RESUMEN
BACKGROUND: The purpose of this study was to compare the combined reconstruction of the superficial medial collateral ligament (sMCL) and the posterior oblique ligament (POL) with the reconstruction of the sMCL associated with the advancement of the posteromedial capsule in a complex knee injury scenario. We hypothesized that both techniques would present similar knee stability and failure rates. METHODS: This is a retrospective case-control study designed to compare the results of the two reported techniques for grade III MCL instability. Patients undergoing MCL reconstruction associated with anterior cruciate ligament, posterior cruciate ligament, or both, from 2010 to 2019, were included. The following parameters were evaluated: demographic data, type of graft, time from injury to surgery, associated meniscus injuries, follow up time, mechanism of trauma, postoperative objective IKDC, subjective IKDC and Lysholm scales, range of motion, reconstruction failure and complications. RESULTS: Seventy-eight patients were evaluated, 37 of whom underwent reconstruction of the sMCL and POL, and 41 of whom underwent reconstruction of the sMCL with advancement of posteromedial structures. There was no difference in any preoperative variable. Patients undergoing reconstruction of the sMCL + advancement had greater loss of flexion (Group 1 3.4 ± 4.6 vs Group 2 8.4 ± 7.9; P = 0.002) and more individuals with flexion loss greater than 10° (Group 1, seven patients (18.9%) vs Group 2, 17 patients (41.5%); P = 0.031). Postoperative knee stability, failures and complications were similar between groups. CONCLUSION: Both techniques presented good functional results and low rates of complications. However, the advancement technique showed greater flexion loss, which should be considered when choosing the best surgical option.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamentos Colaterales , Inestabilidad de la Articulación , Traumatismos de la Rodilla , Ligamento Colateral Medial de la Rodilla , Humanos , Estudios Retrospectivos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Estudios de Casos y Controles , Traumatismos de la Rodilla/cirugía , Ligamento Cruzado Anterior/cirugía , Articulación de la Rodilla/cirugía , Rango del Movimiento Articular , Ligamentos Colaterales/cirugía , Ligamento Colateral Medial de la Rodilla/lesiones , Lesiones del Ligamento Cruzado Anterior/cirugíaRESUMEN
The multiple ligament injured knee is a complex problem in orthopedic surgery. These injuries may or may not present as acute knee dislocations, and careful assessment of the extremity vascular and neurological status is essential because of the possibility of arterial and/or venous compromise, and nerve injury. These complex injuries require a systematic approach to evaluation and treatment. Physical examination and imaging studies enable the surgeon to make a correct diagnosis and formulate a treatment plan. Knee stability is improved postoperatively when evaluated with knee ligament rating scales, arthrometer testing, and stress radiographic analysis. Surgical timing depends upon the injured ligaments, vascular status of the extremity, reduction stability, and the overall health of the patient. The use of allograft tissue is preferred because of the strength of these large grafts, and the absence of donor site morbidity.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Ligamento Colateral Medial de la Rodilla/lesiones , Traumatismo Múltiple/cirugía , Procedimientos de Cirugía Plástica/métodos , Ligamento Cruzado Posterior/lesiones , Tendón Calcáneo/trasplante , Humanos , Inestabilidad de la Articulación/cirugía , Luxación de la Rodilla/diagnóstico , Luxación de la Rodilla/etiología , Luxación de la Rodilla/terapia , Traumatismo Múltiple/clasificación , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/etiología , Examen Físico , Arteria Poplítea/lesiones , Ligamento Cruzado Posterior/cirugía , Tiempo de Tratamiento , Resultado del TratamientoRESUMEN
