RESUMO
OBJECTIVE: Analyze return to sports and related factors after primary anterior cruciate ligament reconstruction. METHODS: Observational descriptive study. 173 patients operated by the same surgeon and standardized technique (patellar autograft) who answered a questionnaire at least 12 months post procedure were included. Questionnaire included Subjective IKDC, Tegner activity level (Pre and Postoperative) and questions elaborated by the group. RESULTS: Mean age was 30.8 years, 85% were men, 73% practiced soccer and median postoperative IKDC was 71. Follow up until questionnaire response was 28 months. Males had a better return to sports than females (70% vs 48%, p » 0.037). Tegner preinjury level was 5 vs 4.3 postoperative, (p < 0.001). Return to sports was 67% according to Tegner scale and 66% by self-assessment. Return to similar previous activity level was 57% by Tegner scale but 24% by direct questions. Of those patients, 51% have fear of reinjury and 26% by reasons other than knee or surgery. We didn't find association between meniscal injuries and return to sports rate. Patients with chondral injuries had lower rates in return to sports (35% vs 60%, p » 0.002). Subjects that returned to sports had higher IKDC scores (73.5 vs 64.3, p < 0.001). CONCLUSIONS: We found 67% return to sports and 57% to the preinjury level. Positive return to sports factors were male sex, absence of chondral injury and better functional outcome. Psychological factors such as fear of injury is frequent in patients who don't achieve previous levels of activity.
OBJETIVOS: Analizar el retorno deportivo y factores asociados tras la reconstrucción primaria de ligamento cruzado anterior (LCA). MÉTODOS: Estudio observacional descriptivo. Se incluyeron 173 operados entre 2014 y 2017 por el mismo cirujano, los cuales contestaron un cuestionario al menos 12 meses después de la cirugía. El cuestionario incluye IKDC subjetivo, Tegner activity level (pre y post operatorio) y preguntas de elaboración propia. RESULTADOS: La edad promedio es 30,8 años, el 85% son hombres, el 73% practicaba fútbol y la mediana del IKDC fue 71. La media de meses hasta responder el cuestionario fue de 28 meses. Tegner pre-lesión promedio fue de 5 vs 4,3 postoperatorio, p < 0,001. Según la escala Tegner el 57% retorna al mismo nivel previo, sin embargo, de acuerdo con el cuestionario propio solo el 24% lo haría. De ese subgrupo, el 51% tiene temor a lesionarse de nuevo y el 26% reporta razones no relacionadas a la rodilla. No encontramos asociación entre lesiones meniscales y la tasa de retorno. Aquellos que retornan tienen menor prevalencia de lesiones condrales (35% vs 60%, p » 0,002). Los pacientes que retornaron tuvieron un IKDC superior (73,5 vs 64,3, p < 0,001). El sexo masculino tiene una tasa de retorno de 70% vs 48% de su contraparte femenina (p » 0,037). CONCLUSIONES: El 67% retorna al deporte y el 57% lo hace al mismo nivel. Factores positivos relacionados al retorno fueron sexo masculino, ausencia de lesión condral y mejor resultado funcional. Factores psicológicos con el miedo a lesionarse de nuevo son frecuentes en pacientes que no recuperan el nivel previo.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Enxerto Osso-Tendão Patelar-Osso/métodos , Reconstrução do Ligamento Cruzado Anterior/métodos , Volta ao Esporte , Lesões do Ligamento Cruzado Anterior/cirurgia , Inquéritos e Questionários , Medo , Lesões do Ligamento Cruzado Anterior/psicologia , Relesões/psicologiaRESUMO
La utilización de autoinjerto huesotendón patelarhueso, para la reconstrucción del ligamento cruzado anterior es considerado por muchos cirujanos como el estándar de oro en pacientes jóvenes con fisis cerrada. Sin embargo, una de las complicaciones técnicas es el riesgo de obtener un injerto de mayor longitud a la deseada, perdiendo la ventaja de mantener el fragmento óseo distal del injerto dentro del túnel tibial. En este trabajo se describe una técnica quirúrgica que permite acortar la longitud del injerto, realizando una migración proximal del fragmento óseo distal (tibial), logrando disminuir la discrepancia entre la longitud del injerto y la longitud de la reconstrucción, sin sacrificar ninguno de los fragmentos óseos, conservando las ventajas del injerto.
The use of autograft bonepatellar tendonbone, for the reconstruction of the anterior ligament cruciate is considered as a gold standard in procedures in young patients with closed physis. However, one of the technical complications is the risk of obtaining a graft with greater length than expected which leads to a disadvantage of maintaining distal bone fragment of the graft within the tibiae tunnel. This work describes a surgical technique that allows to reduce the length of the graft through a proximal migration of the distal bone fragment (tibia) therefore shortening the discrepancy between the longitude of the graft and the longitude of the reconstruction without sacrificing none of the bone fragments and conserving the benefits of the graft.
Assuntos
Humanos , Artroscopia/métodos , Ligamento Cruzado Anterior/cirurgia , Enxerto Osso-Tendão Patelar-Osso/métodos , Reconstrução do Ligamento Cruzado Anterior/métodos , Traumatismos do Joelho/cirurgiaAssuntos
Humanos , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/prevenção & controle , Lesões do Ligamento Cruzado Anterior/reabilitação , Articulação do Joelho/anatomia & histologia , Articulação do Joelho/embriologia , Futebol/lesões , Enxerto Osso-Tendão Patelar-Osso/métodos , Enxerto Osso-Tendão Patelar-Osso/reabilitação , Terapia por ExercícioRESUMO
PURPOSE: To prospectively compare therapeutic effect of femoral tunnel preparation through the tibial tunnel and the anteromedial (AM) portal in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Between June 2008 and October 2010, 76 patients underwent single-bundle ACL reconstruction by autogenous grafting of semitendinosus and gracilis tendon. All cases were randomly divided into two groups according to the method of femoral tunnel preparation: transtibial (TT) group (n=38) and anteromedial (AM) group (n=38). Lysholm knee score and the KT-1000 anterior laxity at 30° of pre-and post-operation were assessed for two groups. RESULTS: Sixty-five patients (TT group, 34; AM group, 31) were followed up for more than 12 months, with a follow-up rate of 86%. The Lysholm knee score and the KT-1000 anterior laxity 12 months after operation were significantly better than before reconstruction. The Lysholm knee score and the KT-1000 anterior laxity were not significantly different between the TT and AM groups after operation. CONCLUSION: Femoral tunnel preparation through tibial tunnel or the anteromedial portal in single-bundle anterior cruciate ligament reconstruction shows same therapeutic effects.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Enxerto Osso-Tendão Patelar-Osso/métodos , Fêmur/cirurgia , Tendões/transplante , Tíbia/cirurgia , Adolescente , Adulto , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Distribuição Aleatória , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To prospectively compare therapeutic effect of femoral tunnel preparation through the tibial tunnel and the anteromedial (AM) portal in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Between June 2008 and October 2010, 76 patients underwent single-bundle ACL reconstruction by autogenous grafting of semitendinosus and gracilis tendon. All cases were randomly divided into two groups according to the method of femoral tunnel preparation: transtibial (TT) group (n=38) and anteromedial (AM) group (n=38). Lysholm knee score and the KT-1000 anterior laxity at 30° of pre-and post-operation were assessed for two groups. RESULTS: Sixty-five patients (TT group, 34; AM group, 31) were followed up for more than 12 months, with a follow-up rate of 86%. The Lysholm knee score and the KT-1000 anterior laxity 12 months after operation were significantly better than before reconstruction. The Lysholm knee score and the KT-1000 anterior laxity were not significantly different between the TT and AM groups after operation. CONCLUSION: Femoral tunnel preparation through tibial tunnel or the anteromedial portal in single-bundle anterior cruciate ligament reconstruction shows same therapeutic effects.
