Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament

Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. The aim of this study was to detail the clinical, radiological, arthroscopic, and pathological findings of mucoid degeneration of the anterior cruciate ligament and report the clinical outcomes following arthroscopic treatment. A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. The minimum follow-up was 3 years. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. Seventeen females (67%) and eight males (33%) were included in the final analysis. The mean age at the time of surgery was 57 years (range, 31 to 78 years). Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. No reconstruction was performed at the same time. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). Our study provides further evidence that arthroscopic total or partial excision of anterior cruciate ligament is a safe and effective treatment for mucoid degeneration of the anterior cruciate ligament, improving patient satisfaction and function without causing clinical instability in daily activities. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary

Relación entre la satisfacción versus dolor en la ligamentoplastia del LCA de forma ambulatoria

INTRODUCCIÓ 32 casos de ligamentoplàstia LEA amb plàstia d'isquiotibials autòloga de forma ambulatòria. Es presenta de forma prospectiva els nostres resultats en quan a la correlació dolor-satisfacció. MATERIAL I MÉTODES Es va procedir a anestèsia intradural amb reforç catèter epidural mantingut 24-48h i bloqueig nervi perifèric crural amb catèter perineural estimulable. Reparació via artroscòpica. RESULTATS Per la valoració dels resultats, mantenim contacte telefònic amb el pacient a les 24h i 48h i a consulta al 7º dia. Cap cas de reingrès. DISCUSIÓ i CONCLUSIONS El procedimient de forma ambulatòria amb un correcte procés de selecció, té un lloc important. Es important la detecció precoç del dolor. El pic de dolor màxim se sitúa entre la 1a nit - 2n dia de la cirurgia. Satisfacció a la setmana de 8 punts sobre 10.INTRODUCCIÓN 32 casos de ligamentoplastia LCA con plastia de isquiotibiales autóloga de forma ambulatoria. Se presenta de forma prospectiva nuestros resultados en cuanto a la correlación dolor-satisfacción.MATERIAL Y MÉTODOSSe procedió a anestesia intradural con refuerzo catéter epidural mantenido 24-48h y bloqueo nervio periférico crural con catéter perineural estimulable. Reparación vía artroscópica. RESULTADOSPara la valoración de los resultados, mantenemos contacto telefónico con el paciente a las 24h y 48h y en consulta al 7º día. Ningún caso de reingreso.DISCUSIÓN Y CONCLUSIONESEl procedimiento de forma ambulatoria con un correcto proceso de selección, tiene un lugar importante. Es importante la detección precoz del dolor. El pico de dolor máximo se sitúa entre la 1a noche - 2n día de la cirugía. Satisfacción a la semana de 8 puntos sobre 10

Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block—a randomized controlled double-blinded trial

Femoral nerve block; Postoperative analgesia; Total knee arthroplastyBloqueo del nervio femoral; Analgesia postoperatoria; Artroplastia total de rodillaBloqueig del nervi femoral; Analgèsia postoperatòria; Artroplàstia total de genollIntroduction Femoral nerve block (FNB) is a well-established analgesic technique for TKA. However, it associates quadriceps weakness. Therefore, femoral triangle block (FTB) and adductor canal block (ACB) were proposed as effective alternative motor-spearing techniques. The primary objective was to compare quadriceps muscle strength preservation between FNB, FTB and ACB in TKA. The secondary objective was to analyze pain control and functional outcomes. Methods This is a prospective, double-blinded RCT. From April 2018 to April 2019, patients who undergo a primary TKA were randomized into three experimental groups: FNB-G1/FTB-G2/ACB-G3. Quadriceps strength preservation was measured as the difference in maximum voluntary isometric contraction (MVIC) preoperatively and postoperatively. Results Seventy-eight patients (G1, n = 22; G2, n = 26; G3, n = 30) met our inclusion/exclusion criteria. Patients with FNB retained significantly lower baseline MVIC at 6 h postoperatively (p = 0.001), but there were no differences at 24 and 48 h. There were no differences between the groups in functional outcomes at any time point. Patients in the FNB-G1 presented significant lower pain scores at 6 h (p = 0.01), 24 h (p = 0.005) and 48 h (p = 0.01). The highest cumulative opioid requirement was reported in ACB-G3. Conclusion For patients undergoing TKA, FTB and ACB preserve quadriceps strength better than FNB at 6 h postoperatively, but there are no differences at 24 and 48 h. Moreover, this early inferiority does not translate to worse functional outcomes at any time point. FNB is associated with better pain control at 6, 24 and 48 h after surgery, while ACB presents the highest cumulative opioid requirement. Clinical trial registration This study was registered in clinicaltrials.gov (NCT03518450; https://clinicaltrials.gov/ct2/show/NCT03518450; submitted March 17, 2018)

Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study

Anterior cruciate ligament; Autografts; TenodesisLigamento cruzado anterior; Autoinjertos; TenodesisLligament creuat anterior; Autoempelts; TenodesiBackground Most athletes who undergo revision of the anterior cruciate ligament reconstruction (ACLR) aim to return to their preinjury sport at a similar level of performance while minimizing the risk for reinjury. Additional lateral extra-articular tenodesis (LET) has recently been correlated with improved outcomes and low complication rate. Yet, there are few series evaluating return-to-sport (RTS) and clinical outcomes after revision ACLR using bone-patellar tendon-bone (BPTB) and LET in athletes. Methods The study cohort consisted of 19 eligible athletes who had undergone their first revision ACLR using BPTB and LET (modified Lemaire) between January 2019 and 2020. Patients were prospectively followed and interviewed in a sports activity survey during a 2-year follow-up. Results Despite all patients returning to sports after revision ACLR surgery, 52.6% resumed playing at their preinjury level. Furthermore, patient-reported functional outcomes improved significantly following revision surgery, as evidenced by improvements in IKDC [64.4 (± 12) to 87.8 (± 6)], Lysholm [71.27 (± 12) to 84.2 (± 9.7)], and SF-12 scales [Physical: 53.3 (± 3) 57 (± 1.2); Mental: 50.2 (± 3.3) to 52.7 (± 2.4)]. One case (5.3%) experienced persistent pain and underwent reoperation for a partial meniscectomy. Conclusion After revision ACLR using autologous BPTB and LET, all active individuals are expected to RTS, similar to primary ACLR. The difference comes down to returning to the preinjury level, where the levels are lower depending on the sport and initial level of play. Good mid-term functional outcomes with a low complication rate can be expected in most cases.Open Access Funding provided by Universitat Autonoma de Barcelona. This work was carried out as part of the Doctorate in Surgery and Morphological Sciences of the Autonomous University of Barcelona. The “Post-FSE Carles Margarit” grant was awarded by the VHIR—Vall d'Hebron Institut de Investigación to one of the authors (FMB)

Is it really advantageous to operate proximal femoral fractures within 48 h from diagnosis? – A multicentric retrospective study exploiting COVID pandemic-related delays in time to surgery

Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF. Conclusion: Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis

Estudio comparativo de la estabilidadrotacional y traslacional de dos técnicas quirúrgicas de reconstrucción del ligamento cruzado anterior mediante cirugía guiada por navegador: técnica monotúnel no anatómica vs técnica anteromedial anatómica

Objetivo: Comparar las técnicas de reconstrucción del LCA por portal Anteromedial (AM) y la técnica monotúnel o Transtibial modificada (TT) desde el punto de vista biomecánico, anatómico y clínico a corto plazo, con un seguimiento mínimo de 1 año. Hipótesis del estudio: La técnica AM reproduce mejor la anatomía y biomecánica de la rodilla con el consiguiente mejor resultado clínico. Material y Métodos: Estudio prospectivo y aleatorizado en 106 pacientes afectos de ruptura crónica del LCA (55 AM, 51 TT) entre julio de 2010 y marzo de 2013. No existen diferencias significativas en edad media, sexo, IMC, cronicidad de la lesión, presencia de meniscopatía y condropatía y de laxitud preoperatoria, valorada con navegación, entre los dos grupos. Para el estudio anatómico de la plastia se utilizó la RNM valorando la angulación de la plastia en los planos coronal y sagital. La biomecánica de la plastia se valoró, a tiempo 0, con ayuda del navegador Orthopilot® obteniendo datos de traslación anteroposterior (AP), rotación interna (RI) y rotación externa (RE) en el preoperatorio y postoperatorio inmediatos. La valoración clínica se llevó a a cabo en el preoperatorio, a los 6 meses y al año de la cirugía con un seguimiento mínimo de 1 año. Se han utilizado las escalas de función de la rodilla IKDC, Lysholm, Tegner y el cuestionario de calidad de vida SF-36. La satisfacción del procedimiento se ha valorado con el cuestionario SAPS. El mecanismo lesional más común son los accidentes deportivos en el 70% (fútbol 46%, esquí 14%, básquet 8%) En el 8% la causa fueron los accidentes de tráfico. Resultados: El 60,4% de los pacientes presenta lesión meniscal y el 16% lesión condral. La presencia de condropatía condiciona el resultado clínico al año de la cirugía (IKDC 83,07 vs 63,23; p=0,000). Los pacientes con condropatía presentan mayor cronicidad de la lesión (77,18 meses vs 27,86 meses; p=0,000). La valoración con navegador a tiempo 0 indica que ambas técnicas mejoran de manera significativa la laxitud traslacional y rotacional en relación a los valores preoperatorios (p=0,000). La técnica AM mejora la laxitud AP en 8,76 mm (62,80%), la RI en 4,94º (27,87%) y la RE en 2º (11,89%). La técnica TT mejora la laxitud AP en 8,92 mm (63,37%), la RI en 3,82º (22,99%) y la RE en 2,71º (15,88%). La técnica AM es superior únicamente en el control de la RI (p=0,016). La laxitud rotacional a tiempo 0, valorada con la maniobra de pívot shift, no evidencia diferencias entre técnicas (p=0,146). El estudio de la orientación de la plastia muestra que la técnica AM consigue una plastia más anatómica tanto en el plano sagital (53,17º vs 59,5º; p=0,002) como en el plano coronal (73,66º vs 79,70º; p=0,016). Ambas técnicas producen una mejoría clínica significativa en las escalas IKDC y Lysholm en relación a los valores preoperatorios (p=0,000) pero sin diferencias entre ellas. El IKDC al año con técnica AM es de 79,71 y con técnica TT de 79,82 (p=0,976). El Lysholm al año de la cirugía con técnica AM es de 84,27 y con técnica TT de 86,40 (p=0,539). Los pacientes realizan, al año de la cirugía, más actividad deportiva que en preoperatorio pero no alcanzan el nivel prelesional y sin diferencias entre técnica AM y TT (p=0,502). El 79,2% está satisfecho con el procedimiento sin diferencias entre grupos (p=0,241). La calidad de vida de los pacientes mejora progresivamente durante el primer año en el global de los pacientes sin diferencias entre ambas técnicas. Conclusión: La reconstrucción del LCA es una técnica que ofrece un buen resultado clínico con un alto porcentaje de satisfacción. La técnica AM consigue una plastia más anatómica con una mejor biomecánica de la plastia en el control de la rotación interna pero esto no se traduce en una superioridad clínica. La lesión condral condiciona el resultado clínico y se relaciona con un mayor tiempo de evolución de la lesión del LCA.Purpose: To compare anteromedial (AM) and one-tunnel or modified transtibial (TT) ACL reconstruction techniques from a biomechanical and anatomic point of view as well as short-term results with a minimum of one-year follow-up. Hypothesis: AM technique better reproduces anatomical and biomechanical aspects of the knee providing thusly a better clinical result. Methods: Prospective randomized study of 106 patients with a chronic rupture of the ACL (55 patients underwent AM technique and 51 patients TT technique) between July 2010 and March 2013.. No statistically significant differences were found between the two groups in terms of age, gender, body mass index, chronicity of the lesion, associated meniscopathy or chondropathy and preoperative joint laxity which was determined with computer navigation. Magnetic resonance imaging was used for the anatomical study of the ligament-plasty and its angulations measured on both a sagital and coronal plane. Biomechanical behavior of the plasty was assessed at 0 time with the help of Orthopilot® computer navigation system obtaining measurements on anteroposterior translation (AP), internal rotation (IR) and external rotation (ER) immediately pre- and postoperative. Clinical evaluation was performed preoperatively, at 6 months and 1 year after surgery with a one-year minimum follow-up. IKDC, Lysholm and Tegner functionality scales and the SF-36 quality of life questionnaire were used. Patient’s satisfaction with the surgical procedure was evaluated using SAPS questionnaire. The most frequent injury mechanism, up to 70% of the cases, was sports related (football 46%, skiing 14%, basketball 8%). In 8% motor accident. Results: 60.4% of patients had an associated menisci lesion and 16% a chondral lesion. The presence of a cartilage lesion conditions clinical results at one year post-surgery (IKDC 83.07 vs. 63.23; p=0.000). Patients with chondropathy had higher lesion chronicity (77.18 months vs. 27.86 months; p=0.000). Computer navigation assessment at time 0 showed that both techniques significantly ameliorate translational and rotational laxity when compared to preoperative results (p=0,000). The AM surgical technique improved AP laxity in 8.76mm (62.80%), IR in 4.94 degrees (27.87%) and ER in 2 degrees (11.98%). The TT technique improved AP laxity in 8,92mm (63.37%), IR in 3.82 degrees (22.99%) and ER in 2.71 degrees (15.88%). The AM technique proved to be superior only in controlling IR (p=0.016). Rotational laxity assessed with the pivot-shift maneuver showed no differences between groups (p=0.146). Regarding anatomical study on plasty’s orientation, AM technique achieves a more anatomical orientation in both sagital (53.17º vs. 59.50º; p=0.002) and coronal plane (73.66º vs. 79.70º; p=0,016). Both groups reported a substantial improvement on IKDC and Lysholm functionality scales, when compared with preoperative punctuations (p=0.000), with no significant differences between techniques. The result of IKDC scale at one year post surgery in the AM group was 79.71 and in the TT group 79.82 (p=0.976). Regarding Lysholm scale at 1-year follow-up, AM group scored 84.27 and the TT group 86.40 (p=0.539). One year after surgery, patients report an increase on physical activity and sports practice compared to preoperative status, nonetheless, none reached the same prelesional tier regardless of the technique employed. No statistical differences were found on this item when comparing groups (p=0.502). 79.2% of patients reported to be satisfied with the procedure showing no differences between techniques (p=0.241). Globally, patients have an improvement on quality of life during the first year. The AM group received higher scores than TT group on Social Function (p=0.045) and Mental Health (p=0.024). Conclusion: ACL reconstruction is a surgical technique that offers good clinical results with high percentage of patient satisfaction. The anteromedial technique (AM) achieves a more anatomically accurate plasty with better biomechanical control of the internal rotation (IR); however, this does not translate to a functional superiority upon clinical assessment. Cartilage lesions condition clinical results and are linked to greater chronicity of the ACL lesion

