Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
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Knee Surg Sports Traumatol Arthrosc · Mar 2009
Revision after early aseptic failures in primary total knee arthroplasty.
The purpose of this study was to evaluate cases of early aseptic failures presented during the first 5-year follow-up in a group of 981 primary total knee arthroplasty (primary TKA). Predisposing factors as well causes of failures and postoperative complications in different groups of aseptic failures were re-assessed and compared to a control group. A retrospective and cohort study compared one group of 944 primary TKA without surgical revision (890 patients) (Group A) with 22 primary TKA (22 patients) (Group B) that had revision TKA secondary to aseptic failure during the first five years follow-up. ⋯ TKA loosening (n = 11) and undiagnosed pain (n = 7) were considered the most frequent modes of failures, and laxity (n = 1) was a very rare early cause of failure. The aseptic failure group was characterized as average 5 years younger with a greater number of previous knee surgeries, lower IKS scores improvement, and more postoperative pain compared to control group, despite the fact that the aseptic failure group showed a prevalence of cases during the first 2-year follow-up. Inside this group, the undiagnosed pain group had lower improvement of IKS scores, a remarkable prevalence in prior surgical procedure (71%) and a minor mean interval between primary and revision TKA (11.6 months).
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Knee Surg Sports Traumatol Arthrosc · Mar 2009
A safe postero-medial approach to posterior cruciate ligament avulsion fracture.
The posterior cruciate ligament (PCL) plays a major role in knee stabilization, and clinical studies have shown an increase in incidence of its injury. Due to the surrounding neurovascular elements in the popliteal space, open approaches to repair such injury are difficult to perform. The "safe postero-medial approach" to PCL avulsion fracture is a simple approach, does not require exploration of the neurovascular elements, and produced satisfactory results in the majority of patients.
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Knee Surg Sports Traumatol Arthrosc · Feb 2009
Open screw fixation of large anterior glenoid rim fractures: mid- and long-term results in 29 patients.
The aim of this retrospective study was to analyse the clinical, functional and radiographic outcomes of patients sustaining traumatic anterior dislocations of the shoulder in combination with large anterior glenoid rim fractures, treated by open reduction and internal screw fixation (ORIF). Twenty-nine patients with a mean follow-up of 6.5 years (2.5-12 years) were evaluated clinically using the Constant and DASH scores, radiographs in two planes and isokinetic muscle strength measurement (Biodex 3 PRO). Mean age was 41.6 years (17-68 years). ⋯ Twenty-seven patients (93%) were satisfied or very satisfied with the result after surgery. ORIF seems to be a good treatment option in cases of large glenoid rim fractures to avoid re-dislocation in the mid-term. Prospective randomised studies are necessary to compare these findings with those after non-operative or arthroscopic treatment of these injuries.
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Knee Surg Sports Traumatol Arthrosc · Jan 2009
A new tourniquet system that determines pressures in synchrony with systolic blood pressure in knee surgery.
This study reports the results of the clinical use of a new tourniquet system for surgery related to knee joint that can determine tourniquet pressure in synchrony with systolic blood pressure (SBP). We prospectively applied additional pressure of 100 mmHg based on the SBP recorded just before infiltration of tourniquet in 163 consecutive procedures, which consisted of 73 TKA related surgeries, 42 arthroscopic related surgeries, 20 ACL reconstructed surgeries, 15 ORIF, and 13 other surgeries. After the infiltration, the tourniquet pressure was automatically synchronized with the SBP. ⋯ All cases kept a good operative field without measurable bleeding and there were no postoperative complications. Sixty-eight (42%) cases had a lower intra-operative SBP than the initial value. Since a tourniquet should be applied at the lowest pressure, and for the shortest amount of time possible, the new system appears to be practical and reasonable for maintaining a bloodless surgical field, as compared to conventional tourniquets, which maintain the initial pressure between 300 and 350 mmHg.
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Knee Surg Sports Traumatol Arthrosc · Jan 2009
Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the Tight Rope device: a technical note.
We present a new arthroscopic technique for chronic AC joint dislocations with coracoacromial ligament transposition and augmentation by the Tight Rope device (Arthrex, Naples, USA). First the glenohumeral joint is visualised to repair concomitant lesions, such as SLAP lesions, if needed. Once the rotator interval is opened and the coracoid is identified, the arthroscope is moved to an additional anterolateral portal. ⋯ The CA ligament is armed with a strong braided suture using a Lasso stitch and dissected from the undersurface of the acromion. It is then reattached to the distal part of the clavicle by transosseous suture fixation after abrasion of its undersurface. Although this combined arthroscopic procedure of AC joint augmentation with a Tight Rope combined with a ligament transposition is technically demanding, it is a safe method to reconstruct the coracoclavicular ligaments and achieve a sufficient reduction of the clavicle without the need of further implant removal or autologous tendon transplantation.