Revista Brasileira de Ortopedia最新文献

Objective  The present study endeavors to scrutinize the precision of magnetic resonance imaging as a diagnostic modality for detecting ligament disruption of the knee, with arthroscopy serving as the gold standard. The study delves into the sensitivity, specificity, positive predictive value, and negative predictive value of magnetic resonance imaging (MRI) results in a cohort of 200 patients against diagnostic arthroscopy. Methods  Our institution conducted a comprehensive clinical examination of all patients with knee injuries, and those with affirmative findings suggestive of ligament disruption were subjected to an MRI scan. The study comprised 200 patients with MRI-confirmed anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears, who subsequently underwent arthroscopy for both diagnostic and therapeutic purposes. The results were subjected to various statistical tests to compare and analyze the outcomes. Results  The study has demonstrated a remarkably high sensitivity and specificity, providing near-optimal accuracy for the diagnosis of ACL and PCL injuries via MRI compared with arthroscopy. Patients with affirmative MRI findings could proceed to undergo diagnostic/therapeutic arthroscopic procedures. Conclusion  The study emphasizes the significance of MRI as a noninvasive and highly precise method for assessing ligament injuries in the knee. Although MRI can be used as a first-line investigation, it must be emphasized that arthroscopy remains the gold standard for diagnosing ACL and PCL tears. The current study recommends the use of MRI as a valuable screening tool in patients with suspected knee ligament disruption, with potential to reduce the number of diagnostic arthroscopies in patients with inconclusive clinical findings, thereby minimizing patient discomfort and healthcare costs.

Objective : This study compared diagnostic methods for meniscal ramp injury (magnetic resonance imaging [MRI], arthrotomography, and arthroscopy) to determine the most sensitive and the agreement level between them. Method:  We studied 21 patients, all young athletes with suspected anterior cruciate ligament (ACL) injury after trauma for at least 3 months and no evidence or history of other osteoarticular injuries in the knee. The patients underwent MRI and arthrotomography. Following ACL injury confirmation, they underwent arthroscopy for ligament reconstruction and evaluation of the medial meniscus to confirm or exclude a ramp injury. McNemar's agreement test compared the diagnostic methods. We also assessed specificity and sensitivity using arthroscopy as the gold standard with a 95% confidence interval and p < 0.005. Result : The results were consistent with the literature. MRI had 73.3% sensitivity and 83.3% specificity, with 76.2% agreement with the gold standard. Arthrotomography sensitivity and specificity were 100% and 66.7%, respectively, with 90.5% agreement with arthroscopy. Conclusion : In our study, arthrotomography was the most sensitive diagnostic method and had the highest agreement with the gold standard. We recommend its consideration for diagnosing ACL injuries.

Objective  To evaluate the validity of the Brazilian Portuguese version of the Western Ontario Shoulder Instability Index (WOSI). Methods  We assessed 51 patients aged 18 to 40 years who were divided into 3 groups: 17 patients with shoulder instability undergoing conservative treatment, 17 with shoulder instability treated surgically, and 17 without shoulder instability. The patients underwent functional and health assessments using the following scores: WOSI, Rowe, Visual Analog Scale (VAS), Subjective Shoulder Value (SSV), Disabilities of the Arm, Shoulder and Hand (DASH), and University of California-Los Angeles (UCLA) Shoulder Scale. Results  The variables sex and age were homogeneous among the groups ( p  > 0.05). A comparative analysis of the scores revealed that patients undergoing treatment (either surgical or conservative) showed significant differences compared with the control group ( p  < 0.05). The determination of score correlation was made using the Spearman correlation coefficient. All instruments analyzed showed a significant relationship among themselves but at different levels: the correlation between the WOSI and DASH instruments was perfectly positive ( r  = 0.96); the comparison of the WOSI and UCLA ( r  = 0.87), DASH and UCLA ( r  = 0.86), SSV and Rowe ( r  = 0.80), VAS and DASH (r = 0.75), VAS and UCLA ( r  = 0.74), and WOSI and VAS ( r  = 0.72) also showed a trend towards positive linearity among measurements; and the comparison of the instruments WOSI and SSV, WOSI and Rowe, DASH and Rowe, SSV and UCLA ( r  = -0.83), SSV and DASH ( r  = -0.79), Rowe and UCLA ( r  = -0.78), VAS and SSV ( r  = -0.68), and VAS and Rowe ( r  = -0.60) revealed a negative correlation. Conclusion  The Brazilian Portuguese version of the WOSI presents good validity.

Objective  Artificial intelligence technologies have been used increasingly in spine surgery as a diagnostic tool. The aim of the present study was to evaluate the effectiveness of the convolutional neural networks in the diagnosis of cervical myelopathy (CM) compared with conventional cervical magnetic resonance imaging (MRI). Materials and Methods  This was a cross-sectional descriptive analytical study. A total of 125 participants with clinical and radiological diagnosis of CM were included in the study. Sagittal and axial MRI images in the T2 sequence of the cervical spine were used. All image parts were obtained as 8 bytes/pixel in 2 different categories, CM and normal, both in axial and sagittal views. Results  Triple cross validation was performed to prevent overfitting during the training process. A total of 242 sample images were used for training and testing the model created for axial views. In the axial view, the calculated values are 97.44% for sensitivity and 97.56% for specificity. A total of 249 sample images were used for training and testing the model created for sagittal views. The calculated values are 97.50% for sensitivity and 97.67% for specificity. After the training, the average accuracy value was 96.7% (±1.53) for the axial view and 97.19% (±1.2) for the sagittal view. Conclusion  Deep learning (DL) has shown a great improvement especially in spine surgery. We found that DL technology works with a higher accuracy than other studies in the literature for the diagnosis of CM.

