Browsing by Author "Calvo, Rafael"
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Item Anterior cruciate ligament reconstruction in patients over 50 years of age(Elsevier, 2014) Figueroa, David; Figueroa, Francisco; Calvo, Rafael; Vaisman, Alex; Espinoza, Gonzalo; Gili, FedericoPURPOSE: To describe the clinical outcomes of patients over 50 years of age with following anterior cruciate ligament (ACL)reconstruction for acute rupture. METHODS: A prospective series of patients over the age of 50 years with a diagnosis of ACL rupture who underwent ACL reconstruction was examined. Lysholm and International Knee Documenting Committee (IKDC) subjective scores were assessed preoperatively and at the final follow-up. All associated injuries were documented, and complications were reported. The patients' satisfaction and return to sports were documented. The statistical analyses were preformed with Student's t-tests for independent samples. RESULTS: Fifty patients with a mean age of 52.12 years (50-64) and a mean follow-up period of 53.17 months (36-68) exhibited a mean postoperative Lysholm score of 93.7 (60-100) and IKDC score of 90.96 (57.5-100). Associated injuries occurred in 90% (45) of the patients and included the following: 76% (38) meniscal tears and 36% (18) osteochondral lesions. Complications occurred in 6% (3) of the patients and included the following: 4% (2) ACL re-ruptures and 2% (1) infections. Among all patients, 88% (44) returned to pre-injury sports levels, and 96% (48) were satisfied. CONCLUSIONS: For patients above the age of 50 years, ACL reconstruction appears to be a safe procedure with good to excellent results that are comparable to those for younger patients, and the possibility for returning to pre-injury sports levels for these patients is high.Item Anterior cruciate ligament regeneration using mesenchymal stem cells and collagen type I scaffold in a rabbit model(Springer, 2014) Figueroa, David; Espinosa, Maximiliano; Calvo, Rafael; Scheu, Maximiliano; Vaisman, Alex; Gallegos, Marcela; Conget, PaulettePurpose: The objective of this study was to determine whether using mesenchymal stem cells (MSC) seeded in a collagen type I scaffold would be sufficient to regenerate the torn anterior cruciate ligament (ACL). Methods: Anterior cruciate ligament transection was performed on both knees in 10 New Zealand rabbits and then repaired with as follows: suture alone (suture-treated group, n = 6), suture associated with collagen type I scaffold (collagen type I scaffold-treated group, n = 8) or suture associated with autologous MSC seeded on collagen type I scaffold (MSC/collagen type I scaffold-treated group, n = 6). At 12-week post-intervention, the animals were killed and the ACLs were characterised macroscopically and histologically. Data of the 3 groups were against normal ACL (normal group, n = 10). Results: Macroscopic observation found that in MSC/collagen type I scaffold group, 33 % of specimens showed a complete ACL regeneration, with a tissue similar to the normal ACL. Regeneration was not observed in the group treated with suture alone or associated with collagen type I scaffold without cells. In the latter, only a reparative attempt at the ends was observed. Histological analysis of the regenerated ACL showed a tissue with organised collagen and peripheric vessels. Conclusions: These results provide evidence that the use of MSC seeded in a collagen type I scaffold in the treatment of ACL injuries is associated with an enhancement of ligament regeneration. This MSC-based technique is a potentially attractive tool for improving the treatment of ACL ruptures.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 Assessment of Cell Viability of Fresh Osteochondral Allografts in N-Acetylcysteine-Enriched Medium(Sage, 2018) Calvo, Rafael; Espinosa, Maximiliano; Figueroa, David; Pozo, Luz María; Conget, PauletteObjective The purpose of this study was to evaluate the effect of N-acetylcysteine (NAC)-enriched storage medium on fresh osteochondral viability at 4°C. Our hypothesis was that the cell viability of chondrocytes obtained from human osteochondral tissue and stored at 4°C significantly improves in the presence of NAC. Design Controlled laboratory study. For this study, 8 samples of femoral condyle osteochondral tissue were obtained from patients undergoing total knee replacement. The samples were stored at either 4°C in phosphate-buffered saline (PBS) or at 3 different concentrations of NAC (NAC 1, 2, and 5 mM). Cell viability was analyzed at time 0 and 4 weeks by flow cytometry. The results of cell viability (median) were analyzed statistically using analysis of variance and Tukey's