Introducción: El ligamento colateral medial (LCM), es el más frecuentemente lesionado a nivel de la rodilla. Caso clínico: Masculino con ruptura aislada grado III de LCM, atléticamente activo, a quien se le realizó cirugía de reparación primaria con uso de ancla biocompuesta. Conclusión: En las lesiones grado III del LCM se recomienda el tratamiento quirùrgico. Con la técnica descrita en el presente caso se logró reparar adecuadamente la lesión del LCM de la rodilla y se consiguió estabilidad en valgo y rotacional además de recuperar toda la amplitud de movilidad articular. Tipo de estudio: Reporte de caso. Nivel de evidencia: IV
Introduction: The medial colateral ligament (MCL) is the most frecuently injured ligament at the knee. Clinical case: male with isolated MCL rupture grade III, athletically active, who went to primary repair surgery with use of a biocomposite anchor. Conclusion: In the grade III MCL injuries it is recommended surgical treatment. With the discribed technique in the present case we properly repaired the MCL injury at the knee and we got a valgus and rotacional stability, also the patient recovered full range of motion of the joint. Type of study: Case report. Level of evidence: IV
Asunto(s)
Adolescente , Artroscopía/métodos , Ligamento Colateral Medial de la Rodilla/cirugía , Ligamento Colateral Medial de la Rodilla/lesiones , Articulación de la Rodilla/cirugíaRESUMEN
PURPOSE: To evaluate the use of platelet-rich plasma in the early stages of healing of traumatic injury of the medial collateral ligament in the knee of rabbits. METHODS: Thirty rabbits were subjected to surgical lesion of the medial collateral ligament. Of these, 16 were treated with platelet-rich plasma and 14 with saline (control). After 3 and 6 weeks of treatment, 50% of the animals from each group were sacrificed, and biomechanical tests were performed on the injured ligament to compare the tensile strength between the two groups. RESULTS: Platelet-rich plasma significantly increased the tensile strength of the ligament in the groups treated after3 and 6 weeks. In the group treated with platelet-rich plasma vs. saline, the tensile strength values were 3192.5 ± 189.7 g/f vs. 2851.1 ± 193.1 g/f at3 weeks (p = 0.005) and 5915.6 ± 832.0 g/f vs. 4187.6 ± 512.9 g/f at 6 weeks (p = 0.0001). CONCLUSION: The use of platelet-rich plasma at the injury site accelerated ligament healing in an animal model, demonstrated by an increase in the tensile strength of the medial collateral ligament.
Asunto(s)
Ligamento Colateral Medial de la Rodilla/lesiones , Plasma Rico en Plaquetas , Cicatrización de Heridas/efectos de los fármacos , Animales , Fenómenos Biomecánicos , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Masculino , Conejos , Rotura/tratamiento farmacológico , Factores de TiempoRESUMEN
Abstract Purpose: To evaluate the use of platelet-rich plasma in the early stages of healing of traumatic injury of the medial collateral ligament in the knee of rabbits. Methods: Thirty rabbits were subjected to surgical lesion of the medial collateral ligament. Of these, 16 were treated with platelet-rich plasma and 14 with saline (control). After 3 and 6 weeks of treatment, 50% of the animals from each group were sacrificed, and biomechanical tests were performed on the injured ligament to compare the tensile strength between the two groups. Results: Platelet-rich plasma significantly increased the tensile strength of the ligament in the groups treated after3 and 6 weeks. In the group treated with platelet-rich plasma vs. saline, the tensile strength values were 3192.5 ± 189.7 g/f vs. 2851.1 ± 193.1 g/f at3 weeks (p = 0.005) and 5915.6 ± 832.0 g/f vs. 4187.6 ± 512.9 g/f at 6 weeks (p = 0.0001). Conclusion: The use of platelet-rich plasma at the injury site accelerated ligament healing in an animal model, demonstrated by an increase in the tensile strength of the medial collateral ligament.
