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Introduction: wrist ligament injuries and triangular fibrocartilage complex (TFCC) lesions are common but often underdiagnosed conditions causing chronic wrist pain. The diagnostic challenge necessitates a combination of clinical examination, imaging studies, and arthroscopy, considered the gold standard. Ligament injuries, particularly scapholunate ligament (SL), and TFCC lesions account for significant wrist instability and ulnar-sided wrist pain, respectively. Material and methods: this retrospective observational study, conducted at Hospital Ángeles Pedregal, Mexico City, aimed to assess the diagnostic accuracy of wrist magnetic resonance imaging (MRI) compared to arthroscopic findings. The sample included patients with clinical suspicion of wrist ligament or TFCC lesions who underwent both wrist MRI and arthroscopy. Clinical examination maneuvers were also evaluated. The study assessed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each diagnostic modality. Results: arthroscopic evaluation, considered the gold standard, revealed a high prevalence of TFCC and scapholunate ligament lesions (96.6% and 96.6%, respectively). Sensitivity for TFCC lesions on MRI was 71.4%, with 100% specificity. For ligament injuries (SL, lunotriquetral, and radioscapholunate), sensitivities ranged from 21.4% to 60.7%, with 100% specificity. Clinical examination showed higher sensitivity (29.2% to 89.3%) but lower specificity (0% to 100%) compared to MRI. Conclusion: wrist MRI remains the non-invasive imaging choice, although discrepancies exist between MRI and arthroscopic findings, emphasizing the need for careful interpretation. Clinical examination enhances sensitivity but lacks specificity. The study highlights the ongoing challenge in achieving optimal diagnostic accuracy for wrist ligament and TFCC lesions, emphasizing the importance of a multimodal diagnostic approach. [ABSTRACT FROM AUTHOR]

Meniscal injuries represent one of the main causes of intra-articular knee pain, especially in young patients, athletes or those with a high demand for physical activity; representing a challenge for the arthroscopist surgeon due to the great complexity that some of these injuries can present. Currently, the advances that have been implemented in arthroscopy allow us to repair meniscal injuries that in the past were considered irreparable. Although our priority is to preserve as much of the meniscus as possible, there are cases in which the injury reaches such complexity that this is impossible, with partial or total meniscectomy being the only therapeutic option. In the United States, approximately 690,000 partial meniscectomies are performed each year. This situation makes us consider meniscal transplantation as a great therapeutic option for patients considered young enough for joint replacement. The ideal patient is a relatively young patient (between skeletal maturity and 50 years), who has a well-documented history of partial or total meniscectomy, pain well localized to the affected compartment, with failure to conservative treatment and without high-grade chondral defects. in a generalized way. We present case of a 35-year-old male patient with a history of total meniscectomy of the right lateral meniscus seven years ago, who currently presents with a postmeniscectomy syndrome of the lateral compartment. Due to the clinical and demographic characteristics of our patient, as well as the findings in the imaging studies, meniscal transplantation with allograft represents an excellent alternative to alleviate the symptoms and slow down as much as possible the need for joint replacement as a definitive treatment. [ABSTRACT FROM AUTHOR]

Introduction: arthroscopy is the gold standard for detecting rotator cuff tears, but its invasive nature limits widespread use. Magnetic resonance imaging (MRI) serves as a precise alternative. The correlation and diagnostic agreement between MRI and arthroscopy are unclear in the Mexican population. Material and methods: adults with rotator cuff syndrome who underwent shoulder arthroscopy and MRI were included. Findings were classified as total tear (100%), partial tear grade I (< 50%), partial tear grade II (≥ 50%), or no tear. Concordance and correlation between MRI and arthroscopy were evaluated. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI for diagnosing rotator cuff tears were calculated. Results: we included 147 patients with rotator cuff syndrome. MRI identified tears in 83%, of which 91.8% were confirmed by arthroscopy. Diagnostic agreement between arthroscopy and MRI was moderate (kappa = 0.452, p = 0.0001). Similarly, arthroscopy and MRI showed moderate agreement in classifying partial tears grade I, partial tears grade II, and complete tears (kappa = 0.412, p = 0.0001). Significant correlations were found in detecting partial tears grade I, partial tears grade II, and complete tears (rho = 0.77, p = 0.0001) between MRI and arthroscopy. Conclusions: magnetic Resonance Imaging (MRI) and arthroscopy demonstrated moderate diagnostic agreement (kappa = 0.452, p = 0.0001) along with a strong positive correlation (rho = 0.77, p = 0.0001) for detecting rotator cuff tears, regardless of severity. [ABSTRACT FROM AUTHOR]

Introduction: pigmented villonodular synovitis (PVNS) is a benign condition that affects the knee, leading to abnormal proliferation of the synovial membrane and the accumulation of hemosiderin in the joint cavity. Although it can be surgically treated, PVNS tends to have a high recurrence rate, potentially resulting in chronic joint damage. Case report: we present the case of a young woman who experienced localized pain in her right knee due to a recurrence of PVNS. Magnetic resonance imaging revealed multiple multilobulated cystic lesions affecting the entire joint, including the ligaments. The patient underwent open surgical resection with a favorable clinical outcome. Histopathological examinations confirmed the absence of malignancy. Conclusion: while arthroscopy is typically the preferred treatment for PVNS, this case highlights the tendency for recurrence associated with this approach. Open surgical resection, supported by benign histopathological findings in this case, suggests a favorable long-term prognosis. [ABSTRACT FROM AUTHOR]

