1,720,968 research outputs found
A comparison of bone-patellar tendon-bone and bone-hamstring tendon-bone autografts for anterior cruciate ligament reconstruction
No full textC-reactive protein changes in the uncomplicated course of arthroscopic anterior cruciate ligament reconstruction
No full textSubcutaneous emphysema and pneumomediastinum following shoulder arthroscopy with brachial plexus block: a case report and review of the literature.
No full textA view from above: A modified Patel's medial midpatellar portal for anterior cruciate ligament arthroscopic surgery
No full textThe use of flexible positions based on the surgeon's need to address specific pathology has been advocated in arthroscopic surgery. In this report we reappraise the midpatellar portals popularized by Patel and present a technique modification of the medial midpatellar portal (mMPP) focusing on its use in anterior cruciate ligament primary and revision arthroscopic surgery. The modified mMPP is established under arthroscopic control from a high anterolateral portal. Its location is more proximal than the original Patel's mMPP. The nearly vertical orientation of the arthroscope and its proximity to the midline offer a wider and almost face-to-face visualization of the intercondylar notch in the coronal plane, which would provide advantages over standard portals. The anteromedial and anterolateral portals may both be used as working portals without crowding because the arthroscope is cranially located. The need to perform notchplasty is reduced, minimizing bleeding from trabecular bone. Aggressive soft-tissue processing in the intercondylar notch to improve visualization is seldom required. The recipient site is less devascularized, which may promote autograft healing. The modified mMPP may also facilitate femoral tunnel placement and setting of an interference screw. It is safe and reproducible and may add to the diagnostic and working capabilities of the knee arthroscopist.La opportunità di utilizzare portali diversi in ragione delle diverse patologie da trattare è spesso utilizzata in chirurgia artroscopia. Nel nostro lavoro, riprendendo il portale medio patellare (mMPP) proposto da Patel, presentiamo una modifica dello stesso, enfatizzando la sua utilizzazione nella ricostruzione primaria e/o di revisione del legamento crociato anteriore. Il mMPP è ricercato sotto controllo artroscopico con l’ottica posizionata nel portale supero laterale e la sua localizzazione risulta più prossimale dell’originale mMPP proposto da Patel: il posizionamento quasi verticale dell’artroscopio e la sua collocazione vicino alla linea mediana del ginocchio offre una diretta visualizzazione della gola intercondilica su di un piano coronale, con significativi vantaggi sul portale standard. Con l’ottica posizionata in tale posizione possiamo utilizzare contemporaneamente i portali antero-mediale e antero-laterale senza avere conflitti meccanici con tal portale posizionato cosi prossimale. La necessità di realizzare una aggressiva notchplasty per migliorare la visualizzazione è quindi ridotta con riduzione anche del sanguinamento dall’osso spongioso, favorendo l’attecchimento dell’innesto.
Il portale mMPP modificato facilita il posizionamento del tunnel femorale e la applicazione della vite ad interferenza. Infine la sua utilizzazione appare scevra di complicanze e migliora la capacità la diagnosi e di trattamento dell’artroscopista
Arthroscopic all-inside suture of symptomatic Baker's cysts: a technical option for surgical treatment in adults
No full textSynovial fluid caused by repeated effusions may replete the gastrocnemius-semimembranosus bursa (GSB) communicating with the knee joint. Fluid trapped inside the GSB through an alleged unidirectional valve-like mechanism forms a so-called Baker's cyst. Since a significant association of Baker's cysts with knee joint disorders has been reported, treatment should primarily address articular lesions causing recurrent effusions. Arthroscopic surgery provides an effective treatment in that both the cyst and associated joint disorders can be optimally visualized and accordingly treated. In the present paper an all-inside arthroscopic technique for suturing the gateway to the GSB through an anterolateral viewing portal and a posteromedial working portal is proposed. The rationale underlying this technique is that no conclusive evidences exist that the one-way valve-like mechanism is purely anatomical. A retrospective study was conducted on 22 patients (9 males and 13 females, mean age 56 +/- 10 SD years) affected by a symptomatic Baker's cyst associated to knee joint disorders. Pre- and post-operative evaluation at 2 year follow-up consisted of clinical assessment by Rauschning and Lindgren criteria and magnetic resonance imaging (MRI). The results showed that 96% of patients showed clinical improvement. Baker's cyst disappeared in 64% of patients, reduced in 27% and persisted in 9% on MRI. All patients with cyst reduction exhibited clinical amelioration. Our results suggest the all-inside arthroscopic suture technique would improve Baker's cyst-related symptoms by either disappearance or reduction of the cyst. We believe the availability of multiple arthroscopic techniques to treat symptomatic Baker's cysts could broaden the therapeutic armamentarium of knee arthroscopists.Il liquido sinoviale conseguente a ripetute sinoviti reattive può determinare la formazione di una dilatazione cistica della borsa gastrocnemio semimembranoso (GSB), in comunicazione con la cavità articolare del ginocchio. Il liquido rimane intrappolato all’interno della GSB attraverso un meccanismo a valvola unidirezionale e determina la formazione della cosiddetta cisti di Baker. Anche se si realizza una significativa cisti di Baker il trattamento consiste nella risoluzione della causa intraarticolare che determina la formazione del liquido sinoviale. La chirurgia artroscopica permette il trattamento sia della cisti sia delle lesioni intraarticolari che possono essere visualizzati e trattati.
