RESUMEN
Introducción: Las fracturas de la diáfisis femoral son lesiones que requieren gran energía y a menudo asocian otras lesiones. Este es el caso de las lesiones ligamentarias de rodilla, las cuales pueden pasar desapercibidas por el equipo médico tratante. El objetivo de nuestro trabajo es revisar la literatura existente sobre esta asociación lesional. Dentro de la misma se buscará la metodología diagnóstica utilizada y la incidencia de las lesiones ligamentarias. Materiales y métodos: Se realizó una búsqueda bibliográfica de forma sistematizada a través de los portales de búsqueda PubMed y Timbó. La búsqueda alcanzó un total de 3099 artículos y de acuerdo a los criterios de inclusión y exclusión se seleccionaron 15 trabajos. Resultados: Los diferentes artículos utilizaron examen físico bajo anestesia, radiografías en estrés, artroscopía o resonancia nuclear magnética para establecer el diagnóstico de las lesiones ligamentarias asociadas a las fracturas de diáfisis femoral. Un 22,5% de las fracturas femorales asoció lesión ligamentaria de rodilla, siendo la lesión del ligamento cruzado anterior el 34% de las lesiones reportadas. Discusión: Se evidencia una gran variabilidad en la incidencia de lesiones ligamentarias y de cuál es el ligamento más frecuentemente lesionado, yendo desde 5,3% a 52,5% en estudios tanto retrospectivos como prospectivos con bajos números de pacientes. Se plantea un algoritmo diagnóstico para los pacientes que puedan presentar esta asociación lesional, para evitar que los mismos pasen desapercibidos al equipo médico tratante. Logrando un diagnóstico precoz se puede mejorar el pronóstico de estos pacientes. Conclusión: De nuestra revisión se desprende que en el contexto de una fractura de diáfisis femoral un 22,5% de los pacientes presenta lesiones ligamentarias de rodilla con un 34% de compromiso del LCA. Sin embargo, estas cifras son muy variables en los distintos trabajos. Por esta razón, creemos necesario llevar a cabo un estudio prospectivo con mayor número de pacientes para lograr valorar la verdadera epidemiología de estas lesiones.
Introduction: Femoral shaft fractures require great energy and are often associated with other injuries. This is the case of knee ligament injuries, which can go unnoticed by the treating physician The objective of our work is to review the existing literature on this injury association. Within it, the diagnostic methodology used and the incidence of ligamentous injuries will be sought. Materials and methods: A bibliographic search was carried out in a systematic way through the search portals PubMed and Timbó. The search reached a total of 3099 articles and according to the inclusion and exclusion criteria, 15 works were selected. Results: The different articles used physical examination under anesthesia, stress radiographs, arthroscopy or magnetic resonance imaging to establish the diagnosis of ligamentous injuries associated with femoral diaphysis fractures. 22.5% of femoral fractures were associated with knee ligament injury, with anterior cruciate ligament accounting for 34% of reported injuries. Discussion: There is evidence of a great variability in the incidence of ligament injuries and which is the most frequently injured ligament, ranging from 5.3% to 52.5% in both retrospective and prospective studies with low numbers of patients. A diagnostic algorithm is proposed for patients who may present this lesional association, to prevent them from going unnoticed by the treating medical team. Achieving an early diagnosis can improve the prognosis of these patients. Conclusion: Our review shows that in the context of a femoral diaphysis fracture, 22.5% of patients present knee ligament injuries with 34% of ACL involvement. However, these figures are highly variable in the different studies. For this reason, we believe it is necessary to carry out a prospective study with a larger number of patients in order to assess the true epidemiology of these lesions.