OBJETIVO: Comparar prospectivamente o efeito terapêutico da preparação do túnel femoral através do túnel tibial (TT) ou da porta ântero-medial(AM) na reconstrução do ligamento cruzado anterior(LCA) em feixe único. MÉTODOS: Entre junho de 2008 e outubro de 2010, 76 pacientes foram submetidos à reconstrução do LCA em feixe único pelo enxerto autógeno de tendão semitendíneo egrácil.Todos os casos foram divididos aleatoriamente em dois grupos de acordo como método de preparação do túnel femoral: grupo transtibial (TT) (n=38) e grupo ântero-medial (AM) (n=38). Foi usado o escore Lysholm para joelho. O relaxamento anterior do joelho a 30° sob força tênsil de 133,32N foi determinado com o medidor KT-1000 no pré e no pós-operatório nos dois grupos. RESULTADOS: Sessenta e cinco pacientes (grupo TT, 34; grupo AM,31)foram acompanhados por mais de 12 meses, com uma taxa de follow-up de 86%.A pontuação do Lysholm para joelho e do relaxamento anterior medido pelo KT-1000 aos 12 meses de pós-operatório foi significativamente melhor do que antes da reconstrução.As pontuações de Lysholme do relaxamento KT-1000 não foram significativamente diferentes comparando os grupos TT e AM após a operação. CONCLUSÃO: A preparação do túnel femoral através do túnel tibial ou da porta ântero-medial na reconstrução do ligamento cruzado anterior em feixe único mostrou os mesmos efeitos terapêuticos.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Reconstrução do Ligamento Cruzado Anterior/métodos , Enxerto Osso-Tendão Patelar-Osso/métodos , Fêmur/cirurgia , Tendões/transplante , Tíbia/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiologia , Período Pós-Operatório , Estudos Prospectivos , Distribuição Aleatória , Resultado do TratamentoRESUMO
BACKGROUND: The patellar tendon has limited ability to heal after harvesting its central third. Platelet-rich plasma (PRP) could improve patellar tendon healing. HYPOTHESIS: Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament (ACL) reconstruction with a patellar tendon graft. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Twenty-seven patients were randomly divided to receive (n = 12) or not receive (n = 15) PRP in the patellar tendon harvest site during ACL reconstruction. The primary outcome was magnetic resonance imaging (MRI) assessment of patellar tendon healing (gap area) after 6 months. Secondary outcomes were questionnaires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups. RESULTS: Patellar tendon gap area was significantly smaller in the PRP group (4.9 ± 5.3 mm(2); 95% confidence interval [CI], 1.1-8.8) than in the control group (9.4 ± 4.4 mm(2); 95% CI, 6.6-12.2; P = .046). Visual analog scale score for pain was lower in the PRP group immediately postoperatively (3.8 ± 1.0; 95% CI, 3.18-4.49) than in the control group (5.1 ± 1.4; 95% CI, 4.24-5.90; P = .02). There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups. CONCLUSION: We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period. Questionnaire and isokinetic testing results were not different between the groups at 6 months.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Patelar/cirurgia , Plasma Rico em Plaquetas , Traumatismos dos Tendões/terapia , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior , Enxerto Osso-Tendão Patelar-Osso/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Medição da Dor , Dor Pós-Operatória , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Intensive scheduling in sports requires athletes to resume physical activity shortly after injury. The purpose of this study was to investigate early isokinetic muscle strength and knee function on bone-patellar tendon-bone (BPTB) ACL reconstruction with double femoral pin fixation or interference screw technique. METHODS: A prospective study was conducted from 2008 to 2009, with 48 athletes who received femoral BPTB fixation with interference screw (n = 26) or double pin (n = 22). Clinical (IKDC objective score and hop test) and isokinetic muscle strength (peak torque (PT), PT/body weight and flexion/extension rate (F/E) in 60 and 240°/s) were analyzed at 6 months of follow-up. RESULTS: Analysis at baseline showed no differences between groups before surgery related to age, gender, associated injury, Tegner or Lysholm score; thus showing that groups were similar. During follow-up, however, there were significant differences between the two groups in some of the isokinetic muscle strength: PT/BW 60°/s (Double Pin = 200% ± 13% vs. Interference Screw = 253% ± 16%*, *P = 0.01); F/E 60°/s (Double Pin = 89% ± 29%* vs. Interference Screw = 74% ± 12%, *P = 0.04). No statistical differences between groups were observed on IKDC objective score, hop test and complications. CONCLUSION: The significant muscle strength outcome of the interference screw group found in this study gives initial evidence that this fixation technique is useful for athletes that may need accelerated rehabilitation. Early return to sports ability signaled by isokinetic muscle strength is of clinical relevance as it is one of the main goals for athletes' rehabilitation.