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Torkaman A, Hosseinzadeh M, Mohammadyahya E, Torkaman P, Bahaeddini MR, Aminian A, Tayyebi H. All-inside anterior cruciate ligament reconstruction with and without anterolateral ligament reconstruction: a prospective study. BMC Musculoskelet Disord 2024; 25:16. [PMID: 38166782 PMCID: PMC10759739 DOI: 10.1186/s12891-023-07128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There is no clear consensus regarding the superiority of a combined anterior cruciate ligament reconstruction (ACLR) with anterolateral ligament reconstruction (ALLR) versus an isolated ACLR. In this study, we compared the postoperative stability profile, complications, and patient-reported outcomes of these procedures. METHODS Twenty-one patients with an anterior cruciate ligament (ACL) tear who were either treated by an isolated all-inside ACLR (n = 21) or a combined all-inside ACLR and ALLR (n = 20) were included. The outcomes were evaluated in the last follow-up and included the postoperative stability profile evaluated by the Lachman test, pivot shift test, and KT-1000 side-to-side difference, postoperative complications, and patient-reported outcomes evaluated by the International Knee Documentation Committee (IKDC) score and Lysholm knee scale. RESULTS The baseline characteristics of the two groups were not significantly different. The residual Lachman and pivot shift were not significantly different between the two groups (P = 0.41 and P = 0.18, respectively). The mean KT-1000 side-to-side difference was 1.93 ± 1.9 mm in the isolated and 1.635 ± 0.91 mm in the combined group (P = 0.01). The mean improvement of the IKDC score was not significantly different between the isolated and combined groups (24.7 vs. 25.2, P = 0.28). The mean improvement of the Lysholm scale was not significantly different between the isolated and combined groups (33.5 vs. 34.1, P = 0.19). ACL re-rupture occurred in three patients of the isolated group and no patient of the combined group. CONCLUSION The outcomes of patients in the present study support performing a combined ALL and ACL reconstruction.
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Affiliation(s)
- Ali Torkaman
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hosseinzadeh
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Mohammadyahya
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parsa Torkaman
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Bahaeddini
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Aminian
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Tayyebi
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Shafa Yahyaian Educational and Medical Center, Iran University of Medical Science, Baharestan Square, Mojahedin-e-Islam St, Tehran, 1157637131, Iran.
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Fernandes JC, Pinho AR, Pereira PA, Madeira MD, Raposo FA, Sousa AN, Lobo JM. Anterolateral ligament of the knee-Cadaver study in a Caucasian population. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T134-8. [PMID: 36528296 DOI: 10.1016/j.recot.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. MATERIALS AND METHODS The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. RESULTS The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from the tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. CONCLUSIONS The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.
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Fernandes JC, Pinho AR, Pereira PA, Madeira MD, Raposo FA, Sousa AN, Lobo JM. Anterolateral ligament of the knee-Cadaver study in a Caucasian population. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:134-138. [PMID: 35691577 DOI: 10.1016/j.recot.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/18/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. MATERIALS AND METHODS The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. RESULTS The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. CONCLUSIONS The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.
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Affiliation(s)
- J C Fernandes
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal.
| | - A R Pinho
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - P A Pereira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal
| | - M D Madeira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal
| | - F A Raposo
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A N Sousa
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - J M Lobo
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Phua SKA, Lim JY, Li T, Ho SWL. The segond fracture: A narrative review of the anatomy, biomechanics and clinical implications. J Clin Orthop Trauma 2023; 38:102127. [PMID: 36860993 PMCID: PMC9969264 DOI: 10.1016/j.jcot.2023.102127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
The Segond fracture is commonly regarded as pathognomonic for significant intra-articular pathology such as an anterior cruciate ligament (ACL) tear. There is worsened rotatory instability in patients with concomitant ACL tear and Segond fracture. Current evidence does not suggest that a concomitant and unrepaired Segond fracture leads to worst clinical outcomes after ACL reconstruction. However, there remains a lack of consensus on several aspects of the Segond fracture such as its exact anatomical attachments, ideal imaging modality for detection and indication for surgical treatment. There is currently no comparative study evaluating the outcomes of combined ACL reconstruction and Segond fracture fixation. More research is necessary to deepen our understanding and establish consensus on the role of surgical intervention.
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Affiliation(s)
| | - Jia Ying Lim
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Tianpei Li
- Department of Radiation Oncology, National Cancer Centre, Singapore
| | - Sean Wei Loong Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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John RS, Solanki JA, Kanna VES, Ram H. Conventional fibrotomy and reconstruction with lateral thigh dermal fat pad in grade III oral submucous fibrosis patients: A case report and review of literature. Natl J Maxillofac Surg 2022; 13:S166-S169. [PMID: 36393940 PMCID: PMC9651222 DOI: 10.4103/njms.njms_167_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/02/2021] [Accepted: 02/26/2021] [Indexed: 01/25/2023] Open
Abstract
Oral submucous fibrosis is a chronic debilitating premalignant condition with progressive stiffening of oral mucosa ultimately ending in trismus most commonly from substance abuse. The most common etiological factor is the consumption of areca nut. Patients usually report to us when the mouth opening is almost nil. Various grafts have been used in the reconstruction of buccal defects after fiberotomy, the most popular being the buccal fat pad. We present the case of a 34-year-old man presenting with the complaint of reduced mouth opening and burning sensation in the mouth for 8 months. The patient is a poor candidate for buccal fat grafting as the patient body type being ectomorphic. The patient had a stigma of scar in the abdomen; hence, the possibility of an abdominal fat graft was out of the equation. Therefore, dermal fat is was harvested from the lateral thigh and reconstructed into the defect. The patient had a favorable outcome with good healing. Further studies are required to assess the quality, microscopic features of the adipose tissue, and the fate of dermal fat from the anterolateral thigh region.
