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BIOMECHANICAL STUDY ON CADAVERIC RECONSTRUCTION WITH GRAFT OF THE ANTERIOR TALOFIBULAR AND CALCANEOFIBULAR LIGAMENTS.
Q3 Medicine Pub Date : 2025-02-14 DOI: 10.1016/j.recot.2025.02.004
Ana Abarquero-Diezhandino, María Ángela Mellado-Romero, María Muñoz de la Espada-López, Rebeca Diaz-Suárez, Eva García-Jarabo, Ana Núñez-García, Enrique Javier Sánchez-Morata, María Teresa Vázquez-Osorio, Francisco Guerra-Pinto, Jesús Vilá-Rico

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.

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引用次数: 0
Induced osteogenesis by chitosan (3-glycidoxypropyl)trimethoxysilane and silica based biomaterial in rabbits.
Q3 Medicine Pub Date : 2025-02-07 DOI: 10.1016/j.recot.2025.02.001
J Orta-Chincoa, M Salido, M Piñero, N García, P Andrés-Cano

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.

{"title":"Induced osteogenesis by chitosan (3-glycidoxypropyl)trimethoxysilane and silica based biomaterial in rabbits.","authors":"J Orta-Chincoa, M Salido, M Piñero, N García, P Andrés-Cano","doi":"10.1016/j.recot.2025.02.001","DOIUrl":"10.1016/j.recot.2025.02.001","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
'À la carte' treatment algorithm for patellofemoral instability.
Q3 Medicine Pub Date : 2025-02-03 DOI: 10.1016/j.recot.2025.01.006
T Pineda, D H Dejour

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.

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引用次数: 0
Is the coronal plane alignment of the knee (CPAK) classification useful to plan individualized total knee arthroplasty surgery for the Spanish population? A critical analysis of the CPAK classification.
Q3 Medicine Pub Date : 2025-01-23 DOI: 10.1016/j.recot.2025.01.002
O Pujol, P Hinarejos, A Pons, E Famada, A Zumel, J Erquicia, J Leal-Blanquet

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.

{"title":"Is the coronal plane alignment of the knee (CPAK) classification useful to plan individualized total knee arthroplasty surgery for the Spanish population? A critical analysis of the CPAK classification.","authors":"O Pujol, P Hinarejos, A Pons, E Famada, A Zumel, J Erquicia, J Leal-Blanquet","doi":"10.1016/j.recot.2025.01.002","DOIUrl":"10.1016/j.recot.2025.01.002","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of lower limb lengthening with telescopic nails on functionality and quality of life in patients with achondroplasia. 软骨发育不全患者下肢伸长术对功能和生活质量的影响。
Q3 Medicine Pub Date : 2025-01-17 DOI: 10.1016/j.recot.2025.01.001
M Galán-Olleros, J Alonso-Hernández, C Miranda-Gorozarri, J García-Fernández, R M Egea-Gámez, Á Palazón-Quevedo

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.

软骨发育不全患者身材矮小的特点会对健康相关生活质量(HRQoL)产生负面影响。重复使用伸缩式髓内钉(timn)进行下肢延长是外固定架的另一种选择,具有增强功能、自尊和HRQoL的潜力,同时减少并发症的风险,本研究旨在对其进行评估。材料和方法:本回顾性研究纳入了9例软骨发育不全患者,这些患者在2015年至2022年间使用TIMN进行了股骨和/或胫骨平行横向延长。术前和术后至少两年评估功能(下肢功能量表,LEFS)、自尊(Rosenberg自尊量表)和HRQoL (Short Form-12、SF-12和EuroQol VAS)。同时记录并发症(Clavien-Dindo-Sink分类)和患者满意度。结果:中位年龄为13.5岁(IQR: 12.5 ~ 17.1),身高增加+19.9 cm +19.9 cm,差异有统计学意义(p < 0.05)。结论:与软骨发育不全患者术前相比,使用timn进行下肢延长似乎可以改善其功能、HRQoL和自尊。观察到患者满意度高,并发症可控,对结果无负面影响,为今后的研究奠定了基础。证据级别IV级,回顾性病例系列。
{"title":"Impact of lower limb lengthening with telescopic nails on functionality and quality of life in patients with achondroplasia.","authors":"M Galán-Olleros, J Alonso-Hernández, C Miranda-Gorozarri, J García-Fernández, R M Egea-Gámez, Á Palazón-Quevedo","doi":"10.1016/j.recot.2025.01.001","DOIUrl":"10.1016/j.recot.2025.01.001","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Translated article] Reamputation prevalence after minor feet amputations in patients with diabetic foot: A cross sectional study [译文]糖尿病足患者轻微截肢后的再截肢率,一项横断面研究。
Q3 Medicine Pub Date : 2025-01-01 DOI: 10.1016/j.recot.2024.11.012
C.A. Sánchez Correa , I. Briceño Sanín , J.J. Bautista Valencia , M.E. Niño , J. Robledo Quijano

