Reliability of preoperative measurement with standardized templating in Total Knee Arthroplasty

AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly, the reliability and correspondence between the size of said measurement and the actual implant utilized was determined. Secondly, the existing correlation between the intra- and interobserver determinations with the intraclass correlation coefficient was analyzed. RESULTS: An overall correspondence of 54%, improving up to 92% when the measured size admitted a difference of one size, was found. Good intra- and interobserver reliability with an intraclass correlation coefficient greater than 0.90 (P < 0.001) was also discovered. CONCLUSION: Agreement between the preoperative measurement with standardized acetate templates and the prosthetic size implanted can be considered satisfactory. We thus conclude it is a reproducible technique

Parálisis del plexo braquial por pseudoaneurisma de la arteria axilar tras luxación de hombro

Las lesiones del plexo braquial y de las arterias subclavia y axilar son complicaciones poco frecuentes, pero importantes, de los traumatismos dé la cintura escapular. Las lesiones neurovasculares son más frecuentes en heridas penetrantes, pero son raras en traumatismos cerrados. Cuando la sintomatología neurológica se desarrolla insidiosamente, días o semanas después del traumatismo, hay que pensar en una lesión vascular. Presentamos un caso de parálisis del plexo braquial tardía, en un paciente varón de 39 años, que sufrió una luxación gleno-humeral anterior diez días antes. La angiografía mostró un pseudoaneurisma de la arteria axilar y el electromiograma confirmó la parálisis del plexo braquial. El tratamiento consistió en la reparación del defecto vascular. Al año de la intervención la evolución tanto clínica, como electrofisiológica fue satisfactoria, aunque no completa.Injuries to the brachial plexus and subclavian and axillary arteries are uncommon and serious complications of shoulder girdle trauma, due to the close anatomical relationship between them. Neurovascular injuries are most frequent in penetrant lesions, but are are after a closed trauma. When neurological symptoms develop insidiously, some days to weeks after trauma, that should lead to the suspicion of a vascular injury. We report a delayed brachial plexus paralysis in a 39 years old male, who sustained an anterior dislocation of the shoulder ten days before. The DIVAS showed a pseudoaneurysm of the axillary artery and the EMG confirmed the brachial plexus palsy. Treatment consisted in surgical release repair of the vascular defect. One year follow-up show good clinical result

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

Resultados de la técnica de Zarins en la reconstrucción del ligamento cruzado anterior

Se presenta una serie de 96 pacientes con lesión crónica del ligamento cruzado anterior de la rodilla que fueron intervenidos mediante un procedimiento combinado intra y extraarticular que utiliza como método de reconstrucción el tendón del semitendinoso y una tira de fascia lata. Ochenta y cinco pacientes pudieron ser revisados a una media de 119 meses de la intervención (rango 110-130). El test de Lachman instrumentado con Genucom fue inferior a 5mm en el 88% de los casos y el pívot-shift fue negativo en el 91%. Se observaron cambios radiológicos en 52% de las rodillas. De acuerdo con la escala de Zarins, 88% de pacientes fueron calificados de excelentes o buenos. En la escala de Lysholm, la puntuación media fue de 93 puntos. Los resultados demuestran que esta técnica puede restaurar la estabilidad de la rodilla con déficit del LCA a largo plazo.Ninety-six patients who had chronic lesions of the anterior cruciata were treated using a combined method of intraarticular and extraarticular transfer of the semitendinous tendon and a strip of fascia lata (Zarins technique). Eighty-five patients were studied at 119 (110 to 130) months after surgery. In 88 percent of the patients, instrumented measurement of anteroposterior laxity at 30 degrees knee flexion was zero to five milimeters. The pivot shift test was negative in 91 percent of them. Radiological changes were observed in 52 percent of the patients. According to the Zarins scale, 88 percent of the patients were rated as excellent or good. Lysholm evaluation showed an average of 93 points. This study demonstrates that this method can restore long term stability to a knee that has a torn anterior cruciate ligament

Bone Cut Accuracy in Total Knee Arthroplasty: Do Conventional Cutting Guides Stay True to the Planned Coronal Orientation of the Components?

Background: Total knee arthroplasty (TKA) has become the gold standard for the definitive treatment of knee osteoarthritis. One crucial aspect in the implantation of a TKA is the precise orientation of the femoral and tibial components. The main purpose of the present study is to assess, in patients undergoing total knee replacement, whether the difference between the planned angulation in the distal femoral cut and the angulation obtained in the postoperative radiological control is low enough to consider the conventional bone-cutting guides reliable. Methods: A retrospective study was designed with a consecutive series of patients who had undergone primary total knee arthroplasty using conventional instrumentation over one year. The authors analysed the main variable (bone cuts) while considering different variables (age, gender, surgeon, prosthesis, laterality, constraint, body mass index and alignment) to identify different patient patterns that justify the results in the main variable. Descriptive variables were analysed using the Mann–Whitney U and Kruskal–Wallis tests. Additionally, the correlation between continuous variables was explored in accordance with the Spearman correlation. Results: A total of 340 patients with a mean age of 75 ± 9.16 years were finally included in the present study. The mean absolute error of the main variable for the femoral coronal bone cut was 1.89° (SD 1.53). For the tibial coronal bone cut, it was 1.31° (SD 2.54). These values correspond to what remains after subtracting the radiological angulation obtained in the postoperative period from the planned intraoperative angulation of the distal femoral cut. No associations were observed between the main variable (the angulation of the proximal tibial cut and distal femoral cut) and the rest of variables for either the femur or tibia. Conclusion: A discrepancy between the planned angulation and the final radiological measure on the coronal plane of the femur and tibia using conventional cutting guides has been demonstrated. The degree of deviation is low enough that it probably does not affect clinical outcomes. Therefore, the use of conventional cutting guides will continue to be an appropriate tool to perform bone cuts in knee replacement surgery