post hoc test. P values <0.05 were considered statistically significant. Results The viability at time 0 was 95.5% ± 3.7%. At 4 weeks, the cell viability was 56.8% ± 20.1% in the control group (PBS), 83.8% ± 11.9% in the group stored with NAC 1 mM, 73.4% ± 13.6% in the group stored with NAC 2 mM, and 66.4% ± 27.7% in the group stored with NAC 5 mM. A statistically significant difference from the baseline viability (time 0) was observed in the PBS control group ( P = 0.0018) but not in the other groups. A statistically significant difference was observed in the NAC 1 mM group compared with the PBS group ( P = 0.0255). Conclusion The use of NAC at 1 mM concentration improves cell viability after 4 weeks of storage in chondrocytes obtained from human osteochondral tissue.Item Cerebral and pulmonary fat embolism after unilateral total knee arthroplasty(2019) Figueroa, David; Figueroa, Francisco; Calvo, Rafael; Figueroa, MaríaFat embolism syndrome is the presence of a fatty embolus in the circulatory system that can manifest itself in multiple ways, ranging from asymptomatic presentation to respiratory failure, neurocognitive deficits, and death. It is a relatively common complication after procedures or conditions such as orthopaedic surgery, severe burns, liver injury, closed-chest cardiac massage, and liposuction. This pathology is relatively common in the field of orthopaedics, especially in long bone fractures and procedures such as total hip replacements. It is typically an exclusion diagnosis, and the management is supportive care. In this report, we present a case of a 63-year-old patient who, during a cemented total knee replacement, presented with fat embolism syndrome with neurological and pulmonary manifestations, and subsequently made a complete recovery at discharge.Item Clinical and arthrometric outcomes of an anatomic outside-in single-bundle anterior cruciate ligament reconstruction using a retrodrill(Elsevier, 2016) Figueroa, David; Calvo, Rafael; Figueroa, Francisco; Paccot, Daniel; Izquierdo, Guillermo; Morales, NelsonBACKGROUND: The main option to perform an anatomic anterior cruciate ligament (ACL) reconstruction is the anteromedial portal (AMP) technique. It has several reported complications (iatrogenic chondral injury, posterior-wall blowout, short sockets, increased risk of injury to common peroneal nerve). In an attempt to avoid these complications the outside-in (OI) technique was revived with the addition of a retrodrill. The aim of this study is to evaluate the clinical and arthrometric outcomes of a series of anatomical OI single bundle ACL reconstruction using a retrodrill. METHODS: Prospective case series. KT-1000 and Pivot Shift Test were done at 24 months follow-up. International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores preoperatively and at final follow-up. Complications were reported. Statistical analysis was done with t-test. RESULTS: 275 knees of 200 (73%) males and 75 (27%) females were enrolled in the study. Mean age 29.1 years (15-54). Mean follow-up 34.5 months (24-49). Mean preoperatively Lysholm Score 62 (25-95) versus 95 (76-100) at final follow-up (p<0.001) Mean preoperatively IKDC score 60 (26.4-90.8) versus 92 (59.8-100) at final follow-up (p<0.001) Mean Tegner activity Score pre injury 5 versus 5 at final follow-up. (p=0.59) Mean KT-1000 side-to-side difference 2mm (1-6). Pivot Shift test negative in 243 patients (90%); positive in 32 (10%) patients. 13 (5%) ACL re-ruptures. 2 (0.7%) infections. No other complications were reported. CONCLUSION: OI single bundle anatomic ACL reconstruction using a retrodrill is a valid and safe option that avoids the complications reported with the AMP technique.Item Clinical and functional outcomes of primary total knee arthroplasty: a South American perspective(2019) Figueroa, David; Calvo, Rafael; Figueroa, Francisco; Avilés, Carolina; Garín, Alan; Cancino, JaimeBackground. The aim of this study was to report the clinical and functional outcomes as well as complications after primary total knee arthroplasty in a cohort of Chilean patients. Methods. We retrospectively reviewed 191 total knee arthroplasties performed in 182 patients over an 8-year period, with a minimum follow-up of 2 years. The primary outcome measure was the rate of major complications. Secondary outcomes were minor complications, residual symptoms, level of satisfaction, and the Knee Injury and Osteoarthritis Outcome Score. Results. Global complication rate was 15.5%, reintervention rate was 9.2%, and revision rate was 2.5%. Major and minor complications were seen in 9.2% and 5.1% of patients, respectively. Average Knee Injury and Osteoarthritis