Estudio comparativo de la estabilidadrotacional y traslacional de dos técnicas quirúrgicas de reconstrucción del ligamento cruzado anterior mediante cirugía guiada por navegador: técnica monotúnel no anatómica vs técnica anteromedial anatómica

Objetivo: Comparar las técnicas de reconstrucción del LCA por portal Anteromedial (AM) y la técnica monotúnel o Transtibial modificada (TT) desde el punto de vista biomecánico, anatómico y clínico a corto plazo, con un seguimiento mínimo de 1 año. Hipótesis del estudio: La técnica AM reproduce mejor la anatomía y biomecánica de la rodilla con el consiguiente mejor resultado clínico. Material y Métodos: Estudio prospectivo y aleatorizado en 106 pacientes afectos de ruptura crónica del LCA (55 AM, 51 TT) entre julio de 2010 y marzo de 2013. No existen diferencias significativas en edad media, sexo, IMC, cronicidad de la lesión, presencia de meniscopatía y condropatía y de laxitud preoperatoria, valorada con navegación, entre los dos grupos. Para el estudio anatómico de la plastia se utilizó la RNM valorando la angulación de la plastia en los planos coronal y sagital. La biomecánica de la plastia se valoró, a tiempo 0, con ayuda del navegador Orthopilot® obteniendo datos de traslación anteroposterior (AP), rotación interna (RI) y rotación externa (RE) en el preoperatorio y postoperatorio inmediatos. La valoración clínica se llevó a a cabo en el preoperatorio, a los 6 meses y al año de la cirugía con un seguimiento mínimo de 1 año. Se han utilizado las escalas de función de la rodilla IKDC, Lysholm, Tegner y el cuestionario de calidad de vida SF-36. La satisfacción del procedimiento se ha valorado con el cuestionario SAPS. El mecanismo lesional más común son los accidentes deportivos en el 70% (fútbol 46%, esquí 14%, básquet 8%) En el 8% la causa fueron los accidentes de tráfico. Resultados: El 60,4% de los pacientes presenta lesión meniscal y el 16% lesión condral. La presencia de condropatía condiciona el resultado clínico al año de la cirugía (IKDC 83,07 vs 63,23; p=0,000). Los pacientes con condropatía presentan mayor cronicidad de la lesión (77,18 meses vs 27,86 meses; p=0,000). La valoración con navegador a tiempo 0 indica que ambas técnicas mejoran de manera significativa la laxitud traslacional y rotacional en relación a los valores preoperatorios (p=0,000). La técnica AM mejora la laxitud AP en 8,76 mm (62,80%), la RI en 4,94º (27,87%) y la RE en 2º (11,89%). La técnica TT mejora la laxitud AP en 8,92 mm (63,37%), la RI en 3,82º (22,99%) y la RE en 2,71º (15,88%). La técnica AM es superior únicamente en el control de la RI (p=0,016). La laxitud rotacional a tiempo 0, valorada con la maniobra de pívot shift, no evidencia diferencias entre técnicas (p=0,146). El estudio de la orientación de la plastia muestra que la técnica AM consigue una plastia más anatómica tanto en el plano sagital (53,17º vs 59,5º; p=0,002) como en el plano coronal (73,66º vs 79,70º; p=0,016). Ambas técnicas producen una mejoría clínica significativa en las escalas IKDC y Lysholm en relación a los valores preoperatorios (p=0,000) pero sin diferencias entre ellas. El IKDC al año con técnica AM es de 79,71 y con técnica TT de 79,82 (p=0,976). El Lysholm al año de la cirugía con técnica AM es de 84,27 y con técnica TT de 86,40 (p=0,539). Los pacientes realizan, al año de la cirugía, más actividad deportiva que en preoperatorio pero no alcanzan el nivel prelesional y sin diferencias entre técnica AM y TT (p=0,502). El 79,2% está satisfecho con el procedimiento sin diferencias entre grupos (p=0,241). La calidad de vida de los pacientes mejora progresivamente durante el primer año en el global de los pacientes sin diferencias entre ambas técnicas. Conclusión: La reconstrucción del LCA es una técnica que ofrece un buen resultado clínico con un alto porcentaje de satisfacción. La técnica AM consigue una plastia más anatómica con una mejor biomecánica de la plastia en el control de la rotación interna pero esto no se traduce en una superioridad clínica. La lesión condral condiciona el resultado clínico y se relaciona con un mayor tiempo de evolución de la lesión del LCA.Purpose: To compare anteromedial (AM) and one-tunnel