Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

Introduction: Ankle sprains can lead to chronic lateral ankle instability (CLAI) in 10-50% of cases. While the anterior talofibular ligament (ATFL) is traditionally considered the primary structure affected, recent studies indicate a high incidence of combined injuries to the ATFL and the calcaneofibular ligament (CFL). Given the importance of the CFL, this study aims to evaluate the biomechanical efficacy of double tendon graft reconstruction of the ATFL and CFL in cases of CLAI.

Materials and methods: This biomechanical study on cadaveric ankles compares two techniques: anatomical reconstruction using a double graft for both the ATFL and CFL versus isolated anatomical reconstruction of the ATFL with a single graft. Stability was assessed using specific examination maneuvers (anterior drawer, forced varus, and pivot shift) with an arthrometer measuring angular displacement across three spatial planes (horizontal, coronal, and sagittal). Four models were analyzed: intact ankle, sectioning of the ATFL and CFL, double graft reconstruction of the ATFL and CFL, and single graft reconstruction of the ATFL.

Results: The results showed no significant differences between the double graft reconstruction and the intact ankle. Comparing the double graft with the single graft reconstruction revealed statistically significant differences, favoring the double graft for greater angular stability in the coronal plane during forced varus and external rotation maneuvers.

Conclusions: Double graft reconstruction of the ATFL and CFL provides greater angular stability compared to isolated ATFL reconstruction, demonstrating significant benefits in lateral and rotational stabilization of the ankle in CLAI cases.

Introduction: Synthetic biomaterials obtained through tissue engineering offer an alternative to the use of autologous and heterologous grafts for the repair of bone defects of various etiologies, although the ideal material for this purpose has not yet been developed. A gel based on Chitosan (CS) ((3-glycidoxypropyl)trimethoxysilane (GPTMS), and silica have shown efficacy in experimental studies from a biomechanical and in vitro osseointegration perspective.

Objective: To demonstrate that the hybrid aerogel based on CS-GPTMS-silica is effective and safe for treating bone defects in load-bearing bone in rabbits.

Materials and methods: A comparative experimental study was conducted on 12 adult New Zealand rabbits, involving osteotomy in both radii as case (osteotomy with biomaterial placement) and contralateral control (osteotomy with placement of the extracted bone), both fixed with plates and screws. After 10 weeks, the animals were euthanized, and the surgical area was subjected to histological analysis.

Results: For all subjects, wound healing was successful, and normal gait was observed within 24-48hours. In case limbs, cortical closure of 95.9% was observed compared to 98% in control limbs. Residual biomaterial was observed in 5 subjects, with an average of 16% of the total analyzed area. Inflammatory cells were grouped (5-10%) in all case samples, with significant differences between case and control samples (P<.05). An increase in the presence of bone precursor cells (5-10%) was observed in all case samples compared to control samples, with significant differences (P<.05).

Conclusions: The aerogel based on chitosan CS-GPTMS, and silica is biocompatible and safe in rabbits, demonstrating minimal inflammatory reaction, good osteoblast adhesion, and a high resorption rate.

Patellar instability is a complex and multifactorial problem that poses difficulties in treatment decision-making. The treatment algorithm proposed by the Lyon School of Knee Surgery aims to guide surgeons in identifying imaging risk factors for failure and proposing a therapeutic plan focused on correcting major risk factors present in specific case.

Introduction: The CPAK classification aims to categorize knee phenotypes. The original study was based on Australian and Belgian population, but significant variation in CPAK distribution exists between different geographic areas. The primary objective is to evaluate knee phenotypes of osteoarthritic Spanish population based on the CPAK system. The secondary objective is to compare the Spanish CPAK distribution with that observed in the original study to analyse if proposing modifications is necessary when applying the classification to our population. Finally, we aim to critically analyse the utility of this classification to plan individualized TKA.

Methods: It is a cross-sectional observational study analysing radiological datasets from 121 patients with knee osteoarthritis treated with a Mako assisted TKA in three Spanish institutions. The preoperative lower limb CT-scan was used to measure the MPTA and LDFA of each patient. Then, the aHKA (MPTA-LDFA) and JLO (MPTA+LDFA) were calculated to categorize patients into the nine CPAK phenotypes.

Results: The commonest knee phenotypes of osteoarthritic Spanish population were the distal apex JLO CPAK types (74%: II (28%), I (23%) and III (23%)). No patient presented a proximal apex type (VII, VIII and IX). The 30% of the patients had a varus alignment and 26% a valgus. No relevant differences were found between the Spanish CPAK distribution and that observed in the original study.

Conclusions: No modifications to the CPAK classification should be necessary for the Spanish population. The CPAK classification can be useful to describe and categorize osteoarthritic patients. However, relevant limitations have been found to the classification, questioning its utility to plan and guide individualized TKA surgery.

Introduction: The short stature characteristic of patients with achondroplasia can negatively affect health-related quality of life (HRQoL). Lower limb lengthening reusing telescopic intramedullary nails (TIMNs) offers an alternative to external fixators, with the potential to enhance functionality, self-esteem, and HRQoL, while reducing complication risks, which this study aims to evaluate.

Materials and methods: This retrospective study included nine patients with achondroplasia who underwent parallel transverse lengthening of femurs and/or tibias reusing a TIMN between 2015 and 2022. Functionality (Lower Extremity Functional Scale, LEFS), self-esteem (Rosenberg Self-Esteem Scale), and HRQoL (Short Form-12, SF-12, and EuroQol VAS) were assessed preoperatively and at least two years post-surgery. Complications (Clavien-Dindo-Sink classification) and patient satisfaction were also recorded.

Results: The median age was 13.5 years (IQR: 12.5-17.1), with a significant height increase of +19.9cm +19.9cm (p<0.05). Improvements were significant in functionality (LEFS, +4.6 points; p<0.05), self-esteem (Rosenberg, +3.7 points; p<0.05), and HRQoL (SF-12 physical, +8.9 points; p<0.05; EQ-VAS, +20 points; p<0.05). A total of 22 complications were reported in 32 treated bones, most classified as grade 2 or 3B, with no significant correlation to functionality, HRQoL, or self-esteem outcomes (p>0.05).

Conclusions: Lower limb lengthening reusing TIMNs appears to improve functionality, HRQoL, and self-esteem in patients with achondroplasia compared to their preoperative status. High patient satisfaction and manageable complications were observed, with no negative impact on outcomes, laying the groundwork for future studies.