Asunto(s)
Animales , Masculino , Ratas , Cicatrización de Heridas/efectos de los fármacos , Ligamento Colateral Medial de la Rodilla/lesiones , Plasma Rico en Plaquetas , Rotura/tratamiento farmacológico , Factores de Tiempo , Fenómenos Biomecánicos , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a DrogaRESUMEN
PURPOSE: Lesions of the medial collateral ligament (MCL) are the most common knee ligament injuries, and lesions associated with the anterior cruciate ligament or the posterior cruciate ligament (PCL) in knee dislocations should be reconstructed to prevent failure of the central pivot reconstruction. The purpose of this study was to evaluate the outcomes of combined PCL/MCL reconstruction using a single femoral tunnel with a minimum 2-year follow-up. METHOD: A retrospective study of thirteen patients with combined PCL/MCL injuries was conducted. The patients underwent PCL and MCL reconstruction using an Achilles tendon allograft with a single tunnel in the medial femoral condyle, thereby avoiding tunnel conversion. RESULTS: All patients achieved a range of motion of at least 100°. The mean loss of extension and flexion values compared to the contralateral side was 1° ± 2° and 9° ± 10°, respectively. Our results included 26 reconstructions with three (11.5 %) failures, two in the PCL (15.3 %) and one in the MCL (7.6 %), in three different patients. In the final evaluation, the mean IKDC subjective score was 71.63 ± 16.23, the mean Lysholm score was 80.08 ± 13.87, and the median Tegner score was 6 (range = 2-7). CONCLUSION: The PCL/MCL reconstruction technique using a single femoral tunnel and an Achilles tendon allograft is safe, avoids the convergence of tunnels in the medial femoral condyle, has excellent results, and is reproducible. LEVEL OF EVIDENCE: IV.
Asunto(s)
Fémur/cirugía , Traumatismos de la Rodilla/cirugía , Ligamento Colateral Medial de la Rodilla/lesiones , Procedimientos Ortopédicos/métodos , Ligamento Cruzado Posterior/lesiones , Tendón Calcáneo/trasplante , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Ligamento Colateral Medial de la Rodilla/cirugía , Persona de Mediana Edad , Ligamento Cruzado Posterior/cirugía , Estudios Retrospectivos , Trasplante Homólogo , Resultado del Tratamiento , Adulto JovenRESUMEN
Si bien la mayor parte de las lesiones del ligamento colateral medial (LCM) pueden ser tratados de forma incruenta con buenos resultados, existen situaciones en las cuales el tratamiento quirúrgico es mandatorio. El objetivo fue describir la técnica quirúrgica mínimamente invasiva para la reconstrucción del complejo posteromedial. Materiales y métodos: Diez rodillas cadavéricas fueron evaluadas bajo tres condiciones: estado intacto del LCM, estado seccionado del LCM y estado de reconstrucción del LCM. La evaluación fue realizada en extensión completa y en 20º de flexión, aplicando 10N de valgo. La brecha medial fue medida en radiografías con estrés en valgo para evaluar la traslación en los tres estados diferentes. Resultados: La brecha medial en promedio aumento estadísticamente luego de la sección de las estructuras posteromediales en extensión y a 20 grados de flexión (11 mm y 12,6 vs 3.3 y 3.7 respectivamente p<0.05). Cuando comparamos el valor del estado intacto y luego de la reconstrucción por técnica mínimamente invasiva, no encontramos diferencia estadística tanto en 0° (p:0,56), y en 20° de flexión (p:0,102). La confiabilidad inter-observador demostró un valor kappa de 0.86. Conclusión: Mediante una técnica mínimamente invasiva de reconstrucción del CPM se puede restaurar la estabilidad medial de la rodilla en extensión completa y en 20° de flexión. Nivel de evidencia: IV...
To evaluate if medial knee stability would be restored to the intact state with a minimally invasive posteromedial reconstruction technique. Methods: Ten cadaveric knees were tested under three conditions: intact state, sectioned state and reconstructed state. Medial compartment opening was measured on valgus stress radiographs (mm) made at full extension and at 20º of flexion with a 10-N valgus load (applied with a dynamometer) to assess valgus stability in the intact, sectioned and reconstructed states. Results: The average medial gap statistically increased after sectioning of the posteromedial structures in both extension and 20 degrees of flexion (11 mm and 12.6 mm vs 3.3 mm and 3.7 mm respectively p<0.05). When comparing the value of the intact state and following the minimally invasive reconstruction technique, there was no statistically significant difference at both 0° (p=0.56), and 20° of flexion (p=0.102). Inter-observer reliability showed a kappa value of 0.86. Conclusion: A minimally invasive approach for a medial knee reconstruction restores near-normal medial stability to the knee at full extension and at 20º of flexion. Clinical relevance: Development of minimally invasive techniques will allow medial ligament reconstruction with minimal disruption of the surrounding tissue, potentially leading to less scarring and easier restoration of knee motion post-operatively, with results similar to that obtained with conventional techniques. Level of evidence: IV...