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Introdução As lesões dos tendões do manguito rotador acometem de 7 a 40% da população mundial, são incapacitantes e impactam na qualidade de vida, dado ao seu caráter algogênico. A prevalência aumenta com a idade. (MIYAZAKI et al., 2017; CARVALHO et al. 2016). Com a popularização da artroscopia nos anos de 1980, o reparo cirúrgico dessas lesões que consiste em reinserir o tendão na tuberosidade umeral, através de sutura trans-óssea, passou a ser realizado sob visualização artroscópica e não mais sob visualização direta. Embora o uso de sistema de ancoragem sem nós seja cada vez mais frequente no mundo, no Brasil, ainda é pouco utilizado, talvez pelo fato de, somente em 2020 ter sido aprovada pela ANVISA para uso comercial no país (SHAH et al., 2018). Métodos Trata-se de uma análise de custo-efetividade (ACE) de mundo real. O caso-base foi composto por um cenário de referência, no qual os reparos cirúrgicos foram reali[1]zados utilizando sistemas de âncoras com nó; e um cenário alternativo, utilizando sistemas de âncoras sem nó. A perspectiva da análise foi a do SUS em nível local, considerando um horizonte temporal de 112 dias. A variável de interesse foi a fun[1]cionalidade da articulação, avaliada por goniometria pelo índice Modified-University of California at Los Angeles Shoulder Rating Scale, da Universidade da Califórnia (UCLA). As avaliações foram realizadas nos dias de pós-operatório D8, D28, D56, D84 e D112. Não foram aplicados ajustes temporais considerando o curto horizonte temporal da análise. Foram considerados apenas os custos médicos diretos do tratamento cirúrgico da lesão do manguito rotador utilizando âncoras com ou sem nó. Foram realizadas análises de sensibilidade determinística multivariada e probabilística, a parti de 10.000 simulações de Monte Carlo. Resultados Um total de 38 pacientes foram analisado, sendo 17 no cenário alternativo (âncora sem nó) e 21 no cenário de referência (âncora com nó). Os pacientes apresentavam lesão completa do supraespinal ou acometimento do tendão longo do bíceps, do infraespinal ou lesão parcial do subescapular. Em relação ao resultado funcional, a proporção de pacientes que apresentou escore da escala UCLA maior do que a média estimada no final do seguimento foi de 70% entre os pacientes que receberam âncoras sem nó, contra 38% (8/21) no grupo dos pacientes que receberam âncora com nó. Os resultados da análise de custo-efetividade sugerem que tanto a âncora sem nó como a âncora com nó poderão ser custo-efetivas, considerando o limiar de dispo[1]sição a pagar (WTP). O uso da âncora sem nó resultou em um incremento de custo de R$ 1.260,97. A curva de aceitabilidade sugere que a probabilidade de a âncora sem nó ser custo- -efetiva no caso-base, passa a ser maior que a âncora com nó, a partir de uma dis[1]posição de pagar de R$ 4.000,00, podendo chegar até 90%, se a disposição de pagar for de R$ 50.000,00 por funcionalidade articular reestabelecida. Discussão e conclusões Não se identificou estudos similares no Brasil ou América Latina. Burns et al (2019) avaliara a relação entre custo e eficácia da âncora “knotless”. Os autores concluíram que, apesar do aumento dos custos, a utilização de âncoras sem nó representou vantagens clínicas e biomecânicas, tornando-o assim mais custo-efetivo. Na realidade brasileira, no entanto, devemos considerar que o material é importado, cotado em dólares americanos. Assim, as questões cambiais e tributárias tornam- -se relevantes. No mercado nacional, o custo da âncora “knotless” é duas vezes e meia maior que o da âncora metálica. Os resultados do modelo analítico proposto sugere que, há vantagem no uso da âncora sem nó e que esta poderá ser uma alternativa custo-efetiva para o tratamento cirúrgico de pacientes com lesão do manguito rotador, no SUS, quando a disposição de pagar por funcionalida de articular recuperada, for maior ou igual a R$ 4.000,00.

Copyright of Colombian Journal of Nephrology / Revista Colombiana de Nefrología is the property of Colombian Association of Nephrology & Hypertension and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: anterior cruciate ligament injuries (ACL) continue increasing in frequency in the general population and sportmen who practice soccer and american football where we can locate 53% of the total of cases, the annual incidence is 70 per 100,000 persons. The incidence of this injuries has being increasing in women probably of the increase of the participation in such sports. Objective: to document the causes of anterior cruciate ligament (ACL) plasty failure, as well as the diagnosis, surgical technique, and postoperative care of a revision ACL plasty surgery. Material and methods: a search for relevant information, original research articles, clinical trials, and reviews in indexed journals was performed. Results: anterior cruciate ligament injuries continue to increase among the general population and athletes who play soccer and American soccer mainly, in this population group we found 53% of the total cases. The gold standard for treatment is arthroscopic reconstruction of the ligament. ACL reconstruction surgery has good results, with an estimated 75-90% success rate. Long-term failures of anterior cruciate ligament repair represent 5-25%. Among the factors associated with this failure are technical errors, traumatic antecedents, biological factors, among others. Conclusions: in ACL revision surgery good results can be achieved with respect to graft stability, return to play and functional stability of the knee, but the results are generally inferior to those of primary ACL reconstruction. [ABSTRACT FROM AUTHOR]

Las artrodesis de muñeca, tanto totales como parciales, son opciones terapéuticas para el tratamiento de las artropatías postraumáticas, degenerativas o reumáticas. El objetivo de estas cirugías es eliminar el dolor y estabilizar la muñeca con el detrimento de pérdida de movilidad, permitiendo a los pacientes retomar sus actividades diarias sin dolor. Las artrodesis parciales tienen como objetivo conservar cierta movilidad al fusionar solo ciertas articulaciones dejando móviles solo las articulaciones no patológicas, mientras que las artrodesis totales involucran la fusión total de la muñeca, ofreciendo soluciones definitivas para el dolor intenso e inestabilidad.

A utilização da artroscopia na cirurgia de tornozelo apresenta uma série de vantagens em comparação a cirurgia aberta e pode ser realizada por via anterior ou posterior. As doenças localizadas na região anterior e posterior do tornozelo podem coexistir e demandar a combinação das técnicas artroscópicas citadas. O objetivo deste estudo é descrever a técnica artroscópica para acesso anterior e posterior do tornozelo para o tratamento da instabilidade lateral e impacto posterior do tornozelo, mantendo o paciente em decúbito ventral.

