Reconstrucción del ligamento cruzado anterior con doble haz de U-Dos y haz único de aloinjerto: Un estudio comparativo

Las lesiones del ligamento cruzado anterior (LCA) son muy frecuentes entre los deportistas. Si estas lesiones no se reparan, se producen daños en el menisco y el cartílago, con graves consecuencias en la articulación. Se han descrito diferentes opciones para la reconstrucción del LCA, con el objetivo de conseguir estabilidad anteroposterior, lateral y rotacional. El uso de injertos de uno o dos haces ha sido uno de los temas más debatidos, con el objetivo de mejorar la estabilidad rotacional. Realizamos un estudio prospectivo aleatorizado para evaluar los resultados de la reconstrucción del LCA utilizando injertos de doble o único haz en 72 pacientes con lesiones agudas del LCA. Los pacientes fueron aleatorizados a ciegas en 2 grupos de 36 rodillas antes de la cirugía mediante un sobre ciego que contenía la técnica que se iba a utilizar: técnica U-Dos de doble haz (grupo DB) o técnica de haz único (grupo SB). Todos los pacientes se sometieron a una evaluación preoperatoria y postoperatoria y fueron seguidos con los mismos parámetros a los 2, 4, 6, 12 y 24 meses. Tanto la estabilidad anteroposterior como la rotacional se evaluaron mediante un artrómetro KT-1000 (MEDmetric) y un dispositivo experimental Pivot-Shift Meter (ORMEDS). Los resultados funcionales se midieron mediante la escala de Tegner-Lysholm. El grupo DB tuvo menos rectificaciones del LCA, menos lesiones meniscales y mejores puntuaciones de Tegner-Lysholm y del Comité Internacional de Documentación de la Rodilla. Este grupo también tuvo mejores valores de KT-1000 y Pivot-Shift Meter. Tras un seguimiento de 2 años, el grupo DB obtuvo resultados significativamente mejores que el grupo SB.Anterior cruciate ligament (ACL) injuries are very common among athletes. If these injuries are not repaired, meniscus and cartilage damage will arise, with serious consequences in the joint. Different options for ACL reconstruction have been described, aiming for anteroposterior, lateral, and rotational stability. Using single- or double-bundle grafts has been one of the most discussed topics, aiming for better rotational stability. We performed a prospective randomized study to evaluate the outcomes of ACL reconstruction using double- or single-bundle grafts for 72 patients with acute ACL injuries. Patients were blindly randomized into 2 groups of 36 knees before surgery using a blind envelope that contained the technique to be used: double-bundle U-Dos technique (DB group) or single-bundle technique (SB group). All patients had a preoperative and postoperative evaluation and were followed with the same parameters at 2, 4, 6, 12, and 24 months. Both anteroposterior and rotational stability were evaluated using a KT-1000 arthrometer (MEDmetric) and an experimental Pivot-Shift Meter (ORMEDS) device. Functional outcomes were measured using the Tegner-Lysholm scale. The DB group had fewer ACL re-tears, fewer meniscal injuries, and better Tegner-Lysholm and International Knee Documentation Committee scores. This group also had better KT-1000 and Pivot-Shift Meter values. After 2-year follow-up, the DB group had significantly better results than the SB group

ALGUNS ASPECTOS DA LINGUAGEM CIENTÍFICA

Considerando a importância da adequação e do rigor no uso de termos científicos o A., após se referir ao uso frequente de palavras comuns na designação de fenômenos ou na descrição de elaborações teóricas, realça a importância da utilização de termos capazes de atender aos níveis hipotético e descritivo das concepções. Tece considerações em relação aos vocábulos conceito e constructo, considerados nos seus níveis crescentes de abstração, e analisa o termo definição, observadas as suas especificidades constitutiva e/ou operacional. Aborda, em seguida, o verbete variável, considerando-o desde a definição tautológica até a sua categorização e ajuizamento de valor quanto às categorias. Enfatiza que a existência de variáveis é essencial a qualquer especulação cientifica e conclui observando sobre a importância de terminologia precisa, face ao rigor demandado em quaisquer das disciplinas cientificas

Double-bundle and double-tunnel ACL reconstruction with looped proximal tibial fixation

Double-bundle anterior cruciate ligament (ACL) reconstruction can be demanding and time consuming and requires twice as many implants, increasing both costs and possible complications. In this article, we present a new approach to double bundle ACL reconstruction: a biological fixation of the tibial side by means of a double tunnel and a U-shape passage of an anterior tibialis allograft, fixed into a double tunnel on the femoral condyle with 2 interference bioabsorbable screws. The technique is designed to combine 2 known procedures for the regular knee surgeon: the mono-tunnel technique and the medial-portal approach

Gluteal Compartment Syndrome following an Iliac Bone Marrow Aspiration

The compartment syndrome is a condition characterized by a raised hydraulic pressure within a closed and non expandable anatomical space. It leads to a vascular insufficiency that becomes critical once the vascular flow cannot return the fluids back to the venous system. This causes a potential irreversible damage of the contents of the compartment, especially within the muscle tissues. Gluteal compartment syndrome (GCS) secondary to hematomas is seldom reported. Here we present a case of a 51-year-old patient with history of a non-Hodgkin lymphoma who underwent a bone marrow aspiration from the posterior iliac crest that had excessive bleeding at the puncture zone. The patient complained of increasing pain, tenderness, and buttock swelling. Intraoperative pressure validation of the gluteal compartment was performed, and a GCS was diagnosed. The patient was treated with a gluteal region fasciotomy. The patient recovered from pain and swelling and was discharged shortly after from the hospital. We believe clotting and hematologic disorders are a primary risk factor in patients who require bone marrow aspirations or biopsies. It is important to improve awareness of GCS in order to achieve early diagnosis, avoid complications, and have a better prognosis