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[PMID]:29201295
[Au] Autor:Kim YK; Ahn JH; Yoo JD
[Ad] Endereço:Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea.
[Ti] Título:A Comparative Study of Clinical Outcomes and Second-Look Arthroscopic Findings between Remnant-Preserving Tibialis Tendon Allograft and Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Matched-Pair Design.
[So] Source:Clin Orthop Surg;9(4):424-431, 2017 Dec.
[Is] ISSN:2005-4408
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Background: This study aimed to compare stability, functional outcome, and second-look arthroscopic findings after anterior cruciate ligament reconstruction between remnant-preserving tibialis tendon allograft and remnant-sacrificing hamstring tendon autograft. Methods: We matched two groups (remnant-preserving tibialis tendon allograft group and hamstring tendon autograft group) in terms of demographic characteristics, associated injury, and knee characteristics. Each group consisted of 25 patients. Results: Operation time was longer in the remnant-preserving tibialis tendon allograft group, but there was no significant intergroup difference in stability, clinical outcome, and second-look arthroscopic findings. Conclusions: When an autograft is not feasible in anterior cruciate ligament reconstruction, the remnant-preserving technique can produce comparable results in terms of restoration of function, stability of the knee, and degree of synovium coverage at second-look arthroscopy compared to remnant-sacrificing hamstring autograft.
[Mh] Termos MeSH primário: Lesões do Ligamento Cruzado Anterior/cirurgia
Reconstrução do Ligamento Cruzado Anterior/métodos
Instabilidade Articular/etiologia
Articulação do Joelho/cirurgia
Tendões/transplante
[Mh] Termos MeSH secundário: Adolescente
Adulto
Aloenxertos
Lesões do Ligamento Cruzado Anterior/complicações
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos
Artroscopia
Autoenxertos
Feminino
Seres Humanos
Imagem Tridimensional
Instabilidade Articular/diagnóstico por imagem
Articulação do Joelho/diagnóstico por imagem
Articulação do Joelho/fisiopatologia
Escore de Lysholm para Joelho
Masculino
Análise por Pareamento
Meia-Idade
Duração da Cirurgia
Estudos Retrospectivos
Cirurgia de Second-Look
Tomografia Computadorizada por Raios X
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.4055/cios.2017.9.4.424


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[PMID]:28146403
[Au] Autor:Cole BJ; Karas V; Hussey K; Pilz K; Fortier LA
[Ad] Endereço:Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA.
[Ti] Título:Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis
[So] Source:Am J Sports Med;45(2):339-346, 2017 02.
[Is] ISSN:1552-3365
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The use of platelet-rich plasma (PRP) for the treatment of osteoarthritis (OA) has demonstrated mixed clinical outcomes in randomized controlled trials when compared with hyaluronic acid (HA), an accepted nonsurgical treatment for symptomatic OA. Biological analysis of PRP has demonstrated an anti-inflammatory effect on the intra-articular environment. PURPOSE: To compare the clinical and biological effects of an intra-articular injection of PRP with those of an intra-articular injection of HA in patients with mild to moderate knee OA. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 111 patients with symptomatic unilateral knee OA received a series of either leukocyte-poor PRP or HA injections under ultrasound guidance. Clinical data were collected before treatment and at 4 time points across a 1-year period. Synovial fluid was also collected for analysis of proinflammatory and anti-inflammatory markers before treatment and at 12 and 24 weeks after treatment. Several measures were used to assess results: (1) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale; (2) International Knee Documentation Committee (IKDC) subjective knee evaluation, visual analog scale (VAS) for pain, and Lysholm knee score; and (3) difference in intra-articular biochemical marker concentrations. RESULTS: There were 49 patients randomized to treatment with PRP and 50 randomized to treatment with HA. No difference was seen between the groups in the primary outcome measure (WOMAC pain score). In the secondary outcome measure, linear contrasts identified a significantly higher IKDC score in the PRP group compared with the HA group at 24 weeks (mean ± standard error [SE], 65.5 ± 3.6 vs 55.8 ± 3.8, respectively; P = .013) and at final follow-up (52 weeks) (57.6 ± 3.37 vs 