Asunto(s)
Humanos , Articulación de la Rodilla/cirugía , Inestabilidad de la Articulación/cirugía , Ligamento Colateral Medial de la Rodilla/cirugía , Ligamento Colateral Medial de la Rodilla/lesiones , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Cadáver , Fenómenos BiomecánicosRESUMEN
Currently, there is no collective consensus on the most effective treatment method for medial collateral ligament injuries with or without associated structural deficiencies. An in-depth understanding of relevant anatomic structures and diagnostic tools is critical to determining an appropriate treatment strategy. This article presents an overview for management of chronic combined posterior cruciate ligament (PCL) and posteromedial instability of the knee, and the results of treatment within the context of the PCL-based multiple ligament injured knee. Recognition and correction of the varying types of posteromedial instability is the key to successful PCL reconstruction in combined PCL posteromedial instability. Reasons for failure of PCL reconstruction include failure to address associated collateral ligament instability, associated limb malalignment, and improper tunnel position. The principles of reconstruction in the combined PCL posteromedial injured knee are to identify and treat all pathology, accurately place tunnels to approximate ligament anatomic insertion sites, utilize strong graft material, employ mechanical graft tensioning, provide secure graft fixation, and perform a deliberate postoperative rehabilitation program. Results of treatment indicate that multiple techniques of posterior ligament reconstruction and posteromedial reconstruction are successful and return patients functional activity with long-term follow-up.
Asunto(s)
Inestabilidad de la Articulación/cirugía , Traumatismos de la Rodilla/cirugía , Ligamento Colateral Medial de la Rodilla/lesiones , Procedimientos Ortopédicos/métodos , Ligamento Cruzado Posterior/lesiones , Humanos , Inestabilidad de la Articulación/diagnóstico , Traumatismos de la Rodilla/diagnóstico , Articulación de la Rodilla/cirugía , Ligamento Colateral Medial de la Rodilla/cirugía , Ligamento Cruzado Posterior/cirugíaRESUMEN
We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management. We review and discuss the anatomy of the LCLC, the unique mechanism of isolated injury, as well as physical and imaging examination findings.
Asunto(s)
Traumatismos en Atletas/patología , Traumatismos de la Rodilla/patología , Imagen por Resonancia Magnética/métodos , Artes Marciales/lesiones , Ligamento Colateral Medial de la Rodilla/lesiones , Ligamento Colateral Medial de la Rodilla/patología , Adulto , Brasil , Humanos , MasculinoRESUMEN
CONTEXT AND OBJECTIVE: Electrical stimulation (ES) is widely used to strengthen muscles following ligament and meniscal injuries. The aim of this study was to evaluate the effectiveness of ES for rehabilitation after soft tissue injuries of the knee treated surgically or conservatively. DESIGN AND SETTING: Systematic review at the Brazilian Cochrane Center. METHODS: We searched the Cochrane Central Register of Controlled Trials (2010, Issue 12), Medline (Medical Analysis and Retrieval System Online) via PubMed (1966 to December 2010), Embase (Excerpta Medica database, 1980 to December 2010), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, 1982 to December 2010), and PEDro (Physiotherapy Evidence Database, 1929 to December 2010). The studies included were randomized controlled trials using ES to increase muscle strength for rehabilitation of patients with soft tissue injuries of the knee. Two authors independently evaluated studies for inclusion and performed data extraction and methodological quality assessment. RESULTS: Seventeen studies evaluating ES after anterior cruciate ligament reconstruction and two studies evaluating ES after meniscectomy were included. There was a statistically significant improvement in quadriceps strength through ES (mean difference, MD: -32.7; 95 percent confidence interval, CI: -39.92 to -25.48; n = 56) and in functional outcomes (MD -7; -12.78 to -1.22; n = 43) six to eight weeks after surgical reconstruction of the anterior cruciate ligament. CONCLUSION: There is evidence that ES coupled with conventional rehabilitation exercises may be effective in improving muscle strength and function two months after surgery.
