Revista Espa?ola de Artroscopia y Cirugía Articular最新文献

The long head of the biceps is a common cause of shoulder pain. Assessment and management requires knowledge of normal anatomy and its many variants described in the literature, as well as appropriate correlation of clinical, imaging, and arthroscopic findings. The case is presented of a 49 year-old male patient of with a traumatic ruptured cuff and biceps pain. In the arthroscopic evaluation duplication of the long head of the biceps was identified with the accessory bundle originated in the rotator cuff. The case was resolved arthroscopically by performing a tenodesis of the fascicles of one, and a tenotomy of the other, plus rotator cuff repair.

Introduction

The best technique for arthroscopic repair of rotator cuff tears is still not clear. Several studies point to an improvement, in biomechanical terms, of repairs in double row. However, few studies have demonstrated clinical superiority of repair in double row, and these have been mainly on large ruptures.

Objective

The objective of this study was to evaluate the clinical differences using the Constant score between two arthroscopic techniques for small and medium-sized tears of the supraspinatus, and to assess the costs and benefits of both techniques.

Material and methods

Prospective, randomised, study involving 114 patients with tears of up to 3 cm of the supraspinatus tendon, diagnosed by magnetic resonance imaging, with failure of up to three months conservative treatment. Patients were randomised into two different surgical techniques: Classic single row technique with one or two anchors in 5.5 mm PEEK, with 3-wire and transosseous-equivalent (TOE) with two anchors 5.5 mm PEEK, 3-wire, medial, and two knotless lateral anchors. All patients were operated on by the same surgeon. All patients underwent the same rehabilitation program.

Patients were evaluated before and at 12 months after the operation by an independent evaluator and using the Constant score.

Results

Results were obtained on 108 patients, after excluding three post-operative complications unrelated to the surgical technique, and loss of follow up of three other patients. The characteristics of both groups, in terms of demographics, rupture dimension and pre-surgical Constant score were analysed, with no significant differences being found. The mean post-surgical Constant score for the single row group was 79, and the TOE group of 78, not having a statistically significant difference. As regards the difference between the pre and post-surgery scores, the mean difference in the single row group was 50, and in the TOE group it was 55, also without significant statistical difference. In patients with abnormally low results (4 cases), a post-operative MRI was performed, with two cases of re-rupture identified for each technique.

Conclusion

In our sample, with the techniques described, no differences in clinical outcome between the two techniques were identified. No differences were observed in the rate of re-rupture between the two techniques. Based on our results, the cost benefit ratio is unfavourable for the TOE technique.

Objective

To analyse the evolution of hip arthroscopy as a technique for the treatment of hip pathology.

Methods

Retrospective analysis of the data (age, sex, diagnosis, year of intervention, surgical technique performed, and reoperations) from the database of the system Basque Public Health System (Osakidetza) and surgery registers of 2 private centres between 2008 and 2013.

Results

Within these six years, 542 arthroscopies (530 primary procedures and 12 re-operations) were performed. There was an increase in the number of interventions: from 15 (2.77%) in 2008 to 149 (27.5%) in 2013 (statistically significant difference; p < .001). The mean age was 44.6 (standard deviation, 13.1) years, and 33.8% of cases were women. The most frequent diagnoses were: femoroacetabular impingement (FAI, 430 patients, 81.1%), extra-articular hip pathology (36 patients, 6.79%), and pathology in hip with prosthesis (26 patients, 4.90%). The labrum was refixed in 56.1% of patients intervened by FAI, and the percentage of repairs increased from 28.6% to 70.5% (p < .001). In addition, 23 patients were re-operated by performing a total hip replacement(4.34%), leaving a total of 35 re-operations (6.60%).

Conclusions

The annual number of hip arthroscopies has multiplied between 2008 and 2013. During these years the labral refixation has progressively increased against its resection.

Clinical relevance

To analyze how the hip arthroscopy application has evolved over recent years.

Level of evidence

Level IV, cross-sectional study.

