Carlos Yacuzzi

Patellofemoral arthritis treated with resurfacing implant: Clinical outcome and complications at a minimum two-year follow-up

BACKGROUNDnThis study evaluated the clinical and radiographic outcomes of a series of patients treated with an anatomic inlay resurfacing implant, with a minimum two-year follow-up.nnnMETHODSnFifteen patients underwent patellofemoral-resurfacing procedures using a HemiCAP Wave Patellofemoral Inlay Resurfacing implant from 2010 to 2013. Clinical outcomes included: Visual Analog Scale (VAS), Lysholm score, Knee Society Score (KSS), and evaluation of Kujala, and Hospital for Special Surgery Patellofemoral score (HSS-PF). The postoperative complications were analyzed.nnnRESULTSnNineteen knees were evaluated; the average follow-up was 35.2months. Fourteen were women, with an average age of 54years. The pre-operative/postoperative clinical results presented a significant improvement: VAS 8/2.5, Lysholm 31.9/85.8, KSS 39.8/82.5, Kujala 32.1/79.3 and Hospital for Special Surgery Patellofemoral score (HSS-PF) 15.9/90.6. A total of 87% of patients were either satisfied or very satisfied with the overall outcome. There were no radiographic signs of loosening. Seven postoperative complications were recorded: two presented ongoing knee pain, one postoperative stiffness, one patellar bounce due to maltracking, two ilio-tibial band syndrome, and one tibial anterior tuberosity osteotomy nonunion. Two patients underwent a total knee arthroplasty conversion and were considered a failure. None of these complications were implant related.nnnCONCLUSIONSnPatellofemoral inlay resurfacing for isolated patellofemoral arthritis was an effective and safe procedure with high levels of patient satisfaction. No mechanical implant failure was seen at a minimum two-year follow-up. This implant design appeared to be an alternative to the traditional patellofemoral prostheses. Concomitant osteochondral lesions, patellofemoral dysplasia or patellar maltracking might be poor prognostic factors for this type of implant.

Rango de movilidad y resultados funcionales en tres diseños diferentes de artroplastia de rodilla primaria: Estudio Comparativo

Introduccion: El objetivo de este trabajoxa0 fue analizar los resultados funcionales y el rango de movixadmiento entre tres grupos de pacientes con arxadtroplastia total de rodilla: dos utilizando protesis de alta flexion y el otro con un diseno convencional. Materiales y Metodos: 64 pacientes fueron operados con protesis total de rodillaxa0 Zimmer NexGen®, y 34 pacientes operados con Optetrack ® xa0de alta flexion. Luego de la exclusion de pacientes;xa0 22 pacientes xa0(grupo A) fueron tratados con diseno de alta flexion de Zimmer, 21 pacientes (grupo B) tratados con protesis Zimmer convencional, y 25 pacientes (Grupo C) con artroplastia xa0Optetrack® PS. La evaluacion funcional se realizo con el Knee Society Score, el Western Ontario and McMaster Universities osteoathritis index y la escala analogica visual. Resultados: En el posoperatorio, el promedio de flexion maxima del grupo A subio de 99° a 113o, con un aumento promedio de 14o, en el grupo B de 106° a 118o con una ganancia promedio de 12o y en el grupo C de 110° a 111° siendo la ganancia de 1°. Los resultados funcionales evaluados con KSS y el WOMAC presentaron mejorias en los tres grupos. Conclusion: Las evaluaciones clinicas funcionales son favorables en los tres disenosxa0 evaluados. Este estudio muestra que no hay diferencias significativas en la flexion final lograda, y resultados funcionales entre los dos primeros disenos entre si, si siendo estos significativamente superiores al diseno del tercer grupo luego de un ano de seguimiento.xa0 Palabras Claves: Protesis total de rodilla, protesis de alta flexion, protesis convencionales, rango de movilidad

Estudio prospectivo randomizado sobre el uso de drenaje vs. no drenaje en artroplastia total de rodilla. [Prospective randomized study on the use of drainage in total knee arthroplasty.]

Introduction The use of drainage in total knee arthroplasty is a widely accepted practice in Orthopedics; however, there is not conclusive evidence about its benefit in the literature. The purpose of this study was to compare two groups of patients in whom primary total knee arthroplasty with and without drainage was performed. Methods Prospective randomized study in which 76 primary total knee arthroplasties were performed; patients were divided into two groups: group A, with drainage, and group B, without drainage. The number of transfusions, the drainage debit, postoperative complications and length of hospital stay were evaluated. Diameter of the thigh, range of motion, hematocrit and hemoglobin were also recorded before and after surgery in both groups. Results No statistically significant differences were found in thigh diameter, range of motion, hematocrit, hemoglobin, number of transfusions, and hospital stay. The number of complications in group B (without drainage) was higher (P = 0.019): two deep infections, two cases of cellulitis, one case of blebs, a hip fracture, a superficial vein thrombosis, a deep venous thrombosis, and one pulmonary thromboembolism. Conclusion Patients without postoperative drainage presented a higher number of complications.