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Affiliation(s)
- Rubin S. John
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Rubin S. John, #702, Akash Ganga Tower, New Hyderabad Colony, Hassanganj, Lucknow - 226 007, Uttar Pradesh, India. E-mail:
| | - Jaykishan A. Solanki
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - V. E. Shanthosh Kanna
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Hari Ram
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
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Siebert MJ, Makarewich CA. Anterolateral Tibial Bowing and Congenital Pseudoarthrosis of the Tibia: Current Concept Review and Future Directions. Curr Rev Musculoskelet Med 2022; 15:438-446. [PMID: 35841513 PMCID: PMC9789274 DOI: 10.1007/s12178-022-09779-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Congenital pseudarthrosis of the tibia (CPT) is a rare condition closely associated with neurofibromatosis type I. Affected children are born with anterolateral bowing of the tibia which progresses to pathologic fracture, pseudarthrosis, and high risk of refracture even after initial union has been attained. There is currently no consensus on the classification of this disease or consensus on its treatment. The purpose of this review is to (1) review the clinical presentation, etiology, epidemiology, classification, and natural history of congenital pseudarthrosis of the tibia and (2) review the existing trends in treatment of congenital pseudarthrosis of the tibia and its associated complications. RECENT FINDINGS Current treatment protocols focus primarily on combining intramedullary fixation with external or internal fixation to achieve union rates between 74 and 100%. Intramedullary devices should be retained as long as possible to prevent refracture. Cross-union techniques, though technically difficult, have a reported union rate of 100% and no refractures at mid- to long-term follow-up. Vascularized fibular grafting and induced membrane technique can be successful, but at the cost of numerous surgical procedures. Growth modulation is a promising new approach to preventing fracture altogether, though further study with larger patient series is necessary. The primary consideration in treatment of CPT is expected union rate and refracture risk. Combined intramedullary and external or internal fixation, especially with cross-union techniques, show most promise. Perhaps most exciting is further research on preventing fracture through guided growth, which may reduce the morbidity of multiple surgical procedures which have been the mainstay of treatment for CPT thus far.
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Affiliation(s)
- Matthew J. Siebert
- grid.223827.e0000 0001 2193 0096Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Christopher A. Makarewich
- grid.223827.e0000 0001 2193 0096Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA ,grid.415178.e0000 0004 0442 6404Primary Children’s Hospital, Salt Lake City, UT USA ,grid.509583.2Shriners Children’s, Salt Lake City, Utah USA
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Noaman HH, Mohamed MA, Faisal A, Soroor YO. Different surgical procedures for reconstruction of soft-tissue defects around the ankle. Injury 2022; 53:2657-2665. [PMID: 35422315 DOI: 10.1016/j.injury.2022.03.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of soft tissue defects around the ankle is a difficult and challenging situation for all reconstructive surgeons. A microsurgical free flaps coverage can solve this problematic situation especially with large defects that is not available in all trauma centers. Moreover, long operating time and suitable operative demands are considered obstacles. MATERIALS AND METHOD Eighty five patients having soft tissue defects around ankle were included in this study. They underwent various reconstructions in our specialized hand and reconstructive microsurgery unit from 2015 to 2019. Fifty two were males and thirty three patients were females. Road traffic accident was the main cause of injury in 66 patients followed by implant exposure in 15 patients and chronic osteomyelitis in 4 patients. Distally based superficial sural artery flap was used to reconstruct the defects in 21 cases, free flap was used in 32 cases, Rotational local flap was used in 8 cases, contralateral distally based superficial sural artery flap was used in 2 cases, full or partial skin flaps were used in 10 cases and Propeller flap was used in 12cases. RESULTS All flaps survived except for one modified sural flap with 98% success rate and average follow up of 48 months. All patients were satisfied with the functional capacity of operated limbs. Average time of bone healing postoperative was 3 months with gradual return to original work with acceptable degrees for cosmotic appearance of the limbs. CONCLUSION Many treatment options are available to cover defects around the ankle. Propeller and rotational flaps are fast and easy but cover small defects, distally-based modified sural artery flap is an excellent reliable flap. Microsurgical free flaps provide good contour, color, texture and cover large defects but require microsurgery facilities to execute.
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Affiliation(s)
- Hassan Hamdy Noaman
- Orthopedics and Traumatology Department, Hand and Microsurgery Unit, Sohag University, Egypt.
| | | | - Ahmed Faisal
- Orthopedics and Traumatology Department, Hand and Microsurgery Unit, Sohag University, Egypt
| | - Yasser Osman Soroor
- Orthopedics and Traumatology Department, Hand and Microsurgery Unit, Sohag University, Egypt
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Gerbers JG, Pijpker PAJ, Brouwer RW, van der Veen HC. Anterolateral proximal tibial opening wedge osteotomy for biplanar correction in genu valgum recurvatum using patient specific instrumentation (PSI). A technical note. Knee 2021; 33:58-64. [PMID: 34560354 DOI: 10.1016/j.knee.2021.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/28/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Biplanar anterolateral proximal tibial opening wedge osteotomy has been described as successful for patients with combined recurvatum and valgus alignment. As it is a correction in two planes, it is a technically demanding procedure. We report the use of a novel technique with patient specific instrumentation (PSI) guides for different steps, aiming to reduce the complexity of this procedure. METHODS One patient was treated for genu valgum recurvatum. A virtual surgical plan was made. A two-step PSI approach was used, consisting of an osteotomy guide and a repositioning guide and a custom trial wedges. RESULTS Follow-up showed full function and improved VAS and KOOS scores. A neutral alignment was achieved. There was 2.76 degrees less varus compared to pre-operative planning, 1.24 degrees of excess slope and a rotational difference of 0.10 degrees. Saw plane accuracy was within 1 mm. CONCLUSIONS PSI is a recent technical addition to HTOs as a modality to improve accuracy and reduce surgical complexity. Pre-planning and PSI use in an anterolateral opening wedge PTO allowed for an accurate and reproducible biplanar correction in genu valgum recurvatum. Accuracy was comparable to PSI use in lateral open wedge high tibial osteotomies.
