RESUMEN
PURPOSE: To report the results of our modified technique for repair of the EWAS 1 lesion of triangular fibrocartilage complex (TFCC). METHODS: This retrospective case series reviewed 22 consecutive patients with EWAS 1 TFCC tear. Arthroscopic repair was done using our modified double-loop arthroscopic outside-in technique which is originally described by Mathoulin and Del Piñal. The repair was performed using single-strand suture and 18-gauge cannula, having three passes through the tear. Follow-ups ranged from 24 to 33 months with an average of 29.3 months. The results were evaluated by the Modified Mayo Wrist Score (MMWS), Visual Analog Score (VAS). In addition, range of motion (ROM) and power grip were compared with the contralateral side. RESULTS: The mean age was 23 years. The dominant side was affected in 16 wrists. There was postoperative improvement of the all functional outcome measures (MMWS, VAS, ROM, and power grip). All the patients returned to their previous activities with no reported intra- or postoperative complications. CONCLUSIONS: The described outside-in technique is safe and effective technique for repair of EWAS 1 TFCC tear. LEVEL OF EVIDENCE: Therapeutic, case series, level IV.
Asunto(s)
Fibrocartílago Triangular , Traumatismos de la Muñeca , Artroscopía , Humanos , Recién Nacido , Estudios Retrospectivos , Resultado del Tratamiento , Fibrocartílago Triangular/cirugía , Articulación de la MuñecaRESUMEN
PURPOSE: We systematically reviewed the literature to compare the clinical and radiologic outcomes and retear rates of superior capsular reconstruction (SCR) using fascia lata autograft (FLA) versus human dermal allograft (HDA) in cases of massive irreparable rotator cuff tears. METHODS: Searches of Pub Med and Cochrane Library identified clinical studies addressing SCR using FLA and HDA. Two reviewers independently screened the titles, abstracts and full texts to extract data from eligible studies. Reported outcome measures were descriptively analyzed. RESULTS: A total of 6 studies with 2 study groups satisfied the inclusion criteria. The number of shoulders in the HDA group was 155, and in the FLA group, the number was 140 shoulders. The mean age at time of surgery for the HDA group and the FLA group was 60.49 years and 65.8 years, respectively, and the mean follow-up was 15.2 months and 44.6 months, respectively. Active elevation improved from of 121°-130° to 158°-160° in the HDA group and from 74.8°-133° to 130.4°-146° in the FLA group. Active external rotation improved from 36°-45° in the HDA group and from 13°-28° to 30°-43° in the FLA group. The Visual Analog Scale for pain improved from 4-6.25 to 0.38-1.7 points in the HDA group, whereas in the FLA group, it improved from 6-2.5 points. In the HDA group, American Shoulder and Elbow Surgeons scores improved from 42-52 to 77.5-86.5, whereas in the FLA group scores improved from 35-54.4 to 73.7-94.3. The acromiohumeral distance improved in both groups. The retear rate was 3.4%-55% in the HDA group and 4.5%-29% % in the FLA group. CONCLUSIONS: Arthroscopic SCR for massive, irreparable rotator cuff tears using both fascia lata allograft and human dermal allograft leads to improvement in clinical outcomes and radiologic outcomes. There is a lower retear rate in fascia lata allografts. The current literature is heterogeneous and has low levels of evidence. LEVEL OF EVIDENCE: Level IV, systematic review of level IV studies.
