bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vancomycin presoaking of hamstring grafts removes the risk of infection in primary anterior cruciate ligament reconstruction
Authors: Figueroa Francisco , Figueroa David , Calvo Rafael , Vaisman Alex , López Mario , Goñi Ignacio 
Published: December 2018

Background: Several strategies have been studied to decrease the rate of infection after hamstring autograft anterior cruciate ligament (ACL) reconstruction. Our group started presoaking grafts with Vancomycin in November 2015 to decrease this risk. Purpose: The objective of the study is to compare the success of this protocol against the immediate previous period in which we did not use the protocol. Study design: Retrospective cohort. Level III. Methods: Consecutive periods were studied: April 2013-October 2015 (pre Vancomycin protocol) and November 2015- May 2018 (Vancomycin protocol). All patients that underwent a hamstring autograft primary ACL reconstruction during the periods studied were included. The final outcome was the presence of postoperative septic arthritis in both groups. Diagnosis of septic arthritis was made using the clinical picture plus cytological analysis of a joint aspiration (cell count > 50.000/uL + > 90% neutrophils) Statistical analysis was made using the Fisher’s exact test. Significance was set in p < 0.05. Results: 490 patients were included in the study, 230 in the pre Vancomycin protocol an 260 in the Vancomycin protocol. 4 postoperative septic arthritis were noted in the pre Vancomycin protocol (1.7%) while no septic arthritis was noted in the post Vancomycin protocol patients during the period studied. (p < 0.05) The 4 postoperative infections were presented at an average 21.7 days (range 16-25). Staphylococcus epidermidis was isolated in 2 of the cases, and in the other 2 no organism was isolated. Conclusion: Vancomycin presoaking of hamstring autografts in primary ACL reconstruction eliminated the risk of postoperative septic arthritis during the studied period compared to the immediate previous period, where no Vancomycin presoaking was used.
Endoscopic Carpal Tunnel Release: Results and Complications in 126 cases
Authors: Pereira Enrique , Argüelles Santiago , Rodriguez Martin , Soutullo Jorge , Santos Gustavo , Gelo Melania 
Published: December 2018

Objectives: To report the results and complications of a two portal endoscopic carpal tunnel release (ECTR) with the use of a clear tube for assessing the quality of decompression of the median nerve. Methods: Retrospective analysis of 126 consecutive cases (126 patients) where a two portal ECTR was performed. The demographic and physical examination data were obtained from the medical history. For evaluation, the preoperative and postoperative Quick DASH and the Boston Questionnaire were used and the complications were recorded. Results: The Quick DASH average was 33.7 preoperative (SD 11.05) and 6.8 postoperative (SD 6.44) P<0.001. The Boston Questionnaire´s median average was 1.24 (SD 0.26) for symptoms and 1.18 (SD 0.22) for function. We recorded seven minor complications (5.5%): two cases of transient hypoesthesia and a permanent one of the third web space, three cases of superficial infection, and one case of postoperative neuropathic pain. No major complications or reoperations were documented. Conclusion: Two portal ECTR with the use of a clear tube for assessing the quality of decompression is a safe, effective, predictable and reproducible technique for treatment of idiopathic carpal tunnel syndrome. The complication rate is low when performed by a trained surgeon
Spontaneous Healing in complete ACL ruptures: results at eight-year mean follow-up
Authors: Costa-Paz Matias , Garcia-Mansilla Ignacio , Ayerza Miguel , Muscolo D. Luis 
Published: December 2018