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Affiliation(s)
- J G Gerbers
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, the Netherlands.
| | - P A J Pijpker
- University of Groningen, University Medical Center Groningen, 3D-lab/Department of Neurosurgery, Groningen, the Netherlands
| | - R W Brouwer
- Department of Orthopedics, Martini Hospital, Groningen, the Netherlands
| | - H C van der Veen
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, the Netherlands
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Rinehart D, Starr A, Sanders D, Cutler H, Gross B, Hull B, Sathy A. Increased Articular Exposure of the Lateral Tibial Plateau with a Midline Lateral Parapatellar Arthrotomy Compared to an Anterolateral Submeniscal Arthrotomy: a Cadaveric Study. Injury 2021; 52:2111-2115. [PMID: 33612254 DOI: 10.1016/j.injury.2021.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/18/2020] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantitatively compare the articular exposure of the proximal tibia with a lateral parapatellar arthrotomy through a straight midline incision (ML) versus a lateral submeniscal arthrotomy through a curvilinear anterolateral incision (AL). METHODS Eight surgical approaches (4 ML and 4 AL) were performed on 4 fresh cadavers. Access to key articular landmarks was assessed, including divisions of the lateral meniscus, lateral tibial spine, and anterior cruciate ligament. The boundary of the exposed articular surface of the tibia was marked, and the proximal tibias were then stripped of soft tissues. A calibrated digital image was taken of each proximal tibia, and exposed articular surface area was calculated with ImageJ software (NIH, Bethesda, MD). Statistical analysis was performed using a two-sample t-test. RESULTS Average articular surface area exposed was 2.2 times greater through the midline approach compared with the anterolateral approach (11.2 vs 5.1 cm2, p = 0.010). All key anatomic landmarks were directly visualized through the midline approach in each specimen. Complete visualization of the lateral meniscus posterior horn, lateral tibial spine, and anterior cruciate ligament was not accomplished through the anterolateral approach in any specimen. CONCLUSIONS The midline approach provides more extensive articular exposure of the lateral tibial plateau compared with the anterolateral approach. This improved exposure may offer an advantage when treating fractures not amenable to arthroscopic or minimally invasive techniques. It may be of most use when treating fractures with extension into the posteromedial quadrant of the lateral plateau, fractures with extensive comminution of the lateral plateau, or fractures with complex lateral meniscus tears and fractures with tibial spine involvement.
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Affiliation(s)
- Dustin Rinehart
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, United States.
| | - Adam Starr
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, United States
| | - Drew Sanders
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, United States
| | - Holt Cutler
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, United States
| | - Bruno Gross
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, United States
| | - Brandon Hull
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, United States
| | - Ashoke Sathy
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, United States
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Migliorini F, Eschweiler J, Trivellas A, Rath B, Driessen A, Tingart M, Arentini P. Implant positioning among the surgical approaches for total hip arthroplasty: a Bayesian network meta-analysis. Arch Orthop Trauma Surg 2020; 140:1115-24. [PMID: 32361952 DOI: 10.1007/s00402-020-03448-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Although there is anatomical individuality among patients, some standardized requirements for component orientation for total hip arthroplasty (THA) exist. To date, no study has compared implant positioning using a network meta-analysis (NMA). Hence, the purpose of this study was to perform a NMA comparing implant positioning among the various approaches for THA. METHODS This study was conducted according to the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. All randomized (RCT) and non-randomized (nRCT) clinical trials comparing two or more different approaches for THA were considered for inclusion. For the statistical analysis, the STATA Software/ MP, Version 14.1 (Stata Corporation, College Station, Texas, USA) was used. The NMA was performed through a Stata routine for Bayesian hierarchical random-effects model analysis. RESULTS We enrolled in the present study, a total of 4060 patients, with a mean of 17.84 ± 16.41 months follow-up. The patient baseline data were very homogeneous across the groups concerning age (P = 0.91), sex (P = 0.52), and BMI (P = 0.83). Concerning the cup anteversion, the anterolateral approach reported the value closest to the reference value. The test for overall inconsistency, however, was not statistically significant (P = 0.30). Concerning cup inclination, the lateral approach reported the value closest to the reference value. The test for overall inconsistency was statistically significant (P = 0.01). CONCLUSION The anterolateral approach for total hip arthroplasty detected the best femoral stem alignment and cup anteversion. Data concerning cup inclination detected no sufficient transitivity to draw consistent conclusions.
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Cha Y, Yoo JI, Kim JT, Park CH, Choy W, Ha YC, Koo KH. Disadvantage during Perioperative Period of Total Hip Arthroplasty Using the Direct Anterior Approach: a Network Meta-Analysis. J Korean Med Sci 2020; 35:e111. [PMID: 32383362 PMCID: PMC7211512 DOI: 10.3346/jkms.2020.35.e111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of this study was to analyze complications of complete hip arthroplasty through systematic review and network meta-analysis of comparative studies of direct anterior approach (DAA), anterolateral approach (LA), and posterolateral approach (PA). METHODS Prospective randomized controlled trials (RCTs) or quasi-experimental designs evaluating clinical outcomes of DAA, LA, and PA for complete hip arthroplasty are valid if they meet the following criteria: 1) Comparison of clinical outcomes between the three methods for main complete hip arthroplasty (total hip arthroplasty, THA); 2) Compared at least one of the following outcomes: blood loss, operating time, and transfusion volume; 3) Sufficient data were available to extract and pool, i.e., mean reported, standard deviation and number of subjects. A network meta-analysis was used to determine the results of treatment across various surgical approaches. Indirect comparisons between the two surgical approaches was made by borrowing details from the standard comparator (i.e., the posterior approach). RESULTS Eight prospective RCTs were included in the meta-analysis of the network. The operation time of the LA was longer than that of PA (standardized mean difference [SMD], 0.96; 95% confidence interval [CI], 0.74-1.18; P < 0.001). DAA also had significantly longer operation time than PA (SMD, 0.45; 95% CI, 0.24-0.66; P < 0.001). However, blood loss of the DAA was the highest compared to other approaches (SMD, 0.60; 95% CI, 0.39-0.82; P = 0.002). CONCLUSION When performing THA with DAA, we should pay attention to increased operation time and blood loss.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jun Il Yoo
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.
| | - Jung Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Wonsik Choy
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Ferguson D, Cuthbert R, Tibrewal S. The role of anterolateral augmentation in primary ACL reconstruction. J Clin Orthop Trauma 2020; 11:S389-S395. [PMID: 32523299 PMCID: PMC7275283 DOI: 10.1016/j.jcot.2019.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
The anterolateral soft tissue envelope of the knee has long been recognised as a key stabilising structure. Once the mainstay of operative management of anterior cruciate ligament (ACL) rupture, interest in the area fell away with the advent of intraarticular arthroscopic reconstruction. Renewed interest in these structures together with cadaveric data evidencing the potential for restoration of near normal knee biomechanics following ACL and anterolateral soft tissue reconstruction has driven current concepts and development of operative techniques. Options for current anterolateral augmentation techniques in primary ACL reconstruction plus patient selection considerations are reviewed, together with an outlook at future research key to development of this area.