Outcome Score was 77 points (14-100), and 90% of patients reported satisfaction with the procedure. At 2-year follow-up, 45.8% of patients had some degree of range of motion limitations. Conclusions. Our results show a medium-term follow-up complication rate comparable to those described in the literature. This is the first series to report on the clinical and functional outcomes after primary total knee arthroplasty in a Chilean population.Item Clinical outcomes after arthroscopic treatment of knee osteoarthritis(Elsevier, 2014) Figueroa, David; Calvo, Rafael; Villalón, Ignacio; Meleán, Patricio; Novoa, Felipe; Vaisman, AlexPURPOSE: The aim of this study was to describe the clinical outcomes of patients with knee osteoarthritis (OA) treated with arthroscopic surgery, documenting the associated injuries and defining the type of treatment selected for OA patients with different symptoms. HYPOTHESIS: Knee arthroscopy is effective for treating patients with symptomatic OA and mechanical symptoms. METHODS: This was a prospective, consecutive series of 100 patients with a clinical and radiological diagnosis of OA who were treated with knee arthroscopy. The average follow-up time was 35.9months (25-71), and the average age was 60.1years (50-83). INCLUSION CRITERIA: >50years of age, a clinical imaging diagnosis of knee OA with an Ahlbäck I-III classification. EXCLUSION CRITERIA: <50years of age, Ahlbäck IV, pathologic lower limb mechanical axis and inflammatory joint diseases. The IKDC and Lysholm scores were assessed before and after surgery. RESULTS: The preoperative average scores were as follows: Lysholm, 56.9±13.5 points (22-71); IKDC, 59.4±21.7 points (45-80). The postoperative average scores were as follows: Lysholm, 86.9 points (22-87); IKDC, 79.5 points (45-100). Regarding the Lysholm scores, 76% were good and excellent results and 24% were moderate (p=0.045). The associated injuries included 48% of chondral and 36% of unstable meniscal injuries. Good or excellent results were observed in 76% of the meniscal injury cases according to the Lysholm scores, while only 84.6% of the cases with unstable chondral lesions had good or excellent results (p=0.035). CONCLUSION: Most patients with knee OA associated with unstable cartilage or meniscal injuries reported good-to-excellent symptomatic results at the short- and mid-term follow-ups. LEVEL OF EVIDENCE: III.Item Comparison of Muscular Power Between Dominant and Nondominant Legs in Healthy Young Adults Associated With Single-Leg-Dominant Sports(2017) Vaisman, Alex; Guiloff, Rodrigo; Rojas, Juan; Delgado, Iris; Figueroa, David; Calvo, RafaelBackground: Achieving a symmetrical power performance (difference <15%) between lower limbs is generally recommended during sports rehabilitation. However, athletes in single-leg-dominant sports, such as professional soccer players, could develop significant asymmetry between their dominant and nondominant legs, such that symmetry does not act as a viable comparison. Purpose: To (1) compare maximal muscular power between the dominant and nondominant legs in healthy young adults, (2) evaluate the effect of a single-leg-dominant sport activity performed at the professional level, and (3) propose a parameter of normality for maximal power difference in the lower limbs of this young adult population. Study Design: Controlled laboratory study. Methods: A total of 78 healthy, male, young adults were divided into 2 groups according to sport activity level. Group 1 consisted of 51 nonathletes (mean ± SD age, 20.8 ± 1.5 ears; weight, 71.9 ± 10.5 kg) who participated in less than 8 hours a week of recreational physical activity with nonspecific training; group 2 consisted of 27 single-leg-dominant professional soccer players (age, 18.4 ± 0.6 years; weight, 70.1 ± 7.5 kg) who specifically trained and competed at their particular activity 8 hours or more a week. For assessment of maximal leg power, both groups completed the single-leg squat jump test. Dominance was determined when participants completed 2 of 3 specific tests with the same extremity. Statistical analysis included the Student t test. Results: No statistical difference was found for maximal power between dominant and nondominant legs for nonathletes (t ¼ –1.01, P ¼ .316) or single-leg-dominant professional soccer players (t ¼ –1.10, P ¼ .281). A majority (95%) of participants studied showed a power difference of less than 15% between their lower extremities. Conclusion: Among young healthy adults, symmetrical power performance is expected between lower extremities independent of the existence of dominance and difference in sport activity level. A less than 15% difference