Inestabilidad patelofemoral en niños con Síndrome de Down

La inestabilidad patelofemoral en el síndrome de Down se presenta en el contexto de hiperlaxitud e inmadurez esquelética suponiendo un reto en el tratamiento. Nuestro objetivo es valorar el resultado clínico-funcional de la cirugía de partes blandas, en estos pacientes hiperlaxos e inmaduros esqueléticamente. Hemos revisado retrospectivamente a los pacientes con síndrome de Down e inmadurez esquelética intervenidos por inestabilidad patelofemoral con seguimiento hasta el cierre fisario. Seis pacientes (9 rodillas) con media de edad de 12,4 años fueron incluidos. El grado de inestabilidad patelofemoral prequirúrgica (clasificación de Dugdale) mostró 1 (11,1%) caso grado 2; 2 (22,2%) casos grado 3 y 6 (66,6%) casos grado 4. El grado de función patelar (según Insall) al alcanzar la madurez esquelética fue malo en un caso (recidiva de la luxación), bueno en 2 y excelente en 6. En definitiva, los procedimientos sobre partes blandas pueden ser suficientes en pacientes con síndrome de Down.Patelofemoral instability in Down syndrome´s patients appears in hiperlaxity and open physis context. Our aim is to make a retrospective clinical-functional assessment of the soft tissue procedure treatment of patellofemoral instability in patients with Down Syndrome skeletally immature (open physeal), following them until the physeal closure. We have included six patients (9 knees) with a mean age of 12.4 years old. Patellar instability (Dugdale´s classification) distribution was 1 (11.1%) cases degree ll; 2 (22.2%) cases degree lll and 6 (66.6%) cases degree IV. Patellar function assessed by Insall score at follow up was excellent in 6 of the cases, good in 2 cases and bad in one case (recurrent dislocation). In summary, a proximal soft tissues procedure in Down syndrome patients could be enough for patellar instability treatment

Osteoma osteoide de rodilla Dos casos de difícil diagnóstico

Presentamos dos casos de osteoma osteoide yuxtacortical de localización infrecuente en la rodilla y de difícil diagnóstico. La gammagrafía reveló la localización de la lesión y la tomografía axial computerizada (TAC) en cortes finos indicó el lugar exacto, facilitando así la planificación del abordaje quirúrgico de la zona. La resonancia magnética no aportó datos de interés. Tras la cirugía, la sintomatología previa remitió completamente en ambos casos.We present two cases of osteoid osteoma affecting the knee, a very infrequent localization and therefore of difficult diagnosis. The scintigraphy was found to be of valuable assitance in revealing the presence of this lesion at the knee and CT-scan was likewise useful for its precision in localizing the tumor as a basis for deciding upon a viable surgical approach. MRI did not contribute some date. After surgical resection of the tumor, a complete relief of the symptoms was experienced in both patients

Tratamiento artroscópico de las lesiones meniscales estudio retrospectivo de 484 casos

Se analizan retrospectivamente 484 procedimientos artroscópicos realizados entre 1980 y 1993, en los que se encontró patología meniscal. La edad de los pacientes estudiados osciló entre los 6 a los 77 años (media de 37). En 447 casos la lesión afectó a un solo menisco. El menisco interno fue el más afectado (344 vs 167). La edad media de las lesiones traumáticas (30 años) fue menor que la de las degenerativas (50 años), ocupando las complejas —lesiones mixtas de difícil explicación etiológica— una posición intermedia (40 años). El daño del cartílago fue la lesión asociada más frecuente, observándose hasta en un 64% afectación del compartimento femoropatelar. El 25% presentaron lesiones del LCA. En las lesiones agudas se observó con más frecuencia la afectación del menisco externo y en las crónicas la del interno. El tratamiento habitual fue la meniscectomía parcial obteniendo resultados a corto plazo satisfactorios en el 9 1% de los casos. No encontramos en nuestra serie complicaciones mayores como infección, parálisis nerviosas o lesiones vasculares.A total of 484 arthroscopy procedures preformed from 1980 to 1993 in cases with meniscal lesions, have been studied retrospectively. The age of patients ranged from 6 to 77 years (mean 37). In 447 cases, the lesion was localized in only one of the meniscus. Patients with traumatic lesion presented a mean age (30 years) inferior to those with degenerative lesions (50 years), complex lesion ocuping a intermediate situation (40 year). Cartilagionous degeneration was found to be the most frequent associated lesion. In 64% of the procedures the cartilage of the femoropatelar compartiment was also affected. In 25% of the knees ACL injuries ware observed. ACL acute lesions were seen more frecuently in external meniscus lesions and ACL chronic lesions in internal meniscus lesions. The standard therapeutic procedure was partial meniscectomy. Satisfactory results were achieved in 9 1% of case. No mayor complications (septic artrhitis, neurologic palsy or vascular lesions) were seen

