Revista Brasileira de Ortopedia最新文献

Objective: To compare short-term complication rates of small-volume adipose tissue harvesting for micro-fragmented adipose tissue (mFAT) knee injections performed by orthopedic surgeons with those performed by plastic surgeons. Additionally, to evaluate the orthopedic surgeon's learning curve.

Methods: The present case-control study enrolled patients with knee osteoarthritis. All patients underwent a single-stage procedure consisting of abdominal adipose tissue harvesting, processing of the extracted material using the Lipogems (Lipogems International SpA) device to obtain mFAT, which was then injected intra-articularly into the knee. The patients were divided into a test group, with harvesting being performed by a recently trained orthopedic surgeon, and a control group, in which the procedure was performed by an experienced plastic surgeon. Short-term adverse effects, minor and major complications related to harvesting, were assessed intraoperatively and at 7-day follow-up.

Results: No major complications (fat embolism, thromboembolic events, abdominal perforation, wound infection, dehiscence, or cosmetic changes) were observed in either group. Abdominal discomfort during harvesting, classified as a minor complication, showed no statistically significant difference between groups ( p  = 0.362). Postoperative adverse effects, such as abdominal ecchymosis ( p  = 0.362) and discomfort ( p  = 0.342), were equivalent in both groups and resolved within 7 days.

Conclusion: The present pilot study suggests that, with adequate training, orthopedic surgeons can perform small-volume adipose tissue harvesting with low complication rates, comparable to those achieved by plastic surgeons experienced in liposuction.

Objective: To analyze the biomechanical consequences on the lesser metatarsals using different screw configurations for fixation of the minimally-invasive Chevron-Akin (MICA) osteotomy, through the finite element method (FEM).

Methods: A FEM model was developed from a computed tomography scan of a moderate hallux valgus (HV) deformity. Five different screw configurations were tested. We measured the maximal tension in the lesser metatarsals for each screw configurations, in physiological and supraphysiological loads.

Results: The lesser metatarsals received the lowest loads when the first metatarsal osteotomy was fixed with one intramedullary and one bicortical screw, with tensile load values varying between 30 and 70 MPa in physiological loads, and 50 to 350 MPa in supraphysiological loads. In all fixing techniques, the 2nd and 4th metatarsals received the highest loads, especially in groups 3 (two bicortical screws) and 5 (only one bicortical screw), with values reaching up to 230 and 600 MPa in physiological and supraphysiological loads, respectively. Regardless of the fixation technique, the region of the lesser metatarsals that received the most load was the diaphysis.

Conclusion: After MICA surgery to correct HV, there is an increase in tension forces on the lesser metatarsals, especially the second and fourth. The technique of fixing the first metatarsal with one bicortical and one intramedullary screw showed the lowest values on the lesser metatarsals load. Furthermore, for physiological and supraphysiological loads, independently of the technique, the forces were concentrated mainly on the metatarsal shaft.

Instability is a challenging complication and a significant revision cause in hip replacement surgery. The incidence of dislocation ranges from 0.5 to 10% in primary prostheses and can reach up to 30% in revision surgeries. The literature describes several risk factors, including surgeon-, patient-, and implant-related factors. Knowledge of these factors is essential to preventing and managing instability cases. Preventive treatment involves preoperative planning, adequate component positioning, normal hip biomechanics reestablishment, risk factor identification, and proper implant selection. Approximately two thirds of dislocation episodes are treatable with non-surgical treatment with closed reduction, education, and muscle strengthening. One third of the cases develop recurrent dislocations and require surgical intervention. Revision surgery should target the cause of instability. When necessary, consider special implants, such as dual-mobility acetabular components, polyethylene-based lipped acetabular liners, constrained acetabular inserts, or large-diameter prosthetic heads. Technological advances in robotic surgery and the understanding of the biomechanics of spinopelvic swing-related dislocation are promising current topics that may improve the prevention and treatment of instability.

