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Purpose The anatomical anterior cruciate ligament (ACL) reconstruction attempts to, by reproducing the natural orientation of its fibres, achieve a better rotational stability of the knee. The aim of this paper is to quantify the anteroposterior and rotational laxity of the knee before and after an anatomic ligamentoplasty using the Orthopilot ® navigation system as a supporting tool. Material and method We describe the distinctive steps of Orthopilot ® navigation as well as conducting a retrospective cross-sectional study on a cohort of 20 patients operated in our hospital for chronic primary ACL rupture from January 2010 to May 2011. The precise location of the tunnels was defined with the help of the navigator and the intra-articular landmarks and stability tests were performed in both the sagittal and axial planes. Results In our technique for anatomical ACL reconstruction placed the tibial tunnel at a mean distance of 16.8 ± 4.92 mm from the posterior cruciate ligament in a position that represented 44.1 ± 4.35% of the total width of the tibial plateau. The average distance from the centre of the femoral tunnel to the posterior cortex of the lateral condyle was 7.89 ± 2.78 mm. Intra-operatively and before ACL reconstruction, the mean (±SD) anteroposterior movement, internal rotation and external rotation of the tibia at 30° position were 15.5 mm (±5.11), 19° (±3.62) and 19.65° (±3.26), respectively. After reconstruction these values decreased to 5.6 mm (±1.72°), 12.17° (±3.76) and 16.9° (±4.42), respectively. Conclusions The use of navigation systems supporting the surgery allows the systematic positioning of bone tunnels and standardises the procedures for the desired reconstruction. ACL reconstruction using the technique described, improves the anteroposterior and rotational stability compared to preoperative status, to a stability state that could be considered physiological according to current scientific knowledge.

Resumen Objetivo La tecnica de reconstruccion anatomica del ligamento cruzado anterior (LCA) persigue, reproduciendo la orientacion nativa de sus fibras, alcanzar una mejor estabilidad rotacional en la rodilla. El objetivo principal del presente trabajo es la evaluacion cuantitativa intraoperatoria, mediante el uso del sistema de navegacion de Orthopilot®, de la laxitud anteroposterior y rotacional de la rodilla antes y despues de una ligamentoplastia anatomica. Material y metodo Descripcion de la tecnica de navegacion y estudio transversal sobre una cohorte de 20 pacientes intervenidos en nuestro centro por rotura primaria cronica del LCA desde enero de 2010 hasta mayo de 2011. Con la ayuda del navegador se definio la posicion exacta de los tuneles en base a referencias anatomicas intraarticulares y se realizaron pruebas de estabilidad, tanto en el plano sagital como en el axial. Resultados Nuestra tecnica de reconstruccion anatomica del LCA situo el tunel tibial a una distancia media de 16,8 ± 4,92 mm del ligamento cruzado posterior y a un 44,1% ± 4,35% de la anchura total del platillo tibial. La distancia media del centro del tunel femoral a la cortical posterior del condilo lateral fue de 7,89 ± 2,78 mm. Intraoperatoriamente y antes de la reconstruccion, los valores medios (± DE) de traslacion anteroposterior, rotacion interna y rotacion externa de la tibia a 30° fueron de 15,5 mm (± 5,11); 19° (± 3,62) y 19,65° (± 3,26) respectivamente. Tras la reconstruccion dichos valores disminuyeron a 5,6 mm (± 1,72); 12,17° (± 3,76) y 16,9° (± 4,42). Conclusiones El empleo de sistemas de navegacion como apoyo al cirujano permite sistematizar la posicion de los tuneles oseos y estandarizar el procedimiento en relacion a la reconstruccion deseada. La reconstruccion del LCA segun la tecnica descrita, mejora la estabilidad anteroposterior y rotacional monoplanar respecto al estado preoperatorio pudiendo restablecer los valores de laxitud a los considerados como fisiologicos acorde al conocimiento cientifico actual.

Objetivo Uno de los puntos mas controvertidos relacionados con la via de abordaje en el enclavado anterogrado del humero es la iatrogenia en el manguito de los rotadores. El objetivo de este trabajo ha sido determinar el impacto clinico-ecografico asociado a este abordaje. Material y metodo Estudio transversal sobre una cohorte retrospectiva de 23 pacientes intervenidos con fracturas diafisarias de humero en el Hospital 12 de Octubre entre los anos 1998 y 2004. Criterios de inclusion Fracturas agudas diafisarias de humero tratadas mediante osteosintesis con enclavado por via anterograda sin limite de edad y seguimiento minimo de un ano. Criterios de exclusion Pacientes con patologia reumatica asociada, antecedente traumatico previo glenohumeral o fracturas del humero proximal antiguas. La valoracion clinica se realizo con el test de Constant y el estudio ecografico utilizo como control el hombro contralateral. Resultados La puntuacion media del test de Constant fue de 82 (49-99), con una agrupacion general de resultado de la serie bueno: 80% mas de 65. Los unicos hallazgos ecograficos observados fueron lineas hiperecogenicas en 4 pacientes, interpretadas como roturas parciales inferiores a 30 mm. Estos pacientes obtuvieron un resultado funcional aceptablemente bueno, sumando mas de 70 puntos en el test de Constant. Conclusiones Los resultados de este estudio sugieren que la utilizacion del abordaje anterolateral para el enclavado humeral anterogrado, con una cuidadosa diseccion y posterior sutura del manguito rotador, asi como un punto de entrada en la cabeza humeral suficientemente medial garantizan un buen resultado funcional sin un impacto clinicoecografico relevante.