Introduction

Reported prevalence for reamputation in diabetic foot is diverse, risk factors are not clear for minor amputations. This study aims to determine the prevalence for reamputation in diabetic foot from minor amputations and to evaluate associated factors for such outcome.

Methods

Cross sectional study developed in 2 hospitals. Patients hospitalized for diabetic foot ulcer requiring a minor amputation were included. A descriptive analysis of all variables is presented, as well as prevalence ratios (PR) and a multivariate logistic regression.

Results

The prevalence was of 48% for 15 years. Toes were the most frequent minor amputation that required reamputation and above the knee amputation was the most frequent reamputation level (45%). Variables whose PR was associated to reamputation risk were: smoking history (PR 1.32, CI 95%: 1.02–1.67, p = 0.03), vascular occlusion in doppler (PR 1.47, CI 95%: 1.11–1.73, p = 0.01), revascularization (PR 1.73, CI 95%: 1.31–2.14, p = 0.00002), Wagner > 3 (PR 1.75, CI 95%: 1.16–1.84, p = 0.01) and leucocytosis > 11,000 (PR 1.39, CI 95%: 1.07–1.68, p = 0.01).
Leucocytosis > 11,000, Wagner > 3, vascular occlusion in doppler and revascularization were the variables that best predicted the outcome. Furthermore, leucocytosis was the best variable for predicting reamputation (OR 2.4, CI 95%: 1.1–5.6, p = 0.04).

Conclusions

Reamputation prevalence was 48%. The toes were the minor amputation more frequently requiring reamputation and above the knee was the most frequent reamputation level. Risk for reamputation was associated with variables related to vascular compromise and infection.
导言:据报道,糖尿病足再截肢的发生率各不相同,轻微截肢的风险因素尚不明确。本研究旨在确定糖尿病足轻微截肢后再次截肢的发生率,并评估造成这种结果的相关因素:方法:在两家医院开展横断面研究。方法:在两家医院开展横断面研究,纳入因糖尿病足溃疡住院并需要进行轻微截肢的患者。研究对所有变量进行了描述性分析,并对患病率比(PR)和多变量逻辑回归进行了分析:结果:15 年间,患病率为 48%。脚趾是最常见的需要再次截肢的轻微截肢部位,膝关节以上截肢是最常见的再次截肢部位(45%)。PR与再截肢风险相关的变量有:吸烟史(PR 1.32,CI 95%:1.02-1.67,P = 0.03)、多普勒血管闭塞(PR 1.47,CI 95%:1.11-1.73,P = 0.01)、血管再通(PR 1.73,CI 95%:1.31-2.14,P = 0.00002)、Wagner>3(PR 1.75,CI 95%:1.16-1.84,P = 0.01)和白细胞>11000(PR 1.39,CI 95%:1.07-1.68,P = 0.01)。白细胞>11,000、Wagner>3、多普勒血管闭塞和血管再通是预测结果的最佳变量。此外,白细胞增多是预测再狭窄的最佳变量(OR 2.4,CI 95%:1.1-5.6,P = 0.04):再次截肢率为48%。脚趾是较常需要再次截肢的小截肢部位,膝关节以上是最常发生再次截肢的部位。再次截肢的风险与血管损伤和感染相关。
{"title":"[Translated article] Reamputation prevalence after minor feet amputations in patients with diabetic foot: A cross sectional study","authors":"C.A. Sánchez Correa ,&nbsp;I. Briceño Sanín ,&nbsp;J.J. Bautista Valencia ,&nbsp;M.E. Niño ,&nbsp;J. Robledo Quijano","doi":"10.1016/j.recot.2024.11.012","DOIUrl":"10.1016/j.recot.2024.11.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Reported prevalence for reamputation in diabetic foot is diverse, risk factors are not clear for minor amputations. This study aims to determine the prevalence for reamputation in diabetic foot from minor amputations and to evaluate associated factors for such outcome.</div></div><div><h3>Methods</h3><div>Cross sectional study developed in 2 hospitals. Patients hospitalized for diabetic foot ulcer requiring a minor amputation were included. A descriptive analysis of all variables is presented, as well as prevalence ratios (PR) and a multivariate logistic regression.</div></div><div><h3>Results</h3><div>The prevalence was of 48% for 15 years. Toes were the most frequent minor amputation that required reamputation and above the knee amputation was the most frequent reamputation level (45%). Variables whose PR was associated to reamputation risk were: smoking history (PR 1.32, CI 95%: 1.02–1.67, <em>p</em> <!-->=<!--> <!-->0.03), vascular occlusion in doppler (PR 1.47, CI 95%: 1.11–1.73, <em>p</em> <!-->=<!--> <!-->0.01), revascularization (PR 1.73, CI 95%: 1.31–2.14, <em>p</em> <!-->=<!--> <!-->0.00002), Wagner<!--> <!-->&gt;<!--> <!-->3 (PR 1.75, CI 95%: 1.16–1.84, <em>p</em> <!-->=<!--> <!-->0.01) and leucocytosis<!--> <!-->&gt;<!--> <!-->11,000 (PR 1.39, CI 95%: 1.07–1.68, <em>p</em> <!-->=<!--> <!-->0.01).</div><div>Leucocytosis<!--> <!-->&gt;<!--> <!-->11,000, Wagner<!--> <!-->&gt;<!--> <!-->3, vascular occlusion in doppler and revascularization were the variables that best predicted the outcome. Furthermore, leucocytosis was the best variable for predicting reamputation (OR 2.4, CI 95%: 1.1–5.6, <em>p</em> <!-->=<!--> <!-->0.04).</div></div><div><h3>Conclusions</h3><div>Reamputation prevalence was 48%. The toes were the minor amputation more frequently requiring reamputation and above the knee was the most frequent reamputation level. Risk for reamputation was associated with variables related to vascular compromise and infection.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T70-T76"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Translated article] Rotator cuff debridement compared with rotator cuff repair in arthroscopic treatment of calcifying tendinitis of the shoulder: A systematic review and meta-analysis [肩袖清创术与肩袖修复术在肩部钙化性肌腱炎关节镜治疗中的比较:系统回顾和荟萃分析。
Q3 Medicine Pub Date : 2025-01-01 DOI: 10.1016/j.recot.2024.11.003
D. González-Martín , M. Garrido-Miguel , G. de Cabo , J.M. Lomo-Garrote , M. Leyes , L.E. Hernández-Castillejo