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Affiliation(s)
- David Ferguson
- Department of Trauma & Orthopaedic Surgery, Barnet General Hospital, Royal Free Hospitals NHS Foundation Trust, EN5 3DJ, London, UK
- Corresponding author.
| | - Rory Cuthbert
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - Saket Tibrewal
- Department of Trauma & Orthopaedic Surgery, Lewisham & Greenwich NHS Trust, University Hospital Lewisham, High Street, London, SE13 6LH, UK
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13
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Abstract
BACKGROUND Rotatory knee instability is an abnormal, complex three-dimensional motion that can involve pathology of the anteromedial, anterolateral, posteromedial, and posterolateral ligaments, bony alignment, and menisci. To understand the abnormal joint kinematics in rotatory knee instability, a review of the anatomical structures and their graded role in maintaining rotational stability, the importance of concomitant pathologies, as well as the different components of the knee rotation motion will be presented. MAIN BODY The most common instability pattern, anterolateral rotatory knee instability in an anterior cruciate ligament (ACL)-deficient patient, will be discussed in detail. Although intra-articular ACL reconstruction is the gold standard treatment for ACL injury in physically active patients, in some cases current techniques may fail to restore native knee rotatory stability. The wide range of diagnostic options for rotatory knee instability including manual testing, different imaging modalities, static and dynamic measurement, and navigation is outlined. As numerous techniques of extra-articular tenodesis procedures have been described, performed in conjunction with ACL reconstruction, to restore anterolateral knee rotatory stability, a few of these techniques will be described in detail, and discuss the literature concerning their outcome. CONCLUSION In summary, the essence of reducing anterolateral rotatory knee instability begins and ends with a well-done, anatomic ACL reconstruction, which may be performed with consideration of extra-articular tenodesis in a select group of patients.
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Affiliation(s)
- Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Thomas Rauer
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christopher M Gibbs
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
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14
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Abstract
PURPOSE This study looks to compare patient outcomes in those with pilon fractures fixed with the anterolateral approach versus those with the posterolateral approach. METHODS 135 patient charts of those with surgically treated pilon fractures over a 7-year period were retrospectively reviewed, recording demographic information, fracture description, surgical intervention timeline, operative outcomes, patient outcomes, and complication rates. RESULTS Of the 44 included patients (32 anterolateral and 12 posterolateral), most were older than 40 years of age (65.9%) and male (63.6%). There was no difference seen between anterolateral approach and posterolateral approach tourniquet times (p = 0.80), operating room time (p = 0.40), or estimated blood loss (p = 0.73). There was also no reported difference in decrease in Numerical Rating Scale pain scores (p = 0.38), FOTO (Focus on Therapeutic Outcomes) percent increase (p = 0.13), active flexion-extension axis range of motion (p = 0.35), or inversion-eversion axis (p = 0.25) range of motion after an anterolateral approach versus a posterolateral approach. Finally, statistically similar complication rates (p = 0.75) were seen between anterolateral and posterolateral approaches, but patients who underwent a posterolateral approach surgical fixation were trending towards significantly using more post-operative outpatient opioid medications for pain control compared to those who underwent surgical fixation with an anterolateral approach (p = 0.09). CONCLUSIONS Pilon injuries that lend themselves to anterolateral fixation have similar outcomes peri-operatively and post-operatively compared to injuries lending to posterolateral fixation. Both approaches can be used as dictated by the injury not fearing poorer outcomes or increased complication rates. However, surgeons must be wary of high complication rates associated with all pilon injury patterns. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Ajith Malige
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum Street Bethlehem, Fountain Hill, PA, 18015, USA.
| | - Shawn Yeazell
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum Street Bethlehem, Fountain Hill, PA, 18015, USA
| | - Chinenye Nwachuku
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum Street Bethlehem, Fountain Hill, PA, 18015, USA
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15
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Chernchujit B, Tharakulphan S, Apivatgaroon A, Prasetia R. Accuracy comparisons of intra-articular knee injection between the new modified anterolateral Approach and superolateral approach in patients with symptomatic knee osteoarthritis without effusion. Asia Pac J Sports Med Arthrosc Rehabil Technol 2019; 17:1-4. [PMID: 30976521 PMCID: PMC6438910 DOI: 10.1016/j.asmart.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/21/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
Background Intra-articular knee injection with steroid or various other agents have been used to control the local inflammation and relieve pain in the osteoarthritis knee. To achieve the maximal potential therapeutic worth and decrease the complications from the inaccurate knee injection, these medications should be delivered directly into the intra-articular space. Injection technique is one of the most important factors for accuracy of knee injection. Therefore, this study was aimed to propose the new modified anterolateral injection technique for higher accuracy of knee injection in symptomatic osteoarthritis knee without effusion. Material and methods Patients with symptomatic osteoarthritis without effusion were included prospectively from May 2014 to May 2015 and randomized into 2 groups for knee injection: Modified anterolateral (MAL), Standard superolateral (SL). Knee injection was performed by one experienced orthopaedic. Accuracy of injection was test by mini air-arthrography technique. The pain from injection were evaluated by visual analog scale (VAS). Result 132 knees were included, 66 knees were modified anterolateral group same as superolateral group. The modified anterolateral injection was significantly yield the higher accuracy rate than the standard superolateral injection (89% vs 58%, P < 0.05). The pain visual analog scale was not significantly different between the modified anterolateral and standard superolateral injection technique (2.61 vs 2.65, P = 0.917) No adverse events were occurred. Conclusion The new modified anterolateral injection yields the higher pooled accuracy rate. From the accuracy and the advantage of the new modified anterolateral injection, this is the preferred injection technique for the symptomatic osteoarthritis without knee effusion.