in power seems to be a proper parameter to define symmetrical power performance assessed by vertical single-leg jump tests.Item Effect of tendon tensioning: An in vitro study in porcine extensor tendons(2010) Figueroa, David; Calvo, Rafael; Vaisman, Alex; Meleán, Patricio; Figueroa, FranciscoGraft tensioning is a controversial issue in anterior cruciate ligament reconstruction (ACLR) that has not achieved consensus between peers. The purpose of this study is to determine if after tensioning tendón length and resistance to maximal load changes. We performed an in vitro study with 50 porcine extensors tendons. The first group (P= 25) was tensioned with 80 N (19.97 lb) for 10 min, using an ACL graft preparation board. The second group (C= 25) was used as control and was not tensioned. The average initial (groups P and C) and post tensioning tendon length (group C) were measured; the average initial and post tensioning tendon diameter were measured as well. All samples were fixated in a tube–clamp system connected to a tension sensor. The samples were stressed with continuous and progressive tensión until ultimate failure at maximum load (UFML) occurs. The initial mean length was: P before tensioning= 13.4 mm± 1.4 mm (range 10.5–16.5); P after tensioning= 13.8 mm± 1.4 mm (range 11.5–16.5); C= 13 mm± 1.35 mm (p= 0.005). The mean diameter was: P= 5.6 mm (4.5–6); C= 5.5 mm (range 4.5–6) (p> 0.05). The UFML was: P= 189.7 N (114–336); C= 229.9 N (143–365) (p= 0.029). Tendon tensioning with 80 N for 10 min produced 3% average elongation. These could be beneficial in ACLR since tendon tensioning decreases elongation of the graft after fixation. Regardless, tendón tensioning is not innocuous since it diminishes their resistance when continuously stressed until complete failure occursItem Five-strand hamstring autograft versus quadruple hamstring autograft with graft diameters 8.0 millimeters or more in anterior cruciate ligament reconstruction: clinical outcomes with a minimum 2-year follow-up(Elsevier, 2017) Calvo, Rafael; Figueroa, David; Figueroa, Francisco; Vaisman, Alex; Schmidt-Hebbel, Andres; Morales, Nelson; Izquierdo, GuillermoPURPOSE: To compare the outcomes of 2 groups of patients undergoing anterior cruciate ligament (ACL) reconstruction: the first with a quadrupled semitendinosus gracilis (ST-G) autograft larger than 8 mm diameter and the second with a 5-strand ST-G autograft larger than 8 mm due to an insufficient diameter graft harvesting. METHODS: This was a retrospective study with 70 patients divided into 2 groups. Inclusion criteria included ACL ruptures of less than 3 months, ST-G ACL reconstructions, and final (4-strand or 5-strand) graft size larger than 8 mm. Exclusion criteria included multiligament knee injuries, meniscal or chondral pathology, ACL re-ruptures, inflammatory joint disease, or other procedures in the knee. RESULTS: Group A comprised 33 patients with a quadruple ST-G graft, and group B comprised 37 patients with an insufficient graft diameter (<8 mm) in which a 5-strand graft was used. Mean age in group A was 29.7 (range 17-52) years and in group B was 30.6 (range 13-53) years (P = .78). Average follow-up in group A was 32.2 (range 24-48) months and in group B was 30.35 (range 24-48) months (P = .75). Average graft diameter in group A was 8.5 mm (range 8-10) and in group B when the graft was measured as quadruple was 7.2 mm (range 6.5-7.5) and 9.2 mm (range 8-10) when it was converted to 5-strand (P = .00596). Group A had 3 (9%) re-ruptures, and group B had 2 (5.4%) (P = .55). The average postoperative Lysholm score in group A was 93.3 (range 71-100) and in group B was 97.1 (range 80-100) (P = .79). Mean postoperative International Knee Documentation Committee in group A was 91 (range 75.9-100) and in group B was 96.8 (range 82-100) (P = .18). CONCLUSIONS: In our study, the 5-strand hamstring autograft in ACL reconstruction was clinically comparable with the quadruple autograft larger than 8 mm. The differences in re-rupture and clinical outcomes were not statistically significant between the 2 groups, suggesting that it is a valid option when we have a graft of insufficient diameter. LEVEL OF EVIDENCE: Level III, retrospective comparative study.Item Fracture Dislocation of the Glenoid Fossa With Open Physis: A Case Report(2010) Toro Saelzer, Felipe; Vaisman, Alex; Villalon, Ignacio E.; Calvo, RafaelBackground: Scapular fractures are uncommon injuries that account for 1% of all fractures. Ten percent of these lesions involve the glenoid fossa and intraarticular displacement is rare, not exceeding 10% of the cases. The classification of intraarticular glenoid fractures was