Regeneración meniscal tras extirpación completa del menisco medial y sustitución por una bandeleta de tendón rotuliano: Estudio experimental con conejos

Los autores estudian la regeneración meniscal tras meniscectomía total y sustitución del menisco por una plastia de tendón rotuliano. Realizan el estudio en 15 conejos, que fueron sacrificados a las 6 semanas (5 casos). Los estudios macroscópico e histológico de las piezas obtenidas tras el sacrificio demuestran que en el conejo adulto siempre se produce regeneración meniscal tras la extirpación total del menisco medial y sustitución por una plastia, aunque de menor tamaño que el menisco original resecado.The authors analyse the meniscal regeneration after complete menis-cectomy and posterior meniscal substitution by a patellar tendon plasty. The study is realized in15 rabbits that were sacrificed after 6 weeks (5 cases), 3 months (5 cases) and 6 months (5 cases). Macroscopic and histologic studies of the pieces obtained have demonstrated that in the adult rabbit meniscal regeneration is always produced after total meniscectomy of the medial meniscus and posterior substitution by patellar tendon plasty, but this meniscal regeneration is smaller than the resected primitive meniscus

Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: long-term follow up of a multicenter randomized controlled clinical trial (phase I/II)

Background: Mesenchymal stromal cells (MSCs) are a promising option to treat knee osteoarthritis (OA). Their safety and usefulness have been reported in several short-term clinical trials but less information is available on the longterm efects of MSC in patients with osteoarthritis. We have evaluated patients included in our previous randomized clinical trial (CMM-ART, NCT02123368) to determine their long-term clinical efect. Materials: A phase I/II multicenter randomized clinical trial with active control was conducted between 2012 and 2014. Thirty patients diagnosed with knee OA were randomly assigned to Control group, intraarticularly administered hyaluronic acid alone, or to two treatment groups, hyaluronic acid together with 10×106 or 100×106 cultured autol‑ ogous bone marrow-derived MSCs (BM-MSCs), and followed up for 12 months. After a follow up of 4 years adverse efects and clinical evolution, assessed using VAS and WOMAC scorings are reported. Results: No adverse efects were reported after BM-MSCs administration or during the follow-up. BM-MSCs-adminis‑ tered patients improved according to VAS, median value (IQR) for Control, Low-dose and High-dose groups changed from 5 (3, 7), 7 (5, 8) and 6 (4, 8) to 7 (6, 7), 2 (2, 5) and 3 (3, 4), respectively at the end of follow up (Low-dose vs Control group, p=0.01; High-dose vs Control group, p=0.004). Patients receiving BM-MSCs also improved clinically accord‑ ing to WOMAC. Control group showed an increase median value of 4 points (−11;10) while Low-dose and Highdose groups exhibited values of −18 (−28;−9) and −10 (−21;−3) points, respectively (Low-dose vs Control group p=0.043). No clinical diferences between the BM-MSCs receiving groups were found. Conclusions: Single intraarticular injection of in vitro expanded autologous BM-MSCs is a safe and feasible proce‑ dure that results in long-term clinical and functional improvement of knee OA

Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft

The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p = 0.897; sidewalk invasions, p = 0.749; pedestrian impact, p = 0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right-left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries

Do we really improve life quality after total knee arthroplasty in patients with Parkinson’s disease?