CONTEXTO E OBJETIVO: A estimulação elétrica (ES) é amplamente utilizada para fortalecimento muscular após lesões ligamentares ou meniscais do joelho. O objetivo deste estudo foi avaliar a efetividade da ES na reabilitação de lesões de tecidos moles do joelho tratadas de forma cirúrgica ou conservadora. TIPO DE ESTUDO E LOCAL: Revisão sistemática no Centro Cochrane do Brasil. MÉTODOS: Realizamos uma busca no Cochrane Central Register of Controlled Trials (2010, Issue 12), Medline (Medical Analysis and Retrieval System Online) via PubMed (1966 até dezembro 2010), Embase (Excerpta Medica Database, de 1980 até dezembro 2010), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, de 1982 até dezembro de 2010), and PEDro (Physiotherapy Evidence Database, de 1929 até dezembro de 2010). Os estudos incluídos foram ensaios clínicos randomizados que utilizaram a ES com o objetivo de aumento de força muscular na reabilitação de pacientes com lesões de tecidos moles. Dois autores avaliaram os estudos para inclusão de forma independente e realizaram a extração de dados e avaliação da qualidade metodológica. RESULTADOS: Dezessete estudos incluídos utilizaram a ES após a reconstrução do ligamento cruzado anterior e dois estudos após meniscectomia. Houve melhora estatisticamente significante na força do quadríceps através da ES (diferença média, MD -32.7; 95 por cento intervalo de confiança, IC -39.92 to -25.48; n = 56) e nos desfechos funcionais (MD -7; -12.78 to -1.22; n = 43), seis a oito semanas após cirurgia de reconstrução do ligamento cruzado anterior. CONCLUSÃO: Há evidências de que a ES combinada a exercícios de reabilitação convencional pode ser efetiva na melhora da força muscular e função dois meses após cirurgia.
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto Joven , Reconstrucción del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/lesiones , Terapia por Estimulación Eléctrica , Ligamento Colateral Medial de la Rodilla/lesiones , Meniscos Tibiales/lesiones , Ligamento Cruzado Posterior/lesiones , Ligamento Cruzado Anterior/cirugía , Terapia por Estimulación Eléctrica/efectos adversos , Traumatismos de la Rodilla/rehabilitación , Ligamento Colateral Medial de la Rodilla/cirugía , Meniscos Tibiales/cirugía , Fuerza Muscular/fisiología , Ligamento Cruzado Posterior/cirugía , Músculo Cuádriceps/fisiología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
CONTEXT AND OBJECTIVE: Electrical stimulation (ES) is widely used to strengthen muscles following ligament and meniscal injuries. The aim of this study was to evaluate the effectiveness of ES for rehabilitation after soft tissue injuries of the knee treated surgically or conservatively. DESIGN AND SETTING: Systematic review at the Brazilian Cochrane Center. METHODS: We searched the Cochrane Central Register of Controlled Trials (2010, Issue 12), Medline (Medical Analysis and Retrieval System Online) via PubMed (1966 to December 2010), Embase (Excerpta Medica database, 1980 to December 2010), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, 1982 to December 2010), and PEDro (Physiotherapy Evidence Database, 1929 to December 2010). The studies included were randomized controlled trials using ES to increase muscle strength for rehabilitation of patients with soft tissue injuries of the knee. Two authors independently evaluated studies for inclusion and performed data extraction and methodological quality assessment. RESULTS: Seventeen studies evaluating ES after anterior cruciate ligament reconstruction and two studies evaluating ES after meniscectomy were included. There was a statistically significant improvement in quadriceps strength through ES (mean difference, MD: -32.7; 95% confidence interval, CI: -39.92 to -25.48; n = 56) and in functional outcomes (MD -7; -12.78 to -1.22; n = 43) six to eight weeks after surgical reconstruction of the anterior cruciate ligament. CONCLUSION: There is evidence that ES coupled with conventional rehabilitation exercises may be effective in improving muscle strength and function two months after surgery.