or modified transtibial (TT) ACL reconstruction techniques from a biomechanical and anatomic point of view as well as short-term results with a minimum of one-year follow-up. Hypothesis: AM technique better reproduces anatomical and biomechanical aspects of the knee providing thusly a better clinical result. Methods: Prospective randomized study of 106 patients with a chronic rupture of the ACL (55 patients underwent AM technique and 51 patients TT technique) between July 2010 and March 2013.. No statistically significant differences were found between the two groups in terms of age, gender, body mass index, chronicity of the lesion, associated meniscopathy or chondropathy and preoperative joint laxity which was determined with computer navigation. Magnetic resonance imaging was used for the anatomical study of the ligament-plasty and its angulations measured on both a sagital and coronal plane. Biomechanical behavior of the plasty was assessed at 0 time with the help of Orthopilot® computer navigation system obtaining measurements on anteroposterior translation (AP), internal rotation (IR) and external rotation (ER) immediately pre- and postoperative. Clinical evaluation was performed preoperatively, at 6 months and 1 year after surgery with a one-year minimum follow-up. IKDC, Lysholm and Tegner functionality scales and the SF-36 quality of life questionnaire were used. Patient's satisfaction with the surgical procedure was evaluated using SAPS questionnaire. The most frequent injury mechanism, up to 70% of the cases, was sports related (football 46%, skiing 14%, basketball 8%). In 8% motor accident. Results: 60.4% of patients had an associated menisci lesion and 16% a chondral lesion. The presence of a cartilage lesion conditions clinical results at one year post-surgery (IKDC 83.07 vs. 63.23; p=0.000). Patients with chondropathy had higher lesion chronicity (77.18 months vs. 27.86 months; p=0.000). Computer navigation assessment at time 0 showed that both techniques significantly ameliorate translational and rotational laxity when compared to preoperative results (p=0,000). The AM surgical technique improved AP laxity in 8.76mm (62.80%), IR in 4.94 degrees (27.87%) and ER in 2 degrees (11.98%). The TT technique improved AP laxity in 8,92mm (63.37%), IR in 3.82 degrees (22.99%) and ER in 2.71 degrees (15.88%). The AM technique proved to be superior only in controlling IR (p=0.016). Rotational laxity assessed with the pivot-shift maneuver showed no differences between groups (p=0.146). Regarding anatomical study on plasty's orientation, AM technique achieves a more anatomical orientation in both sagital (53.17º vs. 59.50º; p=0.002) and coronal plane (73.66º vs. 79.70º; p=0,016). Both groups reported a substantial improvement on IKDC and Lysholm functionality scales, when compared with preoperative punctuations (p=0.000), with no significant differences between techniques. The result of IKDC scale at one year post surgery in the AM group was 79.71 and in the TT group 79.82 (p=0.976). Regarding Lysholm scale at 1-year follow-up, AM group scored 84.27 and the TT group 86.40 (p=0.539). One year after surgery, patients report an increase on physical activity and sports practice compared to preoperative status, nonetheless, none reached the same prelesional tier regardless of the technique employed. No statistical differences were found on this item when comparing groups (p=0.502). 79.2% of patients reported to be satisfied with the procedure showing no differences between techniques (p=0.241). Globally, patients have an improvement on quality of life during the first year. The AM group received higher scores than TT group on Social Function (p=0.045) and Mental Health (p=0.024). Conclusion: ACL reconstruction is a surgical technique that offers good clinical results with high percentage of patient satisfaction. The anteromedial technique (AM) achieves a more anatomically accurate plasty with better biomechanical control of the internal rotation (IR); however, this does not translate to a functional superiority upon clinical assessment. Cartilage lesions condition clinical results and are linked to greater chronicity of the ACL lesion