Purpose One of the most controversial points about antegrade humeral nailing is that of potential iatrogenic injuries to the rotator cuff. The purpose of this paper is to determine the clinical and sonographic impact associated to the use of the anterolateral approach. Materials and methods Transversal study of a retrospective cohort of 23 patients operated on for humeral diaphyseal fractures at the 12 de Octubre Hospital between 1998 and 2004. Inclusion criteria Acute humeral shaft fractures treated by means of antegrade nailing. No age threshold was imposed; minimum follow-up was one year. Exclusion criteria Patients with an associated rheumatic pathology were excluded as well as those that had suffered a prior glenohumeral traumatic event or a proximal humeral fracture. Clinical assessment was conducted with Constant's scale and the sonographic study used the contralateral shoulder as control. Results Mean score on Contant's scale was 82 points (range: 49-99), with most patients achieving a good result, i.e. 80% obtained more than 65 points. The only sonographic findings described were a few hyperechogenic lines in 4 patients, which were interpreted as partial ruptures of less than 30 mm. These patients had an acceptable functional outcome, with a score of more than 70 points on Constant's scale. Conclusions The results of this study suggest that the use of the anterolateral approach for antegrade humeral nailing, provided that there is careful dissection and posterior suturing of the rotator cuff, as well as a sufficiently medialized entry point on the humeral head, ensures a good functional result with no significant clinical-sonographic impact.

Resumen Objetivo Analizar los resultados funcionales y en cuanto al dolor en pacientes con protesis parciales tras una fractura-luxacion en cuatro fragmentos de la cabeza humeral sometidos a un programa de rehabilitacion. Pacientes y metodos Estudio descriptivo en el que se incluyeron todos los pacientes con fractura-luxacion en cuatro fragmentos de cabeza humeral tratados en el Servicio de Rehabilitacion entre 1999 y 2005. Para el analisis estadistico se utilizo el coeficiente de correlacion de Pearson y el Anova, p ≤ 0,05. Resultados Se estudiaron 31 pacientes con una media de edad de 72 anos. No tenia dolor el 41,94 %, en el 48,38 % este era ligero y en el 9,67 % era franco. Los rangos articulares fueron 74,35° ± 44,15° en antepulsion, 73,22° ± 41,86 en abduccion, 33,38° ± 27,70° en rotacion interna y 27,58° ± 23,80° en rotacion externa. La puntuacion en la Escala de Constant fue de 52,38 ± 18. El tiempo desde la intervencion hasta el tratamiento fue de 17,2 dias ± 15,91. El periodo de tratamiento fue 5,8 meses ± 1,48. No hemos encontrado correlacion entre los rangos articulares y la Escala de Constant con el intervalo de tiempo entre la intervencion quirurgica y el inicio del tratamiento, ni con el tiempo de tratamiento. Discusion La disminucion del dolor fue el resultado mas evidente. La funcionalidad resulto variable, quizas por la edad de nuestros pacientes. El tiempo hasta la cirugia, la reconstruccion y las complicaciones posquirurgicas influyeron en los resultados. Los pacientes mostraron un alto grado de satisfaccion al alta.

When it comes to providing a medical indication and selecting a certain surgical technique, surgeons make their decision based on their professional experience, previous results, and personal skills. However very few of them can affirm with scientific rigor that their perceptions are real and are not influenced by some type of bias, either voluntary or not. The great challenge that we are confronted with is trying to bring light to the darkness of scientific knowledge with the help of the different works published.

The anatomical anterior cruciate ligament (ACL) reconstruction attempts to, by reproducing the natural orientation of its fibres, achieve a better rotational stability of the knee. The aim of this paper is to quantify the anteroposterior and rotational laxity of the knee before and after an anatomic ligamentoplasty using the Orthopilot(®) navigation system as a supporting tool. MATHERIAL AND METHOD: We describe the distinctive steps of Orthopilot(®) navigation as well as conducting a retrospective cross-sectional study on a cohort of 20 patients operated in our hospital for chronic primary ACL rupture from january 2010 to may 2011. The precise location of the tunnels was defined with the help of the navigator and the intra-articular landmarks and stability tests were performed in both the sagittal and axial planes.In our technique for anatomical ACL reconstruction placed the tibial tunnel at a mean distance of 16.8±4.92 mm from the posterior cruciate ligament in a position that represented 44.1%±4.35 of the total width of the tibial plateau. The average distance from the centre of the femoral tunnel to the posterior cortex of the lateral condyle was 7.89±2.78 mm. Intra-operatively and before ACL reconstruction, the mean (±SD) anteroposterior movement, internal rotation and external rotation of the tibia at 30° position were 15.5 mm (±5.11), 19° (±3.62) and 19.65° (±3.26), respectively. After reconstruction these values decreased to 5.6 mm (±1.72°), 12.17° (±3.76) and 16.9° (±4.42), respectively.The use of navigation systems supporting the surgery allows the systematic positioning of bone tunnels and standardises the procedures for the desired reconstruction. ACL reconstruction using the technique described, improves the anteroposterior and rotational stability compared to preoperative status, to a stability state that could be considered physiological according to current scientific knowledge.

The load transfer mechanism across the skeleton of the human foot is very important to understand its biomechanical function. In this work, we develop several computational models to compare the biomechanical response of different metatarsal geometries. Finite element 3D simulations of feet reconstructed from computer tomography (CT) scans were used to evaluate the stress/strain distributions during the stance posture. The numerical predictions for pathological and healthy foot geometries present different load transfer mechanisms that can provide a biomechanical explanation of why some metatarsal geometrical configurations cause different foot skeletal stresses. The most significant result in all cases was a reduction between 20% and 30% of the peak load supported by the first metatarsal. Therefore, we conclude that a clearly unloaded first metatarsal, overloading the rest, is a risk factor to induce metatarsalgia.