La cirugía de manguito rotador se ha popularizado en los últimos años y pasó de realizarse mediante una técnica abierta, en la mayoría de los casos, a la reparación artroscópica. Se han descrito múltiples técnicas para la fijación del hueso, pero no se han estandarizado el orden y los pasos para llevar a cabo esta reparación, lo que generó inconsistencias y heterogeneidad en los resultados de la reparación. En este artículo, se propone una nueva clasificación de las lesiones del manguito rotador que les permitirá a los cirujanos tomar decisiones durante la cirugía de reparación artroscópica del manguito rotador.

Introduction: there is scarce information on meniscal repair in the paediatric population in terms of outcomes of this technique. The aim of this study was to evaluate the clinical outcomes and complications of meniscal repair in paediatric population with isolated lesions, associated with ACL rupture and discoid meniscus with unstable lesions. Material and methods: data from 78 patients ≤ 18 years of age, with arthroscopic diagnosis of isolated meniscal lesion, associated with ACL tear or discoid meniscus, in whom arthroscopic repair was performed, were retrospectively analyzed for demographic characteristics, surgical technique, and perioperative complications. Functional results were assessed with the Lysholm and Pedi-IKDC scales. Time to repair failure was defined as the interval between meniscal repair and revision (re-repair or subtotal meniscectomy). Results: mean age was 14 years (SD 3.1, range 3-19). The patients in group C were significantly younger (15.4 years in group A vs 14.9 in group B vs 12.1 in group C, p = 0.001). The average follow-up was 33.8 months. The mean Lysholm score and Pedi-IKDC were 96.1 points (range, 76-100) and 93.8 points (range, 59.8-100), respectively. The overall failure rate was 14.1% (11/78). There were 4 (13%) failures in group A, 3 failures (12%) in group B, and 5 failures (17%) in group C (p = 0.429). We found a tendency towards a greater number of failures in bucket handle injuries (p = 0.08) and a significant association when ≥ 4 sutures were used (p = 0.041). Conclusion: in this series, meniscal repair demonstrated a clinical success rate of 85.9%. Patients with discoid meniscus, bucket handle injuries, and those who required a greater number of sutures had a higher risk of failure. Repair should be considered the first surgical treatment option for most meniscal injuries in children and adolescents. [ABSTRACT FROM AUTHOR]

Introducción La artropatía radiocubital distal produce gran limitación funcional con dolor y pérdida de fuerza durante la pronosupinación del antebrazo. El objetivo de nuestro trabajo fue describir la técnica quirúrgica del procedimiento de Sauvé-Kapandji artroscópico con estabilización tendinosa proximal, así como sus resultados, complicaciones y ventajas.

Se presenta el caso de un paciente de veinte años a quien le queda un fragmento de la ceja acetabular posterior interpuesto dentro de la articulación tras la reducción de una luxación traumática de cadera. Se planteó un tratamiento por vía miniinvasiva anterior, con artroscopía seca con el fin de retirar el fragmento interpuesto, y la limpieza de la avulsión del ligamento redondo. En mesa de tracción se pudo retirar el fragmento interpuesto y evaluar el estado articular. Se muestran excelentes resultados clínicos e imagenológicos que desafían el concepto del abordaje posterior para lesiones posteriores.

Anterior cruciate ligament (ACL) rupture is a very important epidemiological pathology in our environment. It has a peak incidence between 16 to 39 years of age. It is estimated that between 70-84% of ACL injuries are non-contact. The «no return» position describes the knee in valgus, femoral external rotation, tibial internal rotation and semiflexion, promoting injury to this ligament. Geometric measurements of the knee have been associated with an increased probability of non-contact ACL injury. The management of ACL tears is divided into two: conservative treatment and surgical management. Early OA (osteoarthritis) is the most common consequence of an ACL tear. We present the case of a 35-year-old patient with an inveterate ACL rupture of 10 years of evolution. With conservative management initially that progresses to knee instability and pain in the medial and lateral joint line as well as increased volume and functional limitation. After diagnostic studies, it was decided to perform diagnostictherapeutic arthroscopy and continued close follow-up for associated pathology. [ABSTRACT FROM AUTHOR]

Introduction: in the treatment the long head of the biceps tendon (LHBT) pathology, the «relaxed tenodesis» is an arthroscopic articular suprapectoral tenodesis that seeks to lower the tension on the LHBT, and therefore, theoretically avoid persistent pain. Objective: to assess clinical and radiological results of «relaxed» tenodesis in a prospective cohort of patient with work related illness. Material and methods: prospective cohort, 54 shoulders with «relaxed» tenodesis performed with an intra-articular interference screw by the same surgeon, from October 2014 to 2018, in a level 1 trauma center. Demographic, clinical, functional and radiologic results were analyzed. On 6 months follow-up, a sonographic and clinical assessment was performed. Results: mean age 49 ± 9, mean follow-up 16 ± 4 months. The main diagnosis was a rotator cuff tear in 79%, primary biceps pathology in 10% and other pathologies in 11%. At the end of followup, the cohort showed active anterior elevation 157.7 ± 22.7, external rotation 47 ± 16.6, median internal rotation T12, Constant Score 83 ± 12.05 points, subjective shoulder value 83 ± 12.97% and pain visual analogue scale 1.4 ± 1.7 points. One patient had a biceps tear and two had cosmetic arm asymmetry. On ultrasound 98% had the LHBT in situ and 10% had inflammatory changes on the bicipital groove. There were complications in 21% of the sample. Conclusions: «relaxed biceps tenodesis» is a technique that shows good clinical, functional and sonographic results, with low failure rate. [ABSTRACT FROM AUTHOR]