Objectives: The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities. In 2011, we published a series of 14 patients with spontaneous healing following a complete ACL rupture, the mean follow up was 30 months (range 25-36 months). The purpose of this study was to evaluate the long-term results of spontaneous healing in complete ACL ruptures in the same group of patients. Methods: We retrospectively reviewed a cohort of 14 patients with acute ACL injury established by physical examination and MRI (proximal third in eight patients and the midligament in six). Twelve patients were male and average age at injury was 31 years (range, 23-41 years), All patients were athletically active before the injury and suffered the lesion during a sport activity. Surgery was indicated in all patients, but it was postponed for different reasons, including related labor problems, need to travel, illnesses, planned holidays, and the patient’s personal decision not to undergo surgery. Most of the patients let the injury run its course with no bracing and unspecific rehabilitation protocol. The primary outcomes of this study were rerupture rate and time between injury and surgery. Results: Twelve patients out of 14 were reevaluated (86%), with a mean follow up of 8 years (3-14). Ten were men, with a mean age of 38 years (range, 25-51 years). Five patients had an ACL reconstruction during follow-up, with a mean time between injury and surgery of 5 years (range 3-14). Initial injury was located in the proximal third in two patients and in the midligament in three. Conclusion: Although favorable initial evolution at 30 months after a complete ACL lesion, our series show a re-rupture rate or “scar tissue” rupture of 40% at a mean follow-up of 8 years.
Nonsurgical treatment of partial ACL tears: intraarticular injection of Platelet-rich plasma did not change the progression rate to knee instability
Authors: Zicaro Juan Pablo , Yacuzzi Carlos , Garcia-Mansilla Ignacio , Costa-Paz Matias 
Published: December 2018

Objective Diagnosis and treatment of partial tears of the ACL remains controversial. Patients that present a hard end positive Lachman and negative pivot shift in the context of a partial tear in the magnetic resonance imaging (MRI) have a healing potential that could avoid surgery. Platelet-Rich-Plasma (PRP) provides certain growth factors that could improve healing and therefore, clinical outcomes after partial ACL tears. The aim of this study was to report the results of autologous intraarticular PRP injection in patients with partial ACL tears. Methods Prospective cohort of patients between 2015 and 2017 with acute ACL partial tear, treated either with autologous PRP therapy combined with a rehabilitation protocol (group 1) or rehabilitation alone (group 2). The primary outcome was to evaluate return to sports and recurrent knee instability requiring surgery. We performed pre and postoperative subjective evaluation using Tegner, IKDC and Lysholm scores and an objective evaluation using KT1000 arthrometer. and return-to-sports were performed. An MRI was performed at 6 months. Platelets and leukocyte concentration in PRP preparation was analyzed Results A total of 40 patients were included in this study, 21 in group 1 and 19 in group 2. Median age was 26 yeas (IQR 22-35), 85% (n=34) were men with a median follow up of 12 months (IQR 8–15). Eighteen patients (85%) in group 1 and 15 (79%) patients in group 2 were Tegner 7 or above. All patients returned to sports at a mean of 3.8 months in group 1 and 4.2 months in group 2. Five (23,8%) patients in group 1 (1 proximal and 4 mid-third lesions) and four (21%) in group 2 (3 proximal and 1 mid-third lesion) failed and had an ACL reconstruction because of knee instability ( p 0.99). All after a new sport trauma. Lysholm score improved from 62 (SD 20) to 70 (SD 24) in group one and from 67 (SD 14) to 74 (SD 16) in group 2. IKDC score improved from 51 (SD 11) to 68 (SD 19) in group 1 and from 55 (SD 17) to 69 (SD 9) in group 2. Side-to-side difference in arthrometric KT1000 evaluation was less than 3 mm in 80% of patients that did not fail. In MRI studies, twenty-two (55%) had a proximal ACL lesion and eighteen (45%) a mid-substance ACL lesion. Fifteen (71%) patients in group 1 and twelve (63%) in group 2 presented an improvement in signal intensity at 6 months. The platelet concentration was 478% and the leukocyte concentration was 9% in relation to the patient´s baseline serum concentration. Conclusion Return to sports after a partial ACL tear was similar in both groups. Almost 25% of patients progressed to knee instability, without significant differences between those treated or not with an intra-articular PRP injection. Longer follow-up is required before any conclusions.
Similar results for revision ACL with and without a lateral extra-articular reconstruction. A prospective evaluation
Authors: Zicaro Juan Pablo , Yacuzzi Carlos , Garcia-Mansilla Ignacio , Costa-Paz Matias 
Published: December 2018