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Affiliation(s)
- Bancha Chernchujit
- Department of Orthopedics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | - Adinun Apivatgaroon
- Department of Orthopedics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Renaldi Prasetia
- Department of Orthopedics and Traumatology Universitas Padjadjaran, Dr. Hasan Sadikin Teaching Hospital, Bandung, Indonesia
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16
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Yoo JI, Cha YH, Kim KJ, Kim HY, Choy WS, Hwang SC. Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:63. [PMID: 30736783 PMCID: PMC6368707 DOI: 10.1186/s12891-019-2450-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/01/2019] [Indexed: 01/19/2023] Open
Abstract
Background Comparative studies of total hip arthroplasty using the direct anterior approach (DAA) compared with the anterolateral approach (ALA) by gait analysis compared the results of the two groups, the damage to the abductor muscle, with objective and detailed kinematic as well as kinetic data of actual gait. The purpose of this systematic review was to analyze the differences in gait such as time-dependent parameters, kinetics, and kinematics after THA using the DAA compared with ALA. Methods PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE and AHRQ carried out a comprehensive search for all relevant randomized controlled trials and comparative studies, up to December 2018. Based on the following criteria, studies were selected: 1) study design: randomized controlled trials or non-randomized comparative studies; 2) study population: patients with primary osteoarthritis or avascular necrosis; 3) intervention: total hip arthroplasty by DAA or ALA; 4) Kinetic and kinematic data after gait analysis in the plains during postoperative follow-up. Results Of the 148 studies, 7 randomized controlled trials and 5 comparative studies were finally included in this systematic review. The peak hip flexion within 3 months after surgery was described in two studies and was significantly higher in the DAA group. (OR = 1.90; 95% CI [1.67,2.13]; P < 0.01, Z = 16.18). The gait speed within 3 months after surgery was reported in 3 studies and was significantly higher in the DAA group than in the ALA group. (SMD = 0.17; 95% CI [0.12,0.22]; P < 0.01, Z = 6.62) There was no difference between the two groups in stride length, step length, and hip range of motion in sagittal plane. Conclusions In this meta-analysis, gait speed and peak hip flexion within 3 months after surgery were significantly higher in the DAA group than in the ALA group. Despite a few significant differences between two approaches, determining whether the reported differences in terms of postoperative gait values are clinically meaningful remains a substantial challenge. Electronic supplementary material The online version of this article (10.1186/s12891-019-2450-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
| | - Yong-Han Cha
- Department of Orthopedic Surgery, Eulji University Hospital, Dunsan-Seoro 95, Seo-gu, Daejeon, 35233, South Korea.
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Dunsan-Seoro 95, Seo-gu, Daejeon, 35233, South Korea
| | - Ha-Yong Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Dunsan-Seoro 95, Seo-gu, Daejeon, 35233, South Korea
| | - Won-Sik Choy
- Department of Orthopedic Surgery, Eulji University Hospital, Dunsan-Seoro 95, Seo-gu, Daejeon, 35233, South Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
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Wurm M, Herbst E, Forkel P, Imhoff AB, Herbort M. [ Anterolateral stabilization using the modified Lemaire technique for ACL deficiency]. Oper Orthop Traumatol 2018; 31:36-44. [PMID: 30478634 DOI: 10.1007/s00064-018-0579-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Treatment of persistent anterolateral knee instability. INDICATIONS Subjective/objective (rotational) instability of the knee after anatomic anterior cruciate ligament (ACL) reconstruction. ACL re-rupture including special demands (e.g., high-performance athletes, hyperlaxity) RELATIVE CONTRAINDICATIONS: Osteoarthritis, additional instability of the knee, which should be treated independently; non-anatomic ACL reconstruction with persisting instability should be treated first with anatomic ACL reconstruction. ABSOLUTE CONTRAINDICATIONS General contraindications for surgery (e. g. septic arthritis), acute irritation of the affected knee. SURGICAL TECHNIQUE Supine position. Incision along the proximal lateral femoral epicondyle. Marking of the needed width and length of the iliotibial band (ITB) graft. Passing the ITB graft underneath the lateral collateral ligament. Find and mark the isometric point for fixation next to the lateral femoral epicondyle. Fixation of the ITB graft. Layered wound closure. POSTOPERATIVE MANAGEMENT Knee brace for at least 6 weeks. Range of motion (RoM): from postoperative day 1: flexion-extension 90-0-0°; first 2 weeks after surgery: partial weight bearing (20 kg). RESULTS An anterolateral extra-articular reconstruction may reduce a persistent anterolateral rotatory instability as well as the re-rupture rate following ACL reconstruction with good patient-reported short-term outcomes. Based on current (biomechanical) data, anterolateral tenodesis seems to be superior to a reconstruction of the anterolateral ligament. If a tenodesis is performed, the graft should be fixed in an isometric position, with neutral rotation of the knee and low graft tension to avoid extraphysiologic load within the lateral compartment. Indications for such a procedure may include a high-grade pivot shift or revision ACL reconstruction as well as a persistent anterolateral rotatory instability following anatomic ACL reconstruction.