46.6 ± 3.76, respectively; P = .003). Linear contrasts also identified a statistically lower VAS score in the PRP group versus the HA group at 24 weeks (mean ± SE, 34.6 ± 3.24 vs 48.6 ± 3.7, respectively; P = .0096) and 52 weeks (44 ± 4.6 vs 57.3 ± 3.8, respectively; P = .0039). An examination of fixed effects showed that patients with mild OA and a lower body mass index had a statistically significant improvement in outcomes. In the biochemical analysis, differences between groups approached significance for interleukin-1ß (mean ± SE, 0.14 ± 0.05 pg/mL [PRP] vs 0.34 ± 0.16 pg/mL [HA]; P = .06) and tumor necrosis factor α (0.08 ± 0.01 pg/mL [PRP] vs 0.2 ± 0.18 pg/mL [HA]; P = .068) at 12-week follow-up. CONCLUSION: We found no difference between HA and PRP at any time point in the primary outcome measure: the patient-reported WOMAC pain score. Significant improvements were seen in other patient-reported outcome measures, with results favoring PRP over HA. Preceding a significant difference in subjective outcomes favoring PRP, there was a trend toward a decrease in 2 proinflammatory cytokines, which suggest that the anti-inflammatory properties of PRP may contribute to an improvement of symptoms. Registration: ClinicalTrials.gov (Identifier: NCT02588872).
[Mh] Termos MeSH primário: Ácido Hialurônico/uso terapêutico
Osteoartrite do Joelho/terapia
Plasma Rico em Plaquetas
Líquido Sinovial/metabolismo
[Mh] Termos MeSH secundário: Adulto
Idoso
Método Duplo-Cego
Feminino
Seres Humanos
Ácido Hialurônico/administração & dosagem
Injeções Intra-Articulares
Escore de Lysholm para Joelho
Masculino
Meia-Idade
Medição da Dor
Plasma Rico em Plaquetas/metabolismo
Estudos Prospectivos
Líquido Sinovial/efeitos dos fármacos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
9004-61-9 (Hyaluronic Acid)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170915
[Lr] Data última revisão:
170915
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170202
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1177/0363546516665809


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[PMID]:28004177
[Au] Autor:Dickschas J; Tassika A; Lutter C; Harrer J; Strecker W
[Ad] Endereço:Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany. JDICKSCHAS@web.de.
[Ti] Título:Torsional osteotomies of the tibia in patellofemoral dysbalance.
[So] Source:Arch Orthop Trauma Surg;137(2):179-185, 2017 Feb.
[Is] ISSN:1434-3916
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Anterior knee pain or patellofemoral instability is common symptom of patellofemoral dysbalance or maltracking. Tibial torsional deformities can be the reason of this pathology. After appropriate diagnostic investigation, the treatment of choice is a torsional osteotomy. This study addresses the diagnostic investigation, treatment, and the outcome of torsional osteotomies of the tibia. Does this treatment result in patellofemoral stability and provide pain relief? METHODS: Forty-nine tibial torsional osteotomies were included. The major symptoms were patellofemoral instability in 19 cases and anterior knee pain in 42 cases. In addition to clinical and radiographic analysis, a torsional angle CT scan was performed pre-operatively. A visual analog scale (VAS), the Japanese Knee Society score, the Tegner activity score, and the Lysholm score were assessed pre-operatively and at the 42-month follow-up. RESULTS: Mean tibial external torsion was 47.4° (SD 5.41; range 37°-66°; standard value 34°). Surgical treatment consisted of an acute supratuberositary tibial internal torsional osteotomy (mean 10.8°; SD 3.01°; range 5°-18°). At the follow-up investigation, the Tegner activity score was increased 0.4 points (p value 0.014) from 3.9 (SD 1.33; range 2-7) to 4.3 (SD 1.25; range 0-7). The Lysholm score increased 26 points (SD 16.32; p value 0.001) from 66 (SD 14.94; range 32-94) to 92 (SD 9.29; range 70-100) and the Japanese Knee Society score increased 18 points (SD 14.70; p value 0.001) from 72 (SD 13.72, range 49-100) to 90 (SD 9.85, range 60-100). VAS was reduced 3.4 points (SD 2.89; p value 0.001) from 5.7 (SD 2.78; range 0-10) to 2.3 (SD 1.83; range 0-7). As regards patellofemoral instability, no redislocation occurred in the follow-up period. INTERPRETATION: The results of this study show that in cases of tibial maltorsion, a torsional osteotomy can lead to patellofemoral stability and pain relief, and should be considered as a treatment option. The improved clinical scores in the present investigation show the value of the procedure. Level of evidence Level IV.
