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    Influência da displasia da tróclea femoral nos resultados clínico-funcionais do implante autólogo de condrócitos em lesoes condrais da articulação femoropatelar
    (Universidade Federal de São Paulo (UNIFESP), 2020-07-01) Mestriner, Alexandre Barbieri [UNIFESP]; Faloppa, Flavio [UNIFESP]; Universidade Federal de São Paulo
    Background: Autologous chondrocyte implantation (ACI) is a viable treatment option for cartilage lesions in the patellofemoral joint (PFJ). However, the influence of trochlear dysplasia on ACI outcomes in the PFJ remains undetermined. Purpose: to evaluate the influence of trochlear dysplasia on clinical outcomes after ACI for the treatment of cartilage lesions in the PFJ with a minimum of 2 years follow-up. Methods: A retrospective review of 190 patients submitted to cartilage repair with ACI for focal cartilage defects in the PFJ by a single surgeon was performed. Patient factors, lesion morphology, and pre- and postoperative patient-reported outcomes measures (PROMs) including KOOS, Lysholm, Tegner and IKDC scores were collected. Two imaging analyzes, using knee radiography and MRI, were performed. The first analysis excluded patients with alteration in patellar height or TT-TG distance. Two independent observers determined the presence and grade of trochlear dysplasia in the second image analysis, based on Dejour and Lippacher classifications. Forty-six patients with a mean follow-up of 3.7 ± 1.9 years and mean age of 30.1 ± 8.8 were then stratified into two matched groups based on the presence or absence of trochlear dysplasia (23 vs. 23) and a comparison was established based on PROMs and failure rates. A secondary analysis excluded patients with low-grade dysplasia (Dejour type A) and established a comparison between nineteen patients with high-grade dysplasia (Dejour types B, C and D) and nineteen without trochlear dysplasia. XIX Results: Interobserver reliability (k) was 0.774 for the Dejour and 0.924 for the Lippacher classification (p < 0.001). There were no statistically significant differences in demographic characteristics between both groups (23 patients with trochlear dysplasia vs. 23 without dysplasia). PROMs at final follow-up did not differ between control and trochlear dysplasia group (p > 0.05). No difference was seen regarding failure rates between both groups (p > 0.999). Additionally, no differences in clinical outcomes were seen between patients with high-grade dysplasia (Dejour types B, C and D) and patients without dysplasia (p > 0.05). Conclusion: Trochlear dysplasia presence and severity did not influence ACI clinical outcomes in the PFJ at 3.7 years of follow-up. This study suggests that trochlear dysplasia should not be considered as a contra-indication to cartilage repair with ACI in the PFJ.