Introduction

Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy.

Methodology

MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's d-index.

Results

Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (>1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08–3.43, I2 = 0%) for debridement and 9.07 (95% CI: −0.03 to 18.17, I2 = 50.4%) for combined debridement with suture.

Conclusions

Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.
导言:尽管保守治疗钙化性肌腱病的成功率很高,但有时仍有必要在关节镜下切除钙化沉积物。对于剩余的肩袖缺损可以留在原位还是应该进行修复以获得更好的功能效果,目前还存在争议。本研究旨在比较关节镜手术治疗钙化性肌腱病时清创与清创结合缝合的效果:方法:检索了MEDLINE、EMBASE、Cochrane Library和Web of Science上从开始到2023年2月有关关节镜治疗钙化性肌腱病的文章。对功能结果(VAS、ASES、UCLA 和 Constant)和并发症数量进行了分析。研究结果采用科恩d指数计算效应大小:结果:共纳入 21 项研究,包括 1172 名年龄在 44.7 岁至 55 岁之间的患者。平均随访时间为 24.7 个月。清创术和清创与缝合联合术的 VAS、ASES、UCLA 和 Constant 量表总分的 ES 估计值非常高(>1.0)。清创术总并发症数量的 ES 估计值为 1.75(95% CI:0.08-3.43,I2 = 0%),联合清创缝合术的 ES 估计值为 9.07(95% CI:-0.03-18.17,I2 = 50.4%):两种关节镜手术都能显著提高EVA、ASES、UCLA和Constant量表的总分。然而,在进行缝合的一组中,并发症的比例较高。在这方面,我们必须考虑是否真的有必要在清除钙化沉积物后修复所有部分撕裂。
{"title":"[Translated article] Rotator cuff debridement compared with rotator cuff repair in arthroscopic treatment of calcifying tendinitis of the shoulder: A systematic review and meta-analysis","authors":"D. González-Martín ,&nbsp;M. Garrido-Miguel ,&nbsp;G. de Cabo ,&nbsp;J.M. Lomo-Garrote ,&nbsp;M. Leyes ,&nbsp;L.E. Hernández-Castillejo","doi":"10.1016/j.recot.2024.11.003","DOIUrl":"10.1016/j.recot.2024.11.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy.</div></div><div><h3>Methodology</h3><div>MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's <em>d</em>-index.</div></div><div><h3>Results</h3><div>Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (&gt;1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08–3.43, <em>I</em><sup>2</sup> <!-->=<!--> <!-->0%) for debridement and 9.07 (95% CI: −0.03 to 18.17, <em>I</em><sup>2</sup> <!-->=<!--> <!-->50.4%) for combined debridement with suture.</div></div><div><h3>Conclusions</h3><div>Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T91-T103"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Colgajo fasciocutáneo tipo lengüeta medial como alternativa para el manejo de defectos de tejidos blandos en la pierna 内侧标签型筋膜皮瓣作为治疗腿部软组织缺损的替代方法。
Q3 Medicine Pub Date : 2025-01-01 DOI: 10.1016/j.recot.2024.05.002
X. Ríos Garrido , A. De la Rosa , L. Arzuza Ortega , G. Vargas Lievano , J. Molina Gándara , D.A. Tellez Gamarra , C. Medina Monje

