2012, Número 2
<< Anterior Siguiente >>
An Med Asoc Med Hosp ABC 2012; 57 (2)
Reconstrucción del ligamento cruzado anterior en pacientes mayores de 41 años. Resultados utilizando aloinjerto de hueso-tendón rotuliano
Abush TS, Atri LJ
Idioma: Español
Referencias bibliográficas: 46
Paginas: 104-111
Archivo PDF: 56.02 Kb.
RESUMEN
Antecedentes: En este artículo se revisan los resultados de reconstrucciones de ligamento cruzado anterior (LCA) en 23 rodillas de 22 pacientes con promedio de edad de 48 años (rango: 41-60 años). El principal objetivo fue determinar límites de edad para indicar reconstrucciones de LCA en pacientes con inestabilidad funcional.
Métodos: Los pacientes fueron evaluados con cuestionario de rodilla de Lysholm y Gillquist, escala visual analógica, índices de satisfacción, exploración física y radiografías. Diecinueve de los 22 pacientes estuvieron disponibles para un seguimiento promedio de 26 meses después del procedimiento quirúrgico. Diecisiete pacientes regresaron a consulta para ser examinados y dos pacientes aceptaron entrevistas telefónicas.
Resultados: La puntuación promedio de la escala de Lysholm fue 93, la puntuación visual analógica 0.5, el nivel de satisfacción 100% y los arcos de movilidad 0° a 135°. Diecisiete de los 19 pacientes regresaron a niveles de actividad aceptable. Quince pacientes tuvieron resultados excelentes o buenos, mientras que cuatro pacientes tuvieron resultados regulares o pobres. Tres de los cuatro pacientes con resultados regulares o pobres tenían artrosis de rodilla, de moderada a severa.
Conclusión: La reconstrucción del ligamento cruzado anterior con aloinjerto en pacientes con edades entre 41-60 años y artrosis mínima, es un procedimiento seguro y de mínima invasión que les permite regresar a niveles satisfactorios de actividad.
REFERENCIAS (EN ESTE ARTÍCULO)
Kannus P, Jarvinen M. Conservatively treated tears of the anterior cruciate ligament. Long-term results. J Bone Joint Surg Am 1987; 69: 1007-1012.
Ciccotti MG, Lombardo SJ, Nonweiler B, Pink M. Non-operative treatment of ruptures of the anterior cruciate ligament in middle-aged patients. Results after long-term follow-up. J Bone Joint Surg Am 1994; 76: 1315-1321.
Consejo Nacional de Población (CONAPO) www.conapo.gob.mx
Heier KA, Mack DR, Moseley JB, Paine R, Bocell JR. An analysis of anterior cruciate ligament reconstruction in middle-aged patients. Am J Sports Med 1997; 25: 527-532.
Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ. The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med 2006; 34: 128-135.
Abush TS, Ciklik PS. Crioterapia en pacientes intervenidos quirúrgicamente por artroscopia de rodilla An Med Asoc Med Hosp ABC 2003; 48: 142-148.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10: 150-154.
Torg JS, Conrad W, Kalen V. Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 1976; 4: 84-93.
Cameron ML, Briggs KK, Steadman JR. Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 2003; 31: 83-86.
Barber FA, Elrod BF, McGuire DA, Paulos LE. Is an anterior cruciate ligament reconstruction outcome age dependent? Arthroscopy 1996; 12: 720-725.
Hawkins RJ, Misamore GW, Merritt TR. Follow-up of the acute nonoperative isolated anterior cruciate ligament tear. Am J Sports Med 1986; 14: 205-210.
Novak PJ, Bach BR, Hager CA. Clinical and functional outcome of anterior cruciate ligament reconstruction in the recreational athlete over the age of 35. Am J Knee Surg 1996; 9: 111-116.
Noyes FR, Barber-Westin SD. Reconstruction of the anterior cruciate ligament with human allograft: comparison of early and later results. J Bone Joint Surg Am 1996; 78: 524-537.
Plancher KD, Steadman JR, Briggs KK, Hutton KS. Reconstruction of the anterior cruciate ligament in patients who are at least forty years old: a long term follow-up and outcome study. J Bone Joint Surg Am 1998; 80: 184-197.
Viola R, Vianello R. Intra-articular ACL reconstruction in the over-40- year-old patient. Knee Surg Sports Traumatol Arthrosc 1999; 7: 25-28.
Bach BR Jr, Levy ME, Bojchuk J et al. Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Minimum two-year follow-up evaluation. Am J Sports Med 1998; 26: 30-34.
Duthon VB, Barea C, Abrassart S et al. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2006; 14: 204-213.
Hussein M, van Eck CF, Cretnik A et al. Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 2012; 40: 512-520.
Potter HG, Jain SK, Ma Y et al. Cartilage injury after acute isolated anterior cruciate ligament tear. Am J Sports Med 2012; 40: 276-285.
Miller MD, Sullivan RT. Anterior cruciate ligament reconstruction in an 84-year-old man. Arthroscopy 2001; 17: 70-72.