Introdução: As fraturas da diáfise do fêmur são lesões que requerem grande energia e muitas vezes estão associadas a outras lesões. É o caso das lesões ligamentares do joelho, que podem passar despercebidas pela equipe médica que o trata. O objetivo do nosso trabalho é revisar a literatura existente sobre essa associação lesional. Dentro dele, será buscada a metodologia diagnóstica utilizada e a incidência de lesões ligamentares. Materiais e métodos: Foi realizada uma busca bibliográfica de forma sistemática através dos portais de busca PubMed e Timbó. A busca atingiu um total de 3099 artigos e de acordo com os critérios de inclusão e exclusão, 15 trabalhos foram selecionados. Resultados: Os diferentes artigos utilizaram o exame físico sob anestesia, radiografias de estresse, artroscopia ou ressonância magnética para estabelecer o diagnóstico de lesões ligamentares associadas às fraturas da diáfise do fêmur. 22,5% das fraturas do fêmur foram associadas à lesão ligamentar do joelho, sendo a lesão do ligamento cruzado anterior responsável por 34% das lesões relatadas. Discussão: Há evidências de uma grande variabilidade na incidência de lesões ligamentares e qual é o ligamento mais frequentemente lesado, variando de 5,3% a 52,5% em estudos retrospectivos e prospectivos com baixo número de pacientes. Um algoritmo diagnóstico é proposto para os pacientes que podem apresentar essa associação lesional, para evitar que passem despercebidos pela equipe médica responsável. O diagnóstico precoce pode melhorar o prognóstico desses pacientes. Conclusão: Nossa revisão mostra que no contexto de fratura da diáfise do fêmur, 22,5% dos pacientes apresentam lesões ligamentares do joelho com 34% de envolvimento do LCA. No entanto, esses números são altamente variáveis âânos diferentes estudos. Por esse motivo, acreditamos ser necessário realizar um estudo prospectivo com um número maior de pacientes para avaliar a verdadeira epidemiologia dessas lesões.
Asunto(s)
Humanos , Fracturas del Fémur/complicaciones , Inestabilidad de la Articulación , Traumatismos de la Rodilla/diagnóstico , Incidencia , Fracturas del Fémur/epidemiología , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/epidemiologíaRESUMEN
ABSTRACT Objective: There were many constraints produced by training time and joint injury to analyze the influence of the training intensity on the elbow and knee joints of athletes during the training process. Methods: An improved algorithm-based master component analysis (PCA) modeling method is proposed .1 4 4 athletes were selected in xxx and compared in three groups. Results: The improved PCA models for injury prediction were applied to athletes from group A, the traditional injury models for prediction were adopted for athletes from group B, and athletes from group C received the hospital physical examinations. The results showed that the accuracy of elbow injury in group A due to excessive exercise was 66.86%, the accuracy of hospital physical examination in group C was 67%, and the accuracy of the traditional algorithm in group B was 50%, finding that the accuracy of group A was obviously different from group B (P < 0.05). Compared with other injuries caused by excessive friction, the detection accuracy of knee injuries caused by excessive friction in group A was 62%, that in group B was 44%, and that in group C was 63%. There was a statistically marked difference between groups A and B (P < 0.05). Conclusions: A PCA - based model of athletes' overtraining injury has high accuracy and adaptability, predicting elbow injury. Level of evidence II; Therapeutic studies - investigation of treatment results.
RESUMO Objetivo: Houve uma grande quantidade de restrições produzidas pelo tempo de treinamento e lesão articular a fim de analisar a influência da intensidade do treinamento nas articulações do cotovelo e joelho dos atletas durante o processo de treinamento. Métodos: É proposto um método de modelagem aprimorado de análise de componentes mestre (PCA) baseado em algoritmo .1 4 4 atletas foram selecionados em xxx e comparados em três grupos. Resultados: Os modelos aprimorados de PCA para previsão de lesões foram aplicados a atletas do grupo A, os modelos tradicionais de lesões para previsão foram adotados para atletas do grupo B e os atletas do grupo C receberam os exames físicos hospitalares. Os resultados mostraram que a acurácia da lesão de cotovelo no grupo A devido ao exercício excessivo foi de 66,86%, a acurácia do exame físico hospitalar no grupo C foi de 67% e a acurácia do algoritmo tradicional no grupo B foi de 50%, achando que a acurácia do grupo A era obviamente diferente do grupo B (P <0,05). Em comparação com outras lesões causadas por atrito excessivo, a precisão de detecção de lesões no joelho causadas por atrito excessivo no grupo A foi de 62%, no grupo B foi de 44% e no grupo C foi de 63%. Houve uma diferença estatisticamente marcada entre os grupos A e B (P <0,05). Conclusões: Um modelo baseado na PCA de lesão por overtraining em atletas tem alta precisão e adaptabilidade, o que pode prever lesões de cotovelo. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.