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Affiliation(s)
- M Wurm
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81679, München, Deutschland
| | - E Herbst
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81679, München, Deutschland
| | - P Forkel
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81679, München, Deutschland
| | - A B Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81679, München, Deutschland.
| | - M Herbort
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
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18
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Debi R, Slamowicz E, Cohen O, Elbaz A, Lubovsky O, Lakstein D, Tan Z, Atoun E. Acetabular cup orientation and postoperative leg length discrepancy in patients undergoing elective total hip arthroplasty via a direct anterior and anterolateral approaches. BMC Musculoskelet Disord 2018; 19:188. [PMID: 29879934 PMCID: PMC5992835 DOI: 10.1186/s12891-018-2097-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/17/2018] [Indexed: 02/08/2023] Open
Abstract
Background Total hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches. Methods The study included 172 patients undergoing an elective THA by a single surgeon at our institution within the study period. Ninety-eight arthroplasties were performed through the ALA and 74 arthroplasties through the DAA. Preoperative planning was performed for all patients. Assessment of the two groups included the following postoperative parameters: abduction angle, cup anteversion angle and leg length discrepancy (LLD). Additional analysis was done to evaluate component positioning by comparing deviation from the Lewinnek zone of safety in both approaches. Results For the DAA the absolute LLD was 11 mm, ranging from -6 mm to 5 mm. For the ALA, the absolute LLD was 36 mm, ranging from -22 mm to 14 mm. None of the DAA patients had an absolute LLD greater than 6 mm. Comparatively, 7.4% of the ALA group exceeded 6 mm of LLD in addition to 2.1% with LLD greater than 10 mm. 15% of the ALA group resided out of the Lewinnek abduction zone compared to 3% of the DAA group (P = 0.016). 17% of the ALA group were out of the Lewinnek anteversion zone as opposed to 8% of the DAA group (P = 0.094). Conclusion Our study demonstrates good component positioning outcomes and LLD values in patients following THA through the DAA compared to the ALA.
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Affiliation(s)
- Ronen Debi
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Evyatar Slamowicz
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Ornit Cohen
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Avi Elbaz
- AposTherapy Research Group, Herzelyia, Israel
| | - Omri Lubovsky
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Dror Lakstein
- Department of Orthopaedic Surgery, Wolfson Medical Center , Holon, Israel
| | - Zachary Tan
- Department of Orthopaedic Surgery, Wolfson Medical Center , Holon, Israel
| | - Ehud Atoun
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel. .,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel.
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19
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de Jong L, Klem TMAL, Kuijper TM, Roukema GR. The minimally invasive anterolateral approach versus the traditional anterolateral approach (Watson-Jones) for hip hemiarthroplasty after a femoral neck fracture: an analysis of clinical outcomes. Int Orthop 2018; 42:1943-8. [PMID: 29307031 DOI: 10.1007/s00264-017-3756-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/26/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE The minimally invasive (MI) anterolateral approach is a relatively new approach for the treatment of femoral neck fractures with a hemiarthroplasty (HA). There is limited research available presenting clinical outcomes after an HA using the MI approach. Therefore the aim of the present study was to compare clinical outcomes of the MI and traditional anterolateral approaches in patients after HA. METHODS Data were extracted from a prospective hip fracture database and completed by retrospective review of the electronic medical records. Patients undergoing HA in a level II trauma teaching hospital between 1 January 2011 and 1 May 2016 were enrolled. RESULTS A total of 463 patients (67% female), 223 in the MI group (mean age, 82 ± 7) and 240 (mean age, 81 ± 8) in the traditional anterolateral group were enrolled. No significant difference was found in baseline characteristics. The surgeons experience measured by the operations performed per year was in favour of the MI anterolateral group (26 vs 18, p < 0.001). The median operating time for an MI approach was shorter (53 vs 69 min, p < 0.001). No significant differences were found in mortality rates (p = 0.131) and post-operative complications: haematomas (p = 0.63), dislocations (p = 0.63), deep surgical site infections (p = 0.66) and re-operations. CONCLUSIONS Our findings show the MI anterolateral approach has a minimally shorter operation time with no difference in post-operative complications and clinical outcomes. We, therefore, conclude that the MI anterolateral approach is a safe alternative for the traditional anterolateral approach with an improved operation time, a smaller incision and less surrounding tissue damage. LEVEL OF EVIDENCE Prognostic level III retrospective cohort study.
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20
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Amarase C, Thimasarn W, Tantavisut S, Huanmanop T, Wangroongsub Y, Limthongkul W. Different effect of percutaneous plate insertion via anteromedial vs anterolateral approach on intracompartmental pressure of the leg: A cadaveric study. Injury 2017; 48:2407-2410. [PMID: 28927935 DOI: 10.1016/j.injury.2017.08.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Currently Minimally Invasive Plate Osteosynthesis (MIPO) technique for tibial shaft fracture management has gained wide attention. However, an increased intracompartmental pressure after the plate insertion may result in postoperative acute compartment syndrome. We reported the difference of immediate effect of percutaneous plate insertion using 2 approaches of MIPO technique on anterior compartment pressure of the legs. MATERIALS AND METHODS Eight soft cadaveric legs (one female and three males) without previous history of skeletal trauma or surgery were infused with normal saline to create the sustained intracompartmental pressure of 20mm Hg in all four compartments. The Synthes® 4.5mm 11-hole Narrow Locking Compression Plate was inserted via anteromedial and anterolateral approach. Anterior compartment pressure was measured by portable digital monitoring device through side-port needle (Stryker® Intracompartmental Monitoring Device) before and after plate insertion for each approach. RESULTS By using anteromedial approach, a mean of anterior compartment pressure was increased by 0.375mm Hg after plate insertion (5 of 8 legs had no change in pressure and the remaining 3 resulted in 1mm Hg pressure elevation). For anterolateral plate insertion, all of the 8 legs had an elevation of anterior compartment pressure with a mean of 3.5mmHg (ranged from 2 to 6mm Hg). CONCLUSIONS When both approaches were compared to each other, the anterolateral plate insertion resulted in higher intracompartmental pressure elevation of the anterior compartment than the anteromedial approach. Surgeon should be more aware of acute compartment syndrome when considering the anterolateral approach in treating close tibial fracture. However, in patients with suspected acute compartment syndrome, close observation and continuous monitoring of the intracompartmental pressure is still imperative for all healthcare provider.
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Affiliation(s)
- Chavarin Amarase
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road Pathumwan Bangkok 10330, Thailand.
| | - Wanchat Thimasarn
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road Pathumwan Bangkok 10330, Thailand.
| | - Saran Tantavisut
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road Pathumwan Bangkok 10330, Thailand.
| | - Thanasil Huanmanop
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road Pathumwan, Bangkok 10330, Thailand.
| | - Yongsak Wangroongsub
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road Pathumwan Bangkok 10330, Thailand.
| | - Worawat Limthongkul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road Pathumwan Bangkok 10330, Thailand.
