We report a study of 28 women with severe primary gonarthrosis followed for 1 year. Variations in bone mineral density and in functional behaviour of knee extensors and flexors were studied before and after implantation of uncemented total knee prosthesis. A functional deficit was noted in the extensor apparatus, which increased in the first 6 months following surgery. This strength was not improved 1 year following the arthroplasty, but it was more efficient as shown by the reduction of muscle fatigue. Flexor strength was conserved and a pathological muscle balance was maintained, reaching maximum efficiency over a smaller joint range.Résumé Etude des variations de la densité minérale osseuse et du comportement des extenseurs et fléchisseurs du genou avant et après implantation d'une prothèse totale non cimentée chez 28 femmes souffrant d'une gonarthrose primaire sévère et suivies pendant une année. Un déficit fonctionnel de l'appareil de l'extenseur à été noté avant l'intervention et a augmenté dans les six premiers mois suivant la chirurgie. La force d'extension n'était pas améliorée une année après l'arthroplastie, mais l'action était meilleure à cause d'une moindre fatiguabilité du muscle. La force des fléchisseurs a été conservée et un équilibre musculaire a été maintenu, en arrivant à l'efficacité maximale sur une plus petite amplitude articulaire.
Objetivo: Comparar dos series de pacientes sometidos a ligamentoplastia con tendones isquiotibiales autólogos mediante las dos técnicas quirúrgicas preferentes: monotúnel transtibial y bitúnel anatómica, utilizando idénticas fijaciones óseas, y establecerconclusiones funcionalesMateriales y Métodos: Estudio retrospectivo de dos series de 30 pacientes, con un seguimiento superior a un año, sometidos a ligamentoplastia del ligamento cruzado anterior con tendones isquiotibiales mediante técnicas monotúnel transtibial y bitúnel con tunelización retrógrada, utilizando fijación elástica cortical en fémur y fijación tibial mediante tornillo retrógrado. Se los evaluó con la escala del IKDC, y las pruebas de Lachman, de resalte (pivot-shift) y del salto monopodal, valorando la reincorporación a la actividad previa habitual y deportiva, y examen radiológico de la evolución de los túneles óseos.Resultados: La técnica bitúnel anatómica logra resultados significativamente mejores (p <0,05) en la evaluación subjetiva de la escala del IKDC, en las pruebas de resalte, del salto y en la recuperación de la actividad deportiva previa a la lesión, sin diferencias en la prueba de Lachman. No hubo casos de osteólisis en los túneles óseos, en ninguna de las dos series.Conclusiones:La técnica de ligamentoplastia bitúnel anatómica es mejor valorada y más eficaz que la técnica monotúnel transtibial, fundamentalmente en pacientes con actividad deportiva exigente, ya que en aquellos sin actividades de impacto, los resultados son satisfactorios de igual forma. Con el atornillado retrógrado tibial no hubo osteólisis significativa en el túnel tibial. AbstractObjective: Comparison of two series of patients operated on ligamentoplasty with autologous hamstring tendons by the two preferred surgical techniques: transtibial monotunnel and anatomic bitunnel, using identical bone fixations; and establishment of functional conclusions.Material and method: Retrospective study of two series of 30 patients followed up more than one year, undergoing anterior cruciate ligamentoplasty with hamstring tendons performing transtibial montunnel and bitunnel techniques with retrograde tunneling, using the cortical elastic fixation in femur and a tibial fixation by retrograde screw, evaluating the patients by IKDC scale, Lachman, pivot and monopodal jump tests, valuating the reincorporation to the previous habitual and sports activity, and performing radiological examination of the evolution of the bone tunnels. Results: the anatomical bitunnel technique presents significantly (p <0.05) better results in the evaluation of the IKDC scale, in the pivot and in the jump test and in the recovery of sports activity prior to injury, with no differences in the Lachman test. There were no cases of osteolysis in the bone tunnels in none of the two series. Conclusions: The anatomical bitunnel ligamentoplasty technique is better valued by the patient and more efficient than the transtibial monotunnel technique, fundamentally in patients with demanding sports activity, since in patients without impact activities, the results are satisfactory in the same way. With tibial retrograde screwing, there was no significant osteolysis in the tibial tunnel.
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