Alexandre Carneiro Bitar

Conservative Versus Surgical Treatment for Repair of the Medial Patellofemoral Ligament in Acute Dislocations of the Patella

PURPOSE The objective of this study was to analyze and compare the results obtained after 2 types of treatment, surgical and conservative, for acute patellar dislocations. METHODS We divided 33 patients with acute patellar dislocations into 2 groups. One group with 16 patients underwent conservative treatment (immobilization and subsequent physiotherapy), and the other group with 17 patients underwent surgical treatment. A radiographic examination was performed in the evaluation of the patients to verify predisposing factors for patellofemoral instability, and the Kujala questionnaire was applied with the intention of analyzing the improvement of pain and quality of life. The chi(2) test, t test, and Fisher test were used in the statistical evaluation. A significance level of P < .05 was adopted. RESULTS The groups were considered parametric in relation to age and sex. The conservative treatment group exhibited a higher number of recurrent dislocations (8 patients) than the surgical treatment group, which did not have any relapses. In addition, the surgical treatment group obtained a better mean score on the Kujala test (92) than the conservative treatment group (69). CONCLUSIONS We conclude that surgical treatment afforded better results. There were no recurrences in the surgical treatment group, but there were 8 recurrences in the conservative treatment group. The mean Kujala score was 92 in the surgical treatment group and 69 in the conservative treatment group. LEVEL OF EVIDENCE Level II, lesser-quality therapeutic randomized controlled trial.

Traumatic Patellar Dislocation: Nonoperative Treatment Compared With MPFL Reconstruction Using Patellar Tendon

Background: Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment. Purpose: To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Thirty-nine patients (41 knees) (mean age, 24.2 years; range, 12-38 years) with acute patellar dislocation were randomized into 2 groups. One group was treated nonoperatively with immobilization and physiotherapy, the other was treated surgically with MPFL reconstruction; both groups were evaluated with minimum follow-up of 2 years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrence was evaluated. Pearson χ2 or Fisher exact test was used in the statistical evaluation. Results: The statistical analysis showed that the mean Kujala score was significantly lower in the nonoperative group (70.8), when compared with the mean value of the surgical group (88.9; P = .001). The surgical group presented a higher percentage of “good/excellent” results (71.43%) on the Kujala score when compared with the nonoperative group (25.0%; P = .003). The nonoperative group presented a large number of recurrences and subluxations (7 patients; 35% of cases), whereas there were no reports of recurrences or subluxations in the surgical group. Conclusion: Treatment with MPFL reconstruction using the patellar tendon produced better results, based on the analyses of posttreatment recurrences and the better final results of the Kujala questionnaire after a minimum follow-up period of 2 years.

Histological study of fresh versus frozen semitendinous muscle tendon allografts

OBJECTIVE: The purpose of this study was to histologically analyze allografts from cadaveric semitendinous muscle after cryopreservation at −80°C in comparison to a control group kept at only −4°C to test the hypothesis that the histological characteristics of the tissue are maintained when the tendons are kept at lower temperatures. METHODS: In a tissue bank, 10 semitendinous tendons from 10 cadavers were frozen at −80ºC as a storage method for tissue preservation. They were kept frozen for 40 days, and then a histological study was carried out. Another 10 tendon samples were analyzed while still “fresh”. RESULTS: There was no histological difference between the fresh and frozen samples in relation to seven variables. CONCLUSIONS: Semitendinous muscle tendon allografts can be submitted to cryopreservation at −80ºC without suffering histological modifications.

Comparison between Platelet-Rich Plasma and Autologous Iliac Grafts for Tibial Osteotomy

Objective: Platelet-rich plasma (PRP) has the capacity to improve the bone-healing process. The aim of this pilot study was to investigate the occurrence of bone healing and the time taken to achieve this in patients submitted to medial opening wedge high tibial osteotomy (MOWHTO), comparing platelet-rich plasma with bone marrow aspirate to autologous iliac graft. Design: Twenty-five patients who underwent tibial osteotomy were randomly divided into 2 groups: a control group, which received autologous iliac grafts (14 patients), and a study group, which received a compound of PRP and bone marrow aspirate (11 patients). Results: The bone-healing rates achieved were 100% in the control group and 91% in the study group. There was no difference in the time taken to achieve bone healing between the groups. Conclusions: The use of a combination of PRP and bone marrow aspirate, as a bone substitute, did not demonstrate any advantage over the use of an autologous iliac graft in MOWHTO.

