The factors appeared in only 3%-6.5% of the control knees. The etiology of patellar instability is multifactorial. Determination of the factors permits an effective elective therapeutic plan which aims at correcting the anomalies present.
Asunto(s)
Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/patología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Femenino , Humanos , Inestabilidad de la Articulación/terapia , Masculino , Persona de Mediana Edad , Contracción Muscular , Músculo Esquelético/fisiopatologíaRESUMEN
A retrospective review of 77 soccer players with 91 affected knees that had undergone the same operation, a rim-preserving meniscectomy, was made with a minimum followup of 20 years and an average followup of 27 years. The patients were divided into groups based on the presence of an intact (Group 1) or ruptured (Group 2) anterior cruciate ligament. At 5 years after meniscectomy, 75% of Group 1 and 52% of Group 2 were still playing soccer, and 13% in Group 1 as opposed to 28% in Group 2 had given up sports. The sporting class assessment was good in 80% of the Group 1 knees and 62% in the Group 2 knees. By followup, 5% of Group 1 and 32% of Group 2 required further meniscectomies, and 2% of Group 1 and 16% of Group 2 required operations for osteoarthritis. Radiologically diagnosed osteoarthritis was present in 24% of Group 1 knees compared with 77% of Group 2. Functionally, 60% of the Group 1 knees were excellent at followup as opposed to 9% in Group 2 knees. In Group 1, 49% were still involved in sports compared with 22% in Group 2. However, 97% of Group 1 were satisfied with their knees compared with 74% of Group 2. All of these differences were statistically significant.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Meniscos Tibiales/cirugía , Fútbol/lesiones , Adolescente , Adulto , Estudios de Seguimiento , Humanos , Masculino , Osteoartritis/etiología , Osteoartritis/cirugíaRESUMEN
We reviewed 195 knees in 167 patients at least 20 years after a rim-preserving meniscectomy. They were considered in two groups: 102 knees had had an intact anterior cruciate ligament (ACL), and 93 had had an unrepaired rupture. More patients with a ruptured ACL had downgraded their sport activity by five years after meniscectomy. The incidence of radiographic osteoarthritis was about 65% at 27 years in patients with a ruptured ligament, and 86% in those followed up for over 30 years. In the ligament-deficient group 10% had had operations for osteoarthritis, and another 28% had had other operations, mainly further meniscectomies. Only 6% of those with an intact ligament had needed a second operation after meniscectomy and at long-term follow-up 92% of them were satisfied or very satisfied. Only 74% of the ligament-deficient patients were satisfied with their result. The long-term outcome after rim-preserving meniscectomy depends mainly upon the state of the anterior cruciate ligament.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Meniscos Tibiales/cirugía , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Traumatismos de la Rodilla/complicaciones , Masculino , Persona de Mediana Edad , Osteoartritis/fisiopatología , Evaluación de Resultado en la Atención de Salud , Dolor/fisiopatología , Rango del Movimiento Articular , Estudios Retrospectivos , DeportesRESUMEN
Results of 81 total knee replacements in 67 patients with rheumatoid arthritis were studied. Mean follow-up was three years. Pain was the main reason for knee replacement surgery; knee mobility was well preserved prior to surgery. Failure occurred in four patients, as the result of infection, due in three instances to skin necrosis. Arthrodesis of the knee proved necessary in these patients. The fourth patient developed delayed hematogenous infection which was treated by a change of prosthesis. At follow-up, 82% of patients reported no pain and 18% moderate pain. Mean passive flexion was 113 degrees +/- 17 degrees. HSS score was 83.6 +/- 1.3 and all the patients except for the four with prosthesis failure stated that they were satisfied on very satisfied. Mechanical results were satisfactory, with a mean mechanical femur-tibial angle of 180.4 degrees. A circling line was visible at follow-up in 40% of operated knees but was partial in every case. No reoperations for prosthesis loosening were required. These data show that total knee replacement is the only reliable and radical treatment of rheumatoid arthritis of the knee and should be performed as soon as fixed flessum or axial deviation develops.
Asunto(s)
Artritis Reumatoide/cirugía , Articulación de la Rodilla , Prótesis de la Rodilla , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana Edad , Periodo PosoperatorioRESUMEN
Patellar ligament ruptures are difficult to treat, and require transfer of good quality tissues for an effective reconstruction. In this study the contralateral patellar ligament was chosen in preference to other types of graft. A graft was taken from the opposite knee (length 16 cm, width 8 mm) composed of a block of tibial bone, middle third of patellar ligament, block of patella, and quadriceps tendon. The bone blocks were embedded in slots made on the anterior surface of the patella and the tibia. The method of fixation allowed exact positioning as regards the patella height, and was sufficiently strong to allow immediate mobilisation and full weight-bearing. A series of 13 knees was operated on between October 1988 and July 1990, with a mean post-operative follow-up of 8.6 months. The technique was used twice following total patellectomy and once following total knee arthroplasty. This operation, without any complications from the donor site, produced a stable knee, corrected the extensor lag, and resulted in a mean post-operative flexion of 91 degrees.