Introduction: the connection between a critical shoulder angle (CSA) greater than 35o and the presence rotator cuff tears (RCT) is well known. However, it remains unidentified if there is an association between a higher CSA value and the presence of more severity RCT. Material and methods: cross-sectional, descriptive, observational, prospective and analytical study in which patients with RCT had their CSA evaluated by imaging and the degree of the RCT by arthroscopy. Four groups were formed (without lesion; partial lesion; complete lesion; massive lesion) and were compared using ANOVA parametric statistics. The association between RCT and CSA was studied by rho Spearman coefficient. Results: 71 patients were studied, 15 without RCT (CSA of 34.13 ± 0.98), 17 with partial lesion (CSA of 36.00 ± 1.15), 22 with complete lesion (CSA of 40.77 ± 0.69) and 17 with massive lesion (CSA of 41.53 ± 0.68). No significant statistical difference was found between the CSA of the groups without lesion and partial lesion (p = 0.486; 35o) but there was a difference between the groups with complete and massive lesion (p = 0.000 and p = 0.001; 35°). A significant positive association was found between CSA and RCT (rho = 0.605, p = 0.000). Conclusions: an CSA above 35o is associated to complete and massive RCT and it works as a predictor of severity for these lesions. [ABSTRACT FROM AUTHOR]

The discoid meniscus comprises a morphological variant of the menisci, characterized by changes in microarchitecture, vascularity, and abnormal stabilizing mechanisms, altering the biomechanics of the knee, predisposing it to intrasubstance degeneration and tears at an earlier age. Its incidence is unknown since it can occur in asymptomatic patients, usually as an incidental finding on magnetic resonance imaging. However, some patients may have symptoms, for instance pain and instability, and may present more significant alterations, such as joint blockage. These symptoms may occur for long periods of time, leading to early osteoarthritic changes. Because its diagnosis is mainly incidental, it is extremely important to know its characteristics and clinical implications. Its treatment is still in controversy and continues to be a real challenge, mainly for orthopedists. The purpose of this work is to review the literature in order to update concepts such as etiology, diagnosis, classification and therapy from what was found in the literature in the last 10 years. [ABSTRACT FROM AUTHOR]

Introduction: Due to the inherent activities of the active duty personnel of the Mexican Navy, ligament injuries are constant, particularly the anterior cruciate ligament of the knee (ACL). Currently, we have various techniques and resources for its repair. Objective: identify the clinical results obtained in anterior cruciate ligament reconstruction in active military. Material and methods: retrospective observational study comparing clinical outcomes of anterior cruciate ligament repair in active military with the use of allograft and autograft in 23 patients who met inclusion criteria for the surgical procedure from 2017 to 2019 at the Naval Medical Center. 23 patients (46 in total) were considered for each category of anterior cruciate ligament repair with autologous graft (contralateral patellar) and heterologous graft (cadaveric anterior cruciate ligament). With an average age of autologous (35.6 years), heterologous (35 years). BMI average: autologous (26.5), heterologous (26.5). Male gender in its entirety. The IKDC and Lysholm scales were applied to all patients for the evolution of subjective results of clinical improvement in a 2-year follow-up; where a significant difference (p = 0.0001) could be observed when comparing both anterior cruciate ligament reconstruction techniques. Results: we included 46 patients who underwent anterior cruciate ligament reconstruction for indication of complete injury respectively by the Joint Surgery Service of the Naval Medical Center. A better level of clinical benefit was observed in patients with heterologous graft, both in evaluation by IKDC scale (median 95.52 ± 1.85) as in Lysholm scale (median 94.91 ± 1.62) compared to autologous grafts, IKDC (median 89.92 ± 2.55) and Lysholm (median 86.04 ± 5.58), with value of p = 0.0001 for both cases. Conclusions: The results our study suggests that a superiority of functionality is obtained as reported by patients in whom heterograft was used. [ABSTRACT FROM AUTHOR]

Osteoarthritis of the knee is a very common degenerative arthropathy, especially among the elderly, but also present in young adults, as a consequence of overweight and strenuous work or sports activity; this primary form is distinguished from the secondary form, resulting from other pathologies involving the articular surfaces of the knee such as fracture outcomes, osteonecrosis, infections, and femoral, tibial, and patellar malformations. Among the commonly used imaging techniques, the most effective in the evaluation of knee osteoarthritis are MRI and conventional radiology: both provide a wealth of information and highlight various pathological features affecting cartilage, joint spaces, and subchondral bone. A recent review compared the data obtained from preoperative X-ray and MRI examinations with the results of arthroscopic examinations, performed at Outside Facilities, over a period of about five years, to evaluate the reliability of these imaging techniques, in predicting the actual severity of observed knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Objetivos: El propósito de este estudio es realizar una revisión sistemática de la literatura científica para comparar las técnicas de hilera simple y doble para los desgarros del manguito de los rotadores en términos de curación funcional, del dolor y estructural del tendón. Métodos: Para llevar a cabo la investigación se ha realizado una selección sistemática de artículos científicos consultando las bases de datos PubMed y The Cochrane Library. Los artículos incluidos en el presente estudio comparan las técnicas de una y dos hileras, con fecha de publicación entre 2016 y 2021. Resultados: Se observan diversos resultados en las escalas de valoración UCLA, SST, Constant y ASES y en el rango de movilidad, por lo que no se establece la superioridad de una técnica en cuanto a resultados funcionales. La técnica de doble hilera puede mostrar superioridad en la variable fuerza, aunque existe una variabilidad metodológica en su medición. La técnica de doble hilera puede estar relacionada con un dolor postoperatorio más intenso, mientras que la técnica de hilera simple con dolor residual en el hombro. Sin embargo, las variables fuerza y ​​dolor muestran datos no homogéneos o coincidentes. Se establece con resultados estadísticamente significativos, siendo los estudios más homogéneos y coincidentes, la superioridad de la reparación en doble hilera en la cicatrización estructural del tendón y una menor tasa de re-desgarro que la técnica de hilera simple.