Noyes FR, Barber-Westin SD. Arthroscopic-assisted allograft anterior cruciate ligament reconstruction in patients with symptomatic arthrosis. Arthroscopy 1997; 13: 24-32.
Hughston JC. Complications of anterior cruciate ligament surgery. Orthop Clin North Am 1985; 16: 237-240.
Noyes FR, Matthews DS, Mooar PA, Grood ES. The symptomatic anterior cruciate-deficient knee, part 2: the results of rehabilitation, activity modification, and counseling on functional disability. J Bone Joint Surg Am 1983; 65: 163-174.
Shelton WR, Papendick L, Dukes AD. Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy 1997; 13: 446-449.
Shelbourne KD, Wilckens JH. Intraarticular anterior cruciate ligament reconstruction in the symptomatic arthritic knee. Am J Sports Med 1993; 21: 685-689.
Aglietti P, Buzzi R, Zaccherotti G, De Biase P. Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 1994; 22: 211-218.
Clancy WG Jr, Nelson DA, Reider B, Narechania RG. Anterior cruciate ligament reconstruction using one-third of the patellar ligament augmented by extra-articular tendon transfers. J Bone Joint Surg Am 1982; 64: 352-359.
Holmes PF, James SL, Larson RL, Singer KM, Jones DC. Retrospective direct comparison of three intraarticular anterior cruciate ligament reconstructions. Am J Sports Med 1991; 19: 596-600.
Otero AL, Hutcheson L. A comparison of the doubled semitendinosus/gracilis and central third of the patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 1993; 9: 143-148.
Asselmeier MA, Caspari RB, Bottenfield S. A review of allograft processing and sterilization techniques and their role in transmission of the human immunodeficiency virus. Am J Sports Med 1993; 21: 170-175.
Kleipool AE, Zijl JA, Willems WJ. Arthroscopic anterior cruciate ligament reconstruction with bone–patellar tendon–bone allograft or autograft: A prospective study with average follow up of 4 years. Knee Surg Sports Traumatol Arthrosc 1998; 6: 224-230.
Kuechle DK, Pearson SE, Beach WR, et al. Allograft anterior cruciate ligament reconstruction in patients over 40 years of age. Arthroscopy 2002; 18: 845-853.
Lephart SM, Kocher MS, Harner CD, Fu FH. Quadriceps strength and functional capacity after anterior cruciate ligament reconstruction: patellar tendon autograft versus allograft. Am J Sports Med 1993; 21: 738-743.
Meyers JF. Allograft reconstruction of the anterior cruciate ligament. Clin Sports Med 1991; 10: 487-498.
Meyers JF, Caspari RB, Cash JD, Manning JB. Arthroscopic evaluation of allograft anterior cruciate ligament reconstruction. Arthroscopy 1992; 8: 157-161.
Peterson RK, Shelton WR, Bomboy AL. Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy 2001; 17: 9-13.
Shino K, Nakata K, Horibe S, Inoue M, Nakagawa S. Quantitative evaluation after arthroscopic anterior cruciate ligament reconstruction: allograft versus autograft. Am J Sports Med 1993; 21: 609-616.
Valenti JR, Sala D, Schweitzer D. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts. Int Orthop 1994; 18: 210-214.
Jackson DW, Grood ES, Arnoczky SP, Butler DL, Simon TM. Cruciate reconstruction using freeze dried anterior cruciate ligament allograft and a ligament augmentation device (LAD): an experimental study in a goat model. Am J Sports Med 1987; 15: 528-538.
Siebold R, Buelow JU, Bos L, Ellerman A. Primary ACL reconstruction with fresh-frozen patellar versus Achilles tendon allografts. Arch Orthop Trauma Surg 2003; 123: 180-185.
Indelli PF, Dillingham MF, Fanton GS, Schurman DJ. Anterior cruciate ligament reconstruction using cryopreserved allografts. Clin Orthop 2004; 420: 268-275.
Inacio MCS, Paxton EW, Maletis GB et al. Patient and surgeon characteristics associated with primary anterior cruciate ligament reconstruction graft selection. Am J Sports Med 2012; 40: 339-345.
Kaeding C, Farr J, Kavanaugh T, Pedroza A. A prospective randomized comparison of bioabsorbable and titanium anterior cruciate ligament interference screws. Arthroscopy 2005; 21: 147-151.
Brand JC Jr, Nyland J, Caborn DN, Johnson DL. Soft-tissue interference fixation: bioabsorbable screw versus metal screw. Arthroscopy 2005; 21: 911-916.
Aune AK, Ekeland A, Cawley PW. Interference screw fixation of hamstring vs patellar tendon grafts for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1998; 6: 99-102.
Nyland J, Kocabey Y, Caborn DN. Insertion torque pullout strength relationship of soft tissue tendon graft tibia tunnel fixation with a bioabsorbable interference screw. Arthroscopy 2004; 20: 379-384.