Introduction The knee in Parkinson’s disease (PD) patients is a problematic joint due to pain, stifness and gait instability. The aim of this study is to evaluate the functional outcome and degree of pain relief achieved after total knee arthroplasty (TKA) in PD patients. Materials and methods This is a retrospective review of 26 PD patients (32 knees) with osteoarthritis who underwent a TKA between 1994 and 2013. Comorbidities, anesthetic procedures and complications were recorded. Patient functional status was assessed with the Knee Society Function Score (KFS) and the Knee Society Score (KSS). PD stage was classifed with the Hoehn and Yahr Scale. Results The mean follow-up was 3.5 years (range 2–9). The mean age was 71 years (range 61–83) with a mean time since PD diagnosis of 11.8 years (range 4–24). PD severity on the Hoehn and Yahr Scale was 1.5 points before surgery and 2 points postoperatively. Pain on the visual analogic scale improved from 8 points preoperatively to 5 points at 1-year follow-up; function improved from 32 (range 20–45) to 71 (range 50–81) and from 34 (range 28–52) to 59 (range 25–76) on the KSS and KFS, respectively. The mean postoperative hospital stay was 9.8 days (range 5–21). Confusion and fexion contracture were the most frequent perioperative complications. Conclusion TKA successfully provided pain relief in PD patients. However, the functional outcome is related to disease progression and, therefore, variable. Perioperative complications are difcult to avoid and manage

Reconstruction of the extensor mechanism with fresh-frozen tendon allograft in total knee arthroplasty

Purpose: Patellar tendon rupture after total knee replacement is a rare and highly limiting injury with multifactorial aetiology. Many reconstruction techniques have been described with not very predictable results. The use of allografts has been accepted as a suitable solution. Methods: A series of seven patients with patellar tendon rupture treated with fresh-frozen tendon allograft reconstruction after knee arthroplasty is presented. Results: Median follow-up is 25 months (20-31). Functional assessment improved, and the knee society score and knee functional score improved from 26 and 16 to 82 and 55, respectively. Median extension lag was 5° (0°-20°), with a median range of motion of 95° (70-100). Radiological study showed a rise of the patella of 22.26 mm. Conclusion: The use of fresh-frozen allografts as a solution to patellar tendon ruptures after knee arthroplasty seems to provide acceptable results. Increased patellar height does not seem to affect functionality

Cemented Dual Mobility Cup for Primary Total Hip Arthroplasty in Elder Patients with High-Risk Instability

Several studies have shown that double mobility (DM) cups reduce postoperative dislocations. Does the cemented dual mobility cup reduce dislocations in a specific cohort of elder patients with a high dislocation risk? Our hypothesis is that this implant is optimal for elder patients because it reduces early dislocation. We have retrospectively reviewed elder patients who underwent total hip arthroplasty (THA) with cemented double mobility cup between March 2009 and January 2018. The inclusion criteria were patients (>75 years) who were operated on for primary THA (osteoarthritis or necrosis) with a cemented dual mobility cup and a high-risk instability (at least two patient-dependent risk factors for instability). The exclusion criteria were revision surgeries or hip fracture. In all the cases, the same surgical approach was performed with a Watson Jones modified approach in supine position. We have collected demographic data, instability risk factors. Patients were classified using the Devane’s score, Merle d’Aubigné score and the patient’s likelihood of falling with the Morse Fall Scale. Surgical and follow-up complications were collected from their medical history. Sixty-eight arthroplasties (68 patients) were included in the study. The median age was 81.7 years (SD 6.4), and the American Society of Anesthesiologists (ASA) score showed a distribution: II 27.94%, III 63.24% and IV 8.82%. Devane’s score was less than five in all of the cases. At least two patient-dependent risk factors for instability (87% had three or more) were present in each case. The median follow-up time was 49.04 months (SD 22.6). Complications observed were two cases of infection and one case of aseptic loosening at 15 months which required revision surgery. We did not observe any prosthetic dislocation. The cemented dual mobility cup is an excellent surgical option on primary total hip arthroplasties for elder patients with high-risk instability