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Enxerto Osso-Tendão Patelar-Osso/métodos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/fisiologia , Força Muscular , Tenodese/métodos , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/instrumentação , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/reabilitação , Traumatismos em Atletas/cirurgia , Pinos Ortopédicos , Parafusos Ósseos , Enxerto Osso-Tendão Patelar-Osso/instrumentação , Enxerto Osso-Tendão Patelar-Osso/reabilitação , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/reabilitação , Articulação do Joelho/cirurgia , Masculino , Estudos Prospectivos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Tenodese/instrumentação , Tenodese/reabilitação , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To prospectively compare therapeutic effect of femoral tunnel preparation through the tibial tunnel and the anteromedial (AM) portal in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Between June 2008 and October 2010, 76 patients underwent single-bundle ACL reconstruction by autogenous grafting of semitendinosus and gracilis tendon. All cases were randomly divided into two groups according to the method of femoral tunnel preparation: transtibial (TT) group (n=38) and anteromedial (AM) group (n=38). Lysholm knee score and the KT-1000 anterior laxity at 30° of pre-and post-operation were assessed for two groups. RESULTS: Sixty-five patients (TT group, 34; AM group, 31) were followed up for more than 12 months, with a follow-up rate of 86%. The Lysholm knee score and the KT-1000 anterior laxity 12 months after operation were significantly better than before reconstruction. The Lysholm knee score and the KT-1000 anterior laxity were not significantly different between the TT and AM groups after operation. CONCLUSION: Femoral tunnel preparation through tibial tunnel or the anteromedial portal in single-bundle anterior cruciate ligament reconstruction shows same therapeutic effects.(AU)
OBJETIVO: Comparar prospectivamente o efeito terapêutico da preparação do túnel femoral através do túnel tibial (TT) ou da porta ântero-medial(AM) na reconstrução do ligamento cruzado anterior(LCA) em feixe único. MÉTODOS: Entre junho de 2008 e outubro de 2010, 76 pacientes foram submetidos à reconstrução do LCA em feixe único pelo enxerto autógeno de tendão semitendíneo egrácil.Todos os casos foram divididos aleatoriamente em dois grupos de acordo como método de preparação do túnel femoral: grupo transtibial (TT) (n=38) e grupo ântero-medial (AM) (n=38). Foi usado o escore Lysholm para joelho. O relaxamento anterior do joelho a 30° sob força tênsil de 133,32N foi determinado com o medidor KT-1000 no pré e no pós-operatório nos dois grupos. RESULTADOS: Sessenta e cinco pacientes (grupo TT, 34; grupo AM,31)foram acompanhados por mais de 12 meses, com uma taxa de follow-up de 86%.A pontuação do Lysholm para joelho e do relaxamento anterior medido pelo KT-1000 aos 12 meses de pós-operatório foi significativamente melhor do que antes da reconstrução.As pontuações de Lysholme do relaxamento KT-1000 não foram significativamente diferentes comparando os grupos TT e AM após a operação. CONCLUSÃO: A preparação do túnel femoral através do túnel tibial ou da porta ântero-medial na reconstrução do ligamento cruzado anterior em feixe único mostrou os mesmos efeitos terapêuticos.(AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Reconstrução do Ligamento Cruzado Anterior/métodos , Enxerto Osso-Tendão Patelar-Osso/métodos , Fêmur/cirurgia , Tendões/transplante , Tíbia/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiologia , Período Pós-Operatório , Estudos Prospectivos , Distribuição Aleatória , Resultado do TratamentoAssuntos