Estudio descriptivo sobre fracturas supracondíleas y supraintercondíleas de húmero del adulto tratadas mediante reducción abierta y fijación interna con placas

Estudi descriptiu de 28 fractures supracondílees o supraintercondílees d'húmer tractades mitjançant una reducció oberta i fixació interna amb plaques amb disposició a 90º, segons la técnica clàssica de la AO (Associació de l'Osteosíntesi) amb un seguiment mig de 12 mesos. Es realitza una avaluació clínica (sexe, edat, mecanisme lesional, via d'accés, opcions terapèutiques utilitzades, complicacions, seqüeles i evolució postoperatòria), radiològica i funcional dels resultats obtinguts amb aquest tractament.Estudio descriptivo de 28 fracturas supracondíleas o supraintercondíleas de húmero tratadas mediante una reducción abierta y fijación interna con placas dispuestas a 90º, según la técnica clásica de la AO (Asociación de la Osteosíntesis) con un seguimiento medio de 12 meses. Se realiza una evaluación clínica (sexo, edad, mecanismo lesional, vía de acceso, opciones terapéuticas empleadas, complicaciones, secuelas y evolución postoperatoria), radiológica y funcional de los resultados obtenidos con este tratamiento

Primary lipoma arborescens of the knee may involve the development of early osteoarthritis if prompt synovectomy is not performed

Primary lipoma arborescens (LA) is a rare, benign intra-articular hyperplastic tumor that has been associated with osteoarthritis (OA). The aim of this study was to determine whether prompt synovectomy could avoid progressive joint degeneration in cases of primary LA of the knee. A review of currently available literature about the disease was carried out. The clinical, histological and radiological records of a series of nine knees with primary LA diagnosed and treated between 2002 and 2012 were retrospectively reviewed. Eight of the knees had histological confirmation of LA and none had evidence of condropathy on the initial magnetic resonance image or degenerative changes at the initial radiographic examination. At the final follow-up no evidence of OA was found in the three knees that underwent synovectomy when symptoms did not last more than 1 year. The five knees in which synovectomy was delayed developed progressive joint degeneration. In this series, primary LA of the knee involved the development of early osteoarthritis when prompt synovectomy was not performed. Timely synovectomy is strongly recommended, if not mandatory

Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part III-indications for different clinical scenarios using the RAND/UCLA appropriateness method

Purpose: The aim of the ESSKA 2022 consensus Part III was to develop patient-focused, contemporary, evidence-based, guidelines on the indications for revision anterior cruciate ligament surgery (ACLRev). Methods: The RAND/UCLA Appropriateness Method (RAM) was used to provide recommendations on the appropriateness of surgical treatment versus conservative treatment in different clinical scenarios based on current scientific evidence in conjunction with expert opinion. A core panel defined the clinical scenarios with a moderator and then guided a panel of 17 voting experts through the RAM tasks. Through a two-step voting process, the panel established a consensus as to the appropriateness of ACLRev for each scenario based on a nine-point Likert scale (in which a score in the range 1-3 was considered 'inappropriate', 4-6 'uncertain', and 7-9 'appropriate'). Results: The criteria used to define the scenarios were: age (18-35 years vs 36-50 years vs 51-60 years), sports activity and expectation (Tegner 0-3 vs 4-6 vs 7-10), instability symptoms (yes vs no), meniscus status (functional vs repairable vs non-functional meniscus), and osteoarthritis (OA) (Kellgren-Lawrence [KL] grade 0-I-II vs grade III). Based on these variables, a set of 108 clinical scenarios was developed. ACLRev was considered appropriate in 58%, inappropriate in 12% (meaning conservative treatment is indicated), and uncertain in 30%. Experts considered ACLRev appropriate for patients with instability symptoms, aged ≤ 50 years, regardless of sports activity level, meniscus status, and OA grade. Results were much more controversial in patients without instability symptoms, while higher inappropriateness was related to scenarios with older age (51-60 years), low sporting expectation, non-functional meniscus, and knee OA (KL III). Conclusion: This expert consensus establishes guidelines as to the appropriateness of ACLRev based on defined criteria and provides a useful reference for clinical practice in determining treatment indications. Level of evidence: II

Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus

Introduction: Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. Methods: 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. Results: Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. Conclusions: The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer