Quins implants usar en la ruptura de lligament encreuat?

El debat actual en el tractament de la ruptura de lligament encreuat es centra en el tipus d'implants a utilitzar per a la reconstrucció del lligament. Dos casos d'implants reabsorbibles estudiats per investigadors de l'Hospital del Mar han permès ara definir i diagnosticar una lesió provocada per aquests implants.El debate actual en el tratamiento de la ruptura de ligamento cruzado se centra en el tipo de implantes a utilizar para su reconstrucción. Dos casos de implantes reabsorbibles estudiados por investigadores del Hospital del Mar han permitido ahora definir y diagnosticar una lesión provocada por los mismos

A lower starting point for the medial cut increases the posterior slope in opening‑wedge high tibial osteotomy: a cadaveric study

Abstract Purpose: The objective of this study was to evaluate the effects on the posterior tibial slope of different distances from the joint line to start the osteotomy and of varying the placement of the opening wedge in high tibial osteotomy. Starting the osteotomy more distally and an incorrect location for the tibial opening wedge were hypothesized to increase the posterior tibial slope. Methods: A cadaveric study was conducted using 12 knees divided into two groups based on the distance from the joint line to the start of the osteotomy: 3 and 4 cm. The preintervention posterior tibial slope was measured radiologically. Once the osteotomy was performed, the medial cortex of the tibia was divided into anteromedial, medial, and posteromedial thirds. A 10° opening wedge was sequentially placed in each third, and the effect on the posterior tibial slope was evaluated radiographically. Results: Significant changes were observed only in the 3-cm group (p = 0.02) when the wedge was placed in the anteromedial zone. In contrast, in the 4-cm group, significant differences were observed when the opening wedge was placed at both the medial (p = 0.04) and anteromedial (p = 0.012) zones. Conclusion: Correct control of the posterior tibial slope can be achieved by avoiding a low point when beginning the osteotomy and placing the opening wedge in the posteromedial third of the tibia when performing an openingwedge high tibial osteotomy. Level of evidence: Controlled laboratory study. Keywords: Anterior cruciate ligament, Cadaveric study, Lateral knee X-ray, Medial starting point, Posterior tibial slope, Opening-wedge high tibial osteotomy, Osteotomy, Proximal anatomical axi

Three-dimensional-printed patient-specific instrumentation is an accurate tool to reproduce femoral bone tunnels in multiple-ligament knee injuries

Altres ajuts: acords transformatius de la UABMultiple-ligament knee reconstruction techniques often involve the creation of several bone tunnels for various reconstruction grafts. A critical step in this procedure is to avoid short tunnels or convergences among them. Currently, no specific template guide to reproduce these angulations has been reported in the literature, and the success of the technique still depends on the experience of the surgeon. The aim of this study is to analyze the accuracy and reliability of 3D-printed patient-specific instrumentation (PSI) for lateral and medial anatomical knee reconstructions. Ten cadaveric knees were scanned by computed tomography (CT). Using specific computer software, anatomical femoral attachments were identified: (1) on the lateral side the lateral collateral ligament (LCL) and the popliteal tendon (PT) and (2) on the medial side the medial collateral ligament (MCL) and the posterior oblique ligament (POL). Four bone tunnels were planned for each knee, and PSI with different directions were designed as templates to reproduce the planned tunnels during surgery. Twenty 3D-printed PSI were used: ten were tailored to the medial side for reconstructing MCL and POL tunnels, and the other ten were tailored to the lateral side for reconstructing LCL and PT tunnels. Postoperative CT scans were made for each cadaveric knee. The accuracy of the use of 3D-printed PSI was assessed by superimposing post-operative CT images onto pre-operative images and analyzing the deviation of tunnels performed based on the planning, specifically the entry point and the angular deviations. The median entry point deviations for the tunnels were as follows: LCL tunnel, 1.88 mm (interquartile range (IQR) 2.2 mm); PT tunnel, 2.93 mm (IQR 1.17 mm); MCL tunnel, 1.93 mm (IQR 4.26 mm); and POL tunnel, 2.16 mm (IQR 2.39). The median angular deviations for the tunnels were as follows: LCL tunnel, 2.42° (IQR 6.49°); PT tunnel, 4.15° (IQR 6.68); MCL tunnel, 4.50° (IQR 6.34°); and POL tunnel, 4.69° (IQR 3.1°). No statistically significant differences were found in either the entry point or the angular deviation among the different bone tunnels. The use of 3D-printed PSI for lateral and medial anatomical knee reconstructions provides accurate and reproducible results and may be a promising tool for use in clinical practice

