RESUMO
Successful posterior cruciate ligament (PCL) reconstruction surgery results from identification and treatment of associated pathology such as posterolateral instability, posteromedial instability, and lower extremity malalignment. The use of strong graft material, properly placed tunnels to as closely as possible approximate the PCL insertion sites, and minimization of graft bending also enhance the probability of PCL reconstruction success. In addition, mechanical graft tensioning, primary and back-up PCL graft fixation, and the appropriate postoperative rehabilitation program are also necessary ingredients for PCL reconstruction success. Both single-bundle and double-bundle PCL reconstruction surgical techniques are successful when evaluated with stress radiography, KT 1000 arthrometer measurements, and knee ligament rating scales. PCL reconstruction failure may result when any or all of these surgical principles are violated. The purpose of this manuscript was to discuss revision PCL surgery. This presentation will include causes of unsuccessful PCL reconstruction, surgical indications and goals, patient evaluation, surgical decision making, graft selection, surgical technique, associated surgical procedures, postoperative rehabilitation, and revision PCL reconstruction results.
Assuntos
Traumatismos do Joelho/cirurgia , Reconstrução do Ligamento Cruzado Posterior/métodos , Ligamento Cruzado Posterior/lesões , Reoperação/métodos , Humanos , Traumatismos do Joelho/reabilitação , Ligamento Cruzado Posterior/cirurgia , Reconstrução do Ligamento Cruzado Posterior/reabilitação , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Reoperação/reabilitação , Falha de TratamentoRESUMO
OBJECTIVE: To evaluate in-toeing consults to a pediatric orthopedic clinic to determine the proportion that could be managed by a primary care physician. STUDY DESIGN: A prospective registry was created for 143 consecutive children referred to a pediatric orthopedic clinic for "in-toeing." Each patient underwent a careful history and physical examination, which included a rotational profile. We recorded the final diagnosis, treatment offered, follow-up visit results, and the source of the referral. RESULTS: After pediatric orthopedic evaluation, 85% of patients had a confirmed diagnosis of in-toeing, and 15% had a different final diagnosis. Seventy-four percent of patients had 1 consultation visit, 18% had 2, and 8% had >2 visits. None of the referred patients was a candidate for treatment by casting or surgery. CONCLUSION: In most cases, in-toeing is a normal variation of development that can be managed by counseling and observation by the primary care physician alone. Rare cases of severe in-toeing >2 standard deviations from the mean should likely still prompt referral to a pediatric orthopedic surgeon for potential intervention.