described by Ideberg on the basis of his findings in 100 patients with this type of injury. His classification, however, does not include a dislocation of the glenoid fossa without displacement of the humeral head. Methods: We report the case of a fracture dislocation of the glenoid fossa without displacement of the humeral head in a patient with open physis. Our surgical approach and results after 6 years of follow-up. Results: Six years postoperatively the patient has minimal occasional discomfort and a full range of motion and strength, even in external rotation. Shoulder stability is also normal. Her Constant score is 97. The fracture is actually healed clinically and radiographically with no evidence of post traumatic articular degenerative disease or avascular changes. Conclusions: The fracture/dislocation of the glenoid fossa is an uncommon injury that can be effectively treated by open reduction and internal fixation. A posterior surgical approach was useful to achieve anatomic reduction and strong fixation in this case presentation.Item Graft choice in combined anterior cruciate ligament and medial collateral ligament reconstruction(2020-04) Figueroa, Francisco; Figueroa, David; Calvo, Rafael; Vaisman, Alex; Espregueira-Mendes, JoãoThere is a concern regarding which grafts should be used in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstructions, with a paucity of recommendations focused on this specific topic.Expert opinions suggest the use of allograft-only reconstructions to limit donor-site morbidity or using at least one allograft and one autograft.When a hamstring tendon autograft is harvested, techniques that maintain both the integrity of the sartorius fascia and the gracilis are recommended because of the role that the ST-G-S (semitendinosus-gracilis-sartorius) complex plays in valgus stability in the setting of an MCL-deficient knee.Publication Granuloma eosinofílico cervical en el adolescente: Reporte de un caso y revisión de la literatura(2022) Yurac, Ratko; Zamorano, Juan; Calvo, Rafael; Castoldi, María; De la Barra, Camila; Quinteros, Guisela; Novoa, FelipeIntroducción El granuloma eosinofílico (GE) es una patología infrecuente, sobre todo en adultos, que puede afectar la columna cervical. A pesar de la vasta literatura, esta enfermedad afecta principalmente a la población infantil, y no hay un consenso sobre el manejo en adultos. Con el objetivo de aportar conocimiento respecto a esta patología poco frecuente, se presenta un caso clínico de GE cervical en un paciente de 16 años, a quien se trató de manera conservadora, con buenos resultados y retorno completo a sus actividades. Caso Clínico Un hombre de 16 años, seleccionado de rugby, consultó por dolor cervical axial persistente y nocturno de 6 semanas de evolución, sin trauma evidente. Al examen, destacó dolor a la compresión axial sin compromiso neurológico asociado. Los exámenes de tomografía computarizada (TC) y resonancia magnética (RM) revelaron lesión lítica en el cuerpo de C3 de características agresivas, de presentación monostótica en tomografía por emisión de positrones-tomografía computada (TEPTC) compatible con tumor primario vertebral. Se decidió realizar biopsia percutánea bajo TC, para definir el diagnóstico y manejo adecuado, la cual fue compatible con células de Langerhans. Al no presentar clínica ni imagenología de inestabilidad ósea evidente o compromiso neurológico, se manejó con tratamiento conservador, inmovilización cervical, analgesia oral, y seguimiento estrecho. A los cuatro meses de evolución, se presentó con una TC con cambios reparativos del cuerpo vertebral y sin dolor, y logró retomar sus actividades habituales. Conclusiones El diagnóstico de GE es infrecuente a esta edad, y se debe plantear entre diagnósticos diferenciales de lesiones líticas agresivas primarias vertebrales. Es necesario el uso de imágenes, y la biopsia vertebral es fundamental para confirmar el diagnóstico. Su manejo va a depender de la sintomatología, del compromiso de estructuras vecinas, y de la estabilidad de la vértebra afectada. El manejo conservador con seguimiento clínico e imagenológico es una opción viable.Item High-Grade Patellar Chondral Defects: Promising Results From Management With Osteochondral Autografts(2020-07) Figueroa, David; Calvo, Rafael; Donoso, Rodrigo; Espinoza, Jaime; Vaisman, Alex; Yañez, ClaudioBackground: Patellar chondral defects represent up to 34.6% of defects found during routine arthroscopy. Surgical management has evolved during the past 20 years in an effort to develop techniques to replace hyaline cartilage. Currently, the only technique that achieves this is osteochondral autologous transfer (OAT). Although good and excellent results have often been reported at midterm and long-term follow-up for femoral lesions, little is known about isolated patellar defects. Purpose: To assess clinical and imaging results of patients treated with OAT for high-grade patellar defects. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study on all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at our institution. The study included patients younger than 40 years of age with anterior knee pain and a grade 4 International Cartilage Repair Society patellar chondral defect between 1 and 2.5 cm2. Patients with surgery in other knee compartments, concomitant anterior cruciate ligament ruptures, infection, rheumatoid arthritis, and degenerative lesions were excluded. Six months postoperatively, all patients underwent magnetic resonance imaging (MRI) to allow assessment of graft integrity via the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to evaluate morphologic features and integration. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kujala scores were used to assess functional outcomes at final follow-up. Results: A total of 26 patients who received a patellar OAT were included. Most patients were male (88.4%), and the mean ± SD age was 28.5 ± 9.7 years. Patellar chondral defects had a median size of 180 mm2 (range, 64-250 mm2), and patients received a median of 1 autograft (range, 1-3). Functional outcomes assessed at a minimum of 1 year after surgery showed a mean Kujala score of 90.42 ± 6.7 and a mean WOMAC score of 95 ± 3.6. MRI revealed a median MOCART score of 75 points (range, 20-90 points). Conclusion: To our knowledge, this is the largest series to date regarding isolated patellar OAT. At midterm follow-up, most patients reported good and excellent results regarding symptoms and activity levels. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients.Item Magnetic Resonance Imaging Evaluation of the Integration and Maturation of Semitendinosus-Gracilis Graft in Anterior Cruciate Ligament Reconstruction Using Autologous Platelet Concentrate(Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 26, No 10 (October), 2010: pp 1318-1325, 2010) Figueroa, David; Melean, Patricio; Calvo, Rafael; Vaisman, Alex; Zilleruelo, Nicolás; Figueroa, Francisco; Villalón, gnacioPurpose: To evaluate integration and maturation of semitendinosus-gracilis (STG) grafts in anterior cruciate ligament (ACL) reconstruction with magnetic resonance imaging (MRI) in patients who underwent ACL reconstruction with STG with and without autologous platelet concentrate (APC). Methods: A randomized single–blinded evaluator prospective study was performed in 2 consecutive series of patients who underwent reconstruction over a 14-month period: 30 with APC use (group A) and 20 as control subjects (group B). At 6 months, an MRI evaluation was performed, with observation of the graft’s maturation and presence or absence of synovial fluid at the tunnel-graft interface. To facilitate interpretation, a scoring scale was designed to evaluate graft integration and maturation. Results: Regarding the presence of synovial fluid at the bone-graft interface, the test was negative in 86.84% of patients in group A and 94.74% in group B. A disorganized autograft signal pattern was found in 2.63% in group A and 5.26% in group B. Signal intensity was considered hypointense in 63.16% in group A and 42.11% in group B, isointense in 34.21% in group A and 52.63% in group B, and hyperintense in 0% in both groups. The final mean score was 4.45 points in group A and 4.2 points in group B (P .05). Poor integration was found in 2.63% in group A and 5.26% in group B (P .214). Good integration was found in 97.37% in group A and 94.74% in group B (P .784). Conclusions: In our consecutive series of patients who underwent ACL reconstruction with STG grafts, 1 group with intraoperative APC use versus a control group, followed up by MRI at 6 months after reconstruction, we did not find any statistically significant benefit in the APC group in terms of integration assessment and graft maturation (ligamentization). Level of Evidence: Level III, case-control studyItem Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up(2021) Figueroa, David; Figueroa, Francisco; Calvo, Rafael; Gómez, Carlos; Vaisman, AlexBackground: The aim of this study is to report the mid-term follow-up results of a prospective cohort of patients who underwent a polyurethane (PU) meniscal scaffold implantation for post meniscectomy syndrome (PMS), without limb realignment procedures. Methods: Prospective study in patients with PU meniscal scaffolds implanted during 2014e2016. Limb