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Treatment of Distal Patellar Tendon Chronic Rupture: The X-Wave Technique. Arthrosc Tech 2022; 11:e1373-e1380. [PMID: 36061471 PMCID: PMC9437360 DOI: 10.1016/j.eats.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/12/2022] [Indexed: 02/03/2023] Open
Abstract
Injuries to the patellar tendon (PT) are associated with knee function deterioration and loss of the capacity to perform daily and sports activities. Patellar tendon injury is often misdiagnosed at emergency rooms, leading to chronic proximal retraction and a challenging clinical scenario. Proximal PT injuries are more common, while distal ones, which can involve tibial bone avulsion fractures or direct tendon avulsion, are rarer. The low incidence of distal PT rupture and the variety of injury patterns make a personal approach reasonable when based on the intraoperative findings and the surgeon's experience. Our purpose is to describe a surgical technique to restore the knee extensor mechanism after chronic distal PT rupture using two kinds of graft, one as a waveform augmentation of the native tendon and the other as reinforcement in a letter X aspect.
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Estudo epidemiológico das lesões multiligamentares do joelho. Rev Bras Ortop 2022; 57:675-681. [PMID: 35966442 PMCID: PMC9365474 DOI: 10.1055/s-0041-1731798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/08/2021] [Indexed: 12/05/2022] Open
Abstract
Objective
The present paper aims to describe multiligament knee injuries and to associate their features with the profile of the patients and trauma mechanisms.
Methods
This is a cross-sectional study evaluating 82 patients with multiligament knee injuries from September 2016 to September 2018. Evaluated parameters included age, gender, mechanical axis, affected side, range of motion, trauma mechanism, associated injuries, affected ligaments, and absence from work.
Results
The sample included patients aged between 16 and 58 years old, with an average age of 29.7 years old; most subjects were males, with 92.7% of cases. The most common trauma mechanism was motorcycle accident (45.1%). The most injured ligament was the anterior cruciate ligament (80.5%), followed by the posterior cruciate ligament (77.1%), the posterolateral corner (61.0%), and the tibial collateral ligament (26.8%). The most frequent type of dislocation was KD IIIL (30.4%). Only 1 patient had a vascular injury, and 13 (15.9%) presented with neurological injuries. Most subjects took medical leave from work (52.4%).
Conclusion
There is a big difference between patients with multiligament lesions in Brazil compared with international studies. Thus, it is advisable to carry out more specific studies on the topic with our population to improve the treatment of these patients.
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Stress Radiography for Multiligament Knee Injuries: A Standardized, Step-by-Step Technique. Arthrosc Tech 2020; 9:e1885-e1892. [PMID: 33381396 PMCID: PMC7768114 DOI: 10.1016/j.eats.2020.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/10/2020] [Indexed: 02/03/2023] Open
Abstract
Physical examination in the presence of a multiligament knee injury can be complex and challenging. Hence, stress radiography is a useful and inexpensive tool that is widely used in the assessment of this type of injury. It guarantees an objective analysis of the magnitude of knee instability, which may reduce the observer's interpretation bias in relation to the physical examination. However, for the radiographic analysis to be reproducible, it is necessary to standardize the technique to evaluate each of the main knee ligaments. This article aims to describe in detail how to perform stress radiography to assess the sufficiency of the posterior cruciate ligament and collateral ligaments in the context of a multiligament injury.
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How to Perform a Giant Parameniscal Cyst Exeresis: Step by Step Technique. Arthrosc Tech 2020; 9:e669-e674. [PMID: 32489843 PMCID: PMC7253781 DOI: 10.1016/j.eats.2020.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/20/2020] [Indexed: 02/03/2023] Open
Abstract
Parameniscal cysts are usually small cystic lesions, less than 2 cm in size, found along the meniscal periphery. They are rarely associated with extra-articular palpable mass. Magnetic resonance imaging is the diagnostic method of choice; giant meniscal cysts (>5 cm at its greatest diameter) are very rare, with few cases described in the literature. We describe a step-by-step open exeresis and arthroscopic meniscal suture technique for the treatment of a 9-cm giant parameniscal cyst located on the lateral side of the knee. Treatment of giant meniscal lesions requires caution during dissection and exeresis. Because acute meniscal lesions benefit from meniscal suture rather than meniscectomy, horizontal degenerative lesions may also present excellent results with repair techniques. We conclude that the combination of the open excision of the giant cyst with careful dissection and protection of neurovascular structures, combined with the arthroscopic meniscal suture, is a good strategy to approach such lesions.
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Evaluation of the use of tranexamic acid in total knee arthroplasty. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2018; 53:761-767. [PMID: 30377612 PMCID: PMC6205013 DOI: 10.1016/j.rboe.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/20/2017] [Indexed: 11/15/2022]
Abstract
Objective Evaluate the efficacy of tranexamic acid in reducing bleeding in patients undergoing total knee arthroplasty. Methods 101 patients were randomized into two groups: the tranexamic acid group (n = 51) and the placebo group (n = 50). Patients were compared regarding the following parameters: reduction of hemoglobin, total estimated blood loss, drain output, and postoperative blood transfusion rate. Results Comparing the groups, there were statistically significant differences (p < 0.05) in the following parameters: reduction of hemoglobin, decreased hematocrit, estimated blood loss, and drain output. All values were lower in the tranexamic acid group. Only placebo group patients required blood transfusion. Conclusion The use of intravenous tranexamic acid is effective to reduce bleeding in patients undergoing total knee arthroplasty.
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Artroplastia total do joelho em paciente com luxação permanente da patela. Relato de dois casos e revisão da literatura. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Modified axillary radiograph of the shoulder: a new position. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2017; 52:115-118. [PMID: 28194392 PMCID: PMC5290079 DOI: 10.1016/j.rboe.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/28/2016] [Indexed: 11/25/2022]
Abstract
Obtaining axillary radiographs of the shoulder in acute trauma is not always feasible. The authors present a new modification of this radiographic view, in order to assess the anatomic relationship between the humeral head and the glenoid cavity. The incidence is performed with the patient sitting on X-ray table, with the affected limb supported thereon. The authors describe the case of a 28-year-old male who suffered an anterior glenohumeral dislocation that was clearly evidenced by this modified radiograph. The concentric relationship between the humeral head and the glenoid cavity was also easily confirmed by obtaining such radiograph after the reduction maneuver.
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SIMULTANEOUS BILATERAL AVULSION FRACTURE OF THE TIBIAL TUBEROSITY IN A TEENAGER: CASE REPORT AND THERAPY USED. Rev Bras Ortop 2015; 47:381-3. [PMID: 27042651 PMCID: PMC4799418 DOI: 10.1016/s2255-4971(15)30116-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/15/2011] [Indexed: 12/17/2022] Open
Abstract
Simultaneous bilateral avulsion fracture of the tibial tuberosity in teenagers is a rare lesion. We describe the first case in the literature, in a teenage girl who sustained a fall while jumping during a volleyball match. No predisposing factors were iden tified. The lesions were treated with open surgical reduction and internal fixation. The aim of the present study was to present a case of simultaneous bilateral avulsion fracture of the tibial tuberosity in a teenage girl and the therapy used.
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Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament. Rev Bras Ortop 2015; 50:743-6. [PMID: 27218089 PMCID: PMC4867921 DOI: 10.1016/j.rboe.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 11/26/2014] [Indexed: 11/27/2022] Open
Abstract
Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up.
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Fratura avulsão do ligamento cruzado posterior em uma localização incomum associada a lesão distal do ligamento patelar. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Avaliação da radioscopia intraoperatória no alinhamento coronal do componente tibial em artroplastias primárias de joelho. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Comparative radiographic analysis on the anatomical axis in knee osteoarthritis cases: inter and intraobserver evaluation. Rev Bras Ortop 2015; 50:283-9. [PMID: 26229931 PMCID: PMC4519661 DOI: 10.1016/j.rboe.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/01/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To make a comparative inter and intraobserver analysis on measurements of the anatomical axis between panoramic radiographs of the lower limbs in anteroposterior (AP) view with bipedal weight-bearing, on short film. METHODS An accuracy study comparing radiographic measurements on 47 knees of patients attending the knee surgery outpatient clinic due to osteoarthritis. The radiographic evaluation used was as standardized for the total knee arthroplasty program, including panoramic AP views of the lower limbs and short radiographs of the knees in AP and lateral views, all with bipedal weight-bearing. Following this, the anatomical axis of the lower limbs or the femorotibial angle was measured by five independent examiners on the panoramic and short AP radiographs; three of the examiners were considered to be more experienced and two, less experienced. All the measurements were made again by the same examiners after an interval of not less than 15 days. The statistical analysis was performed using the intraclass correlation coefficient, in order to evaluate the inter and intraobserver concordance of the anatomical axis measurements. RESULTS From the statistical analysis, it was observed that there was strongly significant concordance between the anatomical axis measurements on the panoramic and short radiographs, for all the five examiners and for both measurements. CONCLUSIONS Under the conditions studied, short radiographs were equivalent to panoramic radiographs for evaluating the anatomical axis of the lower limbs in patients with advanced osteoarthritis. The measurements used also showed high rates of inter and intraobserver concordance and reproducibility.
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Análise radiográfica de fatores predisponentes às rupturas tendinosas do mecanismo extensor do joelho. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Radiographic analysis of factors predisposing toward tendon tears in the knee extensor mechanism. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2014; 49:374-8. [PMID: 26229830 PMCID: PMC4511568 DOI: 10.1016/j.rboe.2014.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 10/10/2013] [Indexed: 11/16/2022]
Abstract
Objectives Methods Results Conclusion
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Fixation of an osteochondral fragment after acute patellar dislocation in an immature skeleton. Rev Bras Ortop 2014; 49:202-5. [PMID: 26229800 PMCID: PMC4511747 DOI: 10.1016/j.rboe.2014.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/12/2013] [Indexed: 11/29/2022] Open
Abstract
Fixation of an osteochondral fracture after acute patellar dislocation is an infrequent form of treatment. Likewise, the location of this fragment in the lateral region of the lateral femoral condyle, functioning as a free body, is uncommon. The aim of this study was to present a case of osteochondral fracture of the patella at an unusual site, along with the therapy used and the clinical follow-up.
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Fixação do fragmento osteocondral após luxação aguda da patela no esqueleto imaturo. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Supplementary vitamin C does not accelerate bone healing in a rat tibia fracture model. ACTA ORTOPEDICA BRASILEIRA 2014; 20:10-2. [PMID: 24453572 PMCID: PMC3718416 DOI: 10.1590/s1413-78522012000100001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 01/12/2011] [Indexed: 11/21/2022]
Abstract
Objective To investigate the role of ascorbic acid supplementation on bone healing after rat
tibia fracture. Methods Thirty male Wistar rats were randomly divided into Vitamin C (Group A) and sham (Group
B) groups (15 rats each). Group A received 200 mg intraperitoneally per kg per day of
ascorbic acid and Group B was given saline 5 ml per kg per day intraperitoneally once a
day. The animals were caged in pairs and allowed free access to tap water and a standard
rodent chow ad libitum. Fractures were produced manually, they were not stabilized, and
unprotected weight-bearing was allowed. At two, four, and six weeks post-fracture, the
rats in both groups were anesthetized and sacrificed by cervical dislocation. Callus
tissue was dissected, prepared, and analyzed histologically. Histomorphological analysis
was performed at six weeks post-fracture and the extent of fracture healing was
determined using a five-point scale. Results There were no histological and histomorphological differences between drug-treated
animals and the sham in the three different stages studied. By six weeks post-fracture,
the five animals of each group had a complete bone union. Conclusion Under the studied conditions, intraperitoneal Vitamin C supplementation does not
accelerate the fracture healing process after experimental tibia fracture in rats.
Level of evidence: Level 2, individual study with experimental
design.
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Abstract
The fracture of tibial tuberosity is a rare lesion and still more unusual in adults. We describe a case in an adult who suffered a left knee injury due to a fall from height. No risk factors were identified. The lesion was treated with surgical reduction and internal fixation. The rehabilitation method was successful, resulting in excellent function and rage of motion of the knee. The aim of this study was to present an unusual case of direct trauma of the tibial tuberosity in an adult and the therapy performed.
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Análise comparativa entre incidências radiográficas para a osteoartrose do joelho (AP bipodal versus AP monopodal). Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Epidemiological study on tibial plateau fractures at a level I trauma center. ACTA ORTOPEDICA BRASILEIRA 2013; 21:109-15. [PMID: 24453653 PMCID: PMC3861961 DOI: 10.1590/s1413-78522013000200008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 04/22/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES: To review the epidemiological aspects of fractures of the tibial plateau in a level one hospital. METHODS: We retrospectively analyzed 239 tibial plateau fractures treated surgically. We took into account age, gender, trauma mechanism, classification of the injuries, associated injuries and affected side. RESULTS: 168 were male, the fifth decade has been the most affected, the mechanism of trauma, car accident was the main causal fator, 128 cases were on the left side and 22,6% had associated injuries. CONCLUSIONS: Most patients were male, in the fifth decade of life, and victim of traffic accidents, and the depression and shear fractures of the tibial plateau are the most frequent. Associated lesions were infrequent in our study. Level of Evidence II, Prognostic Studies. Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
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Ruptura bilateral e simultânea do mecanismo extensor do joelho em um pré-adolescente: relato de caso. Rev Bras Ortop 2012. [DOI: 10.1590/s0102-36162012000500020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fratura avulsão bilateral e simultânea da tuberosidade tibial em uma adolescente: relato de caso e terapêutica adotada. Rev Bras Ortop 2012. [DOI: 10.1590/s0102-36162012000300018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Estudo epidemiológico das rupturas tendinosas do mecanismo extensor do joelho em um hospital de nível I. Rev Bras Ortop 2012. [DOI: 10.1590/s0102-36162012000600008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Avaliação a médio prazo da artroplastia total do joelho com implante de fabricação nacional. Rev Bras Ortop 2011. [DOI: 10.1590/s0102-36162011000500010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fratura do componente tibial em artroplastia total do joelho: relato de dois casos. Rev Bras Ortop 2011. [DOI: 10.1590/s0102-36162011000300018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Artroplastia total do joelho em paciente com pseudoartrose de fratura de Hoffa: relato de caso. Rev Bras Ortop 2011. [DOI: 10.1590/s0102-36162011000400019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Operative treatment of transverse acetabular fractures: is it really necessary to fix both columns? Int J Med Sci 2009; 6:192-9. [PMID: 19652723 PMCID: PMC2719284 DOI: 10.7150/ijms.6.192] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 07/10/2009] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE we prospectively evaluated clinical and radiographic outcomes in patients with displaced combined transverse-posterior wall acetabular fractures managed at our Institution over a period of seven years by posterolateral single approach, direct posterior wall and posterior column reduction and plating, and indirect reduction of anterior column controlled by fluoroscopic images with or without lag-screw fixation. The aim was to identify if the obtained immediate postoperative Matta radiographic roof-arc angles after fracture reduction and fixation alters in the postoperative period when comparing posterior plating alone versus posterior plate and anterior column lag-screw fixation. PATIENTS AND METHODS 35 skeletally mature patients (31 male and four female, with mean age of 39.9 years old [range, 23.3 to 66.7 y/o]) with combined transverse-posterior wall acetabular fractures surgically treated by a posterolateral single approach were enrolled in this prospective investigation. Nineteen patients had associated orthopaedic injuries. The first part of the acetabular fracture management was similar to all patients and consisted in anatomical reduction and fixation of the transverse posterior component followed by anatomical reduction and fixation of the posterior wall