Marcelo Seiji Kubota

Total knee arthroplasty with computer-assisted navigation: an analysis of 200 cases,

Objective to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty. Method a total of 196 patients who underwent total knee arthroplasty with computer-assisted navigation were evaluated. The extension and flexion spaces (gaps) were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS) questionnaire for assessing patients function was applied preoperatively and postoperatively after a mean follow-up of 22 months. Results in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3° of varus or valgus in relation to the mechanical axis) and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS. Conclusion the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures.

Meniscal repair by all-inside technique with Fast-Fix device

Objective The objective of this study is to evaluate the results and effectiveness of the technique of meniscal repair type all-inside using Fast-Fix device. Methods A retrospective cohort study evaluating 22 patients with meniscal surgery between January 2004 and December 2010 underwent meniscal repair technique for all-inside with the Fast-Fix device with or without ACL reconstruction. Function and quality of life outcomes were chosen by the IKDC and Lysholm score, before and postoperatively, and reoperation rates, relying to the time of final follow-up. Statistical analysis was performed using the Students t test. Results The mean follow-up was 59 months (16–84). The Lysholm score showed 72% (16 patients) of excellent and good results (84–100 points), 27% (6 patients) fair (65–83 points) and no cases classified as poor (<64 points). According to the IKDC: 81% (18 patients) of excellent and good results (75–100 points), 18% of cases regular (50–75 points) and no patient had poor results (<50 points). There were no failures or complications. Conclusion The technique of meniscal repair type all-inside using the Fast-Fix device is safe and effective for the treatment of meniscal lesions in the red zone or red-white with or without simultaneous ACL reconstruction, with good and excellent results in most patients Level 4 Study.

Anatomic Posterolateral Corner Reconstruction With Autografts

Anatomic posterolateral corner reconstruction reproduces 3 main structures: the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon. The LaPrade technique reproduces all 3 main stabilizers. However, it requires a long graft, limiting its indication to clinical settings in which allograft tissue is available. We propose a surgical procedure that is a modification of the LaPrade technique using the same tunnel placement, hamstring autografts, and biceps augmentation when necessary. It relies on artificial graft lengthening provided by the loop of the suspensory fixation device fixed at the anterior tibial cortex. The final reconstruction reproduces the popliteus tendon with the bulkiest end of the semitendinosus; the popliteofibular ligament with a strand of the semitendinosus and a strand of the gracilis; and the lateral collateral ligament with a strand of the semitendinosus and a strand of the gracilis, which can also be augmented with a biceps strip.

MPFL Reconstruction Combined with Anteromedialization Tibial Tubercle Osteotomy Versus Isolated MPFL Reconstruction in Patients with Recurrent Patellar Instability: A Quasi-Randomized Controlled Trial

PURPOSE: Compare the clinical outcomes of the anteromedialization tibial tubercle osteotomy (TTO) combined with medial patellofemoral ligament reconstruction (MPFLR) versus MPFLR alone for the treatment of recurrent patellar instability (RPI) in patients with TT-TG 17 to 20 mm presenting its mid-term outcomes. METHODS: From January 2008 to August 2013, skeletally mature patients with RPI and TT-TG 17-20mm were quasirandomized into two groups: TTO combined with MPFLR (TTO+MPFLR) or MPFLR alone (MPFLRa). Quasirandomization: both interventions were explained to the patients and they chose which one to be submitted. Subjects were evaluated for patellar tracking lateralization, patellar glide, apprehension test, increased femoral anteversion, Caton index, trochlea dysplasia by Dejour classification, TT-TG, Kujala, IKDC, Lysholm and Tegner. RESULTS: Forty-two patients composed the study. TTO+MPFLR group was comprised of 18 patients and MPFLRa group was comprised of 24 patients. Demographics between groups were not significantly different related to age, gender, side, and cartilage lesion. Results are presented comparing TTO+MPFLR and MPFLa, respectively, as follows. Follow-up: 41.33±10.26, 40.5±11.63 months, p=0.81. Patellar tracking lateralization preoperatively: 3.33±0.84, 3.25 ±0.67, p=0.182. Patellar tracking lateralization postoperatively: 1±0, 1.33±0.48, p=0.006. Patellar glide and apprehension test preoperatively: All patients had a positive apprehension test or a patellar luxation at the patellar glide test rated as grade 4 before surgery. Patellar glide postoperatively: 1.17±0.38, 1.21±0.41, p=0.734. Apprehension test postoperatively: none. Increased femoral anteversion: 6%, 25%, p=0.9. Caton index preoperatively: 1.12±0.14, 1.12±0.11, p=0.97. Caton index postoperatively: 1±0.08, 1.12±0.11 (the same preoperatively), p=0.0012. TTO+MPFLR patients submitted to concurrent tibial tubercle distalization: 44%. Trochlea dysplasia: no significant difference between groups, p=0.67. TT-TG preoperatively: 18.5±1.24, 18.04±1.12, p=0.16. TT-TG postoperatively: 10.55±0.83, 18.04±1.12 (the same preoperatively), p<.001. No significant difference was seen International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine 11 th Biennial ISAKOS Congress • June 4-8, 2017 • Shanghai, China ISAKOS