RESUMEN
Cuando fracasa el tratamiento conservador en el Estadio I de Disfunción del Tendón Tibial posterior (DTTP), se debe indicar sinovectomía y debridamiento del tendón. En este estudio evaluamos la evolución con 8 años mínimo de seguimiento, de los pacientes con esta patología tratados vía tenoscópica. Este es un estudio retrospectivo de pacientes operados entre el año 2008 y el año 2011. En ese período de tiempo se intervinieron 11 pacientes con esta patología. Sólo 9 de los 11 pacientes operados pudieron ser evaluados. 7 pacientes mejoraron su sintomatología según el VAS y no progresaron a estadio II. En 3 pacientes se evidenció lesión tendinosa durante la tendoscopía y ameritaron reparación a cielo abierto. La sinovectomía tendoscópica del TTP es un procedimiento quirúrgico efectivo para tratar a los pacientes con DTTP Estadio I, rebeldes a tratamiento conservador(AU)
When conservative treatment fails for Stage I Posterior Tibial tendon dysfunction (PTTD), synovectomy and tendon debridement is indicated. In this study we evaluate tendoscopic treatment results for this pathology with a minimum of 8 years follow up. This is a retrospective study of patients after tendoscopic surgery performed between 2008 and 2011. 9 of the 11 patients were available for evaluation. 7 improved their symptoms according to VAS scale, and did not progress to stage II. In 3 patients tendon tear was visualized during tendoscopy and needed open repair. PTT tendoscopy is an effective surgical treatment to treat Stage I PTTD, failing to conservative treatment(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Artroscopía/métodos , Disfunción del Tendón Tibial Posterior/cirugía , Sinovectomía/métodos , Espectroscopía de Resonancia Magnética , Estudios Retrospectivos , Estudios de Seguimiento , DesbridamientoRESUMEN
Surgical treatment for a stage II adult acquired flatfoot has consisted of reconstruction of the diseased posterior tibial tendon with flexor digitorum longus tendon transfer, combined with osteotomies to address the underlying deformity. This case series presents an alternative to tendon transfer using allograft tendon for posterior tibial tendon reconstruction. Four patients who underwent stage II flatfoot reconstruction with posterior tibial tendon allograft transplantation were included. All patients had preoperative radiographs demonstrating flatfoot deformity and magnetic resonance imaging showing advanced tendinopathy of the posterior tibial tendon. Allograft tendon transplant was considered in patients demonstrating adequate posterior tibial tendon excursion during intraoperative assessment. Additional procedures were performed as necessary depending on patient pathology. Postoperatively, all patients remained non-weightbearing in a short leg cast for 6 weeks. Radiographs performed during the postoperative course demonstrated well-maintained and improved alignment. No complications were encountered. Each patient demonstrated grade 5 muscle strength and were able to perform a single-limb heel rise at the time of final follow-up. The average follow-up duration was 19.0 months. Flexor digitorum longus transfer has been studied extensively for stage II adult acquired flatfoot. However, the flexor digitorum longus has been shown to be much weaker relative to the posterior tibial tendon, and concern remains regarding its ability to recreate the force of the posterior tibial tendon. Our results demonstrate that posterior tibial tendon allograft reconstruction combined with flatfoot reconstruction is a reasonable option. This alternative has the advantage of preserving the stronger muscle without disturbing regional anatomy.