Nel presente lavoro viene proposta una tecnica di sutura all-inside del passaggio tra il tendine del semimembranoso e il gastrocnemio mediale con visualizzazione dal portale antero-laterale e sutura dal portale postero mediale. Il razionale enfatizzato dalla tecnica è che il meccanismo della formazione della GSB non è puramente anatomico .
E’ stato condotto uno studio retrospettivo su 22 pazienti (13 di sesso femminile, età media 56+- 10 anni) affetti da pseudocisti di Baker sintomatica associata a disordini articolari. La valutazione pre e post operatoria è stata condotta utilizzando i criteri di Rauschning e Lindgren ed effettuata valutazione con tomografia a Risonanza Magnetica (RM).
I risultato hanno mostrato che il 96% dei pazienti mostravano un miglioramento clinico, la cisti di Baker risultava scomparsa nel 64% dei pazienti, ridotta nel 27% e immodificata nel 9%. Tutti i pazienti con riduzione della cisti di Baker manifestavano un miglioramento cinico. I nostri risultati suggeriscono che la sutura artroscopica all-inside può migliorare la sintomatologia connessa con cisti sia con la scomparsa che con la riduzione della stessa e riteniamo che la disponibilità di più tecniche nel trattamento della cisti di Baker debba essere messa a disposizione del trattamento artroscopico delle patologie articolari del ginocchio
Comorbidity-related quality of life in anterior cruciate ligament insufficiency: a cross-sectional study involving 282 candidates for arthroscopic reconstruction
No full textBACKGROUND AND PURPOSE
Comorbidity-adjusted health-related quality of life (HRQoL) in anterior cruciate ligament insufficiency (ACLI) has not been assessed to date. A cross-sectional study was conducted to test the hypothesis that HRQoL in ACLI is comorbidity-related and differs from the Italian norm.
METHODS
282 chronically ACL-insufficient candidates for arthroscopic reconstruction with or without meniscal and/or focal chondral lesions were studied. Knee function was evaluated with IKDC form, HRQoL with SF-36, and associated medical comorbidities with a self-administered questionnaire allowing calculation of a comorbidity index (CI). Patients were stratified according to CI into subgroup A (CI = 0) and subgroup B (CI > 0). The SF-36 profiles in the whole sample and in subgroups A and B were compared with the Italian norm.
RESULTS
Of the 282 patients, 82 had associated comorbidity and 200 did not. Patients with comorbidity were older and had a higher degree of knee laxity than patients without comorbidity. Distinctive SF-36 profiles were obtained after stratification by comorbidity and comparison with the age- and sex-matched norm. The SF-36 profile in subgroup A showed statistically significantly lower scores on the PF, RP, BP, and SF domains while the GH and MH domains were statistically significantly higher than the norm. Subgroup B showed statistically significantly lower scores than the norm for the PF, RP, BP, VT, SF and RE domains.
INTERPRETATION
Comorbidity-related HRQoL in ACL-insufficient candidates for arthroscopic reconstruction showed statistically significant differences from the norm. Comorbid illness acting as confounder should thus be controlled for when reporting SF-36 profiles, in order to avoid selection bias. Our findings may also be used as benchmark data for researchers investigating SF-36 profiles in ACLI
Single-bundle versus double-bundle arthroscopic reconstruction of the anterior cruciate ligament: what does the available evidence suggest?
No full textThe introduction of the
double-bundle technique as a surgical
option for primary anterior cruciate
ligament (ACL) surgery stems
from the hypothesis that replicating
the double-bundle anatomy of the
native ACL improves knee kinematics
by supplying better rotational
control. We performed a systematic
review of the literature comparing
double-bundle with standard
single-bundle reconstruction methods.
One RCT and three quasi-
RCTs with a one- to two-year follow-
up were included in this
review. On the basis of these studies,
ACL reconstruction with a double-
bundle technique leads to less
residual pivot-shift as assessed on
manual and instrumented tests.
Conflicting results exist as to
whether the double-bundle technique
leads to less side-to-side
anterior tibial translation, and no
significant differences were found
regarding proprioception, flexorextensor
peak torque and knee
function as assessed with the
International Knee Documentation
Committee score. On the other
hand, better subjective knee function
was found in one quasi-RCT.
However, there is a lack of correlation
between these kinematic differences
and an as yet unproven clinical
effect. Uncertainties also exist
regarding the mid- and long-term
performances of the ACL reconstructed
with a double-bundle technique.
Comparison between the single-
bundle and double-bundle techniques
should be expanded to cover
unresolved issues such as the rate
of complications from a more challenging
surgical technique, the risk
of complicating revision surgery
due to the presence of two tunnels,
and the cost-effectiveness of a procedure
with a higher consumption
of fixation devices. The doublebundle
technique should be further
investigated by experienced knee
surgeons in studies with higher
methodological quality
Resurfacing Versus Non-resurfacing the Patella in Total Knee Arthroplasty: An Appraisal of Available Evidences
No full textThe decision whether to resurface or not
the patella in total knee arthroplasty (TKA) is highly
controversial and surgeons show a wide variety of attitudes
in Europe and in the USA. Surgeons favouring
patellar resurfacing advocate that post-operative knee
pain following TKA is significantly diminished, which
would improve patient-based outcome. On the other
hand, patellar replacement carries a number of potential
complications which may outweigh the benefit of reduced
anterior knee pain. A systematic search of available
evidences comparing the outcome of unresurfaced
versus resurfaced patellae in TKA was therefore conducted.
The purpose of the present paper is providing
orthopaedic surgeons with an updated appraisal of relevant
evidences that may assist them in their decisionmaking
process.
Material and Method: A bibliographic search was
conducted through the most representative databases. We searched for meta-analyses (MA), systematic reviews
(SR) and randomized controlled trials (RCT) comparing
outcome between resurfaced and unresurfaced patellae in
TKA. The following databases were used: Cochrane
Muskuloskeletal Injuries Group Specialized Register, the
Cochrane Register of Controlled Trials, Health Technology
Assessment (HTA), PEDro, Medline, EMBASE,
CINAHL, AMED, DARE, TRIP, The National Research
Register (UK). The search was ended on February 2008.
The search term selected from The National Library of
Medicine’s medical subject heading (MESH) database
were: patella; resurfacing; total knee arthroplasty; TKA;
total knee replacement; TKR. Additionally, the rate of reduced
post-operative anterior knee pain in patients undergoing
patellar resurfacing was compared with the current
rate of complications associated with patellar replacement.
Results: Five MAs, 1 SR and 6 RCTs not included in the
published evidence syntheses were retrieved. All evidence
syntheses would warrant patellar resurfacing in order to
reduce anterior knee pain and the related risk of re-operation.
Conversely, 4 RCTs failed to detect significant differences
using accepted clinical scores at mid- and long-term
follow-up while 2 RCTs did not report significant variations
of the biomechanical performance in vivo between replaced
and un-replaced patellae.
Conclusion: Current evidences would support the decision
to resurface the patella when anterior knee pain and
the related risk of re-operation are used as end-points of
outcome at mid-term follow-up. However, no clinical
differences would be detectable between resurfaced and
unresurfaced patellae at long-term follow-up. In addition,
both patella-replaced and patella-unreplaced TKA
exhibit similar biomechanical behaviour in vivo. The rate
of anterior knee pain improvement in patients undergoing
patellar replacement should be contrasted with the
rate of potential complications related to patellar resurfacing
Comorbidity-related quality of life in anterior cruciate ligament insufficiency - A cross-sectional study involving 282 candidates for arthroscopic reconstruction
No full textBACKGROUND AND PURPOSE:
Comorbidity-adjusted health-related quality of life (HRQoL) in anterior cruciate ligament insufficiency (ACLI) has not been assessed to date. A cross-sectional study was conducted to test the hypothesis that HRQoL in ACLI is comorbidity-related and differs from the Italian norm.
METHODS:
282 chronically ACL-insufficient candidates for arthroscopic reconstruction with or without meniscal and/or focal chondral lesions were studied. Knee function was evaluated with IKDC form, HRQoL with SF-36, and associated medical comorbidities with a self-administered questionnaire allowing calculation of a comorbidity index (CI). Patients were stratified according to CI into subgroup A (CI = 0) and subgroup B (CI > 0). The SF-36 profiles in the whole sample and in subgroups A and B were compared with the Italian norm.
RESULTS:
Of the 282 patients, 82 had associated comorbidity and 200 did not. Patients with comorbidity were older and had a higher degree of knee laxity than patients without comorbidity. Distinctive SF-36 profiles were obtained after stratification by comorbidity and comparison with the age- and sex-matched norm. The SF-36 profile in subgroup A showed statistically significantly lower scores on the PF, RP, BP, and SF domains while the GH and MH domains were statistically significantly higher than the norm. Subgroup B showed statistically significantly lower scores than the norm for the PF, RP, BP, VT, SF and RE domains.
INTERPRETATION:
Comorbidity-related HRQoL in ACL-insufficient candidates for arthroscopic reconstruction showed statistically significant differences from the norm. Comorbid illness acting as confounder should thus be controlled for when reporting SF-36 profiles, in order to avoid selection bias. Our findings may also be used as benchmark data for researchers investigating SF-36 profiles in ACLI.Background : La comorbidità modificata in funzione della qualità della vita (HRQoL) nella insufficienza del legamento crociato anteriore (ACLI) non è mai stata presa in considerazione. E’ stato condotto uno studio cross-section per valutare l’ipotesi che la HRQoL è diversa da quella dell’ italiano medio.
Metodo: Abbiamo preso in considerazione 282 pazienti con insufficienza cronica del legamento crociato anteriore in lista di attesa per la ricostruzione con o senza lesioni meniscali, con o senza lesioni condrali. La funzione del ginocchio è stata valutata tramite la scheda IKDC, la HRQoL con la scheda SF-36, e le comorbidità mediche associate con un questionario che permettesse il calcolo dell’indice di comorbidità (CI). I pazienti sono stati suddivisi in due sottogruppi : quello A con CI=0 e quello B con CI>0. I profili SF-36 generali e dei sottogruppi A e B sono stati comparati con i valori normativi italiani
Risultati: Dei 282 pazienti 82 avevano una associata comorbidità e questi risultavano più anziani e con un grado di instabilità più grave di quelli senza comorbidità. I singoli profili SF-36 sono stati ottenuti dopo stratificazione e comparazione con i valori normativi per età e sesso. Il profilo SF-36 nel sottogruppo A ha mostrato valori significativamente più bassi per i domini PF, RF, BF e SF mentre quelli GH e MH sono risultati significativamente più alti del gruppo normativo. Il sottogruppo B ha mostrato valori statisticamente più bassi del gruppo normativo nei domini PF, RF, BP, VT e RE.
Interpretazione: La comorbidità modificata in funzione della qualità della vita (HRQoL) nei pazienti candidati alla ricostruzione del legamento crociato anteriore del ginocchio mostrano significati differenze dal gruppo normativo . Le comorbidità agiscono come confounder e devono essere controllate quando vengono riempiti i questionari SF-36 perché possono generare bias. I nostri risultati possono essere utilizzati per migliorare i dati dei ricercatori che studiano i profili SF-36 nelle instabilità del ginocchio per insufficienza del legamento crociato anteriore
- …