Objectives Lateral extra-articular augmentation procedure (LEAP) has been proposed as an additional technique in the setting of revision ACL Reconstruction (ACLR). Few case series have been reported. The purpose of this study was to compare the clinical results and return to sports of a consecutive series of patients treated for revision ACLR with and without a LEAP. Methods We prospectively evaluated a series of patients treated for isolated revision ACL between 2014 and 2015 (group 1) and revision ACL associated with a LEAP from 2015 to 2016 (group 2). We analyzed the surgical technique and graft used for primary and revision ACL and for the LEAP. All patients were evaluated at one-year follow-up with Lysholm score and IKDC evaluation, return to sports and MRI evaluation. Results Thirty-six patients were evaluated, eighteen patients in each group. For the revision ACL procedures, 14 autografts and 4 allografts were used in group 1 and 16 autografts and 2 allografts in group 2. For the LEAP, in 13 cases we performed a lateral tenodesis using ilio-tibial band and in 5 patients we used allograft. The mean age was 32 years (SD 8,5) for group 1 and 28,4 (SD 6,5) for group 2. In group 1, the median Lysholm and IKDC scale was 90 (IQR 27) and 80 (IQR 40) respectively, and in group 2 the median was 90 (IQR 48) and 67,5 (IQR 33) respectively. The difference for IKDC was statistically significant (p=0,000). Eight patients return to sports in group 1 and seven in group 2. The MRI shown and homogeneous neoligament in 66% of patients in group 1 and 61% in group 2. Conclusion Despite there was a statistically significant difference in IKDC results in favor of group 2, we found no differences in return to sports, Lysholm score and MRI imaging when a LEAP was associated at one year follow-up.
Autologous Collagen-Induced Chondrogenesis: clinical outcomes at minimum two-years follow-up
Authors: Costa-Paz Matías , Zícaro Juan Pablo , Rómoli Agustín Molina , Yacuzzi Carlos 
Published: December 2018

Objectives: Different surgical approaches are currently available to treat knee chondral defects. The technique used in this article combines microfractures with the use of an injectable atelocollagen matrix (Cartifill®). The matrix covers the defect and improves the mechanical stability of the blood clot and maintains the chondrogenic progenitor cells and growth factors in the defective area. The aim of our study is to evaluate and describe the results in a series of patients treated with atelocollagen matrix and microfractures. Methods: All patients treated with atelocollagen matrix due to a cartilage lesion with a minimum follow-up of 24 months were evaluated. Patients undergoing associated surgeries (osteotomies, meniscectomies, mosaicplasty, ligament reconstruction) in the same surgical procedure were included in the study. Clinical function was assessed before and after surgery with the International Knee Documentation Committee (IKDC), the Lysholm score and the Visual Analogue Scale (VAS). Radiographic and magnetic resonance control were requested according to availability. Results: Twelve patients met the inclusion criteria. Three women. Average age of 50 years. Eight applications in medial condyle, 2 in lateral condyle and 4 in trochlea. One post-operative arthrofibrosis was recorded. One of the patients underwent an articular replacement of his knee 10 months after the surgery with finalization of follow-up. The pre / post-operative average was 39/52 (IKDC), 37/76 (Lysholm) and 8.5 / 3.5 (VAS). Conclusion: In our series, atelocollagen matrix combined with microfractures improved the clinical symptoms of patients with severe knee articular cartilage injury. However, a better selection of patients who require this procedure should be applied in future interventions.
Meniscal Allograft Transplantation: results at 6-year Mean Follow-up
Authors: Costa-Paz Matías , Yacuzzi Carlos , De-Cicco Franco Luis , Theaux Juan Ignacio , Zicaro Juan Pablo , Ayerza Miguel 
Published: December 2018