A lower starting point for the medial cut increases the posterior slope in opening-wedge high tibial osteotomy : a cadaveric study

The objective of this study was to evaluate the effects on the posterior tibial slope of different distances from the joint line to start the osteotomy and of varying the placement of the opening wedge in high tibial osteotomy. Starting the osteotomy more distally and an incorrect location for the tibial opening wedge were hypothesized to increase the posterior tibial slope. A cadaveric study was conducted using 12 knees divided into two groups based on the distance from the joint line to the start of the osteotomy: 3 and 4 cm. The preintervention posterior tibial slope was measured radiologically. Once the osteotomy was performed, the medial cortex of the tibia was divided into anteromedial, medial, and posteromedial thirds. A 10° opening wedge was sequentially placed in each third, and the effect on the posterior tibial slope was evaluated radiographically. Results: Significant changes were observed only in the 3-cm group (p = 0.02) when the wedge was placed in the anteromedial zone. In contrast, in the 4-cm group, significant differences were observed when the opening wedge was placed at both the medial (p = 0.04) and anteromedial (p = 0.012) zones. Correct control of the posterior tibial slope can be achieved by avoiding a low point when beginning the osteotomy and placing the opening wedge in the posteromedial third of the tibia when performing an opening-wedge high tibial osteotomy. Controlled laboratory study

Diagnostic yield of 18F-FDG PET/CT in suspected diagnosis of vascular graft infection: A prospective cohort study

Background. Prosthetic vascular graft infection (PVGI) is a severe complication associated with high morbidity and mortality. Clinical diagnosis is complex, requiring image testing such as CT angiography or leukocyte scintigraphy, which has considerable limitations. The aim of this study was to know the diagnostic yield of PET/CT with 18F-Fluorodeoxyglucose (18F-FDG) in patients with suspected PVGI. Methods. We performed a prospective cohort study including 49 patients with suspected PVGI, median age of 62 ± 14 years. Three uptake patterns were defined following published recommendations: (i) focal, (ii) patched (PVGI criteria), and (iii) diffuse (no PVGI criterion). Results. Sensitivity, specificity, and positive and negative predictive values for 18F-FDG-PET/ CT were 88%, 79%, 67%, and 93%, respectively. 18F-FDG-PET/CT identified 14/16 cases of PVGI showing a focal (n = 10) or patched pattern (n = 4), being true negative in 26/33 cases with either a diffuse pattern (n = 16) or without uptake (n = 10). Five of the seven false-positive cases (71%) showed a patched pattern and all coincided with the application of adhesives for PVG placement. Conclusions. 18F-FDG-PET/CT is a useful technique for the diagnosis of PVGI. A patched pattern on PET/CT in patients in whom adhesives were applied for prosthetic vascular graft placement does not indicate infection. (J Nucl Cardiol 2018) Key Words: Fluorodeoxyglucose (FDG) Æ diagnostic and prognostic application Æ PET/CT imagin

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

Utilitat de l’algometria de pressió en el diagnòstic i seguiment del dolor tibial al compartiment medial del genoll var i al de la punta de tija protètica