Ligamento Cruzado Anterior/cirurgia , Enxerto Osso-Tendão Patelar-Osso/métodos , Fêmur/cirurgia , Lâmina de Crescimento/cirurgia , Traumatismos em Atletas/cirurgia , Fêmur/crescimento & desenvolvimento , Humanos , Recuperação de Função Fisiológica/fisiologia , Resultado do Tratamento , Adulto JovemAssuntos
Humanos , Adulto Jovem , Ligamento Cruzado Anterior/cirurgia , Enxerto Osso-Tendão Patelar-Osso/métodos , Fêmur/cirurgia , Lâmina de Crescimento/cirurgia , Traumatismos em Atletas/cirurgia , Fêmur/crescimento & desenvolvimento , Recuperação de Função Fisiológica/fisiologia , Resultado do Tratamento , Adulto JovemRESUMO
Los resultados a largo plazo de las reconstrucciones del LCA por artroscopia son raros. Nosotros presentamos los resultados de un estudio de 57 pacientes con un seguimiento superior a 15 años. La reconstrucción es realizada bajo control artroscópico. Nosotros utilizamos un injerto hueso ligamento rotuliano hueso. El túnel femoral es realizado de afuera hacia adentro. La fijación femoral obtenida por "pressfit" y la fijación tibial es realizada con un tornillo de interferencia metálico. 240 pacientes fueron operados con esta técnica en 1992. Nosotros pudimos ver 57 de estos pacientes con un seguimiento promedio de 182 meses. Todos los pacientes fueron evaluados con el formulario IKDC. La laxitud diferencial fue medida con el Rolimeter (aircast). Un examen radiológico completo fue realizado a todos los pacientes. A 15 años de seguimiento 43 por ciento de pacientes fueron clasificados como A, 40 por ciento B, 10 por ciento C 5 por ciento y D según el formulario IKDC objetivo. El IKDC subjetivo promedio fue de 85,8/100. La laxitud diferencial instrumental promedio fue de 1,8 mm. 86 por ciento de los pacientes presentaron radiografías normales y solamente 5 por ciento de artrosis. Este estudio demuestra que esta técnica permite obtener buenos resultados en cuanto a la laxitud y la artrosis.
The results of the ACL by arthroscopy in the long term are rare. The following are the results of a study we made of 57 patients with a folloe-up of more than 15 years. The reconstruction was carried out by arthroscopy. We used a patellar ligament bone graft. The femoral tunnel procedure is outside-inside. The femoral attachment was by "pressfit", and the tibial attachment using a metalic interference screw. 240 patients were operated on in 1992 using this technique. We reviewed 57 of these patient with a mean follow-up time of 182 months. All the patients were evaluated using the IKDC formula. The laxity differential was measured using the Rolimeter (aircast). A complete radiological examination was carried out on all the patients. After 15 years follow-up 43 percent of the patients were classified A 40 percent, B 10 percent, C 5 percent and D using the IKDC formula objective. The mean IKDC subjective score was 85,8/100. The mean instrumental laxity diferrential was 1,8 mm. 86 percent of the patients had normal X-rays and only 5 percent had arthritis. This study demonstrates that using this technique good resultd can be obtained with regard to laxity and arthritis.
Assuntos
Humanos , Masculino , Feminino , Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Ligamento Cruzado Anterior/crescimento & desenvolvimento , Ligamento Patelar , Enxerto Osso-Tendão Patelar-Osso/métodos , Radiografia/métodosRESUMO
PURPOSE: The purpose of our study was to compare the technical difficulties and the results of the use of two different types of femoral graft fixation for medial patellofemoral ligament reconstruction in patients with patellar luxation. METHODS: Twenty-four matched pair patients, assigned to two groups of 12 patients each, underwent medial patellofemoral ligament reconstruction using one of two techniques: the adductor magnus rigid and the semitendinosus tendon dynamic femoral fixation. Results were assessed using a scale for activities of daily living before and after surgery. RESULTS: No statistical difference was detected between the groups despite one case of reluxation in the adductor magnus group. No major complication was observed in either group. Patients in the semitendinosus group felt subjectively better, and a larger number of patients in this group resumed the practice of sports. CONCLUSIONS: Even in the absence of significant differences, the present results suggest that a more dynamic femoral fixation is more advantageous than a rigid alternative. LEVEL OF EVIDENCE: Level III, therapeutic comparative study.