Objectives The purpose of this study was to evaluate the clinical and imaging results in a series of patients who underwent a meniscal allograft transplant (MAT). Methods A retrospective study was performed. The International Knee Documentation Committee (IKDC) score, Lysholm score, and physical examinations were reviewed to measure clinical outcomes after MAT. Osteoarthritic changes were assessed by Plain radiography according to Kellgren-Lawrence (KL) classification and meniscal extrusion by magnetic resonance imaging (MRI). Surgical technique and related procedures were analyzed. Complications were registered. The minimum follow-up was 2 years. Results Surgeries were performed in 41 patients, 36 fulfilled the inclusion criteria. Twenty-five were male and 11 women. The mean age was 35 years old (SD 8). The mean follow-up was 71 months (range 24 to 184). The mean time between meniscectomy and meniscal transplant was 12.8 years (SD 6,7). Twenty-three were lateral menisci. The following related procedures were performed: Seven ACL reconstructions, 3 ACL revisions, 19 mosaicplasties and 3 osteotomies. The mean preoperative results of IKDC and Lysholm scores were 30.3 (SD 15.5) and 43.8 (SD 16.8) respectively and postoperative results were 78.8 (SD 21.1) and 61.1 (SD 15) respectively. There were no significative radiographic changes at the end of the follow-up. Mean KL preoperative was 2 (IQR 1) and last follow up was 2 (IQR 1) p= 0.053. Preoperative KL grade 1: 33%, grade 2: 50% and grade 3: 17% and last follow up KL grade 1: 22%, grade 2 56% and grade 3 22%. The average percentage of extruded meniscus was 53% in 22 patients evaluated with MR (range 19% to 100%). Five presented arthrofibrosis that required mobilization under anesthesia and partial meniscectomy of the MAT was required in 6 patients. Two transplants failed. Conclusion Although 53% of meniscal extrusion was observed in the MR, we found no correlation with clinical outcomes. MAT achieved good clinical results without osteoarthritic changes after a mean of 6-years follow-up, with 5% of failure. MAT appears to be a safe and effective treatment, which should be considered as a suitable option in the clinical practice.
Meniscal Repair: Failure rate and clinical outcomes with minimum two years follow-up
Authors: Zicaro Juan Pablo , Yacuzzi Carlos , Garrido Nicolas , Garcia-Mansilla Ignacio , Costa-Paz Matias 
Published: December 2018

Objectives The purpose of our study was to evaluate the clinical outcomes and failure rate of a series of patients who underwent meniscal repair with a minimum two-years of follow-up. Methods We retrospectively reviewed patients treated with meniscal repair between 2004 and 2016. We included patients with at least 2 years of follow-up. Surgical details such as the affected menisci, type of rupture and meniscal repair technique used were analyzed. Clinical and functional outcomes were evaluated using Lysholm and IKDC scores. Patients were studied with x-rays and magnetic resonance imaging (MRI). We analyzed the failure rate (defined as a re-rupture that required surgery). We compared failure rate for isolated meniscal repair vs associated with Anterior cruciate ligament reconstruction (ACLR). Also we compared patients operated before and after 2014. Results One hundred sixty nine patients were operated during that period of time. Ten patients did not meet inclusion criteria and forty were lost in follow-up. Out of the 119 patients evaluated, 35 had bucket-handle lesions, 25 tears in the posterior horn treated with all inside sutures and 59 body and posterior horn lesions treated with a combined suture technique. The mean postoperative Lysholm score was 85 (SD 14) and IKDC 70 (SD 10). The mean return to sports time was 8 months (range 2-19). An MRI was performed in 71 patients. The overall failure rate was 21% (24 /119) at a mean time of 20 months (range 2-60 months) and 26% (9/35) for bucket-handle lesions at a mean time of 21 months (range 2-60 months). Failure rate for the 48 isolated lesions was 20% at a mean of 23 months and 19% for 70 associated to ACLR at a mean of 17 months (p=0.53). Isolated bucket-handle lesions had failure rate of 27% at a mean of 27 months and when associated to ACLR this was 23% at a mean of 12 months (p=1.0) Overall failure rate for patients treated before 2014 was 27% (18/67) and 12% after 2014 (6/52) (p=0.03). For bucket-handle lesions before 2014 was 36% (8/23) and 8% after 2014 (1/12) (p=0.03). Isolated bucket-handle lesions failure rate was 45% (5/11) before 2014 and 0% (0/7) after 2014 (p=0.01) and when associated to ACLR, it was 25% (3/12) before 2014 and 20% (1/5) after 2014 (p=0.09). Conclusion Overall failure rate of our series was 21%. We found no differences between isolated lesions and associated to ACLR. There was a statistically significant difference regarding failure rate results for those operated before and after 2014. This might be the result of an improvement in the surgical devices, modifications in the technique and the number of sutures for each procedure.
Arthoscopy partial meniscectomy: results after more than one year follow up in working compensation vs. Non-working compensation parients
Authors: Villalba Juan Francisco , Gutiérrez Daniel E. , Bennett Cristian , Hernández Emilio , Medina Daniela 
Published: December 2018

