Browsing by Author "Bernal, Nazira"
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Item Arthroscopic Intercondylar Notch Bone Marrow Aspiration During Anterior Cruciate Ligament Reconstruction(2019) Figueroa, David; Calvo, Rafael; Vaisman, Alejandro; Arellano, Sergio; Figueroa, Francisco; Donoso, Rodrigo; Bernal, Nazira; O'Connell, LuisPurpose: To categorize and summarize up-to-date anterior cruciate ligament (ACL) research published in Arthroscopy and The American Journal of Sports Medicine and systematically review each subcategory, beginning with ACL anatomy. Methods: After searching for "anterior cruciate ligament" OR "ACL" in Arthroscopy and The American Journal of Sports Medicine from January 2012 through December 2014, we excluded articles more pertinent to ACL augmentation; open growth plates; and meniscal, chondral, or multiligamentous pathology. Studies were subcategorized for data extraction. Results: We included 212 studies that were classified into 8 categories: anatomy; basic science and biomechanics; tunnel position; graft selection; graft fixation; injury risk and rehabilitation; practice patterns and outcomes; and complications. Anatomic risk factors for ACL injury and post-reconstruction graft failure include a narrow intercondylar notch, low native ACL volume, and increased posterior slope. Regarding anatomic footprints, the femoral attachment is 43% of the proximal-to-distal lateral femoral condylar length whereas the posterior border of the tendon is 2.5 mm from the articular margin. The tibial attachment of the ACL is two-fifths of the medial-to-lateral interspinous distance and 15 mm anterior to the posterior cruciate ligament. Anatomic research using radiology and computed tomography to evaluate ACL graft placement shows poor interobserver and intraobserver reliability. Conclusions: With a mind to improving outcomes, surgeons should be aware of anatomic risk factors (stenotic femoral notch, low ligament volume, and increased posterior slope) for ACL graft failure, have a precise understanding of arthroscopic landmarks identifying femoral and tibial footprint locations, and understand that imaging to evaluate graft placement is unreliable. Level of evidence: Level III, systematic review of Level III evidence.Item Arthroscopic‑assisted latissimus dorsi transfer for irreparable posterosuperior cuf tears: Clinical outcome of 15 patients(2021) Reinares, Felipe; Calvo, Andrés; Bernal, Nazira; Lizama, Pedro; Valenti, Philippe; Toro Saelzer, FelipeObjective We analyzed the clinical and functional results of patients with irreparable posterosuperior rotator cuf tears treated with arthroscopic-assisted latissimus dorsi transfer and the clinical relevance of the addition of partial repair of the remaining cuf to the transfer. Methods This was a prospective cohort study that included patients diagnosed with irreparable massive rotator cuf tears treated by arthroscopic-assisted latissimus dorsi transfer between 2015 and 2018. Demographic characteristics, clinical and functional outcomes (Constant-Murley (CS) score and subjective shoulder value (SSV)), and the incidence of complications were evaluated. Clinical outcomes were compared between patients treated with transfer alone and transfer with partial cuf repair. Results Fifteen patients were included, with an average follow-up of 37±16 months. The median duration of symptoms before surgery was 66 weeks (24–208). A signifcant increase in forward elevation of 52° (p<0.003) and abduction of 48° (p<0.001) was obtained. The CS score increased by 48 points (p<0.001), and the SSV changed from 29% preoperatively to 70% postoperatively (p<0.001), with a signifcant decrease in the visual analog pain score from 7 to 1 (p<0.001). In 10 patients, partial repair of the rotator cuf was also performed. No statistically signifcant diferences were found in these patients compared with patients treated with transfer alone. Two patients presented complications, including transient sensitive neuropraxia of the axillary nerve and seroma, which were managed conservatively and did not afect the outcomes. Conclusion Arthroscopic-assisted latissimus dorsi transfer is a safe technique that signifcantly improves clinical and functional outcomes in selected patients. Longer follow-up and comparison with other treatment options are needed to confrm these excellent results in this group of difcult-to-treat patients.Publication Four-Corner Arthrodesis: Comparative Analysis of Open Technique Versus Percutaneous Technique with Arthroscopic Assistance(2021) Azócar, Camila; Lecaros, Juan; Bernal, Nazira; Sanhueza, Miguel; Liendo, Rodrigo; Cifras, JoséIntroduction Four-corner arthrodesis is a salvage technique for patients with carpal advanced osteoarthritis. Nowadays, percutaneous techniques with arthroscopic assistance have been described, achieving favorable results with minimally invasive techniques advantages over open surgery. Objective To compare functional and radiological results in patients with SLAC or SNAC wrists operated with open surgical technique versus percutaneous surgery with arthroscopic assistance. Materials and Methods Retrospective case-control study of clinical records and radiological images of patients with carpal advanced osteoarthritis operated with both surgical techniques. We studied demographic variables, pain with visual analog scale (VAS) score, function in ranges of mobility, time of consolidation, and correction of DISI deformity. Results A total of 22 male patients with an average age of 32.5 years were studied. Thirteen patients in the case group (percutaneous technique with arthroscopic assistance) and nine patients in the control group (open surgery). Pain score in VAS at discharge was 3 for cases and 5 in controls ( p = 0.008), and at 30 days postoperatively, it was 0 and 3 respectively ( p = 0.00). The extension and flexion ranges were 52.6°and 38.7° in the cases and 35.7° and 32.4° in the control group ( p = 0.119 and 0.0016, respectively). The capitolunate angle was 10°in the controls and 5°in the cases ( p = 0.0008). The time of consolidation was 8.8 weeks in cases and 12.5 weeks in controls ( p = 0.039). Conclusions The percutaneous technique with arthroscopic assistance for the 4-courner arthrodesis is a reproducible technique and is effective in achieving consolidation, pain reduction and preservation of wrist motion. In the present study, we demonstrate superiority of this technique over the open surgery. Level of Evidence This is a Level III, therapeutic study.