RESUMEN Objetivo: Hubo una gran cantidad de restricciones producidas por el tiempo de entrenamiento y la lesión articular para analizar la influencia de la intensidad del entrenamiento en las articulaciones del codo y la rodilla de los atletas durante el proceso de entrenamiento. Métodos: Se propone un método mejorado de modelado de análisis de componentes maestros (PCA) basado en algoritmos .1 4 Se seleccionaron 4 atletas en xxx y se compararon en tres grupos. Resultados: Los modelos mejorados de PCA para la predicción de lesiones se aplicaron a los atletas del grupo A, los modelos tradicionales de predicción de lesiones se adoptaron para los atletas del grupo B y los atletas del grupo C recibieron los exámenes físicos hospitalarios. Los resultados mostraron que la precisión de la lesión del codo en el grupo A por ejercicio excesivo fue del 66,86%, la precisión del examen físico hospitalario en el grupo C fue del 67% y la precisión del algoritmo tradicional en el grupo B fue del 50%, encontrando que la precisión del grupo A fue obviamente diferente del grupo B (P <0.05). En comparación con otras lesiones causadas por fricción excesiva, la precisión de detección de las lesiones de rodilla causadas por fricción excesiva en el grupo A fue del 62%, en el grupo B del 44% y en el grupo C del 63%. Hubo una diferencia estadísticamente marcada entre el grupo A y B (P <0.05). Conclusiones: Un modelo basado en PCA de la lesión por sobreentrenamiento de los atletas tiene una alta precisión y adaptabilidad, lo que puede predecir la lesión del codo. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Traumatismos en Atletas/diagnóstico , Ejercicio Físico , Codo/lesiones , Traumatismos de la Rodilla/diagnóstico , Algoritmos , Análisis de Componente Principal , PredicciónRESUMEN
Durante las últimas décadas, hemos visto un aumento exponencial de las lesiones traumáticas alrededor de la rodilla en niños y adolescentes. La rodilla pediátrica tiene características particulares, que la diferencian de los adultos, y la predisponen a lesiones distintivas que requieren un manejo acorde. El aumento de su incidencia obliga a los médicos a verse enfrentados con mayor frecuencia a patologías como la luxación patelar, la avulsión de espinas tibiales, la avulsión de la tuberosidad anterior de la tibia y la lesión meniscal en probable contexto de un menisco discoideo. Es fundamental conocer los diferentes diagnósticos diferenciales y su enfrentamiento inicial para realizar una derivación oportuna con el fin de que estos pacientes obtengan un tratamiento adecuado
Over the past few decades, we have seen an exponential increase in traumatic injuries around the knee in children and adolescents. The pediatric knee is different from the adult knee, with special characteristics that predispose it to certain types of injuries that require a specific management. The increase in its incidence has faced attendants more frequently with pathologies such as patellar dislocation, tibial eminence fracture, tibial tubercle fractures and meniscal injury in the setting of a discoid meniscus. It is essential to know the differential diagnoses of this age-group, how to obtain an adequate study for a prompt referral
Asunto(s)
Humanos , Niño , Adolescente , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/terapia , Traumatismos de la Rodilla/etiologíaRESUMEN
OBJETIVOS: Determinar el rendimiento de las clasificaciones de Outerbridge (OB) e International Cartilage Repair Society (ICRS). MÉTODO: Estudio de test diagnóstico, diseño y recolección de datos prospectivo. Siete traumatólogos sub-especialistas observaron un mismo video donde se exponían 30 lesiones condrales bajo visión artroscópica, para luego clasificarlas según OB e ICRS y consignar el tratamiento de elección para cada una de las lesiones, eligiendo entre 6 alternativas: observación, debridamiento mecánico o térmico, microfractura, OATS o terapias biológicas. Tras 7 días, los evaluadores debían repetir el mismo procedimiento. RESULTADOS: La concordancia entre los observadores fue débil para clasificación de ICRS (k 0,25 p < 0,001) y moderada para la clasificación de OB (k 0,45 p < 0,001). La concordancia intra-observador para ICRS oscilaba entre moderada y excelente (k promedio de 0,67), y para la clasificación de OB entre buena y excelente (k promedio 0,83). Ninguna de las dos clasificaciones mostró correlación con la experiencia del cirujano. En la elección de tratamiento, la concordancia entre observadores fue débil (k 0,33 p < 0,001), sin embargo, la concordancia intra-observador fue en todos los casos buena o excelente (k 0,82), mostrando una correlación directamente proporcional a la experiencia del cirujano. La capacidad de discriminación terapéutica, evaluada mediante una regresión logística, mostró un área bajo la curva roc en el rango del no-efecto. CONCLUSIÓN: Ambas clasificaciones mostraron una baja correlación inter-observador y una elevada concordancia intra-observador. En ambas categorías, Outerbridge fue más concordante que ICRS. En cuanto al tratamiento, ninguna de las dos clasificaciones logra unificar criterios quirúrgicos. NIVEL DE EVIDENCIA: Nivel I (test diagnóstico).
