OBJECTIVE: To evaluate the clinical and functional results of autologous trapezoidal plug single-block grafts fixed with absorbable chondral darts in patients with osteochondral knee lesions of varying sizes. METHODS: Twenty-five patients underwent surgery from February 2000 to June 2008. Seventy-two percent of the patients were male, and the mean age was 29 years. RESULTS: The right side (56%) and the medial condyle (92%) were most affected. The lesions had an average area of 5.28 cm², and the mean follow-up was 59 months. All of the variables other than instability showed significant improvements (p<0.05), as shown by the increase in the mean Lysholm score from 55 points preoperatively to 92 points (p<0.001) postoperatively. There was no loosening or collapse of the osteochondral graft. All of the patients had patellofemoral crepitation and pain for an average of six months. CONCLUSION: Autologous trapezoidal plug single-block grafts are a therapeutic option for defects of varying sizes and provide good clinical results and low morbidity at the donor site in the medium term.
OBJECTIVE: The aim of this study was to evaluate the treatment of patients with chronic lesions in the posterolateral corner of the knee with reconstruction of the fibular collateral ligament, popliteus tendon and popliteofibular ligament and with autografts of the biceps femoris and fascia lata. METHOD: A total of 129 patients with injuries of the posterolateral corner of the knee that lasted for more than three weeks and were associated with the lesion of at least one of the cruciate ligaments were included. All of the patients were operated on consecutively in the same hospital between March 2004 and April 2009. Clinical evaluation using the Lyshom scale and the International Knee Documentation Committee (IKDC, item 4, assessment ligament) protocol was performed in 114 patients for whom there were complete data available. RESULTS: There was significant improvement in the Lyshom score and improved stability according to the IKDC protocol in the pre- compared to postoperative varus stress test at 30 degrees and the posterolateral rotation test. CONCLUSIONS: Surgical reconstruction of the posterolateral corner of the knee with biceps femoris tendon and fascia lata autografts is effective in stabilizing the posterolateral corner of the knee.
INTRODUCTION: Diagnosis and treatment of multiple ligament injuries of the knee remain a real challenge for most surgeons. OBJECTIVE: To find out the epidemiological profile of patients surgically treated at a Reference Service with more than one chronic ligament injury in the knee joint. MATERIALS AND METHODS: Of a total of 978 operated patients, 109 presented at least two associated ligament injuries in the same knee. Demographic and clinical variables were evaluated. RESULTS: The anterior cruciate ligament group presented a larger number of cases of ligament injuries related with sports practice and falls, while the posterior cruciate ligament and anterior cruciate ligament + posterior cruciate ligament groups presented more cases related to traffic accidents and trauma with object (weight on the knee) (p<0.001). The varus group presented significantly higher values of time since injury (p<0.01). In the group with new anterior cruciate ligament injury (neoligament) associated with other ligament injuries the disruption times were higher, showing statistical significance (p<0.001). CONCLUSIONS: Anterior cruciate ligament injury associated with other ligament injuries other than posterior cruciate ligament injury are related to sports practice and falls. Posterior cruciate ligament injury associated to other ligament injuries, including or not anterior cruciate ligament injury, are related to traffic accidents and direct trauma caused by an object on the knee. Significant delay between primary ligament injuries and their reconstructions generates varus deformity of the affected knee. In spite of the large delay in seeking medical treatment, few patients with neoligament anterior cruciate ligament injury and other combined disruptions will develop varus deformity.
Osteoarthrosic knees with large bone defects usually develop as varus or valgus deformities, with daily functional disabilities such as pain, instability and limping. Between March 1996 and January 2003, 19 knees of 18 patients were treated through primary total knee arthroplasty using autologous bone graft using the Sculco modified technique to correct large tibial defects. Sixteen knees were assigned to group II and three to group III, according to the classification used in our medical service. Postoperative follow up period ranged from eight to 82 months, with an average of 53,73±23,43 months. Postoperative outcomes were similar to those of the primary arthroplasties, with early bone graft incorporation, within an average of 7,58±1,87 months. Collapse was seen in one knee during bone remodeling stage, without infection. The range of motion was between 90º and 125º, with an average of 105,27º±9,47° and the femoral tibial angle was between 170º and 180º, with an average of 175,33º±2,57°. Valgus angle ranging from 3º to 8º was obtained in 73% of the treated knees. The purpose of this study is to assess the effectiveness of the Sculco modified technique in correcting large tibial defects with autologous bone graft through clinical and radiographic observation.
Os joelhos osteoartrósicos acometidos por falhas ósseas importantes cursam com deformidade em varo ou valgo, causando limitação funcional das atividades diárias como dor, instabilidade e claudicação. Entre março de 1996 e janeiro de 2003 foram tratados 19 joelhos em 18 pacientes com artroplastia total primária de joelho, utilizando enxerto ósseo autólogo através da técnica modificada de Sculco para correção de grandes defeitos tibiais. Pela classificação utilizada em nosso serviço, 16 joelhos apresentaram lesão do tipo II e três, do tipo III. O tempo de seguimento pós-operatório variou de 8 a 82 meses, com média de 53,73±23,43 meses. Os resultados pós-operatórios foram semelhantes aos das artroplastias primárias e com incorporação inicial precoce do enxerto ósseo em média de 7,58±1,87 meses. Houve colapso em um joelho na fase de remodelação óssea e não houve caso de infecção. O ângulo de flexão variou entre 90° e 125°, com média de 105,27°±9,47° e o ângulo femorotibial variou entre 170° e 180°, com média de 175,33°±2,57°. Obtivemos valgo de 3° a 8° em 73% dos joelhos tratados. O objetivo deste estudo é analisar a eficácia da técnica modificada de Sculco para correção de grandes defeitos tibiais com enxerto ósseo autólogo, através da observação clínica e radiográfica.