RESUMO
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.
Assuntos
Enxerto Osso-Tendão Patelar-Osso/métodos , Instabilidade Articular/cirurgia , Ligamento Colateral Médio do Joelho/cirurgia , Luxação Patelar/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Instabilidade Articular/diagnóstico , Articulação do Joelho , Masculino , Ligamento Colateral Médio do Joelho/fisiopatologia , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Luxação Patelar/complicações , Luxação Patelar/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
The meniscotibial ligaments (LMT) of humans are capsular fibers with proximal origin in the lateral border of the menisci and distal insertion in the lateral border of the tibial condyle, also called coronary ligament of the knee. However, few studies describe the presence, course and anatomical variations of this ligament. Our objective was to evaluate the LMT through quantitative and descriptive methods. Eighty-five knees were examined(42 right knees [RK] and 43 left knees [LK]), dissected, evaluated, catalogued and photographed by four examiners. Twenty knees (23.53%) presented LMT, 6 (30%) in RK and 14 (70%) in LK. In two RKs, the LMT presented proximal insertion in the medial menisci and distal insertion in medial tibial condyle; in the other ones, the LMT presented proximal insertion in the lateral menisci and distal insertion in the lateral tibial condyle. In the LK, four LMT presented proximal insertion in the medial menisci and distal insertion in the medial tibial condyle, while the other ones presented proximal insertion in the lateral menisci and distal insertionin the lateral tibial condyle. One LMT in the LK presented proximal and distal insertion in both menisci and tibial condyle. The analysis of human corpses in our study suggests that the presence of the LMT is much more common in the LK than in the RK, with more frequent insertion in the proximal region of the lateral menisci and distal insertion in the lateral tibial condyle.
Assuntos
Humanos , Articulação do Joelho , Ligamento Colateral Médio do Joelho/anatomia & histologia , Ligamento Colateral Médio do Joelho/fisiopatologia , Ligamento Colateral Médio do Joelho , Meniscos Tibiais , Cadáver , Joelho/anatomia & histologia , Ligamentos ArticularesRESUMO
El diagnóstico de las lesiones del complejo cápsulo-ligamentario medial es clínico y de confirmación con resonancia magnética y artroscopia. Se requiere unificar criterios en cuanto el conocimiento y clasificación de los diferentes tipos de inestabilidad de la rodilla así como su estudio clínico mediante diferentes signos. Según su tipo de inestabilidad de la rodilla puede ser un plano, rotacional o combinada y según su magnitud puede ser del grado I a IV. En el Hospital Central Militar y otros hospitales tratamos quirúrgicamente mediante reforzamiento aponeurótico a 42 pacientes (44 rodillas), con lesión del complejo cápsulo-ligamentario medial puro o asociado con otras lesiones, grados III o IV, en un periodo de ocho años, con un seguimiento promedio de 3.5 años. Se calificaron los resultados según fue su incorporación completa a sus actividades cotidianas, militares y deportivas, dolor, valoración radiográfica y clínica. El programa de rehabilitación postquirúrgica fue de cuatro meses. Los resultados observados fueron muy buenos en 26 (62 por ciento), buenos en ocho (19 por ciento), regulares en cuatro (9.5 por ciento) e igual número de malos (9.5 por ciento)