OBJECTIVES: Assess de diagnostic accuracy of Outerbridge (OB) and ICRS (International Cartilage Repair Society) classifications. METHODS: We performed a diagnostic test study, with a prospective design and data collection. Seven knee surgeons were asked to observe a video were the 30 chondral lesions were shown through arthroscopic view. Simultaneously they were asked to classify them according to OB and ICRS. Besides, they had to define how they would manage the chondral lesion, choosing among six treatment options (observation, mechanical or thermic chondroplasty, microfracture, osteochondral autologous transfer system (OATS) or biological therapies). A week later, they repeated the same procedure. Intra and interobserver agreement were characterized by κ statistical analysis, and a logistic regression was used to assess the ability of both classifications to discriminate among treatment options. P values < 0,05 were considered significant. RESULTS: Interobserver agreement was weak (κ 0.25 p < 0.001) for ICRS classification and moderate for OB classification (κ 0.45 p < 0.001). Intraobserver agreement for ICRS ranged from moderate to excellent (average κ of 0.67), and for the OB classification ranged from good to excellent (average kappa 0.83). Neither classification correlated with the surgeon's experience. Interobserver agreement for therapeutic choice was poor (κ 0.33 p < 0.001). However, intraobserver agreement was good to excellent (κ 0.82) in all cases, showing a direct correlation with the surgeon's experience. Logistic regression used to assess the ability of both classifications to discriminate among treatment options, showed in both cases an area under the roc curve in the no-effect range. CONCLUSION: Both classifications showed low interobserver and high intraobserver agreements for arthroscopic grading of chondral lesions. In both, Outerbridge was more reliable than ICRS. As for guiding therapeutic management, none of the classifications could unify surgical criteria.
Asunto(s)
Humanos , Artroscopía , Enfermedades de los Cartílagos/clasificación , Enfermedades de los Cartílagos/diagnóstico , Traumatismos de la Rodilla/clasificación , Traumatismos de la Rodilla/diagnóstico , Índice de Severidad de la Enfermedad , Enfermedades de los Cartílagos/cirugía , Variaciones Dependientes del Observador , Estudios Prospectivos , Curva ROC , Traumatismos de la Rodilla/cirugíaRESUMEN
PURPOSE: This study aims to identify multiple ligament knee injury patterns that possess a high-risk of vascular lesion. METHODS: We retrospectively compared torn ligament patterns and the presence of vascular lesions confirmed by magnetic resonance imaging and computed tomography angiography from 122 consecutive patients with diagnoses of multiple ligament knee injury made at the emergency department between January 2012 and December 2017. Patients were not eligible if they had an ipsilateral lower extremity lesion (dislocations or fractures at another level), initial evaluation at another hospital, or follow-up for less than 12 months. The primary outcomes were the comparison between the imaging findings of torn structures patterns and the presence of a vascular lesion. RESULTS: We identified 48 eligible patients (50 knees) with multiligamentary knee lesions, of whom eight had popliteal artery damage, yielding an incidence of 16%. Our clinical examination detected six of these patients that were classified, according to the Schenck system, as KD-IIIL (6 knees) and KD-IIIM (2 knees). The odds of having a popliteal artery injury is 4.69 to 1 with a KD-IIIL injury that with any other type of injury on that classification (95% CI 0.960-22.98). CONCLUSIONS: This data suggests that varus forces causing enough energy to produce a KD-IIIL lesion possess a higher popliteal artery injury risk, making recommendable a thorough examination of the vascular integrity when diagnosing a KD-IIIL lesion.