component. The transverse anterior component reduction was controlled by fluoroscopic images (anteroposterior (AP), iliac oblique, and obturator oblique views) and digital palpation through the greater sciatic notch. Fifteen of the 35 patients had an additional lag-screw fixation from the posterior to the anterior columns with an extra-long small-fragment cortical screw. AP and Judet oblique radiographic views were taken at the end of the procedure and roof-arc angles were measured. Clinical results were assigned according to the grading system of Merle D'Aubigne and Postel as modified by Matta et al. Radiographic roof-arc angles were checked and compared between the two groups of patients to the same data collected both at the time of the surgical procedure and at three months postoperatively. Statistical analysis was done by either using chi-square (clinical outcome) and Mann-Whitney (roentgenographic outcome) tests, with a level of significance of alpha = 5%. RESULTS at final follow-up examination 18 to 84 months postoperatively (mean, 46.8 months), the clinical results were considered satisfactory in 31 (88.6%) patients (excellent in nine (25.7%) and good in 22 (62.9%) patients). There was no difference between patients with (n = 15) and without (n = 20) fixation of the transverse anterior component of the acetabular fracture (p = 0.67). Radiographic roof-arc angles measured at discharge, at three months postoperatively and at the last follow-up consultation didn't changed significantly (p > 0.05). There was no statistically significant difference between patients treated with (n = 15) and without (n = 20) fixation of the anterior component of the transverse acetabular fracture in terms of medial displacement of the femoral head. CONCLUSION the authors suggest that associated transverse-posterior wall acetabular fractures can be managed by a single posterior approach. Direct reduction and fixation of the posterior wall and column components is an adequate option for these injuries. If there is adequate indirect reduction of the anterior column, as checked by digital palpation and fluoroscopy, we feel that it is not necessary to fix the anterior column component of the transverse acetabular fracture.
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[Comparative study between different radiographic plans in knee osteoarthritis]. ACTA REUMATOLOGICA PORTUGUESA 2009; 34:380-387. [PMID: 19727049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Perform a comparative analysis (with the criteria of Ahlbäck original classification) of the anteroposterior (AP) weight-bearing radiograph of knee in extension and of Rosenberg(2) view, in symptomatic arthritic knees. The analysis aims at revealing agreement or disagreement between (AP) view and Rosenberg view and the degree of articular degeneration and the advantages of these views. PATIENTS AND METHODS From January 2005 to March 2007, a prospective study was conducted with 76 selected patients (111 arthritic knees) attending the outpatient clinic, at the knee unit, and subjected to the radiographs proposed in the present study. Of the total number of patients (76), 52 were females and 24 males, having an average age of 62 (range, 50- 82 years). 41 patients had unilateral degeneration and 35 patients had bilateral degeneration. Of the total number of assessed knees (111), 66 were right knees and 45 were left knees. The study used the Kappa statistical analysis, which assesses interobserver agreement of qualitative data. RESULTS According to the Ahlbäck score, there was agreement between the orthopedist and the radiologist in 98.2% of cases in the AP weight-bearing view, and in 88.3% in the Rosenberg view. A highly significant agreement on both views between the orthopedist and the radiologist was noticed. However, the degree of agreement was higher for the AP weigh-bearing view than for the Rosenberg view. According to the Ahlbäck score, the AP weight-bearing view agreed with the Rosenberg view in only 27% of the cases for the orthopaedist, and in 31.5% for the radiologist. No significant agreement was found between the AP weight-bearing view and the Rosenberg view for the orthopedist and the radiologist. CONCLUSIONS There is no significant disagreement between experts concerning the classification of knee osteoarthritis, according to the Ahlbäck score, both for the AP weight-bearing view and the Rosenberg view. There is no agreement between the views, concerning the classification of knee osteoarthritis, both for the orthopedist and the radiologist, the Rosenberg view having shown more clearly the degree of articular degeneration. The posteroanterior view of Rosenberg provided a better assessment of degeneration of the articular surface, which in some cases led to a change in the classification of knee osteoarthritis and was routinely used.
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