INTRODUCCIÓ L’algometria de pressió és una tècnica no invasiva que permet determinar el llindar d’aparició de dolor en un determinat punt del cos humà a partir d’una pressió local progressiva en el lloc d’ estudi. Existeixen, entre altres, dos trastorns que poden provocar dolor tibial. El primer es presenta en els pacients amb un genoll var simptomàtic, que refereixen dolor al compartiment tibial intern. Un dels tractaments definits per millorar aquest quadre àlgic és la osteotomia valguitzant tibial. El segon és el dolor a la punta de la tija tibial, que es pot produir en els pacients als que se’ls ha practicat un recanvi protètic amb una tija tibial no cimentada. L’objectiu del treball és valorar l’ utilitat potencial de l’ algometria de pressió per poder quantificar el grau de dolor tibial en aquests dos processos. MATERIAL I MÈTODE 1. Validació del mètode de l’algometria de pressió aplicada al compartiment intern del genoll i a la diàfisi tibial. Dos investigadors van realitzar un estudi de correlació intra- i interobservador en un grup de 50 voluntaris sans i als dos punts d’estudi. 2. Estudi prospectiu en un grup de pacients portadors d’una pròtesi total de genoll amb tija tibial no cementada. De forma prospectiva es van avaluar 40 pacients pendents de col.locació d’una pròtesi total de genoll amb una tija tibial no cementada. Les mesures es van realitzar durant el periode preoperatori i un any després de la intervenció. Es van registrar dades epidemiològiques, radiològiques i funcionals. 3. Estudi prospectiu en un grup de pacients amb un genu var preartròsic pendents d’una osteotomia valguitzant tibial. Treball prospectiu en un grup de 20 pacients amb un genoll var preartròsic simptomàtic. Es va determinar el llindar d’aparició de dolor a la cara medial de la tíbia, 1 cm per sota de la interlínia articular. Les mesures es van prendre durant el preoperatori i 6 mesos després de la intervenció. RESULTATS 1. Validació del mètode de l’ algometria de pressió aplicada al compartiment intern del genoll i a la diàfisi tibial. En el cas de l’estudi a nivell de la metàfisi interna tibial, el grau de correlació mínima intra i interobservador va ser del 0,87 (0,73-0,9) i 0,84 (0,73-0,9) respectivament. Pel que fa a l’estudi de correlació a nivell de la diàfisi tibial, el grau de correlació mínim intra i interobservador va ser del 0,91 (0,84-0,95) i 0,86 (0,74-0,92) respectivament. 2. Estudi prospectiu en un grup de pacients portadors d’una pròtesi total de genoll amb tija tibial no cementada. En el grup de pacients que van manifestar dolor a la punta de la tija protètica, els valors del llindar d’aparició de dolor no van mostrar diferencies significatives respecte els preoperatoris. 3. Estudi prospectiu en un grup de pacients amb genoll var preartròsic intervinguts d’ osteotomia valguitzant tibial. Es va observar un augment significatiu (p=0,08) en el llindar d’aparició del dolor al compartiment intern, amb una mitjana d’augment de 213,9 KPa. L’ escala d’ EVA va presentar una millora mitjana de 3,8 punts respecte la situació preoperatòria. CONCLUSIONS 1. L’algometria de pressió presenta una excel·lent correlació intra i interobservador quan s’aplica a nivell de la metàfisi proximal i a la diàfisi de la tíbia. 2. L’algometria de pressió no és una tècnica útil pel diagnòstic de dolor en punta de tija tibial. 3. L’algometria de pressió és una tècnica útil per quantificar el grau de millora del dolor compartimental intern en pacients intervinguts d’una osteotomia valguitzant tibial.INTRODUCTION Pressure algometry is a non invasive technique that determins the pressure pain threshold (PPT) by applying progressive localized pressure to a part of the body. There are some issues which can cause tibial pain. First, is presented in patients exhibiting pain at the medial side of the knee with varus disalignement. One of the accepted surgical methods for this problem is a valgus tibial osteotomy. And second, pain at the end of the tibial stem in patients who have undergone a knee surgery with a Total Knee Replacement using a noncemented stem. The main objective of this work is to evaluate the potential utility of pressure algometry to be able to quantify tibial pain in these two situations. METHODS 1. Validation of the pressure algometry technique applied to the medial compartment of the knee and to the diaphysis of the tibia. Two independent researchers performed a preliminary intra- and interrater correlation study in a group of 50 healthy volunteers in these two locations. 2. Prospective study in a group of patients who underwent a total knee replacement by using a noncemented tibial stem. We evaluated prospectively a group of 40 patients waiting for a total knee replacement with a noncemented tibial stem. All measurements were performed preoperatively and one year postoperatively. We also registered epidemiological, functional and radiological data. 3. Prospective study in a group of patients with a simptomatic varus knee and waiting for a tibial valgus osteotomy. We prospectively evaluated a group of 20 patients with simptomatic varus knees waiting for a valgus tibial osteotomy. We registered the epidemiological data and PPT at the medial side of the tibia, 1 cm below the joint line. All measurements were performed preoperatively and at 6 months postoperatively. RESULTS 1. Validation of the pressure algometry technique applied to the medial compartment of the knee and to the diaphysis of the tibia. The intraclass correlation coeficient (ICC) was excellent in all measurements. In the study evaluating medial side of the knee the minimum intra- and interrater correlation was 0,87 (0,73-0,9) and 0,84 (0,73-0,9) respectively. In the case evaluating the tibial shaft, the minimum intra- and interrater correlation was 0,91 (0,84-0,95) and 0,86 (0,74-0,92) respectively. 2. Prospective study in a group of patients who underwent a total knee replacement by using a noncemented tibial stem. In the group of patients who presented pain at the end of the tibial stem, there were no significant differences in the values of the pressure pain threshold compared to the preoperative measurements. 3. Prospective study in a group of patients with a simptomatic varus knee and waiting for a tibial valgus osteotomy. We observed a significant increase of the pressure pain threshold (p=0,08) at the medial side of the tibial epiphysis with a mean of 213,9 Kpa. The VAS scale presented a mean of decreasing value of 3,8 compared to the preoperative evaluation. CONCLUSIONS 1. Pressure algometry has an excellent intra- and interrater correlation when it’s applied to the proximal tibial epiphysis and at the tibial shaft. 2. Pressure algometry is not a useful method to diagnose tibial pain at the end of stem in total knee replacement. 3. Pressure algometry is a useful method to quantify the degree of improvement of pain at the medial side of the tibial epiphysis in patients who underwent a valgus tibial osteotomy