Las roturas irreparables del manguito rotador son lesiones graves que pueden conllevar consecuencias drásticas en la calidad de vida de los pacientes. Pese a que su reparación es compleja y la tasa de re-rotura es alta, el intento de reparación se justifica por la ausencia de alternativas poco agresivas o paliativas. Cuando no se consigue una reparación, la alternativa es la transferencia tendinosa, la reconstrucción capsular superior o incluso la prótesis invertida de hombro. Por tanto, en muchos casos de cirugía primaria, se debe intentar la reparación artroscópica con el fin de “salvar” el manguito rotador gravemente lesionado. El objetivo de este artículo es resumir algunas de las técnicas artroscópicas para conseguir una reparación de roturas “irreparables” del manguito rotador.

Introducción: A pesar de su baja incidencia, las infecciones osteoarticulares pueden generar complicaciones y secuelas devastadoras para el niño en desarrollo con su esqueleto en crecimiento. El manejo general de la patología debe ser multidisciplinario, asociando la terapia antibiótica y un tratamiento quirúrgico adecuado si se requiere. El objetivo de nuestra trabajo es analizar los resultados sobre las diferentes opciones terapéuticas quirúrgicas (punción-aspiración, lavado artroscópico o lavado abierto) en el tratamiento de la artritis séptica en la edad, mediante la realización de revisión sistematizada de la bibliografía . Metodología: Realizamos una búsqueda bibliográfica online en los buscador PubMed y en la Biblioteca Virtual en Salud (BVS) utilizando los siguientes términos MESH: ("Arthritis, Infectious/surgery"(Mesh) OR "Arthritis, Infectious/therapy"(Mesh)), utilizando filtros de búsqueda y aplicando criterios de inclusión y exclusión según nuestro objetivo. De los artículos incluidos se obtuvieron entre otros los siguiente datos: país, año, nivel de evidencia, número de pacientes con artritis séptica, articulación afectada, edad media, seguimiento promedio, tipo de tratamiento quirúrgico realizado de inicio y sus resultados según cada autor : complicaciones ( de la enfermedad y del procedimiento ) y/o secuelas ( en base a evolución clínica y radiológica ), necesidad de un tratamiento quirúrgico adicional ante la falla del método terapéutico inicial y además de conclusiones relevantes de cada autor. Resultados: Se incluyeron un total de 22 artículos: 8 para el lavado por artroscopia, 6 para el lavado por artrocentesis, 4 para el lavado por artrotomía, ademas de otros 4 artículos que realizaba un análisis comparativo: dos de ellos entre lavado artroscópico y lavado por artrotomía y los otros dos entre lavado por artrocentesis y lavado abierto. El lavado artroscópico se encuentra en lo mas alto de nuestra revisión ya que presenta los mejores resultados con solo un 6% complicaciones y/o secuelas (en solo 4 de los 8 artículos incluidos), con un total de 13 pacientes (8,7% ) que requirieron un tratamiento adicional (5 artrotomías y 8 un nueva lavado artroscópico ) y se destacan ademas 3 artículos con un 100% de buenos resultados, en los que no se presentaron complicaciones y/o secuelas, ni se requirió un segundo lavado, mientras que solo en 3 trabajos, de los 8, se necesitó de la artrotomía adicional para la resolución final. Para el lavado por artrocentesis se obtuvo el menor porcentaje de complicaciones y/o secuelas con un 2%, (reportado en tres de los 6 trabajos ), y solo el 9,7% necesitaron de un segundo método terapéutico diferente a la aspiración articular (23 artrotomías y 2 artroscopias ), destacando ademas la repetición de la punción (hasta 4 veces) como dentro de la directiva terapéutica del autor en dos artículos, y que para éste método se encontró el mayor número de pacientes. El lavado por artrotomía como método inicial obtuvo los peores resultados, con un 12% de complicaciones y/o secuelas y un 22,6% de lavados adicionales. Conclusiones: A pesar de que el lavado abierto por artrotomía se toma como el ¨ gold-standard ¨, teniendo indicaciones absolutas en el tratamiento quirúrgico de la artritis séptica en niños (especialmente en cadera), de nuestro análisis se desprende que ésta opción arroja los peores porcentajes de resultados, duplicando el porcentaje de necesidad de lavado adicional y el de complicaciones, en comparación con el lavado artroscópico. Existen otros métodos terapéuticos que se presentan como procedimientos menos invasivos, seguros y eficaces, respaldados por buenos resultados en la biografiaría, como son: el lavado por artroscopia (que presentó el porcentaje mas bajo de pacientes con necesidad de lavado adicional, con el mayor número de artículos con buenos resultados en general, con un porcentaje de complicaciones por debajo del lavado por artrotomía) y el lavado por artrocentesis (que presentó el porcentaje de compilaciones mas bajo de las 3 opciones analizadas.

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Introduction: gonarthrosis is a degenerative disease, whose loss of cartilage causes changes in the adjacent bone and its response produces deformations and attempts at regeneration. In 1934 Meyer and Palmer isolated bovine vitreous humor, a polysaccharide called hyaluronic acid, which has the property of visco-elasticity. Today, multiple procedures performed in orthopedics are known, in order to limit the degenerative process that this entails. Objective: to know the use and efficacy of hyaluronic acid in the patient requiring knee arthroscopy, evaluating the evolution of the patient using the WOMAC scale; as well as the ideal time of application of hyaluronic acid in this study group. Material and methods: clinical, non-randomized, prospective, analytical trial. 48 patients from 45 to 60 years of age, divided into 3 groups with a diagnosis of gonarthrosis grade II-III, who underwent arthroscopy with subsequent hyaluronic acid application, were evaluated; in the postoperative period (group 1), one month after the postoperative period (group 2) and without application (group 3) in a period from September 2015 to June 2016 at the ISSSTE Hospital «Dr. Darío Fernández Fierro». Results: the treatment showed differences in patients regarding reduction of pain and stiffness; and improvement in functional capacity. Conclusion: despite, there are no conclusive results if the treatment is better than the other, certain data suggests that using hyaluronic acid in the postoperative improves rigidity and function, however, it was not statistically significant. [ABSTRACT FROM AUTHOR]

