Alexandre de Christo Viegas

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.

Artroplastia unicompartimental no tratamento da artrose medial do joelho

OBJETIVO: Analisar a evolucao de um grupo de pacientes submetido a artroplastia unicompartimental de joelho para tratamento das artroses e nas osteonecroses que comprometem exclusivamente o comportamento medial. METODOS: Foram avaliados 49 pacientes portadores de artrose unicompartimental de joelho com idade variando entre 47 e 88 anos de idade, sendo 12 homens e 37 mulheres. Todos foram submetidos a artroplastia unicompartimental do tipo Miller-Galante. Apos seguimento minimo de quatro anos, os pacientes foram avaliados subjetivamente pelo exame ortopedico e objetivamente pelo sistema Hospital for Special Surgery (HSS). RESULTADOS: Apenas uma paciente necessitou de revisao para artroplastia total; quatro apresentaram dor nao incapacitante; e tres, queixas de instabilidade esporadica nao incapacitante. Na avaliacao do HSS, 30 pacientes apresentaram resultados excelentes; 18, resultados bons; e um, resultado regular. CONCLUSAO: A artroplastia unicompartimental e uma boa opcao para casos de artrose e osteonecrose do compartimento medial do joelho.

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.

Avaliação biomecânica dos tendões dos músculos tibiais e proposta de sua utilização como aloenxertos nas reconstruções do ligamento cruzado anterior

The purpose of this study was to evaluate the mechanical properties of the anterior (AT) and posterior (PT) tibialis muscle tendons submitted to axial stra...

Tratamento da luxação femoro-patelar aguda pelo reparo do ligamento femoro-patelar medial

Os autores avaliaram a evolucao de 17 pacientes que tiveram luxacao femoropatelar aguda e foram tratados pela sutura do ligamento femoropatelar medial. A sutura do ligamento foi feita por via artroscopica em 9 pacientes que apresentaram a lesao do ligamento proxima a patela. Nos oito pacientes restantes a lesao do ligamento femoropatelar ocorreu proxima ao epicondilo femoral e foi tratada pela reinsercao no epicondilo femoral com âncoras. Os pacientes foram acompanhados por um tempo medio de 40 meses e nao houve nenhuma recidiva da luxacao femoropatelar durante este periodo.

Estudo prospectivo e comparativo entre o tratamento conservador e o cirúrgico (reparo do ligamento femoropatelar medial) nas luxações agudas de patela

Two groups of patients with their first episode of traumatic patellofemoral acute dislocation were studied and prospectively followed up regarding recurrences and predisposing factors to dislocation. In Group I, 17 patients with mean age of 24.6 years old, being 11 females, were submitted to medial patellofemoral ligament repair within less than a month after trauma. The mean follow up time was 40.4 months and the least, 18 months. As a result, there was no recurrence of the dislocation, and two episodes of subdislocation. Nine patients presented predisposing factors to dislocation. In Group II, 15 patients with mean age of 26.8 years old, being eight females, were submitted to conservative treatment with 18.5 days of immobilization, in average. The mean follow-up time was 35.7 months and the least, 11 months. Eight knees presented recurrence of the dislocation, only two knees were regarded as stable. In this group, 14 patients had predisposing factors. We concluded that the surgical treatment of traumatic patellofemoral acute dislocations presents superior outcomes regarding recurrence when compared to the conservative approach within the period of study. The presence of predisposing factors in our patient series did not influence the recurrences of patellofemoral dislocations.