Asunto(s)
Calcáneo , Pie Plano , Disfunción del Tendón Tibial Posterior , Adulto , Aloinjertos , Pie Plano/diagnóstico por imagen , Pie Plano/cirugía , Humanos , Disfunción del Tendón Tibial Posterior/diagnóstico por imagen , Disfunción del Tendón Tibial Posterior/cirugía , Transferencia Tendinosa , Tendones/cirugíaRESUMEN
Posterior tibial tendon dysfunction (PTTD) is a progressive disorder secondary to advanced degeneration of the posterior tibial tendon, leading to the abduction of the forefoot, valgus rotation of the hindfoot, and collapse of the medial longitudinal arch. Eventually, the disease becomes so advanced that it begins to affect the deltoid ligament over time. This attenuation and eventual tear of the deltoid ligament leads to valgus deformity of the ankle. Surgical correction of PTTD is performed to protect the ankle joint at all costs. Generally, this is performed using osteotomies of the calcaneus and repair or augmentation of the deltoid ligament. Unfortunately, there has been no universal procedure adapted by foot and ankle surgeons for repair or augmentation of the deltoid ligament. Articles have discussed the use of suture and suture anchors, suture tape, nonanatomic allograft repair, nonanatomic autograft repair with plantaris, peroneal and extensor halluces longus tendons to repair and augment the deltoid ligament. There is very little literature, however, in regard to using the posterior tibial tendon to augment the deltoid ligament in accordance with hindfoot fusion for end-stage PTTD deformity. In general, the posterior tibial tendon in triple and medial double arthrodesis is generally removed because it is thought to be a pain generator. This article presents a case study and novel technique using the posterior tibial tendon to augment and repair the laxity of the deltoid ligament in an advanced flatfoot deformity.
Asunto(s)
Ligamentos Articulares/cirugía , Disfunción del Tendón Tibial Posterior/cirugía , Transferencia Tendinosa/métodos , Adulto , Humanos , MasculinoRESUMEN
Lateral hindfoot pain associated with stage 2 to 3 adult-acquired flatfoot is often attributed to subfibular impingement. Preoperative magnetic resonance imaging (MRI) is generally performed to assess the extent of degeneration within the posterior tibial tendon, attenuation of medial soft tissue constraints, and degeneration of hindfoot and/or ankle articulations. The purpose of this study is to determine the incidence of lateral collateral ligament disease/injury associated with stages 2 and 3 adult-acquired flatfoot. The subjects were identified using a searchable computerized hospital database between 2015 and 2017. Stage 2 or 3 adult-acquired flatfoot deformity was confirmed in patients via chart review and MRI analysis. Lateral ankle ligament injury was confirmed using patient MRI results per the hospital radiologist and documented within the patients' chart. Inclusion criteria required that patients be diagnosed with Johnson and Strom stage 2 or 3 flatfoot deformity with documented lateral ankle pain and that preoperative MRI scans be available with the radiologist's report. Patient exclusion criteria included patients <18 years of age, patients with flatfoot deformity caused by previous trauma, tarsal coalition, neuropathic arthritis, patients with previous surgery, or patients with incomplete medical records. In total, 118 patients were identified with these parameters. Of the 118 patients, 74 patients (62.7%) had documented lateral ankle ligament injury on MRI. Of the 77 patients with stage 2 adult-acquired flatfoot, 55 (71.4%) had confirmed lateral ankle ligament injury on MRI. Of the 41 patients with stage 3 adult-acquired flatfoot, 19 (46.3%) had confirmed lateral ankle ligament injury on MRI. This study demonstrates a relatively high incidence of lateral ligament disease associated with adult-acquired flatfoot deformity. These findings might have long-term implications regarding ankle arthritis after surgical management of adult-acquired flatfoot.
Asunto(s)
Deformidades Adquiridas del Pie/epidemiología , Ligamentos Laterales del Tobillo/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Disfunción del Tendón Tibial Posterior/cirugía , Rango del Movimiento Articular/fisiología , Adulto , Anciano , Traumatismos del Tobillo/complicaciones , Traumatismos del Tobillo/diagnóstico por imagen , Estudios de Cohortes , Intervalos de Confianza , Bases de Datos Factuales , Femenino , Pie Plano/diagnóstico por imagen , Pie Plano/etiología , Pie Plano/cirugía , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/fisiopatología , Humanos , Ligamentos Laterales del Tobillo/fisiopatología , Ligamentos Laterales del Tobillo/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Disfunción del Tendón Tibial Posterior/complicaciones , Disfunción del Tendón Tibial Posterior/diagnóstico por imagen , Prevalencia , Pronóstico , Recuperación de la Función/fisiología , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