Asunto(s)
Articulación de la Rodilla , Ligamentos Articulares/trasplante , Rótula , Adolescente , Adulto , Femenino , Humanos , Ligamentos Articulares/lesiones , Masculino , Recurrencia , Rotura , Técnicas de Sutura , Trasplante AutólogoRESUMEN
Forty total knee replacements following valgus tibial osteotomy were analysed. There were 38 patients (10 men and 28 women) with a mean age of 72 years at the time of the joint replacement, at a mean of 8.5 years after osteotomy. Mean follow-up was 3 years (1 to 5 years). Performing a total knee replacement after valgus tibial osteotomy posed some specific problems due to asymmetrical bone cuts, residual ligament laxity, loss of bone at the tibial plateau, and especially when there was a malunion of the previous osteotomy. The functional results were good. A group of 208 patients with total knee replacements for untreated osteoarthritis acted as a control for comparison. In the group with an osteotomy the results were worse in respect of the walking distance and flexion angle achieved after joint replacement compared with primary replacement (p < 0.001). However the GUEPAR and HSS score 77.2 +/- 2.3 were very similar. Using unilateral weight-bearing X-rays, 18.8p. 100 demonstrated opening from ligament laxity and 40.6p. 100 had radiolucent lines under the components, which was the same as in the control group. The tibio-femoral mechanical axis using long-leg films had a mean varus angle of 0.7 degrees.
Asunto(s)
Prótesis de la Rodilla , Osteotomía/métodos , Tibia/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Radiografía , Reoperación , Tibia/diagnóstico por imagenRESUMEN
Depending on whether degenerative lesions are localized to one single compartment or extend to all three compartments of the knee, and depending on the state of the ligaments (notably the cruciate ligaments) and on the presence or absence of osseous and frontal deformations, various prostheses can be used in the treatment of gonarthrosis. These prostheses fall into three main categories: (i) hinge prostheses, which are very constrained; (ii) sliding prostheses with varying degrees of constraint depending on whether or not the cruciate ligament(s) are spared, and (iii) one-compartment prostheses which replace only one of the three compartments of the knee. Each type of prosthesis has its advantages and drawbacks. Total knee replacement has become a reliable procedure which regularly provides stable and painless knees with a mean flexion angle of 110 degrees and is mainly applied, for the time being, to subjects leading a sedentary life.
Asunto(s)
Prótesis de la Rodilla , Fenómenos Biomecánicos , Humanos , Rodilla/anatomía & histología , Rodilla/fisiologíaRESUMEN
On the basis of their clinical and surgical experience of 480 shoulders operated upon for rotator cuff pathology, together with a review of the literature, the authors undertake a critical analysis of the Neer impingement syndrome. Since this syndrome cannot explain all lesions and above all cover all rotator cuff pathology, they suggest an anatomical classification based upon a description of lesions. They describe their indications for surgery on the basis of their results and of those from the literature.
Asunto(s)
Dolor/etiología , Periartritis/cirugía , Articulación del Hombro , Calcinosis/complicaciones , Humanos , Periartritis/clasificación , Periartritis/etiología , Rotura Espontánea , Síndrome , Tendinopatía/complicacionesRESUMEN
This study reviews a series of 75 total hip prosthesis (THP) after high femoral osteotomy operated on between 1968 and 1986. The mean delay between osteotomy and THP was 14 years. 53 prosthesis were available for long term follow-up with a mean follow up of 7 years. It was included in the category of total hip prosthesis operations considered as difficult. The lateral view is indispensable to plan the operation. Valgus intertrochanteric osteotomies and moderate internal translations posed no problems. Trochanteric osteotomy did not have to be systematic; it's inconveniences were not neglectible. It was reserved for isolated varizations for it modifies the axis of entry of the stem. The reamer was used in cases of narrowing of the femoral canal; notably after significant medializations. Derotation osteotomy was the last resort when it was impossible to position the stem secondary to a subtrochanteric osteotomy or significant angulation in the sagittal plane. An intertrochanteric osteotomy, when correctly realised, posed few problems during placement of a total hip prosthesis and licits a continued use in young subjects. Results of THP after intertrochanteric osteotomy compared well with primary THP, with 77.5 per cent good results and 15 per cent loosening. In addition to problems posed by etiologies (congenital dislocations), subtrochanteric osteotomies rendered cementing extremely difficult, even impossible. At long term, only 14.5 per cent of the results were good and the loosening rate was 45 per cent. Fortunately subtrochanteric osteotomies are practically abandoned.
Asunto(s)
Fémur/cirugía , Prótesis de Cadera , Osteotomía , Adolescente , Adulto , Niño , Estudios de Seguimiento , Prótesis de Cadera/efectos adversos , Prótesis de Cadera/métodos , Humanos , Persona de Mediana Edad , Osteotomía/efectos adversos , Osteotomía/métodos , Estudios Retrospectivos , Factores de TiempoRESUMEN
Between 1965 and 1989, 46 desmoid tumors were observed in the hospitals of Lyon. Twenty-eight patients with an extra-abdominal tumor, with a follow-up of at least 6 months were observed. In this group, there were 12 males and 16 females with an average of 26.7 years. Surgical treatment was performed in 26 cases (in one case no treatment was given and in another case isolated chemotherapy was given). In 21 cases (80%) a recurrence of the tumor was seen after the first excision, incomplete in 6 cases. The highest rate of recurrence was seen in the neck, the girdles and the lower limbs; at the end of our review, 9 patients still had a tumor. No primary amputation were performed but two late amputations, one of which was major, were necessary. One tumor evolved into a sarcoma and in another case, lung metastases were seen. Associated radiotherapy was given in 9 cases with resolution in 55%. Tamoxifen was used in 5 cases with stabilization of the tumor. The risk of recurrence was higher in males (p = 0.0147). Age less than 30 years, and incomplete removal of the tumor were the other predictive factors for recurrence (the difference was not significant).