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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2018; 59(01): 003-009
DOI: 10.1055/s-0038-1639607
Original Article | Artículo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Reconstrucción de esquina posteromedial: reporte de 30 casos

Posteromedial Corner Reconstruction: a Report of 30 Cases
Agustin Leon
1   Departamento de Traumatología, Hospital Clínico Mutual de Seguridad C.Ch.C, Santiago, Chile
,
Adolfo Mena
1   Departamento de Traumatología, Hospital Clínico Mutual de Seguridad C.Ch.C, Santiago, Chile
2   Residente de Traumatología y Ortopedia U. De Valparaíso, Mutual de Seguridad C.Ch.C, Santiago, Chile
,
Francisco Figueroa
3   Departamento de Traumatología, Hospital Sotero del Río, Puente Alto, Región Metropolitana, Chile
,
Maria Jesús Tuca
1   Departamento de Traumatología, Hospital Clínico Mutual de Seguridad C.Ch.C, Santiago, Chile
,
Gonzalo Ferrer
1   Departamento de Traumatología, Hospital Clínico Mutual de Seguridad C.Ch.C, Santiago, Chile
,
Gonzalo Espinoza
1   Departamento de Traumatología, Hospital Clínico Mutual de Seguridad C.Ch.C, Santiago, Chile
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Publikationsverlauf

19. April 2017

17. Januar 2018

Publikationsdatum:
29. März 2018 (online)

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Resumen

Objetivo Reportar la experiencia, después de 1 año de seguimiento, de una serie de 30 pacientes sometidos a reconstrucción de la esquina posteromedial (EPM) con la técnica descrita por La Prade.

Método Cohorte retrospectiva de 30 pacientes con lesión de EPM operados por el mismo equipo quirúrgico. Criterios de inclusión: diagnóstico clínico, radiografía con estrés y resonancia magnética compatibles con lesión de EPM, inestabilidad grado III luego de 3 meses de tratamiento ortopédico, técnica de reconstrucción de La Prade, al menos 12 meses de seguimiento. Criterios de exclusión: discordancia entre clínica e imagenología, inestabilidad grado I o II, y otra técnica quirúrgica. Evaluación con IKDC y Lysholm antes de la cirugía, a los 6 y 12 meses de seguimiento postcirugía.

Resultados 30 pacientes cumplieron los criterios de inclusión. Promedio de edad 43 años (24–69). Veintiocho pacientes presentaron lesiones de alta energía, 20 pacientes fueron diagnosticados en agudo, mientras que 10 fueron diagnosticados luego de malos resultados en reconstrucción de otros ligamentos. Veintiocho presentaron lesiones asociadas: 11 casos asociados a lesión de ligamento cruzado anterior, 3 casos asociados a lesión de ligamento cruzado posterior, 3 casos en asociación con lesiones meniscales, 9 casos con lesión asociada de ligamento cruzado anterior y posterior, y 2 casos en asociación con ligamento cruzado anterior, posterior y ligamento colateral lateral. Promedio de tiempo hasta la reconstrucción de EPM fue de 5 meses (rango 2–32). Puntuación en Lysholm e IKDC (preoperatorio 18,2 y 24,3 respectivamente), mejoraron a 76,7 y 70,7 después de 1 año de seguimiento. Al fin del seguimiento, el rango articular promedio era 113° (90–140), la mayoría de los pacientes (24) tuvieron estabilidad tipo A según IKDC.

Conclusión La reconstrucción de lesiones de EPM mejora los resultados clínicos en pacientes con inestabilidad crónica posteromedial de rodilla. Se observó mejoría en la estabilidad y scores funcionales de todos los pacientes.

Abstract

Objetive Report the experience, after 1-year follow-up, of 30 patients with La Prade's anatomical reconstruction of posteromedial corner (PMC) injuries.

Methods Retrospective cohort study. 30 patients with PMC injuries operated by the same surgical team. Inclusion criteria: clinical presentation, stress radiographs and MRI compatible with PMC injury, grade III chronic instability in spite of at least 3 months of orthopedic treatment, La Prade's anatomical technique reconstruction, 12 months follow-up at least. Exclusion criteria: discordance between clinical and image studies, grade I or II medial instability, any other surgical technique. IKDC and Lysholm at the preoperative evaluation, 6 and 12 months after surgery.

Results Thirty patients met the inclusion criteria. Mean age 43 years (24–69). 28 patients presented high-energy mechanism of injury. Twenty patients were diagnosed in the acute setting, while 10 had a delayed diagnosis after poor results of other ligament reconstruction. Majority (28) had associated injuries: 11 cases PMC + anterior cruciate ligament (ACL) injury, 3 PMC + posterior cruciate ligament (PCL) injury, 3 PMC + meniscal tears, 9 PMC + ACL + PCL injuries, and 2 PMC + ACL + PCL + lateral collateral ligament injuries. Mean time for PMC reconstruction was 5 months (range 2–32). Preoperative Lysholm and IKDC scores (18,2 and 24,3 respectively) improved to 76,7 and 70,7 after 1-year follow-up. At the end of follow-up, average ROM was 113° (90–140), most patients (24) had type A IKDC stability.

Conclusion Acceptable results were achieved following reconstruction of PMC injuries in patients with chronic posteromedial knee instability. We observed instability and functional scores improvement in all patients.

Palabras Clave

rodilla - ligamento colateral medial - lesión multiligamentaria - reconstrucción

Keywords

knee - medial collateral ligament - multiligament injury - reconstruction

Nota

Este estudio no ha sido publicado en otra revista científica.


Todos los autores han leído el manuscrito y están de acuerdo con su contenido.


 

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