Como resultado de la insuficiencia del tendón tibial posterior (TTP), el arco longitudinal medial se derrumba en forma progresiva. Los intentos de restaurar la función del TTP mediante reparación directa no han sido satisfactorios. Por lo tanto, se ha recomendado la sustitución del TTP por medio de la transferencia de tendones aunque eso no corrige la deformidad. Debido a esto es necesario agregar una osteotomía. La osteotomía por preferencia es la medialización de la tuberosidad posterior del calcáneo. Respecto al método de fijación de la osteotomía existen diferentes alternativas de fijación. El objetivo del trabajo es presentar los resultados radiográficos y clínicos del tratamiento de la insuficiencia del TTP Grado II y sus deformidades resultantes mediante osteotomía de desplazamiento medial del calcáneo fijada con placa escalonada y otros procedimientos. (AU)
As a result of posterior tibial tendon insufficiency (PTT), the medial longitudinal arch collapses progressively. Attempts to restore the TTP function through direct repair have not been satisfactory.2 Therefore, TTP replacement has been recommended by means of tendon transfer although this does not correct the deformity. Because of this it is necessary to add an osteotomy. The osteotomy by preference is the medialization of the posterior tuberosity of the calcaneus. Regarding the fixation method of the osteotomy, there are different fixation alternatives. The objective of this study was to present the radiographic and clinical results of the treatment of TTP grade II insufficiency and its resulting deformities by osteotomy of the medial displacement of the calcaneus fixed with stepped plaque and other procedures. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Calcáneo/diagnóstico por imagen , Disfunción del Tendón Tibial Posterior/cirugía , Disfunción del Tendón Tibial Posterior/diagnóstico por imagen , Osteotomía , Calcáneo/cirugíaAsunto(s)
Traumatismos de los Pies/cirugía , Ligamentos Articulares/lesiones , Ligamentos Articulares/cirugía , Traumatismos de los Pies/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Disfunción del Tendón Tibial Posterior/etiología , Disfunción del Tendón Tibial Posterior/cirugía , Rotura/diagnóstico , Rotura/cirugía , Tenis/lesionesRESUMEN
Stage I PTTD was defined by Johnson and Strom as tenosynovitis or tendinitis whereby tendon length remains normal, there is no hindfoot deformity, and diagnosis is basically clinical, characterized by swelling and tenderness posterior to the medial malleolus. The PTT has a hypovascular zone 40 mm proximal to the insertion of the tendon and 14 mm in length. Pain often is localized to this portion of the tendon. Tendon power might be normal, and the patient can perform single heel rise, sometimes with slight discomfort. This condition is often misdiagnosed as ankle sprain, which delays correct diagnosis and early treatment that may improve symptoms, stop the disease process, and prevent the development of adult acquired flatfoot deformity. Ultrasonography is a valuable adjunctive diagnostic tool for stage I PTTD, but the authors always indicate MRI for accurate diagnosis in such patients. Patients with stage I PTTD are first treated nonoperatively with nonsteroidal anti-inflammatory drugs for 5 days, cryotherapy, local ultrasound, and a PTTD airlift brace (Aircast) for 3 to 6 months. If symptoms persist, surgical debridement and synovectomy has been suggested. PTT tendoscopic synovectomy is a minimally invasive and effective surgical procedure to treat patients with stage I PTTD. It has the advantages of less wound pain, and fewer scar and wound problems. If tendon tear is observed during tendoscopy, it must be repaired with nonabsorbable sutures using a 3- or 4-cm incision.
Asunto(s)
Disfunción del Tendón Tibial Posterior/cirugía , Sinovectomía , Artroscopía , Desbridamiento , Humanos , Disfunción del Tendón Tibial Posterior/diagnóstico , Tendinopatía/diagnóstico , Tendinopatía/cirugía , Tenosinovitis/diagnóstico , Tenosinovitis/cirugíaRESUMEN
Young's procedure contains an action mechanism that works better than other techniques on the pathophysiology of FFD. It respects the anatomy and biomechanics of the foot to reach the necessary muscular balance. The benefits of this technique include that the ATT is not detached, so its function mechanism is still active; the new trajectory of the ATT provides a powerful sling function at the level of the navicular; and the horizontal trajectory of the ATT and the osteoperiosteal flaps constitute a powerful inner capsulartendinousligamentous support. What is more, an insufficiency of the ATT is created, which results in a predominance of the peroneus lateral longus, that descends and prones the forefoot. Additional procedures, such as medial displacement calcaneal osteotomy, should be considered to correct the entire deformity. The combination of these techniques do not sacrifice the joint mobility.