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21
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Yu WH, He SC, Du RJ, Zhu HD, Fang W, Li SS, Sun FH. [Oblique puncture approach via anterolateral to C2: a study of imaging anatomy on corpses]. Zhonghua Yi Xue Za Zhi 2017; 97:2913-2917. [PMID: 29050161 DOI: 10.3760/cma.j.issn.0376-2491.2017.37.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To determine the anatomical relation between the carotid artery or laryngopharynx and the needle path via anterolateral oblique approach to C2 vertebral body, and whether the simulated path can direct the actual procedure. Methods: Contrast agent was injected into bilateral carotid arteries of 10 fresh cadavers (20 sides), and then CT scans were performed on each subject. Bilateral simulated puncture paths were simulated on the image of two-dimensional reconstruction CT. The distance between the puncture site and middle line(AC), the angle between the simulated puncture paths and the median sagittal plane (AOB), the distance between the simulated puncture paths and the side wall of hypopharynx, or the carotid artery was measured respectively. Under the guidance of fluoroscopy, oblique puncture via anterolateral to C2 was performed according to the simulated parameters, and then CT was done. The actual needle path was measured on the image of two-dimensional reconstruction CT. The outcomes were compared by using paired t test between groups. Results: Bilateral simulated puncture paths in all 10 cadavers were achieved on the image of CT. The bilateral punctures via anterolateral to C2 were successfully performed under fluoroscopic guidance in 10 cadavers, and the actual needle path could be showed on the image of two-dimensional reconstruction CT. The AC, angle AOB, the distance to carotid artery and side wall of laryngopharyngeal of the left simulated path was(4.7±1.0)cm, (33±8)°, (6.7±2.6)mm, (6.6±2.8)mm, respectively; and those in the right side was(5.2±1.3) cm, (36±8)°, (7.5±2.2) mm, (7.2±2.5) mm, respectively.The AC, angle AOB, the distance to carotid artery and side wall of laryngopharyngeal of the left actual needle was(4.5±1.1) cm, (33±9) °, (6.7±3.0) mm, (7.1±3.9) mm, respectively; and those in the right side was(5.1±1.5) cm, (35±10) °, (7.4±2.1) mm, (7.2±2.6) mm, respectively.And the actual and simulation data of both sides were compared and no significant differences was found by t test (t=0.104-1.882, all P>0.05). Conclusion: The simulated approach via anterolateral to C2 can be achieved on the image of two-dimensional reconstruction CT, it is consistent with the real needle path and can be used to direct the actual practice to improve the accuracy and safety.
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Affiliation(s)
- W H Yu
- Department of Radiology, School of Medicine, Southeast University, Nanjing 210009, China
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22
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Abstract
This article describes the complex anatomic structures that pass across the lateral aspect of the knee, particularly the iliotibial tract and the underlying anterolateral ligament and capsule. It provides data on their strength and roles in controlling tibiofemoral joint laxity and stability. These findings are discussed in relation to surgery to repair or reconstruct the anatomic structures, or to create tenodeses with similar effect.
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Affiliation(s)
- Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster DE 48149, Germany
| | - Eivind Inderhaug
- Orthopaedic Surgery Department, Haraldsplass Hospital, Bergen 5009, Norway
| | - Andy Williams
- Fortius Clinic, Fitzhardinge Street, London W1H 6EQ, UK
| | - Andrew A Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK; Musculoskeletal Surgery Group, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK.
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23
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Herbst E, Albers M, Burnham JM, Shaikh HS, Naendrup JH, Fu FH, Musahl V. The anterolateral complex of the knee: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2017; 25:1009-1014. [PMID: 28233023 DOI: 10.1007/s00167-017-4449-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 01/26/2023]
Abstract
Injuries to the anterolateral complex of the knee can result in increased rotatory knee instability. However, to diagnose and treat patients with persistent instability properly, surgeons need to understand the multifactorial genesis as well as the complex anatomy of the anterolateral aspect of the knee in its entirety. While recent research focused primarily on one structure (anterolateral ligament-ALL), the purpose of this pictorial essay is to provide a detailed layer-by-layer description of the anterolateral complex of the knee, consisting of the iliotibial band with its superficial, middle, deep, and capsulo-osseous layer as well as the anterolateral joint capsule. This may help surgeons to not only understand the anatomy of this particular part of the knee, but may also provide guidance when performing extra-articular procedures in patients with rotatory knee instability. Level of evidence V.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcio Albers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Humza S Shaikh
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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Bonanzinga T, Signorelli C, Grassi A, Lopomo N, Bragonzoni L, Zaffagnini S, Marcacci M. Kinematics of ACL and anterolateral ligament. Part I: Combined lesion. Knee Surg Sports Traumatol Arthrosc 2017; 25:1055-1061. [PMID: 27631644 DOI: 10.1007/s00167-016-4259-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/29/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To quantify the influence of ALL lesions on static and dynamic laxity in ACL-deficient knee. METHODS The study was performed in 10 fresh-frozen knees. The joints were analysed in the following conditions: intact, ACL resection and ACL + ALL resection. Testing parameters were defined as: anterior displacement at 30° and 90° of flexion (AP30, AP90) applying a manual-maximum load; internal rotation at 30° and 90° of flexion (INT30, INT90) applying a 5 N m torque and internal rotation and acceleration during manual pivot-shift (PS) test. Kinematics was acquired by a navigation system; a testing rig and a torquemeter were used to control the limb position and the applied torque. Paired Student's t test was conducted to assess statistical difference, and significance was set at P < 0.05. RESULTS The ALL resection determined a significant increase in terms of internal rotation (INT30 P = 0.02, INT90 P = 0.03), while AP30 (P n.s) and AP90 (P n.s) were not affected. ALL resection produced a significant increase in terms of acceleration during PS test (P < 0.01), but no significant change in PS internal rotation was observed. CONCLUSION The ALL plays a significant role in controlling static internal rotation and acceleration during PS test. On the other hand, ALL resection did not produce any significant change in terms of anterior displacement. A trend was seen for the internal rotation during the pivot-shift test to increase after ALL resection was higher when compared to the intact and isolated ACL lesion states; however, the differences were not significant. The results highlight the clinical relevance of this structure that should be assessed before an ACL reconstruction in order to avoid residual laxity.