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Objetivo: Analizar los hallazgos de la artroscopia anterior de tobillo en lesiones de Maisonneuve tratadas con reducción bajo visualización artroscópica y fijación percutánea. Materiales y Métodos: Se evaluó el registro de pacientes con lesiones de Maisonneuve agudas tratados con reducción bajo visualización artroscópica y fijación percutánea, entre mayo de 2013 y enero de 2019. Se analizaron los hallazgos artroscópicos buscados (lesiones condrales u osteocondrales, cuerpos libres intrarticulares, lesión de la articulación tibioperonea distal con inestabilidad o sin ella, y lesión del ligamento deltoideo con inestabilidad medial o sin ella). Resultados: Se evaluaron 13 tobillos en 13 pacientes. Todos tenían lesión del ligamento tibioperoneo distal anterior e inestabilidad de la articulación tibioperonea distal. El 92,30% presentaba lesiones de estructuras mediales; el 76,9%, lesión completa e inestabilidad del ligamento deltoideo y el 15,38%, fracturas del maléolo tibial. Uno (7,69%) no tenía lesión medial. El 84,61% tenía lesiones condrales u osteocondrales y el 53,84% (7 pacientes), cuerpos libres. Conclusiones: La lesión de Maisonneuve es una consecuencia de un trauma de alta energía y la incidencia de lesiones de estructuras intrarticulares (ligamentarias y de la superficie articular) es alta. La artroscopia es una herramienta de gran utilidad para identificar y tratar lesiones intrarticulares que, de otra manera, no serían reconocidas.

El tratamiento de las fracturas de clavícula distal se puede lograr a través de varias opciones. Las placas de bloqueo asociadas con los botones coracoclaviculares son una alternativa para estabilizar las lesiones de ligamentos asociadas con las fracturas de tipo IIB de Craig. La artroscopía puede ayudar a colocar el botón subcoracoideo. Presentamos el caso de una mujer de treinta y cinco años quien, al caer de una bicicleta, resultó con traumatismo directo en el hombro izquierdo. Las radiografías mostraron fractura conminuta de la clavícula distal asociada con lesiones de ligamentos (tipo IIB de Craig). Se optó por tratamiento quirúrgico con placa bloqueada con un botón pegado asociado a otro botón subcoracoideo asistido por artroscopía. A través de una vía de acceso directo sobre la clavícula mediolateral, se redujeron anatómicamente los fragmentos de fractura y se fijaron con una placa bloqueada para la clavícula distal y siete tornillos. Se realizó portal artroscópico posterior para visualizar la articulación. Mediante portal anterior se expusieron el espacio rotador y la región subcoracoidea. Con la ayuda de guías especiales se instalaron dos botones (uno subcoracoideo y otro pegado a la placa) conectados por cables especiales. Tres meses después de la cirugía, la paciente estaba sin dolor y volvió a practicar deportes al nivel previo a la lesión. Se logró un ROM normal y radiografías con la fractura anatómicamente consolidada y distancia coracoclavicular normal.

Introduction: Management of intraoperative hemodynamics and postoperative analgesia during arthroscopic shoulder surgeries remains a challenge. Although interscalene brachial plexus block (ISB) is considered ideal for shoulder anesthesia it requires skill and proficiency unlike intravenous (IV) dexmedetomidine. Objective: This randomized trial was performed to observe the efficacy of dexmedetomidine infusion which is less invasive and demands lesser skills than plexus block. Methodology: All patients scheduled for elective arthroscopic shoulder surgery under general anesthesia were assigned either to group DEX, which received an IV dexmedetomidine bolus of 0.5 mcg/kg over 20 minutes, followed by an infusion of 0.5 mcg/kg/hour that was stopped 30 minutes before surgery the end of surgery or to group BLOCK which received ultrasound guided ISB with 20ml of 0.25% bupivacaine. The primary outcome assessed was intraoperative hemodynamics; the secondary outcomes were immediate postoperative pain, operating condition as assessed by the surgeon, recovery time, and patient satisfaction after 24 hours. Blinded investigator and composite scores were used for the assessment. Results: Both groups displayed equivalent scores for intraoperative hemodynamics whereas ISB resulted in a better post-operative analgesia (p < 0.001). Surgeon's opinion and recovery time were comparable. Overall, the patients had a satisfactory experience with both techniques, according to the quality assessment. Conclusions: IV dexmedetomidine infusion is an effective alternative to ISB for reconstructive shoulder surgeries under general anesthesia. [ABSTRACT FROM AUTHOR]

Calcaneal articular fractures are fractures classically associated with a high rate of complications and poor outcomes. Osteosynthesis of the calcaneus through a sinus tarsi approach has shown results equal to or superior to those of the extended approach, having become the new gold standard.The objective: of this article is to detail step by step the surgical technique of osteosynthesis of intra-articular fractures of the calcaneus through a sinus tarsi approach, from the selection of the fracture, positioning of the patient, layout of the operating room and the fluoroscope, the entire surgical process until postoperative treatment.The surgical technique described below is described in 6 steps.Layout of the operating room. Patient and Fluoroscope Positioning.Reduction of the posterior tuberosity (correct height and varus).Sinus tarsi approach.Reduction of the articular surface and correct visualization. Arthroscopy.Fixation of the articular surface.Fixation of the posterior tuberosity.Anatomical reduction of complex calcaneal fractures through an Sinus Tarsi Approach requires an understanding of the fracture and its associated deformities. Following the described sequence step by step will help to achieve a better reduction in order to achieve better functional results., (Copyright © 2024 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