Asunto(s)
Traumatismos de la Rodilla/epidemiología , Arteria Poplítea , Adolescente , Adulto , Angiografía , Femenino , Humanos , Incidencia , Luxaciones Articulares/complicaciones , Luxación de la Rodilla , Traumatismos de la Rodilla/diagnóstico , Articulación de la Rodilla , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Examen Físico , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE OF REVIEW: To summarize and discuss the fundamentals of pediatric tibial tubercle avulsion fractures (TTAFs) including preferred imaging modalities, systems for fracture classification, frequently associated injuries, treatment options, outcomes, and common complications. RECENT FINDINGS: Although TTAFs amount to fewer than 1% of all physeal injuries in children, the incidence is increasing, likely because of greater participation in high-level athletics. SUMMARY: TTAFs tend to occur in adolescents nearing skeletal maturity who engage in sports with repetitive jumping. The most popular classification system was proposed by Ogden, which defines five fracture types based on the fracture pattern and extent of fragment displacement. Treatment can be nonsurgical or surgical, and indications depend on fracture type. Most fractures are surgical candidates and can be repaired with open reduction and internal fixation (ORIF) or arthroscopy. Arthroscopic approaches can reveal associated soft tissue injuries, such as meniscal tears, and confirm articular reduction. The most common postoperative complication is irritation because of hardware. With proper treatment, both nonsurgical and surgical outcomes are excellent. TTAFs have high rates of union and patients typically return to sports.
Asunto(s)
Fracturas por Avulsión , Traumatismos de la Rodilla , Fracturas de la Tibia , Adolescente , Artroscopía , Niño , Tratamiento Conservador , Fijación de Fractura , Fijación Interna de Fracturas , Fracturas por Avulsión/clasificación , Fracturas por Avulsión/diagnóstico , Fracturas por Avulsión/etiología , Fracturas por Avulsión/terapia , Humanos , Traumatismos de la Rodilla/clasificación , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/terapia , Fracturas de la Tibia/clasificación , Fracturas de la Tibia/diagnóstico , Fracturas de la Tibia/etiología , Fracturas de la Tibia/terapia , Resultado del TratamientoRESUMEN
Abstract. Knee pathology is a reason for consultation and prevalent condition in children, making it important to know the normal variants as well as the most frequent pathologies. This review includes a brief description of the main pathologies and normal variants that affect the knee in children, with their main clinical features, as well as the findings described in the various, most-used, imaging techniques (X-ray, ultrasound, computed tomography, and magnetic resonance (MR).
Resumen. La patología de rodilla es un motivo de consulta y una entidad prevalente en la edad pediátrica, razón por la cual es importante conocer tanto las variantes normales como las patologías más frecuentes. En esta revisión se realiza una breve descripción de las principales patologías y variantes normales que afectan a la rodilla en la edad pediátrica, tanto de sus características clínicas principales como de los hallazgos descritos en las distintas modalidades de imagen más utilizadas (radiografía, ecografía, tomografía computarizada y resonancia magnética (RM).
Asunto(s)
Humanos , Niño , Traumatismos de la Rodilla/diagnóstico , Rodilla , Rodilla/patologíaAsunto(s)
Artralgia/diagnóstico , Neoplasias Óseas/diagnóstico , Fracturas por Estrés/diagnóstico , Traumatismos de la Rodilla/diagnóstico , Articulación de la Rodilla/patología , Artralgia/etiología , Neoplasias Óseas/complicaciones , Neoplasias Óseas/terapia , Niño , Preescolar , Diagnóstico Diferencial , Fracturas por Estrés/complicaciones , Fracturas por Estrés/terapia , Humanos , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/terapiaRESUMEN
On the basis of primarily consensus due to lack of relevant clinical studies, the most important evaluative step for knee pain is to identify any emergent conditions, including limb- and life-threatening disorders (septic arthritis, osteomyelitis, and malignancy), hip pathology, or conditions associated with effusions. (2)(3)(6)(8)(11)(13)(14)
Asunto(s)
Artralgia/etiología , Articulación de la Rodilla , Artralgia/microbiología , Infecciones Bacterianas/diagnóstico , Neoplasias Óseas/diagnóstico , Niño , Exudados y Transudados , Humanos , Rodilla/fisiopatología , Traumatismos de la Rodilla/diagnóstico , Enfermedades Musculoesqueléticas/diagnóstico , Osteosarcoma/diagnóstico , Epífisis Desprendida de Cabeza Femoral/diagnósticoRESUMEN
PURPOSE: To compare the magnetic resonance imaging (MRI) findings of patients undergoing knee arthroscopy for chondral lesions. The hypothesis was that MRI displays low sensitivity in the diagnosis and classification of chondral injuries. METHODS: A total of 83 knees were evaluated. The MRIs were performed using the same machine (GE SIGNA HDX 1.45 T). The MRI results were compared with the arthroscopy findings, and an agreement analysis was performed. Thirty-eight of the 83 MRI exams were evaluated by another radiologist for inter-observer agreement analysis. These analyses were performed using the kappa (κ) coefficient. RESULTS: The highest incidence of chondral injury was in the patella (14.4 %). The κ coefficient was 0.31 for the patellar surface; 0.38 for the trochlea; 0.46 for the medial femoral condyle; 0.51 for the lateral femoral condyle; and 0.19 for the lateral plateau. After dividing the injuries into two groups (ICRS Grades 0-II and Grades III and IV), the following κ coefficients were obtained as follows: 0.49 (patella); 0.53 (trochlea); 0.46 (medial femoral condyle); 0.43 (medial plateau); 0.67 (lateral femoral condyle); and 0.51 (lateral plateau). The MRI sensitivity was 76.4 % (patella), 88.2 % (trochlea), 69.7 % (medial femoral condyle), 85.7 % (medial plateau), 81.8 % (lateral femoral condyle) and 75 % (lateral plateau). Comparing the radiologists' evaluations, the following κ coefficients were obtained as follows: 0.73 (patella); 0.63 (trochlea); 0.84 (medial femoral condyle); 0.72 (medial plateau); 0.77 (lateral femoral condyle); and 0.91 (lateral plateau). CONCLUSION: Compared with arthroscopy, MRI displays moderate sensitivity for detecting and classifying chondral knee injuries. It is an important image method, but we must be careful in the assessment of patients with suspected chondral lesions. LEVEL OF EVIDENCE: III.
Asunto(s)
Enfermedades de los Cartílagos/diagnóstico , Cartílago Articular/lesiones , Traumatismos de la Rodilla/diagnóstico , Adolescente , Adulto , Anciano , Artroscopía , Enfermedades de los Cartílagos/diagnóstico por imagen , Niño , Femenino , Humanos , Traumatismos de la Rodilla/clasificación , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
OBJECTIVE: To determine the sensitivity and specificity of a new clinical test for the diagnosis of injuries to the posterolateral corner of the knee by using magnetic resonance imaging (MRI) as the reference standard. DESIGN: Diagnostic accuracy study. SETTING: A tertiary care teaching hospital. PARTICIPANTS: Twelve subjects with chronic instability of the knee and posterolateral corner injury diagnosed by intraoperative findings and 9 subjects without posterolateral corner injury (used as controls). INTERVENTIONS: Injured and uninjured knees were assessed blindly by 2 examiners using a new clinical diagnostic test (the frog-leg test) and the classic varus stress test. MAIN OUTCOME MEASURES: Injuries to the posterolateral corner of the knee identified by the 2 clinical tests. Findings were compared and examined for reproducibility, and kappa statistic was used to assess interobserver agreement. Test results were compared with those of MRI and intraoperative findings to determine diagnostic accuracy. RESULTS: The frog-leg test showed high interobserver agreement (kappa, 0.86), with a high rate (83%-100%) of agreement with the intraoperative diagnosis. The frog-leg test had high sensitivity (91.7%) and specificity (94.5%) for detecting posterolateral corner injuries. The sensitivity of the varus stress test increased from 83.3% to 90.0% when combined with the frog-leg test. CONCLUSIONS: Examiners were able to identify posterolateral corner injuries and differentiate injured from uninjured knees using the frog-leg test, which could potentially be used as an ancillary tool to the varus stress test in diagnosing injuries to the posterolateral corner of the knee. Larger studies are needed to confirm our findings.
Asunto(s)
Traumatismos de la Rodilla/diagnóstico , Examen Físico/métodos , Adulto , Femenino , Humanos , MasculinoRESUMEN
Los ligamentos cruzados (LC) de la rodilla, anterior (A) y posterior (P), localizados dentro de la articulación, unen fémur y tibia, dando estabilidad sobre la dirección anteroposterior de un hueso sobre otro. El LCA puede lesionarse mediante rotaciones provocadas en algún deporte que implique giro con el pie apoyado sobre el suelo. Las lesiones del LCA se determinan con maniobras como la de Lachman, cajón y pivote. Se utilizan acelerómetros que permiten graficar la maniobra de pivote en pacientes que acuden a consulta ortopédica, utilizando la prueba de KT1000 como estándar de oro. El trabajo ha sido aprobado por el Comité de Ética del Hospital. Estudio descriptivo entre casos y controles. Resultados: 92 pacientes aceptaron participar mediante consentimiento informado, nueve casos resultaron con KT1000 positivo, de los negativos, seleccionamos nueve controles afines a edad y género. Alteraciones de KT1000 fueron mayores en mujeres (78%) y en 67% de los casos la pierna alterada fue la derecha. Los resultados promedio de KT1000 en casos fue de 5.44 mm, en controles de 0.66 mm. Los acelerómetros permitieron graficar la maniobra de pivote y observamos gráficas similares tanto en casos y controles, solamente se muestran diferencias notables en un paciente masculino con KT1000 de 15 mm que fue sometido a reparación de LCA izquierdo, la maniobra se realizó al estar sedado. Concluimos que el paciente, en estado consciente, pone resistencia en la maniobra, a diferencia de la obtenida con anestesia, y que el uso de acelerómetros permite documentar la maniobra de pivote observando diferencias entre un LCA normal y uno lesionado.
The anterior (A) and posterior (P) cruciate ligaments (CL) of the knee, located inside the joint, connect the femur and the tibia and thus provide stability in the anteroposterior axis of one bone over the other. The anterior cruciate ligament (ACL) may be injured as a result of rotation when practicing a sport involving turning with the foot on the ground. ACL injuries are diagnosed with maneuvers like the Lachman, drawer and pivot. Accelerometers were used to plot the pivot maneuver in patients seeing the orthopedist surgeon using the KT1000 test as gold standard. This case-control descriptive study was approved by the Hospital's Ethics Committee. Results: 92 patients accepted to participate through an informed consent; nine cases were KT1000 positive, and nine age- and gender-matched controls were selected among KT1000 negative patients. KT1000 alterations were greater among females (78%) and in 67% of cases the right leg was affected. Mean KT1000 results were 5.44 mm in cases and 0.66 mm in controls. Accelerometers allowed plotting the pivot maneuver and the resulting charts for cases and controls were similar. Remarkable differences were seen only in one male patient with a 15 mm KT1000, who underwent repair of the left ACL; the maneuver was performed under sedation. We concluded that conscious patients oppose the maneuver, unlike anesthetized patients, and that the use of accelerometers helps document the pivot maneuver which, in turn, helps detect differences between a normal ACL and an injured one.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Acelerometría/métodos , Ligamento Cruzado Anterior/lesiones , Traumatismos de la Rodilla/diagnóstico , Procedimientos Ortopédicos/métodos , Ligamento Cruzado Anterior/patología , Estudios de Casos y Controles , Traumatismos de la Rodilla/patologíaRESUMEN
In order to reconstruct the medial knee to restore the original biomechanical function of its ligamentous structures, a thorough understanding of its anatomic placement and relationship with surrounding structures is required. To restore the knee to normal kinematics, the diagnosis and surgical approach have to be aligned, to successfully reconstruct the area of injury. Three important ligaments maintain primary medial knee stability: the superficial medial collateral ligament, posterior oblique ligament, and deep medial collateral ligament. It is important not to exclude the assistance that other ligaments of the medial knee provide, including support of patellar stability by the medial patellofemoral ligament and multiligamentous hamstring tendon attachments. Valgus gapping and medial knee stability is accounted for collectively by every primary medial knee stabilizing structure. The following will review the principal medial knee anatomic and biomechanical properties.