RESUMEN
PURPOSE: To report the midterm results of mini-invasive anatomical no hardware combined reconstruction of the medial patellofemoral ligament (MPFL) and medial patellotibial (MPTL) using single semitendinosus tendon autograft. MATERIALS AND METHODS: A prospective study was performed on 33 cases with recurrent patellar dislocation treated with combined MPFL and MPTL reconstruction by a described Relay Technique. Evaluation was focusing on return to previous level of activity, range of motion, apprehension, overall patient satisfaction and scoring with VAS, Cincinnati, Kujala's, Lysholm scores. Radiological evaluation was based on congruence and tilting angles. Four cases were lost to follow-up and excluded from the study, so the study included 29 patients. RESULTS: The mean VAS had improved from 6.3 to 1.8. Cincinnati score increased from 50 ± 7.1 (range, 38-60) to 88 ± 6 (range, 76-100). The mean Kujala score increased from 36.6 ± 6 (range, 22-48) to 90.6 ± 7 (range, 78-100). The mean Lysholm score increased from 51.9 ± 4.7 (range, 42-59) to 89.5 ± 5.6 (range, 78-98). The congruence angle improved from 11.93° to -6.48°, and the patellar tilt angle from 10.9° to 2.45°. All improvements were statistically significant. Only one case reported unsatisfaction, and 96.4 % were satisfied and returned to previous activity. No single recurrence was reported. CONCLUSION: Combined anatomical MPFL and MPTL reconstruction with semitendinosus (ST) autograft using mini-invasive Relay Technique is safe, and its midterm results show significant clinical and radiological improvements with 96.4 % patient satisfaction and nil rate of recurrence.
Asunto(s)
Plastía con Hueso-Tendón Rotuliano-Hueso , Inestabilidad de la Articulación , Ligamento Colateral Medial de la Rodilla , Luxación de la Rótula , Ligamento Rotuliano , Complicaciones Posoperatorias/prevención & control , Adulto , Plastía con Hueso-Tendón Rotuliano-Hueso/efectos adversos , Plastía con Hueso-Tendón Rotuliano-Hueso/métodos , Egipto , Femenino , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/prevención & control , Masculino , Ligamento Colateral Medial de la Rodilla/diagnóstico por imagen , Ligamento Colateral Medial de la Rodilla/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Luxación de la Rótula/diagnóstico , Luxación de la Rótula/etiología , Luxación de la Rótula/cirugía , Ligamento Rotuliano/diagnóstico por imagen , Ligamento Rotuliano/cirugía , Satisfacción del Paciente , Estudios Prospectivos , Radiografía , Rango del Movimiento Articular , Procedimientos de Cirugía Plástica , Prevención Secundaria , Trasplante Autólogo , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of this study was to evaluate the safety and clinical outcome of a new posterior approach for the known outside-in technique for repair of tears of the posterior horn of the medial meniscus (PHMM). METHODS: First, a cadaveric study was performed on 6 cadaveric knees to assess the safety of a point just lateral to the semitendinosus tendon as an entry point for outside-in repair. Dissection was done to measure the clearance of this point to the nearby popliteal bundle and saphenous nerve. A prospective case series study was then performed to assess the clinical outcome of such an approach. We treated 41 consecutive cases with PHMM tears by the outside-in technique using a shuttle relay method through the same point. Clinical assessments, magnetic resonance imaging findings, Lysholm scores, and International Knee Documentation Committee subjective scores were recorded for all patients. After a minimum postoperative period of 2 years, all cases were re-evaluated and re-scored. RESULTS: The cadaveric study showed a mean clearance distance of 2.4 cm for the popliteal bundle and 4.6 cm for the saphenous nerve. The case series study was done on 41 meniscal repairs; 15 of 41 cases (37%) were performed in conjunction with anterior cruciate ligament reconstruction. There were 22 right knees (54%) and 19 left knees (36%). After a mean follow-up period of 27 months, patients showed a clinical success rate of 88% in terms of disappearance of pain, locking, and swelling, together with improved Lysholm scores (from 34 to 88) and International Knee Documentation Committee scores (from 25 to 88). These improvements were statistically significant (P < .05). CONCLUSIONS: An outside-in repair technique with a posterior entry central to the semitendinosus tendon was used safely with 88% satisfactory clinical results for treatment of PHMM tears. LEVEL OF EVIDENCE: Level IV, therapeutic case series.