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1.
Bull Hosp Jt Dis (2013) ; 82(4): 231-236, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-39259948

RESUMEN

BACKGROUND: An isolated medial patellofemoral ligament (MPFL) reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of patellar instability, but there is growing support for performing a tibial tubercle osteotomy (TTO) in patients with an elevated tibial tubercle-trochlear groove distance. The purpose of this study was to evaluate the impact of adding a TTO to MPFLR on patient reported outcomes. METHODS: A retrospective review of patients who underwent MPFLR with or without TTO with a minimum of 12-month follow-up was performed. Patients in both groups were matched based on age, sex, and follow-up time. Recurrent instability (including re-dislocation and subluxation), visual analog scale (VAS) for pain score, Kujala score, and satisfaction were evaluated. RESULTS: There were 59 patients who underwent MPFLR with concomitant TTO performed at our institution and met our inclusion and exclusion criteria. These patients were then matched to patients undergoing isolated MPFLR based on demographics and follow-up time. The mean age was 25.0, 76.3% were female, and the mean follow-up time was 49 months. There was a significant difference in mean tibial tubercle-trochlear groove distance (19.8 ± 3.9 vs. 14.1 ± 2.8) between groups. There was no significant difference in VAS (1.48 ± 2.0 vs. 1.49 ± 2.1, p = 0.972), satisfaction (86.1% ± 24.2% vs. 81.2% ± 27.9, p = 0.311), or revision surgeries (10.2% vs. 10.2%) between groups. CONCLUSION: There was a low complication rate, excellent patient reported outcomes, and a low rate of recurrent patellar instability following TTO and MPFLR with allograft.


Asunto(s)
Inestabilidad de la Articulación , Osteotomía , Articulación Patelofemoral , Tibia , Humanos , Femenino , Osteotomía/métodos , Osteotomía/efectos adversos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Masculino , Estudios Retrospectivos , Adulto , Tibia/cirugía , Articulación Patelofemoral/cirugía , Articulación Patelofemoral/fisiopatología , Articulación Patelofemoral/diagnóstico por imagen , Adulto Joven , Resultado del Tratamiento , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Adolescente , Luxación de la Rótula/cirugía , Luxación de la Rótula/fisiopatología , Luxación de la Rótula/diagnóstico por imagen , Recurrencia , Ligamentos Articulares/cirugía , Ligamento Rotuliano/cirugía
2.
JBJS Rev ; 12(9)2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-39236152

RESUMEN

¼ Patellar instability is challenging to address, and although there are many surgical options, proximal patellar realignment (PPR) and medial patellofemoral ligament (MPFL) reconstruction are both used-recently, the MPFL reconstruction has become more popularized.¼ Both procedures have demonstrated similar recurrent dislocation rates and rates of arthritic progression.¼ PPR is a cost-efficient procedure using just suture alone as compared with MPFL reconstruction, which uses different grafts and methods of fixation.¼ PPR has demonstrated durable results, with a lower overall complication rate, much of which is caused by the MPFL reconstruction having unique complications due to fixation methods.¼ The PPR is a beneficial procedure and should still be considered when dealing with patellar instability.


Asunto(s)
Ligamentos Articulares , Articulación Patelofemoral , Humanos , Articulación Patelofemoral/cirugía , Ligamentos Articulares/cirugía , Inestabilidad de la Articulación/cirugía , Luxación de la Rótula/cirugía , Procedimientos de Cirugía Plástica/métodos
3.
Clin Orthop Relat Res ; 482(9): 1685-1695, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-39158387

RESUMEN

BACKGROUND: Intraarticular hip pain represents a substantial clinical challenge, with recent studies implicating lesions in the ligamentum teres as potential contributors. Even more so, damage to the ligamentum teres is particularly prevalent among young patients undergoing joint-preserving interventions. Although several studies have investigated the biomechanical attributes of the ligamentum teres, inconsistencies in reported findings and reliance on cadaveric or animal models have raised concerns regarding the extrapolation of results to clinical practice. Furthermore, there is a lack of research examining ligamentum teres biomechanics specifically within the relevant patient cohort-individuals who benefit from joint-preserving surgical interventions. QUESTIONS/PURPOSES: We sought (1) to determine the biomechanical properties (ultimate load to failure, tensile strength, stiffness, and elastic modulus) of fresh-frozen ligaments from patients undergoing surgical hip dislocation, and (2) to identify patient-specific factors that are associated with them. METHODS: This was an institutional review board-approved study on intraoperatively harvested ligamentum teres from 74 consecutive patients undergoing surgical hip dislocation for joint preservation (August 2021 to September 2022). After the exclusion of patients with previous surgery, posttraumatic deformities, avascular necrosis, slipped capital femoral epiphysis, and Perthes disease, 31 ligaments from 31 patients were analyzed. The mean age of the study group was 27 ± 8 years, and 61% (19) of participants were male. The main indication for surgery was femoroacetabular impingement. Standardized AP pelvic and axial radiographs and CT scans were performed in all patients for better radiological description of the population and to identify associated radiological factors. The ligament was thoroughly transected at its origin on the fossa acetabuli and at the insertion area on the fovea capitis and stored at -20°C until utilization. Specimens were mounted to a materials testing machine via custom clamps that minimized slippage and the likelihood of failure at the clamp. Force-displacement and stress-strain curves were generated. Ultimate failure load (N), tensile strength (MPa), stiffness (N/mm), and elastic modulus (MPa) were determined. Using a multivariate regression analysis and a subgroup analysis, we tested demographic, degenerative, and radiographic factors as potential associated factors. RESULTS: The ligamentum teres demonstrated an ultimate load to failure of 126 ± 92 N, and the tensile strength was 1 ± 1 MPa. The ligaments exhibited a stiffness of 24 ± 15 N/mm and an elastic modulus of 7 ± 5 MPa. After controlling for potential confounding variables like age, fossa/fovea degeneration, and acetabular/femoral morphologies, we found that female sex was an independent factor for higher tensile strength, stiffness, and elastic modulus. Excessive femoral version was independently associated with lower load to failure (HR 122 [95% CI 47 to 197]) and stiffness (HR 15 [95% CI 2 to 27]). Damage to the acetabular fossa was associated with reduced load to failure (HR -93 [95% CI -159 to -27]). CONCLUSION: Overall, the ligamentum teres is a relatively weak ligament. Sex, degeneration, and excessive femoral version are influencing factors on strength of the ligamentum teres. The ligamentum teres exhibits lower strength compared with other joint-stabilizing ligaments, which calls into question its overall contribution to hip stability. CLINICAL RELEVANCE: Young patients undergoing hip-preserving surgery are the population at risk for ligamentum teres lesions. Baseline values for load to failure, tensile strength, elastic modulus, and stiffness are needed to better understand those lesions in this cohort of interest.