Prótesis total de rodilla en pacientes con enfermedad de Parkinson. Resultados preliminares

Background:xa0 Parkinson’s disease is a progressive, chronic, neurodegenerative disorder with an approximate incidence of 31/100,000 persons in Argentina. The aim of this study was to assess a group of patients with Parkinson’s disease who underwent total knee arthroplasty. Methods:xad xa0Between 2009 and 2011, 11 patients with Parkinson’s disease (average age 68 years, range 65-80) who underwent cemented posterior stabilized total knee arthroplasty for osteoarthritis were retrospectively reviewed. All patients were evaluated with a visual analogue scale for pain, the Knee Society Scoring, the WOMAC and the degree of subjective satisfaction. Degree of Par- kinson severity was measured with the Modified Hoehn and Yahr Scale. Complications were recorded. Results: xa0The average follow-up was two years (range 1-3). Results for pain and function were: visual analogue scale for pain improved an average of 3 points; KSS pain 37/74; functional KSS 36/51, WOMAC 67/31. Satisfaction was good to excellent in 7 cases. The Modified Hoehn and Yahr Scale was 1.5 points preoperatively and 2.6 points postoperatively. There were 6 complications: two confusional syndromes, a deep venous thrombosis, a prosthetic dislocation and two painful prostheses. Conclusion: xa0xadTotal knee arthroplasty in patients with Parkinson’s disease is a procedure that improves functional outcomes and pain, but it produces more complications than in the general population.

ISAKOS Classification of Meniscal Tears. Intra and Interobserver Reliability.

Objectives: To analyze the intra and interobserverreliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Methods: Thearthroscopic classification of meniscal lesions created by the ISAKOS was used. Thirty one arthroscopic videos, made between June and December 2013,with different meniscal tear characteristics were analyzedby three orthopedic surgeons (two specialists in knee surgery and a fellowship), twice at an interval of 30 days. The Kappa Coefficients (k) was used to assess the intraobserver reliability and intraclass correlation coefficient (ICC) for interobserverreliability. Results: The averageintraobserver reliability was for the first observer 51%, the second 65% and the third 58%, reaching moderate agreement according to the Kappa coefficient used by Landis and Koch. Regarding interobserver reliability, good agreement (ICC = 0.71) was obtained as the intraclass correlation coefficient. The whole results were significantlystatical (p <0.05). Conclusion: While this classification provides a detailed description of meniscal lesions, the intraobserver reliability did not reach the optimum values obtained despite having on average a moderate agreement. However interobserver reliability results showed on average 70% of agreement (good agreement), which can affirm that the agreement and interobserver reliability is acceptable.

Intra articular knee cycts: diagnosis and treatment

Objectives: The goal of this study is to investigate a series of patients diagnosed with symptomatic intraarticular knee cysts and describe the diagnostic algorithm and surgical techniques. Materials and Methods: This is a retrospective study including 35 patients diagnosed with intraarticular knee cycts who underwent surgical treatment. We excluded patients diagnosed with a mucoid ligament and meniscal cycts. Twenty of the patients were men and 15 women with an average age of 39 years old. All patients underwent anecscional biopsy: 31 arthroscopically and 4 with an open resection. Hydrarthrosis, joint lock and complaints of unspecific pain were present among some of the clinical variations. All of the mentioned cases were diagnosed using MRI imaging and clinical follow up care in order to evaluate suspicion of relapse. Results: In all of the mentioned cases, diagnosis were confirmed through anatomical pathology, with 16 focalized pigmented villonodular synovitis, 5 mucoidcycts, 4 synovial cysts, 1 fibrosis cyst , 6 ACL ganglions, 1 PCL ganglion, 2 ACL post operative fibrosis and 2 Bakers cycts. Of those patients: 34 showed favorable outcome and one patient with a Bakers Cyst presented complications with a relapse 6 months after the inicial surgery. Conclusion: The pre operative MRI is of great importance due to the fact thatcycts can be found in areas that are difficult to access or rarely explored. It is of much importance to investigate these types of pathologies being that an early diagnosis with surgical treatment can lead to favorable results.