Asunto(s)
Trasplante Óseo , Pie Plano/cirugía , Deformidades Adquiridas del Pie/cirugía , Osteotomía/métodos , Disfunción del Tendón Tibial Posterior/cirugía , Transferencia Tendinosa/métodos , Adulto , Fenómenos Biomecánicos , Terapia Combinada , Femenino , Pie Plano/etiología , Pie Plano/fisiopatología , Deformidades Adquiridas del Pie/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Disfunción del Tendón Tibial Posterior/complicaciones , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resistencia a la TracciónRESUMEN
Las deformidades axiales de los miembros inferiores, motivo de consulta habitual, no corregen espontáneamente si son persitentes y sginificativas. La epifisiodesis produce la corrección grudual de la deformidad en un procedimiento mínimamente invasivo, en pacientes esqueléticamente inmaduros, en genu valgum y varum, con grapas o placas y tornillos. Según las observaciones clínicas, las placas permiten un mejor resultado en tiempo más corto, menor daño a la fisis y menos riesgo de complicaciones o falla de material en comparación con las grapas. La comparación de las técnicas en engrapado y placa en la resolución de deformidades en valgo de tibia proximal en los pacientes pediátricos en el Hospital Ortopédico Infantil, durante el periodo 2000 al 2007. Estudio retrospectivo simple y comparativo, se evaluaron 36 pacientes de ambos sexos con el diagnostico de Valgo Proximal Tibial, idiopáticos o asociados a otras patologías, que fueron tratados en el Hospital Ortopédico Infantil durante 2000 al 2007 con las técnicas de grapa y placa, mediante revisión de controles pre y postoperatorios de la historia clínica, y por medición radiológica de los ángulos FDLm, TPMm y MAD en radiogrfías panorámicas pre y postoperatorias. Se estudiaron 36 pacientes de ambos sexos, (16 varones y 20 niñas), promedio de edad de 10 años +/- 3,3 años. Existen similitudes en los primeros 12 meses en esta muestra, pero a partir de ese momento la Placa alcanza los valores de corrección antes que las grapas. Según la pendiente Y, la placa se proyecta para correcciones de 6,62 mm cada 6 meses, en cambio la grapa se proyecta para correciones de 5,72 mm cada 6 meses. Los valores del ángulo se estabilizan con la placa, y en cuanto a la grapa, se continúa la corrección en sentido contrario. La pendiente Y indica que la placa corrige -1,95º cada 6 meses, y la grapa corrige -2,95º cada 6 meses hacia el varo. Según la prueba ANOVA, combinando las variables Tiempo-Material, la placa alcanza....
The axial deformities of the lower limbs, common reason for consulation, will not correct spontaneously if they are persistent and significant. Epiphysiodesis produce gradual correction of deformity in a minimally invasive procedure in skeletally immature patients in valgum and genu varum with staples or plates and screws. According to clinical observations, the plates allow a better result in shorter time, less damage to the physis and less risk of complications or failure of material compared with the staples. Comparison of stapling techniques and plaque in the resolution of valgus deformity of proximal tibian in pediatric patients at Children's Orthopedic Hospital during the period 2000 to 2007. A retrospective and comparative simple, we evaluated 36 patients of both sexes with a diagnosis of Proximal Tibial Valgus, idiopathic or associated with other diseases, which were treated at the Children's Orthopedic Hospital during the period 2000 to 2007 with the techniques staple and plate by reviewing pre-and postoperative checks of medical record, and radiological measurements of the angeles FDLm, TPMm, and MAD in pre-and postoperative panoramic radiographs. We studied 36 patients of both sexes (16 boys and 20 girls), mean age 10 +/- 3,3 years. There are similarities in the first 12 months in this sample, but from that moment on the plate reaches the values of correction rather than staples. According to the slope and The plate is projected to corrections from 6,62 mm every 6 months, however the clip is projected to corrections of 5,72 mm every 6 months. The angle values are e¡stabilized with the plate, and as for the clip, continue the correction in the opposite direction. The slope indicates that the board and fixes -1,95º every six months, and the clip fixes -2,95º every six months into varus. According to the ANOVA test, combining the time-material variables, the plate reaches the expected correction before on the staple, the period aroun 12 months would.....