Background

Selecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity.

Objective

Demonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps.

Materials and methods

Cohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group 1) medial tab flap, and group 2) conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications.

Results

The patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2 ± 11.2 days in the tab flap and 16.1 ± 11.2 days in conventional flaps, no statistically significant differences were found between the groups (P = .89).
The surgical time for tab flaps was 225.2 ± 117.8 minutes, and 191.3 ± 117.2 minutes for the comparison flaps (P = .65), there were no statistically significant differences. There were no complications in the medial tab flaps.

Conclusion

The findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.
背景:选择正确的下肢软组织重建技术是一项治疗挑战。尽管有多种重建方案可供选择,但重要的是要选择一种有效且供体部位发病率最低的技术。目的:与传统皮瓣相比,证明内侧袢皮瓣在腿部软组织重建中的治疗效果:按年龄进行队列研究。选取了64名软组织缺损患者,根据干预方式分为:1)内侧皮瓣组;2)传统皮瓣组(硬韧带、比目鱼肌、腓肠肌),术后随访一年。结果变量:手术时间(分钟)、愈合情况、愈合时间(天)、并发症:结果:使用内侧皮瓣和传统皮瓣手术的患者完全愈合。标签皮瓣的愈合时间为(16.2±11.2)天,传统皮瓣的愈合时间为(16.1±11.2)天,组间差异无统计学意义(P= 0.89)。标签皮瓣的手术时间为(225.2 ± 117.8)分钟,对比皮瓣的手术时间为(191.3 ± 117.2)分钟,P= 0.65,差异无统计学意义。内侧皮瓣未出现并发症:结论:研究结果表明,内侧皮瓣技术与传统皮瓣技术一样有效,皮瓣完全存活和愈合,研究组无任何重大并发症。
{"title":"Colgajo fasciocutáneo tipo lengüeta medial como alternativa para el manejo de defectos de tejidos blandos en la pierna","authors":"X. Ríos Garrido ,&nbsp;A. De la Rosa ,&nbsp;L. Arzuza Ortega ,&nbsp;G. Vargas Lievano ,&nbsp;J. Molina Gándara ,&nbsp;D.A. Tellez Gamarra ,&nbsp;C. Medina Monje","doi":"10.1016/j.recot.2024.05.002","DOIUrl":"10.1016/j.recot.2024.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Selecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity.</div></div><div><h3>Objective</h3><div>Demonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps.</div></div><div><h3>Materials and methods</h3><div>Cohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group 1)<!--> <!-->medial tab flap, and group 2)<!--> <!-->conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications.</div></div><div><h3>Results</h3><div>The patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2<!--> <!-->±<!--> <!-->11.2 days in the tab flap and 16.1<!--> <!-->±<!--> <!-->11.2 days in conventional flaps, no statistically significant differences were found between the groups (<em>P</em> <!-->=<!--> <!-->.89).</div><div>The surgical time for tab flaps was 225.2<!--> <!-->±<!--> <!-->117.8<!--> <!-->minutes, and 191.3<!--> <!-->±<!--> <!-->117.2<!--> <!-->minutes for the comparison flaps (<em>P</em> <!-->=<!--> <!-->.65), there were no statistically significant differences. There were no complications in the medial tab flaps.</div></div><div><h3>Conclusion</h3><div>The findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 17-26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Understanding limb necrotizing infections: A comprehensive approach 了解肢体坏死性感染:一种全面的方法。
Q3 Medicine Pub Date : 2025-01-01 DOI: 10.1016/j.recot.2024.03.012
A. Garrido-Hidalgo , J. García-Coiradas , M. Echevarría-Marín , S. Llanos , J.A. Valle-Cruz , F. Marco

Introduction

Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain.