Objective: To investigate the value of clinical diagnostic tests for diagnosing anterior cruciate ligament (ACL) tears with the anterior drawer, Lachman, Pivot-shift, Lever sign, and Forced Active Buckling (FAB)sign tests.

Methods: A cross-sectional study was conducted on 165 knee injury patients who were indicated for knee arthroscopy from January to December 2022. The clinical examination results were compared with the procedure's gold standard to determine the value of clinical diagnostic tests.

Results: The sensitivity and specificity values, respectively, were anterior drawer test: 77.5% and 86.1%; Lachman: 87.6% and 88.9%, Pivot-shift: 65.9% and 94.4%; Lever sign: 93.8% and 94.4%; and FAB sign: 81.4% and 97.2%.

Conclusion: There are various clinical diagnostic tests for ACL tears. The Lever sign is a useful clinical test for physicians to examine and diagnose ACL tears.

Objective: To evaluate the success rate of the reverse posterior interosseous artery flap, inferring its predictability, reliability, and safety.

Methods: We conducted a retrospective observational study including 18 patients with soft tissue lesions in the distal third of the upper limb who underwent posterior interosseous artery flap surgery. The study analyzed the flap size, the recipient area, the need for additional grafting, the clinical outcome, and the complications.

Results: There was one total and one partial loss of the flap, resulting in a success rate of 94.45%. Most cases healed well, and we did not observe major complications. More than half (55.5%) of the cases required grafting. In four cases, the flap was insufficient to cover the defect, requiring skin grafting in areas of granulation. In four cases, we performed thumb coverage, which is essential for hand function. The average flap size was of 9.6 cm in length by 4.4 cm in width, with the length ranging from 5.5 to 13 cm, and the width, from 3 to 7 cm. The flap was beneficial in functional areas such as the thumb and first commissure.

Conclusion: The posterior interosseous artery flap is a safe and effective option to cover defects in the distal third of the upper limb, especially on the dorsum of the hand and thumb, with low morbidity and good functional and esthetic outcomes.

Level of evidence: IV, case series.

Objective: To evaluate the success rate of the reverse posterior interosseous artery flap, inferring its predictability, reliability, and safety.

Methods: We conducted a retrospective observational study including 18 patients with soft-tissue lesions in the distal third of the upper limb who underwent posterior interosseous artery flap surgery. The study analyzed the flap size, the recipient area, the need for additional grafting, the clinical outcome, and the complications.

Results: There was one total and one partial loss of the flap, resulting in a success rate of 94.45%. Most cases healed well, and we did not observe major complications. More than half (55.5%) of the cases required grafting. In four cases, the flap was insufficient to cover the defect, requiring skin grafting in areas of granulation. In four cases, we performed thumb coverage, which is essential for hand function. The average flap size was of 9.6 cm in length by 4.4 cm in width, with the length ranging from 5.5 to 13 cm, and the width, from 3 to 7 cm. The flap was beneficial in functional areas such as the thumb and first commissure.

Conclusion: The posterior interosseous artery flap is a safe and effective option to cover defects in the distal third of the upper limb, especially on the dorsum of the hand and thumb, with low morbidity and good functional and esthetic outcomes.

Level of evidence: IV, case series.

Objective: To analyze the biomechanical consequences on the lesser metatarsals using different screw configurations for fixation of the minimally-invasive Chevron-Akin (MICA) osteotomy, through the finite element method (FEM).

Methods: A FEM model was developed from a computed tomography scan of a moderate HV deformity. Five different screw configurations were tested. We measured the maximal tension in the lesser metatarsals for each screw configurations, in physiological and supraphysiological loads.

Results: The lesser metatarsals received the lowest loads when the first metatarsal osteotomy was fixed with one intramedullary and one bicortical screw, with tensile load values varying between 30 and 70 MPa in physiological loads, and 50 to 350 MPa in supraphysiological loads. In all fixing techniques, the 2nd and 4th metatarsals received the highest loads, especially in groups 3 (2 bicortical screws) and 5 (only 1 bicortical screw), with values reaching up to 230 and 600 MPa in physiological and supraphysiological loads, respectively. Regardless of the fixation technique, the region of the lesser metatarsals that received the most load was the diaphysis.