Utilitat de l'algometria de pressió en el diagnòstic i seguiment del dolor tibial al compartiment medial del genoll var i al de la punta de tija protètica

INTRODUCCIÓ L'algometria de pressió és una tècnica no invasiva que permet determinar el llindar d'aparició de dolor en un determinat punt del cos humà a partir d'una pressió local progressiva en el lloc d' estudi. Existeixen, entre altres, dos trastorns que poden provocar dolor tibial. El primer es presenta en els pacients amb un genoll var simptomàtic, que refereixen dolor al compartiment tibial intern. Un dels tractaments definits per millorar aquest quadre àlgic és la osteotomia valguitzant tibial. El segon és el dolor a la punta de la tija tibial, que es pot produir en els pacients als que se'ls ha practicat un recanvi protètic amb una tija tibial no cimentada. L'objectiu del treball és valorar l' utilitat potencial de l' algometria de pressió per poder quantificar el grau de dolor tibial en aquests dos processos. MATERIAL I MÈTODE 1. Validació del mètode de l'algometria de pressió aplicada al compartiment intern del genoll i a la diàfisi tibial. Dos investigadors van realitzar un estudi de correlació intra- i interobservador en un grup de 50 voluntaris sans i als dos punts d'estudi. 2. Estudi prospectiu en un grup de pacients portadors d'una pròtesi total de genoll amb tija tibial no cementada. De forma prospectiva es van avaluar 40 pacients pendents de col·locació d'una pròtesi total de genoll amb una tija tibial no cementada. Les mesures es van realitzar durant el periode preoperatori i un any després de la intervenció. Es van registrar dades epidemiològiques, radiològiques i funcionals. 3. Estudi prospectiu en un grup de pacients amb un genu var preartròsic pendents d'una osteotomia valguitzant tibial. Treball prospectiu en un grup de 20 pacients amb un genoll var preartròsic simptomàtic. Es va determinar el llindar d'aparició de dolor a la cara medial de la tíbia, 1 cm per sota de la interlínia articular. Les mesures es van prendre durant el preoperatori i 6 mesos després de la intervenció. RESULTATS 1. Validació del mètode de l' algometria de pressió aplicada al compartiment intern del genoll i a la diàfisi tibial. En el cas de l'estudi a nivell de la metàfisi interna tibial, el grau de correlació mínima intra i interobservador va ser del 0,87 (0,73-0,9) i 0,84 (0,73-0,9) respectivament. Pel que fa a l'estudi de correlació a nivell de la diàfisi tibial, el grau de correlació mínim intra i interobservador va ser del 0,91 (0,84-0,95) i 0,86 (0,74-0,92) respectivament. 2. Estudi prospectiu en un grup de pacients portadors d'una pròtesi total de genoll amb tija tibial no cementada. En el grup de pacients que van manifestar dolor a la punta de la tija protètica, els valors del llindar d'aparició de dolor no van mostrar diferencies significatives respecte els preoperatoris. 3. Estudi prospectiu en un grup de pacients amb genoll var preartròsic intervinguts d' osteotomia valguitzant tibial. Es va observar un augment significatiu (p=0,08) en el llindar d'aparició del dolor al compartiment intern, amb una mitjana d'augment de 213,9 KPa. L' escala d' EVA va presentar una millora mitjana de 3,8 punts respecte la situació preoperatòria. CONCLUSIONS 1. L'algometria de pressió presenta una excel·lent correlació intra i interobservador quan s'aplica a nivell de la metàfisi proximal i a la diàfisi de la tíbia. 2. L'algometria de pressió no és una tècnica útil pel diagnòstic de dolor en punta de tija tibial. 