Rethinking Trauma Hospital Services in one of Spain's Largest University Hospitals during the COVID-19 pandemic. How can we organize and help? Our experience

The severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals' current service needs during this pandemic. The aim is to share our experiences and outcomes during the first month of the Covid-19 pandemic, based on the strategies recommended and strategies we have implemented. Our experience comes from our work at a referral hospital within the Spanish National Health System. Changes to clinical practice have largely been guided by the current evidence and four main principles: (1) patient and health-care worker protection, (2) uninterrupted necessary care, (3) conservation of health-care resources, (4) uninterrupted formation for residents. Based on these principles, changes in the service organization, elective clinical visits, emergency visits, surgical procedures, and inpatient and outpatient care were made. Using the guidance of experts, we were able to help the hospital address the demands of the Covid-19 outbreak. We reduced to a third of our orthopaedics and trauma hospital beds, provided coverage for general emergency services, and five ICUs, all continuing to provide care for our patients, in the form of 102 trauma surgeries, 6413 phone interviews and 520 emergency clinic visits. Also in the third week, we were able to restart morning meetings via telematics, and teaching sessions for our residents. On the other hand, eight of the healthcare personnel on our service (10.8%) became infected with Covid-19. As priorities and resources increasingly shift towards the COVID-19 pandemic, it is possible to maintain the high standard and quality of care necessary for trauma and orthopaedics patients while the pandemic persists. We must be prepared to organize our healthcare workers in such a way that the needs of both inpatients and outpatients are met. It is still possible to operate on those patients who need it. Unfortunately, some healthcare workers will become infected. It is essential that we protect those most susceptible to severer consequences of Covid-19. Also crucial are optimized protective measures

Allografts and lateral extra-articular tenodesis for revision anterior cruciate ligament reconstruction: enhanced rotational stability and improved functional outcomes

Altres ajuts: acord transformatiu CRUE-CSICPurpose: Multiple studies have shown higher failure rate and patient-reported outcomes to be significantly worse following revision anterior cruciate ligament reconstructive (ACLR) surgery, especially using allografts. One of the reasons being rotational instability. Because of this, augmentation with lateral extra-articular tenodesis (LET) is often considered. Good short-term results in regards to functional and perceived scores and low complication rate can be expected in revision ACLR using allografts in combination with LET. Methods: Between 2014 and 2021, 46 patients were registered for revision ACLR using allografts and extra-articular augmentation (modified Lemaire) and included in this prospective study. Patients' demographic and clinical data were collected preoperatively, postoperatively, and during the follow-up period of 12 months. Results: Patient-reported functional outcomes were statistically significant for IKDC, Lysholm, and SF-12 physical scale (p < 0.05). Tegner score showed a decreased number of patients who were able to return to sport at their previous level (p = 0.001). Stability examination tests (Lachman and pivot-shift) showed significant improvements. Concomitant lesions were present in 76.1% of patients. Ten patients (21.7%) presented major complications, including six cases of anteroposterior instability, three cases of knee pain and one graft re-rupture. Conclusion: Revision procedures are inherently challenging with a high number of associated chondral and meniscus lesions. However, good short-term functional outcomes and enhanced rotational stability with an acceptable complication rate can be expected in most cases where revision ACLR using allografts is augmented with LET