La incidencia de lesiones meniscales en adolescentes ha aumentado debido a la creciente tendencia, en este grupo de edad, de realizar actividades deportivas, una mayor sospecha diagnóstica y mejora en los métodos para su detección. Estas lesiones suelen asociarse a otras patologías, como lesiones de ligamento cruzado anterior o la presencia de menisco discoideo, un factor de riesgo importante. El menisco discoideo fue descripto por primera vez por Young en 1889, es una variación congénita morfológica del menisco lateral o medial, caracterizado por una hipertrofia central y un diámetro mayor de lo normal. Puede ser asintomático o manifestarse con dolor, bloqueo, chasquidos e hinchazón. El tratamiento histórico era la meniscectomía completa, la que se asociaba a cambios degenerativos articulares tempranos, por lo que actualmente se preconiza la saucerización como tratamiento de elección; además, se describe el trasplante meniscal como procedimiento de salvataje, en caso de daño meniscal irreparable. Se presenta el caso de una paciente femenina de doce años sometida a este procedimiento con antecedentes de múltiples intervenciones quirúrgicas en la rodilla izquierda, incluida la meniscectomía parcial, sin resultado clínico favorable.

La extracción artroscópica de un proyectil articular de cadera por herida de bala se introdujo por primera vez por Cory y cols. en 1998. El misil puede ubicarse flotando libremente dentro de la articulación, ubicado cercano a esta o alojado dentro del hueso del acetábulo o de la cabeza femoral. Se presenta el caso de un paciente de treinta y dos años, quien fue asaltado. El proyectil se alojaba en el trasfondo del acetábulo luego de un trayecto abdominal. La artroscopía de cadera es un procedimiento mínimamente invasivo que resultó efectivo para el retiro de un proyectil articular, resultando menos cruento que una artrotomía. No se encontraron complicaciones.

La artritis séptica se define como una infección que se da dentro del espacio articular. Está a pesar de ser una enfermedad poco frecuente toma vital importancia debido a la severidad de sus secuelas. Es por esta severidad la importancia de la revisión de este tema en este artículo. El objetivo principal es valorar todas las posibles causas, clínica característica, los métodos diagnósticos, estudios complementarios y los diferentes abordajes terapéuticos de esta patología. Este tema de revisión es de vital importancia debido a que las secuelas de esta patología pueden ser devastadoras para la articulación y el paciente sino se trata oportuna y adecuadamente. La artritis séptica se considera una emergencia quirúrgica, ya que el retraso en su diagnóstico y tratamiento pueden llevar a daño irreversible de la articulación.

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Objective: To determine whether hip rotation correlates with the radiographic signs of cam or pincer deformity after hip arthroscopy in patients with femoroacetabular impingement syndrome. Materials and Methods: This was a single-center retrospective study of data collected between 2014 and 2017. The study sample included 65 patients between 18 and 55 years of age who underwent hip arthroscopy for the treatment of unilateral femoroacetabular impingement. The following data were collected for the periods prior to and six months after surgery: range of medial and lateral rotation of the hip; measures on anteroposterior X-rays of the pelvis obtained in the standing position and on lateral X-rays in the Ducroquet profile view; and score on the 33-item International Hip Outcome Tool. Results: Mean preoperative and postoperative values were as follows: 19.26 ± 10.39° and 30.95 ± 3.52°, respectively, for medial rotation of the hip (p < 0.001); 73.85 ± 6.62° and 68.12 ± 5.04°, respectively, for the anteroposterior alpha angle (p < 0.001); 56.97 ± 6.09° and 50.61 ± 5.39°, respectively, for the lateral alpha angle (p < 0.001); and 0.17 ± 0.11 and 0.07 ± 0.08, respectively, for the acetabular retroversion index (p < 0.001). The crossover sign was identified in 75.4% of the patients before surgery and in 44.6% after (p < 0.001). Although there was an increase in the range of hip rotation and an improvement in radiographic parameters after arthroscopy, we detected no direct correlation between the two. Conclusion: Hip arthroscopy can improve medial rotation of the hip, as well as reducing cam and pincer deformities, in patients with femoroacetabular impingement syndrome. However, those findings do not appear to be directly correlated. [ABSTRACT FROM AUTHOR]

Background and objectives: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. Methods: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D – blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C – 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). Results: Seventy-four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p

Introducción: según la literatura existen discrepancias entre los hallazgos en el ultrasonido, la resonancia magnética nuclear y la artroscopía, por lo que se considera a esta última como el patrón de oro para el diagnóstico de lesiones de estructuras internas de la rodilla. Objetivo: evaluar la relación entre el ultrasonido, la resonancia magnética nuclear y la artroscopía en lesiones meniscales. Método: se realizó un estudio descriptivo y observacional en el Hospital “Arnaldo Milián Castro” de la Provincia de Villa Clara entre enero de 2015 y marzo de 2017. Resultados: el 3,33% de los pacientes tenía entre 40 y 49 años y el 77,7% era masculino. En el 58,7% la rodilla afectada fue la derecha y en el 86,1% la causa fue no traumática. Según la localización de la ruptura meniscal el mayor número de lesiones del menisco medial se diagnosticó por RMN (61%) y US (58%), las del menisco lateral fueron diagnosticadas por US (41%) y artroscopía (39%). El ultrasonido y la resonancia mostraron una buena concordancia para la localización y la ubicación de la lesión. Conclusiones: la correlación fue muy buena para las variables analizadas entre los tres métodos diagnósticos, la mayor es entre la resonancia magnética y la artroscopía debido al índice de coincidencia detectado entre ellos.