[Mh] Termos MeSH primário: Instabilidade Articular/cirurgia
Osteotomia/métodos
Articulação Patelofemoral/cirurgia
Tíbia/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seguimentos
Seres Humanos
Instabilidade Articular/fisiopatologia
Escore de Lysholm para Joelho
Masculino
Meia-Idade
Articulação Patelofemoral/fisiopatologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161223
[St] Status:MEDLINE
[do] DOI:10.1007/s00402-016-2599-1


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[PMID]:27884644
[Au] Autor:Oh CW; Park KC; Jo YH
[Ad] Endereço:Department of Orthopedic Surgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu 41944, Republic of Korea. Electronic address: cwoh@knu.ac.kr.
[Ti] Título:Evaluating augmentation with calcium phosphate cement (chronOS Inject) for bone defects after internal fixation of proximal tibial fractures: A prospective, multicenter, observational study.
[So] Source:Orthop Traumatol Surg Res;103(1):105-109, 2017 Feb.
[Is] ISSN:1877-0568
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Managing subchondral bone defects in proximal tibia fractures after plateau reduction is an important consideration. ChronOS Inject is a recently developed calcium phosphate bone substitute that shows relatively fast osteointegration. HYPOTHESIS: Using chronOS Inject during internal fixation of proximal tibial fractures provides a satisfactory treatment option that is both clinically and radiologically safe. PATIENTS AND METHODS: Patients enrolled in this study were treated with chronOS Inject bone void filler, during internal fixation of proximal tibial fractures. Patients were evaluated preoperatively and at 6 weeks, 6 and 12 months postoperative. Radiographic union was assessed using plain films supplemented by CT scans. Pain, function and adverse events were collected at all visits. A total of 36 patients were enrolled in the study and treated according to a predetermined protocol. Seven of the 36 patients (19.4%) were lost to follow-up. RESULTS: Successful radiographic union was achieved in 27/29 (93.1%) of patients at final follow-up. Articular subsidence of>2mm only occurred in one patient. Statistical analysis showed significant improvements both in leg pain and knee function. Progress in knee function was observed in 93.1% (27/29) of patients from 6 weeks to 12 months. No product-related complications were reported. CONCLUSIONS: Successful union was achieved based on radiographic criteria as well as clinical outcomes. When managing bone defects after internal fixation of proximal tibial fractures, the use of chronOS Inject resulted in significant improvement of knee function and reduction of leg pain. LEVEL OF EVIDENCE: Level IV, prospective observational study.
[Mh] Termos MeSH primário: Cimentos para Ossos/uso terapêutico
Fosfatos de Cálcio/uso terapêutico
Fixação Interna de Fraturas
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Feminino
Consolidação da Fratura
Seres Humanos
Escore de Lysholm para Joelho
Masculino
Meia-Idade
Osseointegração
Estudos Prospectivos
Amplitude de Movimento Articular
Fraturas da Tíbia/classificação
Fraturas da Tíbia/diagnóstico por imagem
Escala Visual Analógica
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Bone Cements); 0 (Calcium Phosphates); 97Z1WI3NDX (calcium phosphate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161126
[St] Status:MEDLINE


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[PMID]:27742158
[Au] Autor:Wierer G; Runer A; Gföller P; Fink C; Hoser C
[Ad] Endereço:Department of Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria. Electronic address: wierer@gmail.com.
[Ti] Título:Extension deficit after anterior cruciate ligament reconstruction: Is arthroscopic posterior release a safe and effective procedure?
[So] Source:Knee;24(1):49-54, 2017 Jan.
[Is] ISSN:1873-5800
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Postoperative extension deficits following anterior cruciate ligament (ACL) reconstruction can cause major limitation during daily life. The purpose of this study was to evaluate the efficiency of an all-arthroscopic approach and posterior capsule release for the treatment of persistent knee extension deficits following ACL reconstruction. METHODS: Between 2009 and 2013 a total of 10 patients with knee flexion contractures after ACL reconstruction were assessed following an all-arthroscopic approach and posterior capsulotomy. The clinical outcomes were reviewed using the range of motion (ROM), Tegner Activity Level, Lysholm score and visual analogue pain scale (VAS). RESULTS: Four women and six men with a median age of 34years (range: 17 to 49years) were included in the study. The median follow-up period was 25months (range: 14 to 69months). The median preoperative extension deficit was 15° (range: 10 to 20°) compared to the normal contralateral knee. Postoperatively at final follow-up the median extension deficit was one degree (range: 0 to five degrees) (P<0.01). The median preoperative Lysholm score improved from 52 (range: 32 to 67) to 92 (range: 84 to 100) postoperatively (P<0.01), while the median Tegner Activity Level improved from three (range: two to six) to six (range: three to seven) respectively (P<0.02). The median VAS status for pain decreased from five (range: one to 10) to one (range: 0 to three) (P<0.01). No complications were observed. CONCLUSIONS: Arthroscopic posterior capsulotomy is a safe and effective additional procedure in the treatment of persistent knee extension deficits following ACL reconstruction with excellent results regarding ROM and subjective outcomes. LEVEL OF EVIDENCE: Level IV.
[Mh] Termos MeSH primário: Reconstrução do Ligamento Cruzado Anterior/efeitos adversos
Contratura/etiologia
Contratura/cirurgia
Liberação da Cápsula Articular
[Mh] Termos MeSH secundário: Adolescente
Adulto
Lesões do Ligamento Cruzado Anterior/complicações
Lesões do Ligamento Cruzado Anterior/cirurgia
Estudos de Coortes
Contratura/fisiopatologia
Feminino
Seres Humanos
Escore de Lysholm para Joelho
Masculino
Meia-Idade
Amplitude de Movimento Articular
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161016
[St] Status:MEDLINE


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[PMID]:27692693
[Au] Autor:Yasen SK; Borton ZM; Eyre-Brook AI; Palmer HC; Cotterill ST; Risebury MJ; Wilson AJ
[Ad] Endereço:Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom; Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester SO22 4NR, United Kingdom. Ele
[Ti] Título:Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction.
[So] Source:Knee;24(1):55-62, 2017 Jan.
[Is] ISSN:1873-5800
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This paper reports the outcomes of patients undergoing ACL reconstruction using a TransLateral single bundle, all-inside hamstring technique at a minimum of two year follow-up. METHODS: The semitendinosus alone is harvested, quadrupled and attached in series to two adjustable suspensory fixation devices. Femoral and tibial sockets are produced using a retrograde drill. The graft is deployed, fixed and tensioned on both tibia and femur. Patients were evaluated preoperatively using the KOOS, Lysholm and Tegner scores and at six, 12 and 24months postoperatively. Objective assessment of knee laxity was performed using the KT-1000 along with goniometric measurement of range or motion. RESULTS: One hundred and eight patients, mean age 30.9years (range 15 to 61) were included. Mean follow-up 49.8months (range 30-66). The mean increase in KOOS at two years was 30.3 points; Lysholm, 33.1 points; Tegner Activity scale, 2.0 levels. These were all statistically significant (p<0.001). Range of motion in the reconstructed knee approximated the uninjured knee by 12months and was restored by two years. KT-1000 showed significant reduction in side-side difference to no more than 2.4mm at all postoperative time points (p<0.001). Re-rupture rate in this series was 6.5%, all following episodes of significant additional postoperative trauma to the knee. CONCLUSIONS: TransLateral all-inside ACL reconstruction demonstrates good medium term subjective and objective outcomes with a low complication and failure rate.
[Mh] Termos MeSH primário: Lesões do Ligamento Cruzado Anterior/cirurgia
Reconstrução do Ligamento Cruzado Anterior/métodos
Instabilidade Articular/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Lesões do Ligamento Cruzado Anterior/complicações
Lesões do Ligamento Cruzado Anterior/fisiopatologia
Estudos de Coortes
Feminino
Seres Humanos
Instabilidade Articular/etiologia
Instabilidade Articular/fisiopatologia
Escore de Lysholm para Joelho
Masculino
Meia-Idade
Amplitude de Movimento Articular
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161004
[St] Status:MEDLINE


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[PMID]:27692556
[Au] Autor:Kim JM; Bin SI; Lee BS; Kim NK; Song JH; Choi JW; Lee CR
[Ad] Endereço:Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
[Ti] Título:Long-term Survival Analysis of Meniscus Allograft Transplantation With Bone Fixation.
[So] Source:Arthroscopy;33(2):387-393, 2017 Feb.
[Is] ISSN:1526-3231
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To investigate the long-term clinical results and clinical survival rate of meniscus allograft transplantation (MAT) with bone fixation. METHODS: The inclusion criteria of this study were previous MAT with bone fixation technique in our institution and minimum follow-up duration of 8 years. Potential subjects were identified using the medical records and database that was prospectively collected from December 1996 to December 2005. The exclusion criteria were diffuse International Cartilage Repair Society grade IV articular cartilage degeneration that was not treated with a concomitant or staged cartilage repair procedure. Surgical indication for MAT was previous total or subtotal meniscectomy followed by persistent swelling and pain in involved compartment. Recommendations to return to contact sports or strenuous activities were not made. Clinical outcomes were evaluated using the modified Lysholm score, and comparison between preoperative and final Lysholm score was done using Student t-test. During the follow-up period, failure was defined as (1) subtotal resection of the allograft, (2) conversion to total knee arthroplasty, or (3) a modified Lysholm score less than 65 or that of the preoperative status. Survival analysis was performed using the Kaplan-Meier method. RESULTS: During the study period, 52 knees underwent MAT in our institution and 49 knees were eligible for this study. Three knees were excluded because they had diffuse grade IV cartilage degeneration in the respective compartment. Among the 49 knees enrolled, 34 underwent lateral and 15 underwent medial MAT. Two patients had bilateral lateral MAT. Of those 47 patients, 37 were male and 10 were female. Mean patient age at the time of the MAT was 30.4 ± 8.6 years. The median follow-up period was 11.5 years (8 to 17 years). The preoperative mean modified Lysholm score was 73.2 ± 10.6, which significantly increased to 89.4 ± 13.2 at the time of the final follow-up (P < .001). There were 2 failures noted at 6 months and 11.3 years, respectively, after MAT. All of the other allografts were surviving at the time of the latest follow-up. The 10-year survival rate was 98.0% (95% confidence interval [CI], 94.1%-100%), and the 15-year survival rate was 93.3% (95% CI, 83.7%-100%) according to the Kaplan-Meier analysis. CONCLUSIONS: MAT using the bone fixation techniques demonstrated a high clinical survival rate according to the long-term observation. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
[Mh] Termos MeSH primário: Sobrevivência de Enxerto
Articulação do Joelho/cirurgia
Meniscos Tibiais/transplante
[Mh] Termos MeSH secundário: Adulto
Aloenxertos
Terapia por Exercício
Feminino
Seguimentos
Seres Humanos
Escore de Lysholm para Joelho
Masculino
Cuidados Pós-Operatórios
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161004
[St] Status:MEDLINE


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[PMID]:27670876
[Au] Autor:Drexler M; Rutenberg TF; Rozen N; Warschawski Y; Rath E; Chechik O; Rachevsky G; Morag G
[Ad] Endereço:Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. mt.drexler@gmail.com.