Conclusion: After MICA surgery to correct HV, there is an increase in tension forces on the lesser metatarsals, especially the second and fourth. The technique of fixing the first metatarsal with one bicortical and one intramedullary screw showed the lowest values on the lesser metatarsals load. Furthermore, for physiological and supraphysiological loads, independently of the technique, the forces were concentrated mainly on the metatarsal shaft.

Objective: To investigate the value of clinical diagnostic tests for diagnosing anterior cruciate ligament (ACL) tears with the anterior drawer, Lachman, Pivot-shift, lever sign, and Forced Active Buckling (FAB)-sign tests.

Methods: A cross-sectional study was conducted on 165 knee injury patients who were indicated for knee arthroscopy from January to December 2022. The clinical examination results were compared with the procedure's gold standard to determine the value of clinical diagnostic tests.

Results: The sensitivity and specificity values, respectively, were anterior drawer test: 77.5% and 86.1%; Lachman: 87.6% and 88.9%; Pivot-shift: 65.9% and 94.4%; Lever sign: 93.8% and 94.4%; and FAB sign: 81.4% and 97.2%.

Conclusion: There are various clinical diagnostic tests for ACL tears. The Lever sign is a useful clinical test for physicians to examine and diagnose this condition.

Objective: To compare short-term complication rates of small-volume adipose tissue harvesting for micro-fragmented adipose tissue (mFAT) knee injections performed by orthopedic surgeons with those performed by plastic surgeons. Additionally, to evaluate the orthopedic surgeon's learning curve.

Methods: The present case-control study enrolled patients with knee osteoarthritis. All patients underwent a single-stage procedure consisting of abdominal adipose tissue harvesting, processing of the extracted material using the Lipogems (Lipogems International SpA) device to obtain mFAT, which was then injected intra-articularly into the knee. The patients were divided into a test group, with harvesting being performed by a recently trained orthopedic surgeon, and a control group, in which the procedure was performed by an experienced plastic surgeon. Short-term adverse effects, minor and major complications related to harvesting, were assessed intraoperatively and at 7-day follow-up.

Results: No major complications (fat embolism, thromboembolic events, abdominal perforation, wound infection, dehiscence, or cosmetic changes) were observed in either group. Abdominal discomfort during harvesting, classified as a minor complication, showed no statistically significant difference between groups ( p  = 0.362). Postoperative adverse effects, such as abdominal ecchymosis ( p  = 0.362) and discomfort ( p  = 0.342), were equivalent in both groups and resolved within 7 days.

Conclusion: The present pilot study suggests that, with adequate training, orthopedic surgeons can perform small-volume adipose tissue harvesting with low complication rates comparable to those achieved by plastic surgeons experienced in liposuction.

Instability is a challenging complication and a significant revision cause in hip replacement surgery. The incidence of dislocation ranges from 0.5 to 10% in primary prostheses and can reach up to 30% in revision surgeries. The literature describes several risk factors, including surgeon-, patient-, and implant-related factors. Knowledge of these factors is essential to preventing and managing instability cases. Preventive treatment involves preoperative planning, adequate component positioning, normal hip biomechanics re-establishment, risk factor identification, and proper implant selection. Approximately two thirds of dislocation episodes are treatable with non-surgical treatment with closed reduction, education, and muscle strengthening. One third of the cases develop recurrent dislocations and require surgical intervention. Revision surgery should target the cause of instability. When necessary, consider special implants, such as dual-mobility acetabular components, polyethylene-based lipped acetabular liners, constrained acetabular inserts, or large-diameter prosthetic heads. Technological advances in robotic surgery and the understanding of the biomechanics of spinopelvic swing-related dislocation are promising current topics that may improve the prevention and treatment of instability.