Asunto(s)
Articulación de la Cadera , Humanos , Masculino , Femenino , Fenómenos Biomecánicos , Adulto , Adulto Joven , Articulación de la Cadera/cirugía , Articulación de la Cadera/fisiopatología , Articulación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/fisiopatología , Luxación de la Cadera/cirugía , Luxación de la Cadera/diagnóstico por imagen , Ligamentos Articulares/fisiopatología , Ligamentos Articulares/cirugía , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Redondos/cirugía , Ligamentos Redondos/fisiopatología , Resistencia a la Tracción , Adolescente , Módulo de Elasticidad
4.
Jt Dis Relat Surg ; 35(3): 699-705, 2024 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-39189581

RESUMEN

Dislocations of the fourth and fifth carpometacarpal joints (CMCJs) are rare and often misdiagnosed via radiography. Moreover, treatment strategies have not yet been standardized. Herein, we report a case of chronic dislocations of the fourth and fifth CMCJs with delayed diagnosis and successful treatment via ligament repair. A 29-year-old male patient who was initially diagnosed with contusion at another center following a fall on the stairs was referred to our hospital one month later due to persistent pain and swelling. Fourth and fifth CMCJ dislocations were diagnosed using radiography and computed tomography. Closed reduction attempts were unsuccessful, prompting open reduction. The operative findings included rupture of the dorsal carpometacarpal ligament and hamate cartilage injury. Using two mini anchors, the fourth and fifth dorsal carpometacarpal ligaments were repaired, and Kirschner-wire (K-wire) pinning was performed. The K-wire was extracted after four weeks. At the eight-month follow-up, the only remaining symptom was mild discomfort, and the range of motion and grip strength was fully recovered. Our findings highlight the difficulties in diagnosing CMCJ dislocation and suggest ligament repair as a treatment option for chronic cases of CMCJ dislocation.


Asunto(s)
Articulaciones Carpometacarpianas , Luxaciones Articulares , Ligamentos Articulares , Humanos , Masculino , Articulaciones Carpometacarpianas/lesiones , Articulaciones Carpometacarpianas/cirugía , Articulaciones Carpometacarpianas/diagnóstico por imagen , Adulto , Luxaciones Articulares/cirugía , Luxaciones Articulares/diagnóstico por imagen , Ligamentos Articulares/cirugía , Ligamentos Articulares/lesiones , Enfermedad Crónica , Hilos Ortopédicos , Resultado del Tratamiento , Rango del Movimiento Articular , Recuperación de la Función
5.
BMC Musculoskelet Disord ; 25(1): 642, 2024 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-39143601

RESUMEN

PURPOSE: To confirm which method provides lower rate of recurrent instability and superior clinical outcomes. METHOD: We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis. RESULTS: In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5-60.0 years), with a mean follow-up time of 3.2 years (range, 1-8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07-8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96-1.02; P = 0.4848). CONCLUSION: MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.


Asunto(s)
Inestabilidad de la Articulación , Osteotomía , Articulación Patelofemoral , Tibia , Humanos , Osteotomía/métodos , Inestabilidad de la Articulación/cirugía , Tibia/cirugía , Articulación Patelofemoral/cirugía , Resultado del Tratamiento , Procedimientos de Cirugía Plástica/métodos , Adulto , Luxación de la Rótula/cirugía , Adulto Joven , Ligamento Rotuliano/cirugía , Adolescente , Ligamentos Articulares/cirugía , Recurrencia
6.
Jt Dis Relat Surg ; 35(3): 674-683, 2024 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-39189578

RESUMEN

OBJECTIVES: This study aims to evaluate the clinical outcomes of an anatomical medial patellofemoral ligament (MPFL) reconstruction and the effects of concomitant patellofemoral joint injuries and radiological findings on outcomes in adolescents with recurrent patellar dislocation (RPD). PATIENTS AND METHODS: Between January 2011 and January 2020, a total of 34 patients (19 males, 15 females; median age: 15.6 years; range, 13 to 17 years) with RPD who underwent anatomic MPFL reconstruction were retrospectively analyzed. Lateral release was performed as indicated. Clinical outcomes were evaluated preoperatively and at the final follow-up using the Visual Analog Scale (VAS), Lysholm, Kujala, and Tegner activity rating scales. Magnetic resonance imaging was performed to detect concomitant injuries such as bone, cartilage, and soft tissue injuries. RESULTS: The mean follow-up was 5±2 years. All postoperative knee functions and activity levels were statistically significantly improved without re-dislocation (p<0.001). There was no statistically significant relationship between the presence and location of cartilage lesions and clinical outcomes (p>0.05). Patients with cartilage lesions had a significantly higher CatonDeschamps index and a higher incidence of bone edema in both the patella and femur than patients without. CONCLUSION: Anatomic MPFL reconstruction with meticulous physical therapy has successful clinical outcomes, prevents re-dislocation, and increases participation in sports and activity levels in adolescent patients with RPD. Although cartilage injuries are common after RPD, it has no adverse effect on clinical outcomes in the mid-term.