Results of meniscectomy for treatment of isolated meniscal injuries: Correlation between results and etiology of injury

PURPOSE To evaluate the results of the treatment of patients with isolated meniscal injuries of different etiologies. MATERIALS AND METHODS 435 patients of both sexes and different age groups underwent meniscectomy after their isolated meniscal injuries were clinically diagnosed and confirmed by nuclear magnetic resonance imaging. RESULTS Most patients achieved good results and were able to return to the activities they had practiced prior to surgery without major limitations. CONCLUSIONS Meniscectomy for the treatment of traumatic meniscal injury provides better results than meniscectomy for the treatment of degenerative meniscal injury. The results of meniscectomy for the treatment of meniscal injury due to fatigue are similar to those of meniscectomy for the treatment of traumatic meniscal injury, although the risk of osteonecrosis development is higher.

RANDOMIZED PROSPECTIVE STUDY ON TRAUMATIC PATELLAR DISLOCATION: CONSERVATIVE TREATMENT VERSUS RECONSTRUCTION OF THE MEDIAL PATELLOFEMORAL LIGAMENT USING THE PATELLAR TENDON, WITH A MINIMUM OF TWO YEARS OF FOLLOW-UP

Objective: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL) with non-operative treatment of primary patellar dislocation. Methods: Thirty-nine patients (41 knees) with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy) and other was treated surgically with reconstruction of the MPFL, and the results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearsons chi-square test and Fishers exact test were used in the statistical evaluation. Results: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8), compared with the mean value in the surgical group (88.9), with p = 0.001. The surgical group presented a higher percentage of “good/excellent” Kujala score results (71.43%) than in the conservative group (25.0%), with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases), while in the surgical group there were no reports of recurrences and/or subluxation. Conclusions: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years.

Bioabsorbable Suture Anchor Migration to the Acromioclavicular Joint: How Far Can These Implants Go?

Few complications regarding the use of bioabsorbable suture anchors in the shoulder have been reported. What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far. A 53-year old male with previous rotator cuff (RC) repair using bioabsorbable suture anchors presented with pain and weakness after 2 years of surgery. A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint. The complications reported with the use of metallic implants around the shoulder led to the development of bioabsorbable anchors. Advantages are their absorption over time, minimizing the risk of migration or interference with revision surgery, less artifacts with magnetic resonance imaging, and tendon-to-bone repair strength similar to metallic anchors. Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

Acute Calcaneus Tendon Rupture Associated with Ipsilateral Malleolar Fracture: Case Report and Literature Review

Malleolar fractures are rarely associated with lesions of the adjacent tendons or neurovascular structures. The association of ankle fractures with Achilles tendon rupture is even more infrequent, although both of these injuries are very common in and of themselves. To our knowledge, fracture of the lateral malleolus in association with an acute rupture of the ipsilateral calcaneus tendon has not been previously described. In this article, we describe a female patient who sustained an acute rupture of the Achilles tendon in conjunction with fracture of the ipsilateral lateral malleolus.

Neurapraxia do femoral pelo uso do garrote: relato de caso

The authors describe the case of a 27 year-old female patient submitted to knee surgery for patellar realignment with the use of a pneumatic tourniquet, who developed femoral neurapraxia. They make a brief literature review about the advantages and disadvantages of using a tourniquet in knee surgeries, and discuss the need for tourniquet indication considering the complications entailed by the incorrect use of the tourniquet.

Tratamento artroscópico da instabilidade anterior do ombro: estudo retrospectivo de 159 casos

OBJETIVO: Analise dos resultados de 159 pacientes com instabilidade anterior do ombro submetidos ao tratamento artroscopico de janeiro de 2001 a dezembro de 2005. METODOS: Estudo retrospectivo de prontuarios com dados completos. RESULTADOS: Em 108 pacientes notou-se a lesao de Bankart e em 62 pacientes a lesao do tipo SLAP estava presente. Utilizou-se em media 2,7 âncoras. Apresentaram complicacoes 42 casos; 14 tinham dor aos esforcos, 12 tinham algum grau de diminuicao da rotacao externa, 16 apresentaram recidiva. Os pacientes que evoluiram com complicacoes utilizaram em media 2,5 âncoras, enquanto naqueles sem complicacoes a media foi de 2,8 (p<0,05). De 35 pacientes com lesao ossea da borda anterior da glenoide 8 tiveram recidiva e de 124 casos sem fratura 8 recidivaram (p<0,05). De 113 pacientes com primo-luxacao traumatica 12 evoluiram com limitacao da rotacao externa enquanto em 46 casos atraumaticos nenhum apresentou limitacao (p<0,05). Dos casos que apresentavam lesao SLAP 11 evoluiram com dor, enquanto que nos casos sem esta lesao tres apresentaram dor (p<0,05). CONCLUSAO: Houve maior indice de recidiva na presenca da lesao ossea da borda anterior da glenoide. Dor pos-operatoria foi mais frequente quando presente a lesao SLAP. Limitacao da rotacao externa esta relacionada com instabilidade traumatica.