Objectives: The aim of the study was to retrospectively evaluate and compare the results of arthroscopic partial meniscectomy for meniscus tears in working compensation vs. non-working compensation patients. Methods: Sixty patients treated in our institution between June 2016 and May 2017 with the diagnosis of acute meniscus tears that did not respond to conservative treatment were evaluated. All lesions were diagnosed with previous MRI. There were 30 patients under working compensation insurance and 30 under another insurance system (53 men, and 7 women). The age ranged between 18 and 45 years. Thirty-six tears were located in the internal menisci and twenty-four in the external menisci. The average follow-up was 18 months. Lysholm and EVA scores were obtained. Results: Of the 30 non-working compensation patients, 28 evolved favorably with an improvement in the Lysholm score of 53 to 93 points and EVA of 7 to 1 points on average and returned to activity prior to the injury. Two of them continued with mild discomfort, without affecting their daily routines. In working compensation patients 14 evolved favorably, with improvement in the Lysholm score of 48 to 74 points and EVA 7 to 2 points on average and return to their usual work activity. Sixteen of them presented moderate pain with partial job return or required change of tasks. Conclusion: The results of partial meniscectomy in non-work-related patients were excellent to good, with 96% return to daily activities. Regarding work-related patients, regular results were obtained, with a return to their usual work activity of only 53%.
Comparative results between two femoral fixation methods in hamstring graft anterior cruciate ligament reconstruction
Authors: Abalo Eduardo , Mallea Andrés , Previgliano Juan Pablo , Pinotti Norberto 
Published: December 2018

Introduction: Femoral graft fixation in the anterior cruciate ligament reconstruction is a key factor to the success of this procedure. The aim of this study is to compare two different femoral fixation methods in the anterior cruciate ligament reconstruction. Material and methods: 147 patients with an anterior cruciate ligament reconstruction with quadruple hamstring grafts were retrospectively analyzed. 16 were female and 131 male, average age was 26.3 years. The minimum follow-up was 12 months with an average of 62 months. Patients were divided into two groups according to the femoral graft fixation: in ninety eight patients a transverse fixation was used, and in forty nine a cortical fixation with femoral button. Tibial interference screws were used for both groups. Clinical evaluation with Lysholm Score and IKDC was performed. Results: Lysholm score results show no significant differences between the groups, being 94.24 points in the group with the transversal fixation system and 93.26 in the other group. According to the IKDC, 141 patients presented a normal or close to normal knee and 1 patient presented an abnormal knee. Five patients presented graft rupture (3.4%), 3 from the cortical fixation with button group (6.12%) and two with transverse fixation (2.04%). Conclusion: In this study, cortical button femoral fixation for autogenous hamstring ACL reconstruction had no significant difference in terms of clinical outcomes compared with suspensory transfemoral fixation.
Rotational knee instability, Extra articular technique
Authors: Lapera Miguel , Gigante Facundo , Zabala Manuel Perez , Adjigogovic Esteban , Sylvester Francisco , Abuye Hernán Fernández , Baigorria José 
Published: December 2018

Objectives: The Associated Extra-Articular Technique (AET) with Lateral Tenodesis (LT) to the current techniques of intra-articular reconstruction of the Anterior Cruciate Ligament (ACL) could potentially improve the laxity of the knee and act synergically in controlling the phenomenon of the pivot displacement in cases of severe rotational instability. Methods: Twenty-two consecutive patients were selected who met all the inclusion criteria and underwent reconstruction of the ACL with double bundle and AET between February 2012 and May 2013. The inclusion criteria in this study was the presence of moderate to severe rotational instability as revealed by a score of pivot test of 2 to 3 (on a scale ranging from 0 = negative, to 3 = subluxation). The least time between trauma and surgery was 3 months, and average age under 40 years old. Results: The mean time of follow-up was 32.4 ± 3.9 months. In all cases, the Lysholm and IKDC test scores improved significantly (p <0.0001). The differential laxity above the average was 8 ± 1.9 mm before surgery and significantly reduced to 0.7 ± 0.8 mm at the last follow-up (p <0.0001). Prior to surgery, patients had a Grade 3 Pivot Shift according to the IKDC criteria. After surgery, 15 patients had turned to a negative Pivot (Grade 0), and 7 patients were Grade 1. Conclusion: The lateral extra-articular reconstruction is generally used to control the internal rotation laxity of the tibia, and we are convinced that the combination of the LT with the reconstruction of the double bundle LCA would reduce the rotational translation during the pivot test.