Asunto(s)
Luxación de la Rótula , Articulación Patelofemoral , Humanos , Luxación de la Rótula/cirugía , Luxación de la Rótula/diagnóstico por imagen , Adolescente , Femenino , Masculino , Estudios Retrospectivos , Articulación Patelofemoral/cirugía , Articulación Patelofemoral/diagnóstico por imagen , Recurrencia , Procedimientos de Cirugía Plástica/métodos , Resultado del Tratamiento , Ligamentos Articulares/cirugía , Ligamentos Articulares/lesiones , Ligamento Rotuliano/cirugía , Ligamento Rotuliano/diagnóstico por imagen
7.
Clin Orthop Surg ; 16(4): 586-593, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39092301

RESUMEN

Background: The morphology of the suprascapular notch (SSN) and the ossification of the superior transverse suprascapular ligament (STSL) are risk factors for injury of the suprascapular nerve (SN) during arthroscopic shoulder procedures. The purpose of the current study was to compare preoperative clinical and radiologic characteristics between patients with and without STSL ossification and to evaluate SSN morphology in patients who underwent arthroscopic rotator cuff repair using a 3-dimensional (3D) reconstructed model. Methods: Patients who underwent arthroscopic rotator cuff repair and were given a computed tomography (CT) scan from March 2018 to August 2019 were included in this study. Patients were divided into 2 groups: those without STSL ossification (group I) and those with STSL ossification (group II). Tear size of the rotator cuff and fatty infiltration of rotator cuff muscles were assessed in preoperative magnetic resonance imaging. The morphology of the SSN was classified following Rengachary's classification. The transverse and vertical diameters of the SSN and the distances from anatomical landmarks to the STSL were measured. All measurements were completed using a 3D CT reconstructed scapula model. Results: A total of 200 patients were included in this study. One hundred seventy-eight patients (89.0%) without STSL ossification were included in group I, and 22 patients (11.0%) with STSL ossification were included in group II. Group II showed a significantly advanced age (61.0 ± 7.4 vs. 71.0 ± 7.3 years, p < 0.001) and a shorter transverse diameter of SSN (10.7 ± 3.1 mm vs. 6.1 ± 3.7 mm, p < 0.001) than group I. In the logistic regression analysis, age was an independent prognostic factor for STSL ossification (odds ratio, 1.201; 95% confidence interval, 1.112-1.296; p < 0.001). Patients in type VI showed significantly shorter transverse diameters than other types (p < 0.001). The patient with type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than those with other types (p < 0.001). Conclusions: In the 3D morphological analysis, age was the independent factor associated with STSL ossification in patients who underwent arthroscopic rotator cuff repair. Type VI showed significantly shorter transverse diameters than other types. Type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than other types.


Asunto(s)
Artroscopía , Imagenología Tridimensional , Lesiones del Manguito de los Rotadores , Tomografía Computarizada por Rayos X , Humanos , Artroscopía/métodos , Femenino , Masculino , Persona de Mediana Edad , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Anciano , Estudios Retrospectivos , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/cirugía , Manguito de los Rotadores/cirugía , Manguito de los Rotadores/diagnóstico por imagen , Escápula/diagnóstico por imagen , Escápula/cirugía , Ligamentos Articulares/cirugía , Ligamentos Articulares/diagnóstico por imagen , Adulto
8.
Am J Sports Med ; 52(9): 2196-2204, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39101725

RESUMEN

BACKGROUND: It remains unclear which subset of patients with recurrent patellofemoral instability would benefit from a concomitant bony realignment procedure in addition to a medial patellofemoral ligament (MPFL) reconstruction. PURPOSE: To provide midterm results for patients who underwent an isolated MPFL reconstruction as part of an ongoing prospective trial. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients with recurrent patellar instability were prospectively enrolled in an institutional registry beginning in March 2014. Exclusion criteria included history of a previous surgery for patellar instability, an off-loadable (inferior/lateral) chondral defect, anterior knee pain ≥50% of their chief complaint, and a "jumping J" sign. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of their bony anatomic characteristics. Patient-reported outcome measures (PROMs), episodes of recurrent instability, and ability to return to sport were obtained annually. Radiographic measurements of baseline radiographs and MRI were obtained at baseline. RESULTS: A total of 138 patients underwent isolated MPFL reconstruction between March 2014 and December 2019. The mean radiographic measurements were tibial tubercle-trochlear groove, 15.1 ± 4.9 mm; Caton-Deschamps index, 1.14 ± 0.16; patellar trochlear index, 46.9% ± 15.1%; trochlear depth index, 2.5 ± 1.2 mm; tibial tubercle to lateral trochlear ridge, -8.4 ± 5.7 mm; and patellar tendon to lateral trochlear ridge, 5.7 ± 6.2 mm. Trochlear dysplasia, defined as a trochlear depth index <3 mm, was present in 79/125 (63%) patients. A total of 50 patients reached ≥5 years, of whom 40 (80%) completed follow-up PROMs. A total of 119 patients reached ≥2 years, of whom 89 (75%) completed follow-up PROMs. Six patients (5%) reported recurrent instability with a mean time of 2.97 years after surgery. All PROMs improved over time except for the Pediatric Functional Activity Brief Scale (Pedi-FABS), which had no change. At 2 years, the mean changes from baseline for Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscale (QOL), Pedi-FABS, International Knee Documentation Committee (IKDC) score, KOOS Physical Function Short Form (PS), and Kujala score were 42.1, 0.6, 35.1, -23.5, and 32.3, respectively. All changes had P values <.001 except for Pedi-FABS, which showed no change and had P > .999. At 5 years, the mean changes from baseline for KOOS-QOL, Pedi-FABS, IKDC, KOOS-PS, and Kujala score were 42.6, -2.8, 32.6, -21.5, and 31.6, respectively. All changes had P values <.001 except for Pedi-FABS, which showed no change and had P > .453. In total, 89% of patients returned to sport with a mean of 9.1 months. CONCLUSION: Midterm outcomes for patients who underwent isolated MPFL reconstruction were favorable and were maintained at 5 years. Outcomes for the expanded cohort of patients with a minimum 2-year follow-up support previously published results.