Background: Given the boom in sports in school age, its intensity and the increase in sports in females, we are experiencing a boom in sports injuries characteristic of "adults" in growing patients, the anterior cruciate ligament being an injury with possible serious consequences., Methods: To show the surgical technique "without bone tunnels" by Micheli-Kocher in anterior cruciate ligament reconstruction in growing patients based on our results in 20 patients., Results: Since 2017 we have performed the technique "without bone tunnels" by Micheli-Kocher in 30 patients, 20 of whom have been followed up for more than 2 years. In our study, we have observed a return to previous sports activity in more than 90% of the patients, with only one patient undergoing reoperation due to a new rupture of the plasty. The results on the IKDC scales show an improvement in mean score from 42 points preoperatively to 84 postoperatively and on the Lysholm scale from 48 preoperatively to 94 postoperatively., Conclusions: The technique "without bone tunnels" by Micheli-Kocher is a technique indicated in patients under 12 years of age and Tanner stage 2 or less. It is a technique of moderate complexity with excellent results in recovery from previous sports activity and knee stability., (Copyright © 2024 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introducción: el objetivo de este trabajo es evaluar resultados clínicos y funcionales de pacientes con una rotura irreparable del manguito rotador posterosuperior, sometidos a una transferencia artroscópica del trapecio inferior. Materiales y métodos: estudio de una cohorte retrospectiva de pacientes con roturas irreparables del manguito rotador, en quienes se realizó una transferencia del trapecio inferior asistida por artroscopía. Se evaluó la evolución clínica mediante la ganancia del rango de movilidad del hombro y la disminución del dolor. Del mismo modo, se evaluó la evolución funcional usando el índice de Constant-Murley y la valoración subjetiva del hombro (SSV, por sus siglas en inglés). Resultados: se incluyeron ocho pacientes, con un seguimiento promedio de veintidós meses. Obtuvimos una ganancia estadísticamente significativa de rotación externa de 32°, disminución de 5 puntos en la escala del dolor, aumento de 31 puntos en el score de Constant y un aumento de 38% del SSV. Se registró un aumento de 12° de elevación, sin embargo, este no fue estadísticamente significativo. Dos pacientes presentaron un seroma en el sitio de la cosecha del trapecio, que se resolvió con manejo conservador. Conclusión: la transferencia del trapecio inferior con asistencia artroscópica, en pacientes con rotura irreparable del manguito rotador posterosuperior, es una técnica segura que mejora significativamente la rotación externa y los índices funcionales en este grupo de pacientes.

Introduction: Anterior cruciate ligament injuries are common, however, tibial avulsions in adults are rare. The gold standard continues to be reconstruction. In recent years, primary repairs have been reported in femoral side lesions by bioabsorbable anchorage. Clinical case: We present the case of a primary repair of the anterior cruciate ligament in tibial avulsion in a patient 19 years old after presenting direct trauma with added injuries of the posterior cruciate ligament and posterolateral corner. Primary repair was performed by transtendon portal with suture of the anterior cruciate ligament with FiberTape and FiberWire and fixed with 4.75 mm SwiveLock anchor in tibial footprint. Results: At 24 months of surgery he is with independent gait, complete range of motion, with clinical assessment scales, Tegner before the injury and after the injury at a level 6, Lysholm scale 91, subjective International Knee Documentation Committee (IKDC) 73.6, objective IKDC in C and EQ-5D 0.79. Conclusion: The avulsion of ACL on its tibial side can be repaired in certain conditions with adequate evolution and satisfaction for the patient. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the prevalence and epidemiology of knee cartilage lesions in the work environment, and to assess whether they increase the patient's work leave and thus also cost. We also analyzed the prevalence of concomitant pathology and how it affected recovery and final outcome. Material and methods: Monocentric retrospective cohort of patients with occupational injuries who underwent knee arthroscopy during 2018. Demographic data, diagnosis, concomitant chondral pathology, treatment, symptoms and signs at discharge, work leave and total cost were collected. Results: 123 patients were analyzed, with a mean age of 47 years. No differences were found between sexes or with respect to obesity. Asymptomatic chondral lesions were found in 35.25% of the patients, primarily the older ones (48-53 years). The presence of cartilaginous pathology did not increase days of work leave or total cost (p > 0.05). In patients with meniscopathy in whom meniscectomy is performed, the chondral lesion increased the number of days of work leave (p = 0.03). There were no differences in the number of days of work leave nor total cost for different treatments of chondral pathology. Conclusion: The management of a concomitant chondral knee lesion is still controversial. These lesions might convey poorer functional prognosis in patients with meniscopathy. Current therapies have not shown a clear benefit in work injuries. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Ortopédica y Traumatologia (English Edition) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduct ion: Diagnosis and management of congenital and traumatic articular ailments carry an additional problem in young people. Arthroscopy has improved treatment of these injuries, which are more frequent. Objective: To describe the experience of arthroscopic handling in pediatric patients affected with knee disease, managed at a third level hospital in Puebla, Mexico. Material and methods: Descriptive, retrospective, cross sectional study performed in patients having knee disease, admitted at Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Puebla, from March first, 2015 to February 28th, 2018. Lysholm and IKDC functional scales and Tegner functional satisfaction scale were applied at zero, six and twelve months. Student's t and Wilcoxon tests were used. Results: 29 young ones of five to 17 years of age became recruited, slightly more women (62.06%). The most frequently affected limb was the left one, with 55.17%. The disorders found are: discoid meniscus, harm of the anterior cruciate ligament, idiopathic inflammatory synovitis, tumor, meniscal injury, chondral damage, patellar hyperlaxity. Lysholm and IKDC registered improvement from the first semester. Tegner registered their ability to go back to previous daily occupations. On the Lysholm scale, there was improvement at six months. On the Tegner scale there was complete incorporation to their activities (previous to the presentation and surgical intervention). At six months subsequent to treatment, the IKDC evidenced improvement and recovery, and reintegration to their activities. Statistically significant differences (p ≤ 0.01) resulted, in measurements at zero, six and 12 months. Conclusions: Congenital and traumatic illnesses were found, the latter ones sports related. Arthroscopic approach registered positive functional results in these children. [ABSTRACT FROM AUTHOR]

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Copyright of Revista Española de Cirugía Ortopédica y Traumatologia (English Edition) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)