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Terapia por Estimulación Eléctrica , Ligamento Colateral Medial de la Rodilla/lesiones , Ligamento Cruzado Posterior/lesiones , Lesiones de Menisco Tibial , Adolescente , Adulto , Ligamento Cruzado Anterior/cirugía , Terapia por Estimulación Eléctrica/efectos adversos , Femenino , Humanos , Traumatismos de la Rodilla/rehabilitación , Masculino , Ligamento Colateral Medial de la Rodilla/cirugía , Meniscos Tibiales/cirugía , Fuerza Muscular/fisiología , Ligamento Cruzado Posterior/cirugía , Músculo Cuádriceps/fisiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto JovenRESUMEN
Radiografia e ultrassonografia foram avaliadas como técnicas no diagnóstico por imagem na ruptura do ligamento cruzado cranial (LCCr) em cães. Vinte e cinco cães foram submetidos à radiografia e ultrassonografia e seus resultados foram comparados aos obtidos por artrotomia (teste padrão ouro). O exame radiográfico diagnosticou corretamente a lesão em 84 por cento (21/25) dos casos, mas 16 por cento (4/25) apresentaram resultado falso-negativo. O exame ultrassonográfico foi capaz de diagnosticar acertadamente 76 por cento (19/25) dos casos, e sugeriu a ruptura do LCCr nos 24 por cento (6/25) restantes, apresentando 100 por cento de resultados positivos. Concluiu-se que a radiografia e a ultrassonografia são ferramentas valiosas para diagnosticar casos de ruptura do LCCr em cães.(AU)
Radiography and ultrasonography were evaluated as tools for diagnosis of the rupture of cranial cruciate ligament (CrCL) in dogs. Twenty-five dogs were submitted to radiographic and ultrasonographic examinations and their results were compared with those obtained by artrotomy (gold standard). Radiography detected the rupture in 84 percent (21/25) of the cases, but 16 percent (4/25) were false-negative. Ultrasonography identified accurately 76 percent (19/25) of the cases and gave a probable diagnosis for the remaining 24 percent (6/25) what means that this technique presented 100 percent of positive results. It was possible to conclude that radiography and ultrasonography are valuable tools for the diagnosis of CrCL rupture in dogs.(AU)
Asunto(s)
Animales , Perros , Ligamentos , Ligamentos , Articulaciones/lesiones , Ligamento Colateral Medial de la Rodilla/lesiones , RodillaRESUMEN
Radiografia e ultrassonografia foram avaliadas como técnicas no diagnóstico por imagem na ruptura do ligamento cruzado cranial (LCCr) em cães. Vinte e cinco cães foram submetidos à radiografia e ultrassonografia e seus resultados foram comparados aos obtidos por artrotomia (teste padrão ouro). O exame radiográfico diagnosticou corretamente a lesão em 84 por cento (21/25) dos casos, mas 16 por cento (4/25) apresentaram resultado falso-negativo. O exame ultrassonográfico foi capaz de diagnosticar acertadamente 76 por cento (19/25) dos casos, e sugeriu a ruptura do LCCr nos 24 por cento (6/25) restantes, apresentando 100 por cento de resultados positivos. Concluiu-se que a radiografia e a ultrassonografia são ferramentas valiosas para diagnosticar casos de ruptura do LCCr em cães.
Radiography and ultrasonography were evaluated as tools for diagnosis of the rupture of cranial cruciate ligament (CrCL) in dogs. Twenty-five dogs were submitted to radiographic and ultrasonographic examinations and their results were compared with those obtained by artrotomy (gold standard). Radiography detected the rupture in 84 percent (21/25) of the cases, but 16 percent (4/25) were false-negative. Ultrasonography identified accurately 76 percent (19/25) of the cases and gave a probable diagnosis for the remaining 24 percent (6/25) what means that this technique presented 100 percent of positive results. It was possible to conclude that radiography and ultrasonography are valuable tools for the diagnosis of CrCL rupture in dogs.