Asunto(s)
Inestabilidad de la Articulación , Articulación Patelofemoral , Medición de Resultados Informados por el Paciente , Recurrencia , Humanos , Masculino , Inestabilidad de la Articulación/cirugía , Femenino , Articulación Patelofemoral/cirugía , Estudios Prospectivos , Adulto Joven , Adolescente , Adulto , Tibia/cirugía , Volver al Deporte , Rótula/cirugía , Ligamentos Articulares/cirugía
9.
J Orthop Trauma ; 38(9S): S15-S20, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-39150289

RESUMEN

SUMMARY: Longitudinal forearm instability is a consequence of interosseous ligament complex disruption. Radiographic identifiers should alert the surgeon to the disrupted structures. Understanding the injury pattern can simplify the treatment process. The clinical presentation will vary based on the involved interosseous ligament components. The surgeon should aim to restore the anatomic radioulnar relationship and then address the remaining pathology as needed. The central band is the foundational structure that maintains this relationship and should be addressed in each injury pattern when disrupted. In this study, we describe rare forms of longitudinal forearm instability.


Asunto(s)
Traumatismos del Antebrazo , Inestabilidad de la Articulación , Humanos , Inestabilidad de la Articulación/cirugía , Traumatismos del Antebrazo/cirugía , Traumatismos del Antebrazo/diagnóstico por imagen , Ligamentos Articulares/cirugía , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/lesiones , Masculino , Femenino
10.
Knee Surg Sports Traumatol Arthrosc ; 32(9): 2452-2462, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39033348

RESUMEN

PURPOSE: The purpose of this retrospective review was to determine the prevalence of osteochondral lesions (OCLs) of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament. METHODS: Retrospective chart review identified 40 patients who underwent anterior ankle arthroscopy for the management of anterior ankle impingement. Clinical outcomes assessed included pre- and postoperative foot and ankle outcome score (FAOS), visual analogue scale (VAS), complications, failures, secondary surgical procedures, return-to-work data and return-to-sport data. RESULTS: Thirty-two patients with a mean follow-up time of 29.3 ± 10.4 months were included. The hypertrophic distal fascicle of the anterior tibio-fibular ligament was hypertrophic in 29 patients (90.6%), with a mean thickness of 2.5 ± 0.4 mm on MRI. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament visualized during arthroscopy. The international cartilage repair society gradings of the lesions included 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from preoperative to postoperative (p < 0.001). No cases of syndesmotic instability were observed following resection of hypertrophic distal fascicle of the anterior tibio-fibular ligament. CONCLUSION: This retrospective case series demonstrated that a hypertrophic distal fascicle of the anterior tibio-fibular ligament was associated with an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, preoperative MRI demonstrated poor sensitivity for the detection of these OCLs. Heightened awareness is warranted for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf identified on preoperative MRI in the absence of an associated OCLs. LEVEL OF EVIDENCE: Level IV, Retrospective case series.


Asunto(s)
Articulación del Tobillo , Artroscopía , Hipertrofia , Imagen por Resonancia Magnética , Astrágalo , Humanos , Estudios Retrospectivos , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Masculino , Femenino , Adulto , Artroscopía/métodos , Hipertrofia/cirugía , Articulación del Tobillo/cirugía , Persona de Mediana Edad , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/complicaciones , Adulto Joven , Ligamentos Articulares/cirugía , Cartílago Articular/cirugía , Cartílago Articular/diagnóstico por imagen
11.
Med Sci Monit ; 30: e943537, 2024 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-38954596

RESUMEN

BACKGROUND The Lisfranc ligament is crucial for maintaining the transverse and longitudinal arch of the foot. Owing to the disruption between the medial cuneiform bone and the base of the second metatarsal bone, the currently preferred fixation method remains controversial. Our fixation technique involves screwing one anchor to the medial and intermediate cuneiform bones and using the anchor to carry the ligament to bind the Lisfranc joint and first and second metatarsal joints altogether for elastic fixation. This study evaluated the clinical and functional outcomes of InternalBrace fixation for Lisfranc injury. MATERIAL AND METHODS This retrospective study included 58 patients who underwent InternalBrace fixation for Lisfranc injury between January 2019 and September 2022 by an experienced surgeon. One-way analysis of variance or t test was used. Preoperative classification was performed according to the Myerson classification with imaging data. Postoperative follow-up was performed based on intraoperative blood loss, fracture healing time, visual analog scale (VAS) score, the American Orthopedic Foot and Ankle Society (AOFAS) score, Tegner score, and complications. RESULTS Surgery was completed in all patients, and follow-up was performed. The patients' ages ranged from 19 to 62 years (average: 34.6±9.4 years). The postoperative follow-up time was 12-24 months (average: 16.9±3.0 months). The average time for fracture healing was 12.8±3.0 (10-24) weeks. The VAS, AOFAS, and Tegner scores significantly improved postoperatively (from 5.33±1.0 (3-7) to 1.24±0.57 (0-2); 28.02±6.70 (18-51) to 91.59±4.76 (82-96); and 2.40±0.67 (1-4) to 6.53±0.54 (6-7), respectively), which was statistically significant (P<0.01), and the good rate of AOFAS was 91.4%. The postoperative complications were traumatic arthritis, incision infection, and temporary dorsal foot numbness, which gradually recovered. No other rejection reactions or Lisfranc fracture/dislocations recurrence occurred during the follow-up period. CONCLUSIONS InternalBrace fixation for Lisfranc injury is beneficial for restoring Lisfranc joint stability and function and allows for early and more aggressive rehabilitation for patients, with fewer surgical complications.


Asunto(s)
Fijación Interna de Fracturas , Huesos Metatarsianos , Humanos , Estudios Retrospectivos , Adulto , Femenino , Masculino , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Huesos Metatarsianos/cirugía , Huesos Metatarsianos/lesiones , Adulto Joven , Traumatismos de los Pies/cirugía , Resultado del Tratamiento , Ligamentos Articulares/cirugía , Ligamentos Articulares/lesiones
12.
JBJS Case Connect ; 14(3)2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-39028830

RESUMEN

CASE: A patient presented with complete coracoclavicular ligament ossification after an unnoticed acromioclavicular joint Rockwood Type IV dislocation. He had full passive range of motion in the glenohumeral joint but was disabled by a loss of both active (80°) and passive (90°) abduction due to insufficient passive scapulo-thoracic motion. He was treated with an arthroscopic osteotomy of the coracoclavicular ligament ossification. CONCLUSION: One year after the surgery, active abduction was improved by 45° (80°-125°) with no recurrence of the ossification on the radiographs. Arthroscopic osteotomy of complete coracoclavicular ligament ossification seems effective in restoring abduction in these patients. LEVEL OF EVIDENCE: IV.


Asunto(s)
Articulación Acromioclavicular , Ligamentos Articulares , Osificación Heterotópica , Humanos , Masculino , Articulación Acromioclavicular/cirugía , Articulación Acromioclavicular/diagnóstico por imagen , Osificación Heterotópica/cirugía , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/etiología , Ligamentos Articulares/cirugía , Ligamentos Articulares/diagnóstico por imagen , Artroscopía/métodos , Osteotomía/métodos , Adulto
13.
BMC Musculoskelet Disord ; 25(1): 581, 2024 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-39054544

RESUMEN

PURPOSE: The purpose of this study was to propose a surgical technique for arthroscopic medial patellofemoral ligament (MPFL) reconstruction with polyethylene suture combined with medial retinaculum plication and to evaluate the efficacy of this surgical technique in the treatment of acute patellar dislocation. METHODS: Clinical data of patients with acute patellar dislocations treated with arthroscopic MPFL reconstruction with polyethylene tape (FiberTape) combined with medial support band compression were analyzed retrospectively from January 2018 to January 2021. The mean age of the patients was 25.15 ± 4.66 years; the mean follow-up time was 27.5 (24-36) months. Clinical evaluation consisted of apprehension test results, patellar extrapolation test results, Lysholm score, Kujala score, and IKDC score, the Patellar lateral shift distance and patellar tilt angle (PTA) measured by CT scan. RESULTS: All patients had no recurrent patellar dislocation or subluxation after surgery, and the apprehension test was negative. In all patients, the Kujala score (36.0 ± 9.9 vs. 98.2 ± 3.1), the IKDC score (48.6 ± 7.0 vs. 90.6 ± 4.4) and the Lysholm score (32.8 ± 10.4 vs. 96.7 ± 3.1) had improved at the 24-month follow up (P < 0.05). In addition, PTA was significantly lower at the 12-month follow-up and 24-giving-month follow-up compared to the preoperative period (P < 0.05, Table 2). The patellar lateral shift distance decreased from 14.94 ± 6.11 mm preoperatively to 3.00 ± 1.40 mm (12-month follow up) and 3.26 ± 1.37 mm (24-month follow up), respectively. CONCLUSION: Arthroscopic MPFL reconstruction with polyethylene suture combined with medial retinaculum plication is a safe and reliable surgical technique for the treatment of acute patellar dislocation in young and middle-aged patients. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Asunto(s)
Artroscopía , Luxación de la Rótula , Polietileno , Humanos , Luxación de la Rótula/cirugía , Luxación de la Rótula/diagnóstico por imagen , Masculino , Femenino , Adulto , Estudios Retrospectivos , Artroscopía/métodos , Adulto Joven , Estudios de Seguimiento , Resultado del Tratamiento , Suturas , Adolescente , Articulación Patelofemoral/cirugía , Articulación Patelofemoral/diagnóstico por imagen , Técnicas de Sutura , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/instrumentación , Ligamentos Articulares/cirugía , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/lesiones , Ligamento Rotuliano/cirugía , Ligamento Rotuliano/diagnóstico por imagen
14.
J Pediatr Orthop ; 44(9): e767-e772, 2024 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-38907588

RESUMEN

BACKGROUND: Disparity in surgical care of patellar instability patients has not been fully investigated in the adolescent Hispanic population. This demographic has been shown to have differences in their care, including a lower rate of surgical treatment for patellar instability. Socioeconomic factors have been cited as a factor that influences patient outcomes and its relationship with ethnicity in context of patellar instability has not been evaluated. METHODS: Review performed of patients <19 years of age who underwent MPFL reconstruction between September 2008 and December 2015. Demographics, patient median household income data, and clinical variables were collected. Generalized linear mixed model (GLMM) with subject as random effects factor was utilized to evaluate differences between ethnicity groups due to nonindependence of data. It was then expanded to incorporate interactions between ethnicity and income. RESULTS: Ninety-five patellar dislocation events met criteria in 85 adolescents (mean age: 15.5 y). Thirty-four (40%) adolescents identified as Hispanic. In univariate analysis no differences were found between Hispanic and non-Hispanic patients. The multivariate GLMM demonstrated a significant interaction between ethnicity and income. The Hispanic group in the >100% State median income category had the highest rate of postoperative clinic appointments attended ( P =0.019). The Hispanic group in the <100% State median income category had the lowest rate of physical therapy appointments attended ( P =0.044). No differences were observed for duration of follow-up ( P =0.57) or final Kujala score ( P =0.75). CONCLUSIONS: Hispanic ethnicity alone is not associated with inferior postoperative management after MPFL reconstruction in adolescents. However, when socioeconomic status is considered, Hispanic patients of lower-income backgrounds are found to have lower compliance with postoperative rehab recommendations. LEVEL OF EVIDENCE: Level III.


Asunto(s)
Hispánicos o Latinos , Inestabilidad de la Articulación , Cooperación del Paciente , Humanos , Adolescente , Hispánicos o Latinos/estadística & datos numéricos , Masculino , Femenino , Estudios Retrospectivos , Inestabilidad de la Articulación/cirugía , Cooperación del Paciente/estadística & datos numéricos , Luxación de la Rótula/cirugía , Ligamentos Articulares/cirugía , Articulación Patelofemoral/cirugía , Disparidades en Atención de Salud/etnología , Procedimientos de Cirugía Plástica/métodos , Niño , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Factores Socioeconómicos
15.
Medicine (Baltimore) ; 103(26): e38379, 2024 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-38941440

RESUMEN

BACKGROUND: This study aimed to evaluate the clinical and radiological features of the patella fixation technique using Toggleloc suspension system in a single ellipsoidal blind patellar tunnel during medial patellofemoral ligament (MPFL) reconstruction. METHODS: This study included 52 patients (25 men, 27 women) who underwent MPFL reconstruction using a semitendinosus tendon graft. The graft was fixed to the ellipsoidal single blind tunnel opened on the medial side of the patella with an endobutton and was fixed to the femoral tunnel by using bioabsorbable screw. Clinical scores (Kujala score, Lysholm score, Tegner activity score and the visual analog scale [VAS] score) were evaluated preoperatively and at the end-follow up. Preoperative and postoperative radiological measurements (trochlea depth, sulcus angle, patellar height, patellar congruence angle, patellar tilt angle and lateral patellofemoral angle) were evaluated with X-ray (Merchant X-ray, anteroposterior and lateral radiography) and computed tomography (CT) of the knee. RESULTS: Postoperative patellar redislocation or subluxation was not observed in any patient. Patellar congruence angle, patellar tilt angle and lateral patellofemoral angle mean values were found to return to normal values in the postoperative period and the results were statistically significant. Also statistically significant improvement in all clinical scores postoperatively. According to the Insall-Salvati index (ISI) and Caton-Deschamps index (CDI) on lateral radiography of the knee at 30° flexion, patellar height decreased in the postoperative period statistically significant. The CDI was above 1.3 in 17 (%32) of our patients. Thirteen of these values decreased to normal values. No radiological progression of patellofemoral osteoarthritis was observed in all patients at the final follow-up evaluation. CONCLUSION: In cases of patellofemoral instability, fixation of the tendon graft in blind ellipsoid tunnel using the Toggleloc suspension system provides satisfactory patellar graft fixation strength, significant functional improvement and a low failure rate.


Asunto(s)
Rótula , Articulación Patelofemoral , Humanos , Femenino , Masculino , Adulto , Articulación Patelofemoral/cirugía , Articulación Patelofemoral/diagnóstico por imagen , Estudios de Seguimiento , Rótula/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto Joven , Ligamentos Articulares/cirugía , Resultado del Tratamiento , Adolescente
16.
Am J Sports Med ; 52(8): 1984-1989, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38828633

RESUMEN

BACKGROUND: Recent systematic reviews on the outcomes of sulcus-deepening trochleoplasty with adjuvant medial patellofemoral ligament (MPFL) reconstruction at a follow-up of 2 to 6 years have found that the procedure grants good clinical outcomes with low redislocation rates. However, there is a lack of evidence in the literature regarding mid- and long-term follow-ups. PURPOSE: To evaluate the radiographic and clinical outcomes of thick-flap sulcus-deepening trochleoplasty with MPFL reconstruction at a minimum follow-up of 10 years to assess the signs of patellofemoral arthritis, incidence of recurrent dislocation, and grade of patient satisfaction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors evaluated a retrospective series of 43 patients (48 knees) who underwent sulcus-deepening trochleoplasty between 2003 and 2013. All patients underwent thick-flap sulcus-deepening trochleoplasty with additional MPFL reconstruction. All patients were assessed at a minimum follow-up of 10 years by an independent clinician who noted any patellar redislocation or reoperations in the operated knee and collected the International Knee Documentation Committee (IKDC), Kujala, and satisfaction scores. Furthermore, a radiographic examination was performed to assess patellar height using the Caton-Deschamps index and patellofemoral arthritis using the Iwano classification. RESULTS: At a mean follow-up of 14.8 ± 2.1 years (range, 10-20 years), 4 patients (4 knees) were lost to follow-up (8.3%). The satisfaction, Kujala, and IKDC scores were 8.2 ± 1.6, 77.5 ± 14.4, and 65.7 ± 13.5, respectively. Only 1 patient reported a traumatic patellar dislocation (2%). Radiographs at the final follow-up were available for 34 knees, which revealed Iwano grade 1 in 14 knees (41%), Iwano grade 2 in 7 knees (21%), and no patellofemoral arthritis in 13 knees (38%). CONCLUSION: Sulcus-deepening trochleoplasty with MPFL reconstruction provides satisfactory results and prevents patellar redislocations with no or minimal patellofemoral arthritis.