3. L'algometria de pressió és una tècnica útil per quantificar el grau de millora del dolor compartimental intern en pacients intervinguts d'una osteotomia valguitzant tibial.INTRODUCTION Pressure algometry is a non invasive technique that determins the pressure pain threshold (PPT) by applying progressive localized pressure to a part of the body. There are some issues which can cause tibial pain. First, is presented in patients exhibiting pain at the medial side of the knee with varus disalignement. One of the accepted surgical methods for this problem is a valgus tibial osteotomy. And second, pain at the end of the tibial stem in patients who have undergone a knee surgery with a Total Knee Replacement using a noncemented stem. The main objective of this work is to evaluate the potential utility of pressure algometry to be able to quantify tibial pain in these two situations. METHODS 1. Validation of the pressure algometry technique applied to the medial compartment of the knee and to the diaphysis of the tibia. Two independent researchers performed a preliminary intra- and interrater correlation study in a group of 50 healthy volunteers in these two locations. 2. Prospective study in a group of patients who underwent a total knee replacement by using a noncemented tibial stem. We evaluated prospectively a group of 40 patients waiting for a total knee replacement with a noncemented tibial stem. All measurements were performed preoperatively and one year postoperatively. We also registered epidemiological, functional and radiological data. 3. Prospective study in a group of patients with a simptomatic varus knee and waiting for a tibial valgus osteotomy. We prospectively evaluated a group of 20 patients with simptomatic varus knees waiting for a valgus tibial osteotomy. We registered the epidemiological data and PPT at the medial side of the tibia, 1 cm below the joint line. All measurements were performed preoperatively and at 6 months postoperatively. RESULTS 1. Validation of the pressure algometry technique applied to the medial compartment of the knee and to the diaphysis of the tibia. The intraclass correlation coeficient (ICC) was excellent in all measurements. In the study evaluating medial side of the knee the minimum intra- and interrater correlation was 0,87 (0,73-0,9) and 0,84 (0,73-0,9) respectively. In the case evaluating the tibial shaft, the minimum intra- and interrater correlation was 0,91 (0,84-0,95) and 0,86 (0,74-0,92) respectively. 2. Prospective study in a group of patients who underwent a total knee replacement by using a noncemented tibial stem. In the group of patients who presented pain at the end of the tibial stem, there were no significant differences in the values of the pressure pain threshold compared to the preoperative measurements. 3. Prospective study in a group of patients with a simptomatic varus knee and waiting for a tibial valgus osteotomy. We observed a significant increase of the pressure pain threshold (p=0,08) at the medial side of the tibial epiphysis with a mean of 213,9 Kpa. The VAS scale presented a mean of decreasing value of 3,8 compared to the preoperative evaluation. CONCLUSIONS 1. Pressure algometry has an excellent intra- and interrater correlation when it's applied to the proximal tibial epiphysis and at the tibial shaft. 2. Pressure algometry is not a useful method to diagnose tibial pain at the end of stem in total knee replacement. 3. Pressure algometry is a useful method to quantify the degree of improvement of pain at the medial side of the tibial epiphysis in patients who underwent a valgus tibial osteotomy

Lateral Capsular Fixation : An Implant-Free Technique to Prevent Meniscal Allograft Extrusion

Although several surgical techniques have been described to perform meniscal allograft transplantation with good clinical results and although different methods of capsular stabilization can be found in the literature, there is no standard surgical technique to prevent a common complication in the most of series: the tendency to a radial displacement or extrusion of the transplanted menisci. We present a simple, reproducible, and implant-free technique to perform a lateral capsular fixation (capsulodesis) at the time of only the soft-tissue fixation technique of meniscal allograft transplantation in an effort to reduce or prevent the risk of graft extrusion. Using a minimum of two 2.4-mm tunnels drilled from the contralateral side of the tibia with the help of a regular tibial anterior cruciate ligament guide, a capsular attachment to the lateral tibial plateau is obtained