Methods

A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.

Results

Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8 °C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%).
Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25 h. Intraoperative cultures were positive in twenty patients: twelve Streptococcus pyogenes, four Staphylococcus aureus, one Escherichia coli, and four polymicrobial infection. In-hospital mortality rate was 22.73%.

Conclusions

We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.
{"title":"Understanding limb necrotizing infections: A comprehensive approach","authors":"A. Garrido-Hidalgo ,&nbsp;J. García-Coiradas ,&nbsp;M. Echevarría-Marín ,&nbsp;S. Llanos ,&nbsp;J.A. Valle-Cruz ,&nbsp;F. Marco","doi":"10.1016/j.recot.2024.03.012","DOIUrl":"10.1016/j.recot.2024.03.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.</div></div><div><h3>Results</h3><div>Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8<!--> <!-->°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%).</div><div>Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25<!--> <!-->h. Intraoperative cultures were positive in twenty patients: twelve <em>Streptococcus pyogenes</em>, four <em>Staphylococcus aureus</em>, one <em>Escherichia coli</em>, and four polymicrobial infection. In-hospital mortality rate was 22.73%.</div></div><div><h3>Conclusions</h3><div>We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 9-16"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Análisis de modelos algorítmicos de aprendizaje automático para la predicción del estado vital a los seis meses tras fractura de cadera en pacientes mayores de 74 años 分析机器学习算法模型,以预测 74 岁以上髋部骨折患者六个月后的生命体征状况。
Q3 Medicine Pub Date : 2025-01-01 DOI: 10.1016/j.recot.2024.05.005
I. Calvo Lorenzo, I. Uriarte Llano, M.R. Mateo Citores, Y. Rojo Maza, U. Agirregoitia Enzunza

Background and objective

The objective is to develop a model that predicts vital status six months after fracture as accurately as possible. For this purpose we will use five different data sources obtained through the National Hip Fracture Registry, the Health Management Unit and the Economic Management Department.

Material and methods

The study population is a cohort of patients over 74 years of age who suffered a hip fracture between May 2020 and December 2022. A warehouse is created from five different data sources with the necessary variables. An analysis of missing values and outliers as well as unbalanced classes of the target variable («vital status») is performed. Fourteen different algorithmic models are trained with the training. The model with the best performance is selected and a fine tuning is performed. Finally, the performance of the selected model is analyzed with test data.

Results

A data warehouse is created with 502 patients and 144 variables. The best performing model is Linear Regression. Sixteen of the 24 cases of deceased patients are classified as live, and 14 live patients are classified as deceased. A sensitivity of 31%, an accuracy of 34% and an area under the curve of 0.65 is achieved.

Conclusions

We have not been able to generate a model for the prediction of six-month survival in the current cohort. However, we believe that the method used for the generation of algorithms based on machine learning can serve as a reference for future works.
背景和目的:目的是建立一个模型,尽可能准确地预测骨折后六个月的生命状况。为此,我们将使用通过国家髋部骨折登记处、健康管理部门和经济管理部门获得的五个不同数据源:研究对象为 2020 年 5 月至 2022 年 12 月期间髋部骨折的 74 岁以上患者。从五个不同的数据源创建了一个包含必要变量的仓库。对目标变量("生命状态")的缺失值、异常值以及不平衡类进行分析。利用训练结果对 14 种不同的算法模型进行训练。选出性能最佳的模型并进行微调。最后,利用测试数据对所选模型的性能进行分析:结果:创建了一个包含 502 名患者和 144 个变量的数据仓库。性能最好的模型是线性回归模型。24 例死亡患者中有 16 例被归类为存活患者,14 例存活患者被归类为死亡患者。灵敏度为 31%,准确度为 34%,曲线下面积为 0.65:结论:在目前的队列中,我们还无法生成一个预测 6 个月存活率的模型。但我们相信,基于机器学习的算法生成方法可为今后的工作提供参考。
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Revista Espanola de Cirugia Ortopedica y Traumatologia
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