Asunto(s)
Articulación Patelofemoral , Satisfacción del Paciente , Humanos , Estudios Retrospectivos , Adulto , Masculino , Femenino , Articulación Patelofemoral/cirugía , Adulto Joven , Adolescente , Luxación de la Rótula/cirugía , Estudios de Seguimiento , Ligamentos Articulares/cirugía , Resultado del Tratamiento , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Radiografía
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(6): 655-659, 2024 Jun 15.
Artículo en Chino | MEDLINE | ID: mdl-38918183

RESUMEN

Objective: To evaluate the early-term effectiveness of Latarjet procedure with double EndoButtons fixation for recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament. Methods: Between January 2021 and June 2023, 19 patients with recurrent anterior shoulder dislocations were treated by arthroscopic Latarjet procedure with double EndoButtons fixation, all of which underwent coracoid osteotomy with preserving the coracoacromial ligament. There were 11 males and 8 females, with an average age of 23.3 years (range, 17-32 years). Shoulder dislocations ranged from 3 to 11 times, with an average of 6.4 times. The disease duration ranged from 3 to 35 months, with an average of 12.9 months. All apprehension tests were positive. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 13%-26%, with an average of 19.8%. After operation, the shoulder range of motion was examined, including flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery (ASES) score, and Rowe score. Imaging examinations were taken to observe the position and shaping of coracoid. Results: All incisions healed by first intention and no nerve or vessel injury occurred. All patients were followed up 9-24 months (mean, 14.5 months). There was no recurrence of shoulder dislocation and the apprehension tests were negative during follow-up. There was no significant difference in the shoulder range of motion (flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation) between preoperation and at last follow-up ( P>0.05). The Walch-Duplay score, ASES score, and Rowe score significantly improved when compared with those before operation ( P<0.05). Postoperative imaging showed that coracoid graft was at the same level with the glenoid in all cases; the center of coracoid graft was located between 3 to 5 o'clock. During follow-up, there was no glenohumeral joint degeneration, the acromiaohumeral distance was not reduced when compared with preoperation, and the coracoid bone gradually formed concentric circles with the humeral head. Conclusion: The Latarjet procedure with double EndoButtons fixation can effectively treat recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament, and the early-term effectiveness is satisfactory.


Asunto(s)
Apófisis Coracoides , Ligamentos Articulares , Osteotomía , Rango del Movimiento Articular , Luxación del Hombro , Humanos , Luxación del Hombro/cirugía , Masculino , Femenino , Adulto , Osteotomía/métodos , Adolescente , Adulto Joven , Apófisis Coracoides/cirugía , Ligamentos Articulares/cirugía , Recurrencia , Artroscopía/métodos , Resultado del Tratamiento
18.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(6): 635-640, 2024 Jun 15.
Artículo en Chino | MEDLINE | ID: mdl-38918180

RESUMEN

Objective: To review the development and research progress of suture button fixation Latarjet procedure. Methods: A comprehensive literature review was conducted to summarize the development and related modified techniques of the suture button fixation Latarjet procedure. Results: Since the Latarjet procedure was first introduced by French scholar Latarjet in 1954, it has undergone three key transformations, resulting in suture button fixation Latarjet procedure, which has shown satisfactory outcomes in treatment of recurrent shoulder dislocation. However, there are still drawbacks such as the risk of impingement of the graft on surrounding tissues, and the surgical disruption of anatomical structures like the coracoclavicular ligament and the pectoralis minor muscle. The scholars have proposed several modified techniques based on the suture button fixation Latarjet procedure to further reduce complications from impingement of the graft, to lower the glenohumeral contact pressure, and to eliminate the impact of surgery on the physiological structures of the shoulder joint. The modified techniques include the arthroscopic suture button fixation Latarjet procedure using FiberTape Cerclage, reconstruction of the coracoacromial ligament during congruent-arc Latarjet procedures, and limit unique coracoid osteotomy suture button Latarjet procedure (LU-tarjet procedure). These modified techniques have also shown good clinical outcomes. Additionally, other related modified techniques for reconstruction of the glenoid, such as Chinese unique Inlay Bristow procedure (Cuistow procedure), arthroscopic glenoid bone grafting with soft fixation, and all-arthroscopic modified Eden-Hybinette procedure, have also demonstrated favorable efficacy. However, there is still a lack of long-term follow-up results for these techniques and comparative studies between them. Conclusion: Suture button fixation Latarjet procedure is an effective method for the treatment of recurrent shoulder dislocation. There are various techniques, but there is no recognized gold standard, and further clinical and basic research is needed.


