Complete proximal hamstring tendon avulsions from the ischial tuberosity, though infrequent, are the most severe type of hamstring muscle injury in the field of sport medicine. These serious injuries are commonly associated with a delayed or even misdiagnosis, despite obvious clinical findings. The published literature favours surgical repair even though the studies represent lower levels of evidence. Non-surgical treatment is a viable option for lower physical demand patients. This state-of-the-art article reviews the relevant anatomy, the clinical assessment including specific physical examination signs and diagnostic testing in patients suspected of a proximal hamstring avulsion. Up-to-date evidence is reviewed to address surgical and non-surgical treatment options and outcome assessment. The authors provide a detailed description of what would be considered the current worldwide standard of care; an open, suture-anchor-based repair of the avulsed tendon complex (semitendinosus, long head of biceps femoris and semimembranosus) securely to the ischial tuberosity. Also included are surgical tips and tricks, with advice on postsurgical management and rehabilitation. Future perspectives should involve higher quality, prospective research to better define the indications for surgery, evaluate the emerging role of endoscopic repair and disclose complications along with measuring patient-reported outcomes.
Objectives:To identify patients with a diagnosis of acute and complete ACL rupture that healed spontaneously, and to determine whether such healing is related to age, sex, type of rupture, resting time, and trauma mechanisms.Materials and Methods:30 patients with complete acute ACL rupture were evaluated by clinical diagnosis and Magnetic Resonance Image (MRI). Both Lysholm test and IKDC 2000 were used for subjective evaluation.Results:All patients improved from the first to the second consult, with the following results: Lachman (p <0.0406), pivot shift (p = 0.071), and anterior drawer (p <0.001). During the follow-up MRI, all patients showed signs of healing in ACL. With an average follow-up of 12 months for men (95% CI 6-17) and 13 months for women (95% CI 31 max.), a nearly complete clinical recovery could be inferred, as well as healing occurring independently of variables such as age, sex, or specific treatment (p = 0.795 and p = 0.841).Discussion:Despite this study size limitation, the objectives were achieved. There would be spontaneous ACL healing associated with a 3-month post-injury resting time, but it is unrelated to age, sex, specific physiotherapy treatments, or the use of immobilizers. Level of evidence: level of evidence IV
Materials and methods:We retrospectively reviewed 1,186 knee MRI reports from January 1, 2015 to July 31, 2015, using the computerized clinical history system. These were classified according to the origin of the request for the images (specialists in orthopedics and traumatology, residents of traumatology and other medical specialties). This information was explored for its characterization.Retrospective study. Level of evidence IV Results: We obtained 33% (389) normal report of knee, significantly lower (p <0.001) to 67% reporting injuries.The proportion of studies requested was mostly by specialists in orthopedics and traumatology (59%), followed by the proportion required by different medical specialties (27%) and by those prescribed by traumatology residents (13%). The percentages of normal reports of those studies requested were different (p <0.05) 29, 42 and 32%, respectively. Conclusion:In primary care by physicians and residents of traumatology, the request for knee MRI reports a high percentage of normal reports. Specialists in orthopedics and traumatology request this exam with greater demand and present greater findings of injuries.
Introduction:Faced with a bucket meniscal lesion we have two treatment options. A frequently practiced option is to remove the bucket handle, another is to repair it. Generally, they are associated with ligament injuries. In this context, it has been shown that meniscal repair has a good result, but the evolution of isolated meniscal repairs is not entirely clear. The purpose of this systematic review is to determine the results after the repair of bucket handle injuries.Materials and Methods:A bibliographic search of the computerized database was carried out pubmed. Eight articles were included according to the inclusion and exclusion criteria. The results of interest included, level of evidence, number of patients, follow-up, average age, surgical technique,% cure,% failure, complications, associated injuries and average time from injury to surgical repair.Results:The works studied, on average, 43 patients, with ages between 16 and 33 years making 341 patients. The follow-up period was focused on 58 months. The percentage of cure varies from 52% to 98%.Conclusion:The isolated repair of this type of meniscal lesions has a good overall evolution associated with a low rate of failure and complicationsLevel of evidence:IVType of studysystematic review
Introduction:Indications in the treatment of rotator cuff lesions are widely discussed and not standardized. The aim of this study is to evaluate the variability among Argentinean orthopedic surgeons regarding the indications of treatment in different rotator cuff lesions.Methods:A questionnaire was designed based on the study carried out by Dunn et al. (JBJS Am 2005). Its aim was to gather the opinion of Argentine orthopedic surgeons on decision making concerning different rotator cuff lesions. Surgeons were divided into general orthopedic surgeons or shoulder specialists according to the number of shoulders treated surgically in the last year. The questionnaire has two sections: four hypothetical clinical cases and 11 questions about factors that could influence treatment selection.Results:Out of 556 questionnaires sent, 162 were completed, 117 by orthopedic surgeons and 45 by shoulder specialists. The specialists reported mostly arthroscopic repairs (57%), orthopedic surgeons reported repairing these lesions mainly by mini open or open technique (48% and 21% respectively). The highest agreement between both groups was evidenced in case number 1 (traumatic partial injuries in young patients (70% in favor of rotator cuff repair)). There was also agreement in the contraindication of the use of corticosteroids before surgery (p = 0.74), and in the repair of rotator cuff as a factor to prevent osteoarthritis (p = 0.27). Rotator cuff repair failure rate was considered to be 20%, not evidencing differences between groups.Conclusions:This study evidences the variation in indications between Argentinean surgeons in the treatment of rotator cuff lesions. The variability in the management of these patients, makes it difficult to establish protocols of treatment, or consensus guidelines to help standardize treatments for these injuries
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.