[Ti] Título:Single minimal incision fasciotomy for the treatment of chronic exertional compartment syndrome: outcomes and complications.
[So] Source:Arch Orthop Trauma Surg;137(1):73-79, 2017 Jan.
[Is] ISSN:1434-3916
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Chronic exertional compartment syndrome (CECS) is a common injury in young athletes, causing pain in the involved leg compartment during strenuous exercise. The gold standard treatment is fasciotomy, but most of the reports on its effectiveness include relatively small cohorts and relatively short follow-up periods. This study reports the long-term results of a large cohort of young athletes who underwent single-incision fasciotomy for CECS. MATERIALS AND METHODS: This a retrospective case-series study. All patients treated by fasciotomies performed for CECS between 2007 and 2011, in a tertiary medical institution. CECS was diagnosed following history taking and clinical evaluation, and confirmed by compartment pressure measurements. Ninety-five legs that underwent single-incision subcutaneous fasciotomy were included. Data on the numerical analog scale (NAS), Tegner activity score, and quality-of-life (QOL) as measured via the short form-12 (SF-12) were retrieved from all patients preoperatively and at the end of follow-up. RESULTS: The average time to diagnosis was 22 months and the mean follow-up was 50.1 months. Sixty-three legs underwent anterior compartment fasciotomy (an additional 30 legs also underwent lateral compartment release), and two legs underwent lateral and peroneal compartment releases. The average change in Tegner score was an improvement of 14.6 points. Similarly, the patients reported a significant improvement in the SF-12 and NAS scores. Satisfaction rates were high (average 75.5 %). The main complications were wound infection (2 patients) and nerve injuries (4 patients). Eight patients had recurrence. CONCLUSION: Single-incision fasciotomy leads to long-term improvement in the activity level and QOL of patients with CECS.
[Mh] Termos MeSH primário: Síndromes Compartimentais/cirurgia
Fasciotomia/métodos
Perna (Membro)/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Doença Crônica
Síndromes Compartimentais/etiologia
Fasciotomia/efeitos adversos
Feminino
Seres Humanos
Escore de Lysholm para Joelho
Masculino
Dor/etiologia
Esforço Físico
Complicações Pós-Operatórias
Pressão
Qualidade de Vida
Recidiva
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160928
[St] Status:MEDLINE
[do] DOI:10.1007/s00402-016-2569-7


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[PMID]:27631646
[Au] Autor:Hamilton TW; Choudhary R; Jenkins C; Mellon SJ; Dodd CAF; Murray DW; Pandit HG
[Ad] Endereço:Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK. thomas.hamilton@ndorms.ox.ac.uk.
[Ti] Título:Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up.
[So] Source:Knee Surg Sports Traumatol Arthrosc;25(3):652-659, 2017 Mar.
[Is] ISSN:1433-7347
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Lateral osteophytes have been reported to be associated with lateral compartment disease and as such it is unclear whether medial unicompartmental knee arthroplasty should be performed if these are present. METHODS: Using the OARSI classification system, 0 (no osteophyte) to 3 (large osteophyte), radiographs from a series of cemented meniscal-bearing unicompartmental knee arthroplasty implanted in the setting of full-thickness lateral cartilage where lateral osteophytes were not considered a contraindication were identified and factors associated with the presence and size of lateral osteophytes, and their impact on clinical outcomes and implant survival were assessed. RESULTS: Pre-operative radiographs from 458 knees (392 patients), independently followed up for a mean 10.5 years (range 5.3-16.6), were assessed. Lateral osteophytes were present in 62 % of knees with 18 % scored as Grade 3. Inter-observer reliability was good (kappa = 0.70). The presence and size of lateral osteophytes was associated with younger age at joint replacement (p = 0.01) and increasing BMI (p = 0.01). No association was seen with gender, pre-operative status, assessed using the Oxford Knee Score (OKS), American Knee Society (AKSS) Objective or Functional Score, Tegner activity score, or size of medial tibial lesion. Subgroup analysis of Grade 3 Osteophytes revealed that these were associated with a greater degree of macroscopic ACL damage. At 10 years there was no difference in function (n.s.), and at 15 years no difference in implant survival or mechanism of failure between groups (n.s.). Subgroup analysis of Grade 3 osteophytes found no significant difference in functional outcome at 10 years or implant survival at 15 years. CONCLUSION: The presence of lateral osteophytes is not a contraindication to medial meniscal-bearing unicompartmental knee arthroplasty. The clinical relevance of this study is that it highlights the importance of an appropriate pre-operative assessment of the lateral compartment as in the setting of full-thickness cartilage at operation lateral osteophytes do not compromise long-term functional outcome or implant survival. LEVEL OF EVIDENCE: IV.
[Mh] Termos MeSH primário: Artroplastia do Joelho
Articulação do Joelho/cirurgia
Osteoartrite do Joelho/cirurgia
Osteófito/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Cartilagem
Contraindicações
Bases de Dados Factuais
Feminino
Seguimentos
Seres Humanos
Articulação do Joelho/diagnóstico por imagem
Escore de Lysholm para Joelho
Masculino
Meia-Idade
Osteoartrite do Joelho/complicações
Osteoartrite do Joelho/diagnóstico por imagem
Osteófito/complicações
Radiografia
Tíbia/diagnóstico por imagem
Tíbia/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160916
[St] Status:MEDLINE
[do] DOI:10.1007/s00167-016-4313-9


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[PMID]:27614391
[Au] Autor:Sofu H; Kockara N; Oner A; Camurcu Y; Issin A; Sahin V
[Ad] Endereço:Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey. Electronic address: hakansofu@yahoo.com.
[Ti] Título:Results of Hyaluronic Acid-Based Cell-Free Scaffold Application in Combination With Microfracture for the Treatment of Osteochondral Lesions of the Knee: 2-Year Comparative Study.
[So] Source:Arthroscopy;33(1):209-216, 2017 Jan.
[Is] ISSN:1526-3231
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To determine the clinical and radiographic efficacy of hyaluronic acid-based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint. METHODS: Clinical data of 43 patients between 24 and 55 years of age were evaluated. Hyaluronic acid-based cell-free scaffold was applied in combination with microfracture for 19 knees (group 1), whereas microfracture alone was the surgical intervention for 24 knees (group 2). All lesions were Outerbridge grade III or IV with a mean size of 3.6 ± 1.3 cm . The mean follow-up time was 25.7 months. Visual analog scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments used to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. RESULTS: Better VAS and Lysholm scores were detected in group 1 at 12 and 24 months (P = .019 and P = .025). According to the Tegner activity scale, group 1 had also better activity level at the end of 24 months after surgery (P = .020). The mean time from surgery to return to nonimpact sports activities was 7.8 months in group 1, whereas it was 9.2 months in group 2 (P = .013). Complete repair with the filling of the defect was achieved in 7 (36.8%) of the knees in group 1, whereas it was 4 (16.6%) of the knees in group 2 according to the MOCART system at 24 months. CONCLUSIONS: Single-stage regenerative cartilage surgery using hyaluronic acid-based cell-free scaffold in combination with microfracture for focal osteochondral lesions of the knee revealed promising clinical outcomes at 24 months of follow-up, but the clinical significance of the differences seen is simply not known. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
[Mh] Termos MeSH primário: Ácido Hialurônico
Traumatismos do Joelho/cirurgia
Osteocondrite Dissecante/cirurgia
Tecidos Suporte
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Cartilagem Articular/cirurgia
Feminino
Seguimentos
Seres Humanos
Traumatismos do Joelho/complicações
Traumatismos do Joelho/diagnóstico por imagem
Traumatismos do Joelho/reabilitação
Escore de Lysholm para Joelho
Masculino
Meia-Idade
Osteocondrite Dissecante/complicações
Osteocondrite Dissecante/diagnóstico por imagem
Osteocondrite Dissecante/reabilitação
Medição da Dor
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
9004-61-9 (Hyaluronic Acid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160912
[St] Status:MEDLINE



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