Asunto(s)
Artroscopía , Luxación del Hombro , Articulación del Hombro , Técnicas de Sutura , Humanos , Artroscopía/métodos , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Trasplante Óseo/métodos , Suturas , Anclas para Sutura , Resultado del Tratamiento , Inestabilidad de la Articulación/cirugía , Rango del Movimiento Articular , Ligamentos Articulares/cirugía
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(6): 691-695, 2024 Jun 15.
Artículo en Chino | MEDLINE | ID: mdl-38918189

RESUMEN

Objective: To investigate the morphological characteristics of the glenohumeral joint (including the glenoid and coracoid) in the Chinese population and determine the feasibility of designing coracoid osteotomy based on the preoperative glenoid defect arc length by constructing glenoid defect models and simulating suture button fixation Latarjet procedure. Methods: Twelve shoulder joint specimens from 6 adult cadavers donated voluntarily were harvested. First, whether the coracoacromial ligament and conjoint tendon connected was anatomically observed and their intersection point was identified. The vertical distance from the intersection point to the coracoid, the maximum allowable osteotomy length starting from the intersection point, and the maximum osteotomy angle were measured. Next, the anteroinferior glenoid defect models of different degrees were randomly constructed. The arc length and area of the glenoid defect were measured. Based on the arc length of the glenoid defect of the model, the size of coracoid oblique osteotomy was designed and the actual length and angle of the coracoid osteotomy were measured. A limited osteotomy suture button fixation Latarjet procedure with the coracoacromial ligament and pectoralis minor preservation was performed and the position of coracoid block was observed. Results: All shoulder joint specimens exhibited crossing fibers between the coracoacromial ligament and the conjoint tendon. The vertical distance from the tip of the coracoid to the coracoid return point was 24.8-32.2 mm (mean, 28.5 mm). The maximum allowable osteotomy length starting from the intersection point was 26.7-36.9 mm (mean, 32.0 mm). The maximum osteotomy angle was 58.8°-71.9° (mean, 63.5°). Based on the anteroinferior glenoid defect model, the arc length of the glenoid defect was 22.6-29.4 mm (mean, 26.0 mm); the ratio of glenoid defect was 20.8%-26.2% (mean, 23.7%). Based on the coracoid block, the length of the coracoid osteotomy was 23.5-31.4 mm (mean, 26.4 mm); the osteotomy angle was 51.3°-69.2° (mean, 57.1°). There was no significant difference between the arc length of the glenoid defect and the length of the coracoid osteotomy ( P>0.05). After simulating the suture button fixation Latarjet procedure, the highest points of the coracoid block (suture loop fixation position) in all models located below the optimal center point, with the bone block concentrated in the anteroinferior glenoid defect position. Conclusion: The size of the coracoid is generally sufficient to meet the needs of repairing larger glenoid defects. The oblique osteotomy with preserving the coracoacromial ligament may potentially replace the traditional Latarjet osteotomy method.


Asunto(s)
Ligamentos Articulares , Osteotomía , Articulación del Hombro , Humanos , Osteotomía/métodos , Ligamentos Articulares/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/anatomía & histología , Adulto , Masculino , Femenino , Huesos Pélvicos/cirugía , Huesos Pélvicos/anatomía & histología
20.
Am J Sports Med ; 52(9): 2215-2221, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38872411

RESUMEN

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is considered by many to be the gold standard to treat lateral patellar instability; however, some investigators have reported good clinical results after isolated medial quadriceps tendon-femoral ligament (MQTFL) reconstruction or a combined MPFL/MQTFL reconstruction. A handful of studies have preliminarily investigated the biomechanical consequences of these various medial patellar stabilizing procedures. Despite this, no existing study has included multiple medial patellofemoral complex (MPFC) reconstructions and assessment of lateral patellar translation at distinct flexion angles. HYPOTHESIS: Combined MPFL/MQTFL reconstruction would restore patellofemoral contact areas, forces, and kinematics closest to the native state compared with isolated reconstruction of the MPFL or MQTFL alone. STUDY DESIGN: Controlled laboratory study. METHODS: Ten adult cadaveric knee specimens were prepared and analyzed under 5 different conditions: (1) intact state, (2) transected MPFC, (3) isolated MPFL reconstruction, (4) isolated MQTFL reconstruction, and (5) combined MPFL/MQTFL reconstruction. Patellar tilt, lateral patellar translation, patellofemoral contact forces, and patellofemoral contact areas were measured in each condition from 0° to 80° through simulated knee flexion using a custom servohydraulic load frame with pressure sensor technology and a motion capture system for kinematic data acquisition. RESULTS: The isolated MPFL, isolated MQTFL, and combined MPFL/MQTFL reconstruction conditions produced significantly less lateral patellar tilt compared with the transected MPFC state (P < .05). No statistically significant differences were found when each reconstruction technique was compared with the intact state in patellar tilt, lateral patellar translation, contact forces, and contact areas. CONCLUSION: All 3 reconstruction techniques (isolated MPFL reconstruction, isolated MQTFL reconstruction, and combined MPFL/MQTFL reconstruction) restored native knee kinematics, contact forces, and contact areas without overconstraint. CLINICAL RELEVANCE: Isolated MPFL reconstruction, isolated MQTFL reconstruction, and combined MPFL/MQTFL reconstruction all restore patellofemoral stability comparable with the intact MPFC state without the overconstraint that could be concerning for increasing risk of patellofemoral arthritis.


Asunto(s)
Articulación Patelofemoral , Humanos , Fenómenos Biomecánicos , Articulación Patelofemoral/cirugía , Masculino , Femenino , Persona de Mediana Edad , Cadáver , Adulto , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/fisiopatología , Anciano , Presión , Procedimientos de Cirugía Plástica/métodos , Ligamentos Articulares/cirugía
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