The concept of a “fallen” Anterior Cruciate Ligament (ACL) refers to the wrong conception of the native ACL based on the orientation, tension and appearance of a transtibial, non-anatomic, vertical ACL graft. This appearance could be considered as the appearance of a normal ligament. When, later, we see an uninjured ACL, anatomically orientated and inserted in its footprint, we could think of it as “fallen”. The fact is that that is its anatomic insertion.

The tension pattern can also confuse us because that of the native ligament varies throughout the range of flexion-extension whilst non-anatomic grafts, being isometric, are always tense.

The fact that the study of the anatomy as well as imaging tests are done with the knee in full extension but arthroscopy is performed with the knee in 90° of flexion adds confusión to the perception of the uninjured ligament.

We must discard the concept of the “fallen” ligament and take this opportunity to better understand the anatomy of the femoral footprint, the tension, and the real orientation of the ligament.

Objective

Surgical stabilization of split fractures of the lateral tibial plateau may involve percutaneous insertion of cannulated screws or more invasive implantation of locked plating systems. In any case, six to eight weeks of non-weight-bearing are recommended. By using the finite element (FE) method, this study aimed to assess whether immediate weight bearing can generate excessive interfragmentary motions (IM).

Methods

A validated femur-tibia FE model of a healthy patient was used. The tibia model was reconverted into geometry, and a Schatzker I fracture was re-created based on patient x-rays. Cannulated 6.5 mm cancellous bone screws, and a Polyax tibial locked plating system (Biomet Inc, USA) were modelled, and virtually implanted into the fractured tibia geometry. An axial force of 400 N pressed the femur model against the tibial plateau, simulating the weight of an 80 Kg patient in bipedal stance. IM were calculated as the displacements between two nodes initially superimposed in the fracture area

Results

Maximum IM calculated with the Polyax and with the cannulated screw fixations were around 0.1-0.15 mm, and 0.25-0.3 mm, respectively. Both systems led to similar IM up to 80-90% of applied body weight. However, applying over 20% of the simulated body weight might lead to a risk of compression bone fracture. With the Polyax system, bone stresses were better distributed, and remained below 100 MPa at 30% of body weight. Maximum stresses in the implants were about half the reported strength for the alloy simulated.

Conclusion

This study suggested that IM caused by weight bearing might not impede bone healing in a fracture stabilized with either a Polyax locked plating system or cannulated screws. However, cannulated screw systems could lead to harmful load concentrations in the bone with immediate weight bearing. Plate systems will allow around 50% of immediate weight bearing.

Objective

To evaluate the potential usefulness of online educational videos for knee arthroscopy patients.

Methods

Prospective multicenter randomized study with 105 patients. Three educational videos for patients were made and uploaded on to a web page: 1 isometric exercise, 2 heparin subcutaneous administration, 3 bandages and wound care. A multicenter study of 105 knee arthroscopy patients that were Internet users. Randomized to 2 groups. Group A (48 patients) was invited watch videos on a web page. Group B (57 patients) was not. Both groups completed a 34 items questionnaire.

Results

As a whole, group A got more correct answers (85%), less incorrect (13.2%), and less blank answers (1.6%) than group B (respectively, 79.9, 16.9 and 3.1%, p<.001). Group A had mean of 1.8 more correct answers than group B, and a 5.28% higher probability to give a correct answer to a question. There were significant differences in number of correct answers between patient populations (p<.0001).

Conclusions

The group of patients that were invited to watch the Internet videos had better knowledge of self-care than those who where not invited.

Level of evidence: Therapeutic study. Prospective randomized non-blinded comparative study, level II.

Clinical relevance

This study demonstrates that the Internet may be a useful channel to enhance patient knowledge of self-care techniques.

Fractures of the clavicle account for 4% of adult fractures. About 18% of them are located in the lateral end of the clavicle. The location, relationship with coraco-clavicular ligaments and pattern of injury are of considerable importance in stability of the fracture. For the most part, they have been treated conservatively. Surgical treatment is necessary in displaced fractures. It is usually managed with plating and Kirschner wires with tension-band wires. Specific plates were engineered, such as the hook-plate, improving the results. Arthroscopic assisted treatment is rare and based on acromioclavicular dislocation procedures.