Asunto(s)
Animales , Perros , Articulaciones/lesiones , Ligamentos , Ligamentos , Rodilla , Ligamento Colateral Medial de la Rodilla/lesionesRESUMEN
El presente estudio pretende evaluar la alternativa quirúrgica de usar dos botones uno a nivel femoral y el otro a nivel tibial para fijar el injerto autologo hueso tendón hueso, en pacientes con ruptura del ligamento cruzado anterior, fabricado los 24 primeros botones en nuestro país, y los 16 restantes con algunas modificaciones en USA. Se realizaron los primeros 12 casos en pacientes con déficit de LCA utilizando injertos de tendón rotuliano autologos entre abril y diciembre de 2005 con edad promedio 31,7 años con la salvedad de no comenzar con una rehabilitación agresiva sino con una rehabilitación suave, evaluados pre y post-operatorio con el test de Lisholm, se encontraron luego de 35 meses de seguimiento resultados excelentes y buenos en el 91,6% y regulares en el 8,4% los siguiente 8 casos se realizaron entre febrero y mayo 2006, con edad promedio de 25 años evaluados con el mismo test, se evidenciaron a los 28 meses de evolución resultados excelentes y buenos en el 75%, un caso regular 12,5% y un caso malo 12,5%. Si sumamos ambos estudios de 20 casos los resultados son, excelentes y buenos 17 casos 85% dos casos regulares 10% y un caso malo 5%. Se concluye que los dos botones es una altenativa segura, confiable y barata.
Asunto(s)
Humanos , Masculino , Adolescente , Adulto , Aparatos Ortopédicos , Ligamento Colateral Medial de la Rodilla/cirugía , Ligamento Colateral Medial de la Rodilla/lesiones , Ligamentos/cirugía , Ligamentos/lesiones , Ortopedia , TraumatologíaRESUMEN
Descreve-se o tratamento cirúrgico de ruptura de ligamento colateral medial em um cão da raça Rotweiler, com acesso medial e cranial ao ligamento. O diagnóstico foi realizado por meio de exame ortopédico e radiográfico. Como tratamento cirúrgico, o ligamento rompido foi reconstituído com fio mononáillon e foram inseridos dois pinos de Shans de 2,5 mm, para proporcionar maior estabilidade da articulação, sendo um no epicôndio femoral medial, e o outro na face medial do platô tibial. A seguir realizou-se sutura dupla em forma de 8, envolvendo ambos os pinos. No período pós-operatório, imobilizou-se o membro com bandagem acolchoada de Robert Jones, e indicou-se o uso de tramadol e cetoprofeno. A cada 30 dias o animal foi avaliado, e na terceira avaliação não se observou nenhum sinal de dor ou claudicação
This paper reports the surgical treatment of the collateral medial ligament in a Rottweiler dog, with medial and cranial access to the ligament. Diagnosis was based on orthopedic and radiographic examination. Treatment was surgical reconstitution of the ligament with mononylon sutures and insertion of two 2.5 mm Shans wires, in order to givestability to the joint, being one the femoral medial epicondyle and the other in the medial aspect of the tibial plateau. After this there was applied a double 8- shaped suture linking both wires. In the post-op period there was prescribed tramadol plus ketoprofen and the limb was immobilized with a padded Robert Jones bandage. The patient was evaluated every 30 days and in the third monthly evalution there was not observed signs pf pain or lameness
Asunto(s)
Perros , Perros/cirugía , Hilos Ortopédicos , Hilos Ortopédicos/veterinaria , Ligamento Colateral Medial de la Rodilla/lesiones , Clavos Ortopédicos , Rotura , Ortopedia/veterinariaRESUMEN
Descreve-se o tratamento cirúrgico de ruptura de ligamento colateral medial em um cão da raça Rotweiler, com acesso medial e cranial ao ligamento. O diagnóstico foi realizado por meio de exame ortopédico e radiográfico. Como tratamento cirúrgico, o ligamento rompido foi reconstituído com fio mononáillon e foram inseridos dois pinos de Shans de 2,5 mm, para proporcionar maior estabilidade da articulação, sendo um no epicôndio femoral medial, e o outro na face medial do platô tibial. A seguir realizou-se sutura dupla em forma de 8, envolvendo ambos os pinos. No período pós-operatório, imobilizou-se o membro com bandagem acolchoada de Robert Jones, e indicou-se o uso de tramadol e cetoprofeno. A cada 30 dias o animal foi avaliado, e na terceira avaliação não se observou nenhum sinal de dor ou claudicação(AU)