Objective  To clinically evaluate the medium-term results of the arthroscopic treatment of partial-thickness rotator cuff tears (PTRCT) using the transtendon repair (TTR) technique and the tear completion repair (TCR) technique through the modified University of California, Los Angeles (UCLA) Shoulder Rating Scale, the Constant-Murley score, and force analysis. Methods  The present was a retrospective reevaluation study of cases operated on arthroscopically for PTRCT after a minimum follow-up of 6 years. There were 34 patients, 18 of whom underwent TTR and 16, TCR. We compared the current UCLA and Constant-Murley scores, the mean strength between the techniques, and the UCLA score currently and 2 years after surgery for the same group, as published in a previous study, to assess whether or not the results changed throughout time. Results  There was no statistical difference regarding the scores. The current UCLA scores were of 33.8 for the TTR and of 32.9 for the TCR ( p  = 0.113), and the current Constant-Murley scores were of 91.9 and 86.8 respectively ( p  = 0.075). For the TTR, the previous UCLA score was (2 years postoperatively) of 32.4 and the current score was of 33.8 ( p  = 0.374); for the TCR, the score after 2 years was of 32.4, and the current score was of 32.9 ( p  = 0.859). In the TTR, the mean strength was statistically higher on the dominant side (11 kg) than on the non-dominant side (7.80 kg) ( p  = 0.023) and those of the TCR (8.25 kg) ( p  = 0.042). Conclusion  There was no statistical difference in the medium term when comparing the UCLA and Constant-Murley scores concerning the technique used (TTR or TCR), nor was there any change in UCLA scores between 2 and 6 years postoperatively. Among the patients submitted to TTR, the mean strength was statistically higher on the dominant side than on the non-dominant side, and higher than that of the patients submitted to TCR.

Objective  To evaluate the effectiveness of the use of polypropylene prostheses in the treatment of extensive limb injuries. Methods  There were 13 patients evaluated for the final aspects of the treatment, including the presence of epithelization and granulation, reduction of raw area, and coverage of deep structures. Results  A reduction greater than 40% of the raw area in all cases and complete coverage of noble structures were visualized. Conclusion  An effective, reproducible, low-cost alternative for treating extensive injuries has been demonstrated.

Objective  This study aimed to evaluate and compare the clinical and functional outcomes of two surgical procedures performed in patients with severe grade III and IV rhizarthrosis. Methods  We evaluated 39 patients who underwent two surgical techniques for rhizarthrosis treatment: trapeziectomy using the Kuhns technique or tendon interposition, with a minimum follow-up period of 6 months. The primary outcome assessment used the specific Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire, and the secondary outcome evaluation employed the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the visual analog scale (VAS). Results  There was no statistically significant difference between groups in the TASD, QuickDASH, and VAS results, and both techniques demonstrated good functional and pain outcomes. No complication required a new surgical approach. We found a positive correlation between TASD and QuickDASH questionnaire scores, suggesting their effectiveness in assessing functionality and disability in subjects with rhizarthrosis. Conclusion  Trapeziectomy using the Kuhns technique and tendon interposition proved effective in the surgical treatment of rhizarthrosis. There was no significant difference between the techniques concerning functional outcomes.

Objective  The purpose of this study was to evaluate the clinical and functional results of simultaneous reconstruction of the ACL and PCL with bilateral hamstring autografts. We hypothesized that this reconstruction technique results in less morbidity and has similar results to the ones published in the previous literature. Methods  Eighteen patients with bicruciate lesions were selected and treated by arthroscopic surgery with autologous hamstring tendons in a single-stage procedure. The thicker semitendinosus tendon (ST) and the two gracilis tendons (G) were used for a 6-strand PCL reconstruction. The thinner ST was used for a 3-strand ACL reconstruction. The average patient age at surgery was 31 years, and the minimum follow-up was 2 years. Function of the operated knee was evaluated according to the Lysholm scale. Anterior knee laxity was examined with a KT-1000 arthrometer. Posterior laxity was evaluated using stress radiographies. Results  Statistically significant improvements were found for all three measurements ( p  < 0.001). Knee function by the Lysholm score increased from 43.8 ± 4.1 to 89.9 ± 3.8 post-surgery. The average anterior knee laxity improved from 5.2 + -0.8 mm initially to 2.4 + - 0.5 mm post-surgery. The posterior translation of the tibia relative to the femur decreased from 10 ± 3.4 mm to 3 ± 1.6 mm post-surgery. No patient showed loss of motion in extension or knee flexion. Conclusion  The simultaneous bicruciate reconstruction with bilateral hamstring autograft is a valuable option to achieve good functional outcomes and ligamentous stability.

Objective  The present study aims to analyze histomorphometrically the repair of a non-critical bone defect after implantation of hydroxyapatite (HA) microspheres substituted by magnesium (Mg). Methods  Thirty rats were distributed into 3 experimental groups, evaluated at 15 and 45 days postoperatively: HAG (bone defect filled with HA microspheres); HAMgG (bone defect filled with HA microspheres replaced with 1 mol% Mg), and CG (bone defect without implantation of biomaterials). Results  After 15 days, the biomaterials filled the entire defect extent, forming a new osteoid matrix between the microspheres. In the CG, this neoformation was restricted to the edges with the deposition of loose connective tissue with reduced thickness. At 45 days, new bone formation filled almost the entire extension of the bone defect in the 3 groups, with statistically significant osteoid deposition in the CG despite the reduced thickness compared with the HAG and HAMgG. The groups with biomaterial implantation displayed a more abundant osteoid matrix than at 15 days. Conclusion  The biomaterials studied showed biocompatibility, osteoconductivity, and bioactivity. The Mg concentration in the substituted HA did not stimulate more significant bone formation than HA without this ion.