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Affiliation(s)
- T Bonanzinga
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy. .,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.
| | - C Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - A Grassi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - N Lopomo
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia, BS, Italy
| | - L Bragonzoni
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
| | - S Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
| | - M Marcacci
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, BO, Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, BO, Italy
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Bonanzinga T, Signorelli C, Grassi A, Lopomo N, Jain M, Mosca M, Iacono F, Marcacci M, Zaffagnini S. Kinematics of ACL and anterolateral ligament. Part II: anterolateral and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:1062-7. [PMID: 28280906 DOI: 10.1007/s00167-017-4496-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/21/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To quantify the influence of Single-Bundle with Lateral Plasty and Double-Bundle reconstruction on static and dynamic laxity in combined ACL- and ALL-deficient knees. METHODS The study included 10 fresh-frozen human knees. The joints were analyzed in the following conditions: ACL + ALL resection, Single-Bundle with Lateral Plasty (SBLP) reconstruction, Double-Bundle (DB) reconstruction. Testing parameters were: anterior displacement at 30° and 90° of flexion (AP30, AP90) applying a manual maximum load; internal rotation at 30° and 90° of flexion (INT30, INT90) applying a 5 Nm torque and acceleration and internal rotation Pivot-Shift (PS) test. Kinematics was acquired by a navigation system. Paired Student's t test was conducted to assess statistical difference (P < 0.05). RESULTS At both 30° and 90° of knee flexion, both SBLP and DB surgical techniques showed a significant reduction (P < 0.01) of anterior-posterior tibial displacement compared to the resection of ACL + ALL. At 30° on knee flexion it is the SBLP that allows the greatest reduction of internal rotational laxity when compared to DB reconstruction. Concerning the PS test, only SBPL procedure had a significant laxity decrease considering the acceleration reached by the joint when compared with the ACL + ALL state (P < 0.01). CONCLUSION Clinical relevance of this study is that the internal rotation and PS test were more efficiently controlled by the SBLP technique than by the DB one at both 30° and 90° of flexion in case of ACL + ALL lesions.
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Pascal S, Deveze A, Casanova D, Philandrianos C. Treatment of a mastoid defect by free anterolateral thigh flap. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:195-8. [PMID: 26363599 DOI: 10.1016/j.anorl.2015.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Free anterolateral thigh (ALT) flap constitutes an alternative to latissimus dorsi and radial forearm flaps for head and neck reconstruction. The authors report a case of mastoid reconstruction in a patient with multi-operated cholesteatoma associated with tubal dysfunction. CASE REPORT This patient presented a fistula of the lateral semicircular canal and invagination of retroauricular soft tissues responsible for non-compensated almost complete areflexia with anacusis. She did not present any signs of cholesteatoma recurrence, but chronic inflammation of the mastoidectomy cavity. The head and neck procedure consisted of translabyrinthine labyrinthectomy: resection of the atrophic retroauricular skin, resection of the vestibular neurosensory tissue and obliteration of the mastoidectomy cavity. An ALT flap measuring 5×5 cm, anastomosed to the superior thyroid artery and facial vein, was used to cover the defect. Careful defatting of the flap allowed filling of the defect, while providing a sufficient quantity of appropriate tissue. The postoperative course was uneventful and the patient was considerably improved. The only donor site sequelae consisted of a thin linear scar. CONCLUSION The free anterolateral thigh flap, a reliable, polyvalent flap that can be shaped as needed and which is associated with minimal donor site morbidity, constitutes a good alternative for head and neck reconstruction.
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Ozgur BM, Agarwal V, Nail E, Pimenta L. Two-year clinical and radiographic success of minimally invasive lateral transpsoas approach for the treatment of degenerative lumbar conditions. SAS J 2010; 4:41-6. [PMID: 25802648 PMCID: PMC4365615 DOI: 10.1016/j.esas.2010.03.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The lateral transpsoas approach to interbody fusion is a less disruptive but direct-visualization approach for anterior/anterolateral fusion of the thoracolumbar spine. Several reports have detailed the technique, the safety of the approach, and the short term clinical benefits. However, no published studies to date have reported the long term clinical and radiographic success of the procedure. Materials and methods The current study is a retrospective chart review of prospectively collected clinical and radiographic outcomes in 62 patients having undergone the Anterolateral transpsoas procedure at a single institution for anterior column stabilization as treatment for degenerative conditions, including degenerative disk disease, spondylolisthesis, scoliosis, and stenosis. Only patients who were a minimum of 2 years postoperative were included in this evaluation. Clinical outcomes measured included visual analog pain scales (VAS) and Oswestry disability index (ODI). Radiographic outcomes included identification of successful arthrodesis. Results Sixty-two patients were treated with lateral interbody fusion between 2003 and December 2006. Twenty-six patients (42%) were single-level, 13 (21%) 2-level, and 23 (37%) 3- or more levels. Forty-five (73%) included supplemental posterior pedicle fixation, 4 (6%) lateral fixation, and 13 (21%) were stand-alone. Pain scores (VAS) decreased significantly from preoperative to 2 years follow-up by 37% (P < .0001). Functional scores (ODI) decreased significantly by 39% from preoperative to 2 years follow-up (P < .0001). Clinical success by ODI-change definition was achieved in 71% of patients. Radiographic success was achieved in 91% of patients, with 1 patient with pseudarthrosis requiring posterior revision. Conclusion The lateral transpsoas approach is similar to a traditional anterior lumbar interbody fusion, in that access is obtained through a retroperitoneal, direct-visualization exposure, and a large implant can be placed in the interspace to achieve disk height and alignment correction. The 2 years plus clinical and radiographic success rates are similar to or better than those reported for traditional anterior and posterior approach procedures, which, coupled with significant short-term benefits of minimal morbidity, make the lateral approach a safe and effective treatment option for anterior/anterolateral lumbar fusions.
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Affiliation(s)
- Burak M Ozgur
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Vijay Agarwal
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Erin Nail
- Division of Neurosurgery, University of California, San Diego, San Diego, CA ; Seattle Pacific University, Seattle, WA
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