This paper reports the surgical treatment of the collateral medial ligament in a Rottweiler dog, with medial and cranial access to the ligament. Diagnosis was based on orthopedic and radiographic examination. Treatment was surgical reconstitution of the ligament with mononylon sutures and insertion of two 2.5 mm Shans wires, in order to givestability to the joint, being one the femoral medial epicondyle and the other in the medial aspect of the tibial plateau. After this there was applied a double 8- shaped suture linking both wires. In the post-op period there was prescribed tramadol plus ketoprofen and the limb was immobilized with a padded Robert Jones bandage. The patient was evaluated every 30 days and in the third monthly evalution there was not observed signs pf pain or lameness(AU)
Asunto(s)
Perros , Ligamento Colateral Medial de la Rodilla/lesiones , Clavos Ortopédicos , Hilos Ortopédicos , Hilos Ortopédicos/veterinaria , Rotura , Perros/cirugía , Ortopedia/veterinariaRESUMEN
We present 3 cases of simultaneous rupture of the patellar tendon and the anterior cruciate ligament (ACL) and discuss the diagnosis and treatment of this infrequent association. Between 1997 and 2000, 3 patients with a mean age of 37 years were treated with an ACL reconstruction and repair of the patellar tendon. The average follow-up was 3 years. Two of them were initially misdiagnosed. At follow-up, all patients had stable knees and the average Lysholm score was 95. In acute knee injuries with gross anteroposterior instability and a huge hematoma, the occurrence of this complex lesion should be considered. A careful clinical evaluation may be correlated with magnetic resonance imaging findings to provide the orthopaedic surgeon with the appropriate information for planning the timing and surgical treatment.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Artroscopía , Ligamento Rotuliano/lesiones , Accidentes de Tránsito , Enfermedad Aguda , Adulto , Ligamento Cruzado Anterior/cirugía , Ciclismo/lesiones , Tirantes , Terapia Combinada , Hematoma/etiología , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/terapia , Traumatismos de la Rodilla/terapia , Imagen por Resonancia Magnética , Masculino , Ligamento Colateral Medial de la Rodilla/lesiones , Ligamento Colateral Medial de la Rodilla/cirugía , Persona de Mediana Edad , Ligamento Rotuliano/cirugía , Ligamento Rotuliano/trasplante , Recuperación de la Función , Rotura , Fútbol/lesiones , Trasplante AutólogoRESUMEN
Avaliou-se por estudo clínico e isocinético o resultado da reconstrução do ligamento cruzado anterior (LCA) com o uso do tendão do quadríceps (TQ). Compararam-se os resultados objetivos da avaliação isocinética com os dados clínicos e de exame físico obtidos com os sistemas de avaliação de Lysholm e do Hospital for Special Surgery Knee Score (HSSKS). Comparou-se a avaliação isocinética do membro operado com a do membro contralateral. Material e métodos: Os pacientes com lesão do LCA foram submetidos à reconstrução pelo mesmo cirurgião, usando técnica cirúrgica artroscópica transtibial com enxerto do tendão do quadríceps. Dos pacientes, 54 foram avaliados em consultório segundo critérios clínicos e 32 realizaram exame isocinético. Resultados: Na escala de Lysholm a média foi de 97,66 pontos e na escala HSSKS, de 94,88 pontos. O torque máximo do quadríceps do lado operado apresenta déficit médio de 12,1por cento, 20,3 por cento e 25,5 por cento nas velocidades de 60°, 180° e 3000/seg, respectivamente. Não houve déficit de f1exão