Asunto(s)
Traumatismos de la Rodilla/diagnóstico , Articulación de la Rodilla/anatomía & histología , Fenómenos Biomecánicos , Humanos , Traumatismos de la Rodilla/fisiopatología , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/fisiología , Articulación de la Rodilla/cirugíaRESUMEN
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
The anterior (A) and posterior (P) cruciate ligaments (CL) of the knee, located inside the joint, connect the femur and the tibia and thus provide stability in the anteroposterior axis of one bone over the other. The anterior cruciate ligament (ACL) may be injured as a result of rotation when practicing a sport involving turning with the foot on the ground. ACL injuries are diagnosed with maneuvers like the Lachman, drawer and pivot. Accelerometers were used to plot the pivot maneuver in patients seeing the orthopedist surgeon using the KT1000 test as gold standard. This case-control descriptive study was approved by the Hospital's Ethics Committee. Results: 92 patients accepted to participate through an informed consent; nine cases were KT1000 positive, and nine age- and gender-matched controls were selected among KT1000 negative patients. KT1000 alterations were greater among females (78%) and in 67% of cases the right leg was affected. Mean KT1000 results were 5.44 mm in cases and 0.66 mm in controls. Accelerometers allowed plotting the pivot maneuver and the resulting charts for cases and controls were similar. Remarkable differences were seen only in one male patient with a 15 mm KT1000, who underwent repair of the left ACL; the maneuver was performed under sedation. We concluded that conscious patients oppose the maneuver, unlike anesthetized patients, and that the use of accelerometers helps document the pivot maneuver which, in turn, helps detect differences between a normal ACL and an injured one.
Asunto(s)
Acelerometría/métodos , Lesiones del Ligamento Cruzado Anterior , Traumatismos de la Rodilla/diagnóstico , Procedimientos Ortopédicos/métodos , Adolescente , Adulto , Anciano , Ligamento Cruzado Anterior/patología , Estudios de Casos y Controles , Femenino , Humanos , Traumatismos de la Rodilla/patología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
La rotura aguda de ligamento cruzado anterior (LCA) frecuentemente se asocia a lesiones de distintas estructuras en la rodilla por lo cual es importante identificarlas para realizar un adecuado tratamiento. El examen físico sigue siendo el principal método para diagnosticarlas, a su vez la resonancia nuclear magnética (RNM) es el estudio complementario de elección para acompañarlo. El objetivo de este trabajo es analizar las lesiones y la frecuencia con que se asocian a la rotura de ligamento cruzado anterior (LCA), visual izadas con claridad en la resonancia nuclear magnética (RNM). Material y Métodos: Se evaluaron retrospectivamente 71 pacientes con lesión aguda de ligamento cruzado anterior (LCA), de los cuales 18 sufrieron rotura aislada del mismo, y en el resto, 53 pacientes, se evidenciaron lesiones asociadas a aquella mediante examen físico y resonancia nuclear magnética (RNM). Durante el examen físico se realizaron además del interrogatorio previo, maniobras semiológicas para identificar: lesión de ligamento cruzado anterior (LCA), lesiones meniscales, lesión de ligamento cruzado posterior (LCP), lesión de ligamento lateral interno (LLI) y ligamento lateral externo (LLE), lesión de complejo posteroexterno (CPE), presencia y cuantificación clínica de aumento de líquido intra articular. En cuanto a la resonancia nuclear magnética (RNM) se utilizaron secuencias Tl, T2 Y STIR obteniéndose cortes sagitales, axiales, coronales y oblicuos. Resultados: Asociadas a la rotura aguda de ligamento cruzado anterior (LCA) se encontraron las siguientes lesiones: contusión ósea en cóndilo femoral y platillo tibial externo llamado "bonebruise" , lesiones de estructuras como meniscos externo e interno, ligamentos lateral interno y externo, ligamento cruzado posterior, complejo postero-externo y fractura de platillo tibial. Conclusiones: Es de suma importancia reconocer lesiones asociadas a la rotura aguda de ligamento cruzado...
Asunto(s)
Adolescente , Adulto , Adulto Joven , Ligamento Cruzado Anterior/lesiones , Traumatismos de la Rodilla/diagnóstico , Traumatismos en Atletas , Enfermedad Aguda , Prevalencia , RoturaRESUMEN
This study aimed to verify the accuracy of low-field-intensity magnetic resonance imaging (MRI) in diagnosing meniscus tears. A total of 171 patients were examined through low-field-intensity MRI to detect meniscus injuries. These patients were then diagnosed through arthroscopy. Examination results were recorded and compared. The accuracy of the diagnosis for internal and external meniscus tears through low-field-intensity MRI was 95.91% and 95.91%, respectively, the sensitivities were 95.60% and 96.47%, respectively, and the specificities were 96.25% and 95.35%, respectively. Low-field-intensity MRI is an accurate and cost-effective method for diagnosing meniscus tears.