Autologous osteochondral transfer for the treatment of full-thickness defects in patients with or without ACL reconstruction. Results with 7 years follow-up

Objectives: The aim of this study was to evaluate the results of autologous osteochondral transfer for the treatment of cartilage defects in 2 groups of patients: The first with an isolated osteochondral injury and the other with associated anterior cruciate ligament (ACL) injury treated in one stage surgery Materials and Methods: We retrospectively evaluated 25 patients with symptomatic focal full-thickness chondral lesions in the femoral condyles during the years 2003-2009, with a minimum of 5 years of follow up. The patients were divided into 2 groups: Group A: 10 patients with associated ACL injury, and Group B: 15 patients with an isolated osteochondral lesion. Clinical outcome was analyzed by Lysholm and IKDC scores. Results: There was an improvement of all scores in both groups. There were no significant differences between the groups in the IKDC (82/84) and Lysholm (87/86) scores. The mean age at the time of assessment for group A was 46 years and 44 for the group B. The mid term follow-up was 96 months for group A and 103 months for group B. Two complications were recorded in group A: 1 infection and 1 arthrofibrosis. 2 complicationsoccurred in group B: 2 arthrofibrosis. Conclusion: The results of the mosaicplasty for the focal full-thickness chondral lesions in the femoral condyles are favorable after 5 years of follow up. There was no difference between the associated or not ACL injury.

High Tibial Valgus Osteotomy and Concomitant Anterior Cruciate Ligament Reconstruction. Which is the most appropriate surgical technique

Introduction: The aim of this study is to evaluate advantages of close vs. open HTO of a group of patients who underwent a one-stage combined operation for chronic ACL rupture and early medial compartment arthritis. Material and Methods: We retrospective evaluated two series of patients operated on for anterior cruciate ligament (ACL) reconstruction combined with high tibial valgus osteotomy (HTO) for chronic anterior knee instability associated with medial tibio femoral osteoarthritis. Close HTO using rigid plate fixation and ACL reconstruction with bone patellar tendon bone graft was performed in Group A (7 patients). An open HTO using Puddu plate and ACL reconstruction with hamstring tendon graft was performed in Group B (9 patients). The mean age in Group A was 41 years old with an average varus of 8 degrees. Mean age in Group B was 42 years old and with 4 degrees of varus. Lysholm Score, HSS and Radiographs were performed. Results: Group A obtained a mean Lysholm score of 94, mean HSS of 91. Group B showed a mean Lysholm score of 83, mean HSS of 87. The mean follow-up was 5 years in both groups. In all cases osteotomies consolidated. Discussion: Technically we found that open HTO with hamstrings had several advantages such as lower risk of peroneal nerve injury, use of one incision, no problems as regards graft length, possibility of fixing the graft in the proximal tibia, maintenance of tibial slope and preservation of bone stock. The Open HTO need of osseous graft, may produce patella baja and the risk of nonunion is higher. This technique is indicated for relaxed medial collateral ligament. As regards the Close HTO there may be possibilities of a peroneal nerve injury, it may decrease the tibial slope, patellar ascent, loss of bone, the need to disrupt either the fibula or proximal tibio-fibular joint and may generate instability in the posterolateral corner and the screws could compromise the tunnels path. The advantages are provision of bone to bone contact with excellent union rates and the potential for full early weight-bearing. Conclusion: In spite of these issues, both procedures relieved pain and restored knee stability and the choice will depend on each particular case.

Ligamento Cruzado Anterior Mucoide. [Mucoid degeneration of the anterior cruciate ligament]

Background The purpose of this study is to perform a systematic literature review of the ACL mucoid and describe our experience in the diagnosis and surgical treatment of this pathology. Methods We describe the clinical features, the pathophysiology, the imaging findings and surgical treatment of this condition. Furthermore we present a retrospective study performed between 2004 and 2011 including 27 patients (average age 55 years; range: 34-68 years). Pain, range of motion and stability were taken into account in the evaluation of patients. Clinical maneuvers and KT-1000 test were used to assess post-surgical stability. X-rays and MRI were performed before and after surgery. Post-surgical results were evaluated using the Lysholm score, IKDC and with the visual analogue scale. Samples were taken for biopsies. Results Visual analogue scale improved 6 points (max 8- min 2). Mobility range improved an average of 26o. Knee stability was not affected. As regards the functional evaluation, final IKDC was A in 50% of patients, B in 33% and C in 17%. Lysholm score was 95 points. Results in the subjective rating scale ranged from very good to excellent in most patients. There were no post-surgical complications. Conclusions MRI is the best imaging technique for diagnosis. Findings are characteristic and should not be confused with ACL tears. Final diagnosis is histological. We believe that the arthroscopic treatment is effective and with a low incidence of complications.