realignment procedures excluded. Clinical outcomes were prospectively evaluated pre-operatively and every year post-operatively using patient-reported outcome scores (KOOS, VAS, Lysholm and IKDC). Postoperative radiologic evaluation was done using 3.0 T magnetic resonance imaging (MRI). Meniscal scaffold extrusion, signal intensity, tibio-femoral cartilage degeneration progression and complications were analyzed. Results: Fourteen patients with an average age of 25.8 years (range: 17e47) received a PU scaffold (8 lateral and 6 medial). Associated procedures were done in all patients, with an osteochondral allograft transplantation (OAT) being the most common. Mean follow up was 51.6 (range: 39e66) months. Postoperative mean clinical outcomes scores showed significantly improved results compared to the preoperative scores. Lysholm scores increased from 62.4 to 80.2 (P ¼ 0.0023), KOOS from 68.9 to 80 (P ¼ 0.0083) and VAS for pain decreased from 5.3 to 3.1 (P ¼ 0.0024). Average post-operative IKDC score was 67.7. There were 8 cases of complete extrusion (>3 mm). The mean extrusion value was 4.0 mm (range: 3e6 mm). Three patients showed signs of a ruptured meniscal scaffold. One patient showed progression of the cartilage degenerative process. Conclusion: The use of a PU scaffold, associated with other surgical procedures in the knee, especially chondral repair, had a significant improvement in clinical outcomes compared to the baseline status, at an average of 51.6 months follow-up in patients suffering from PMS. Although imaging results show a high proportion of implant extrusion, this does not appear to imply a worsening in clinical outcomes in the short term. Level of evidence: IV. Case seriesItem Meniscus allograft transplantation: indications, techniques and outcomes(British Editorial Society of Bone & Joint Surgery, 2019) Figueroa, Francisco; Figueroa, David; Calvo, Rafael; Vaisman, Alex; Espregueira-Mendes, JoãoNew indications for meniscal allograft transplantation (MAT) are being added, but the general expert opinion is that it is still a procedure reserved for symptomatic meniscal loss. Lateral MAT has better clinical outcomes and less failure risk compared to medial MAT. Ideal conditions (low-grade chondral lesions) make MAT a more survivable and successful procedure. Meniscal extrusion after MAT is common and does not seem to alter results. Midterm survivorship of a MAT is reported to be 85–90%, while long-term survivorship decreases to 50–70% depending on chondral status and concomitant procedures. Even if the procedure is a success, there are high possibilities of not being able to resume sports activities.Publication Over 50% of self-reported burnout among Latin American orthopaedic surgeons: A cross-sectional survey on prevalence and risk factors(2023) Vaisman, Alex; Guiloff, Rodrigo; Contreras, Martín; Casas, Juan; Calvo, Rafael; Figueroa, DavidObjective: Assess the prevalence of self-reported burnout and identify risk and protective factors based on demographic and life quality aspects, among Latin American orthopaedic surgeons. Methods: This study employed a cross-sectional analytical design. An original design survey was developed using multiple-choice and Likert-scale questions to gather self-reported burnout, demographic, work-related, social, personal, and mood-related data. The survey was electronically distributed to the Chilean Orthopaedic Surgery Society and the Latin American Society of Arthroscopy, Knee Surgery, and Sports Medicine members. Statistical analysis included Chi-square and Fisher's exact tests to determine associations between self-reported burnout and other variables. Subsequently, a multivariate logistic regression was carried out to identify key risk and protective factors (p < 0.05). Results: The survey's response rate was 20 % (n = 358) out of the 1779 invitations that were sent. The most representative age range was 41-60 years (50 %) and 94 % were men. Of those surveyed, 50 % reported a burnout episode more than once per year, 60 % depersonalization when treating patients at least yearly, 13 % anhedonia, 11 % a depressive mood more than half of the month or almost every day, and 61 % weariness at the end of a working day. Burnout was statistically associated with age under 40 years old (p = 0.012), fewer years as a specialist (p = 0.037), fear of lawsuits (p < 0.001), a non-healthy diet (p = 0.003), non-doing recreational activities (p = 0.004), depersonalization when treating their patients (p < 0.001), weariness (p < 0.001), anhedonia (p < 0.001), depressive mood (p < 0.001), and career dissatisfaction (p < 0.001). The logistic regression demonstrated that fear of lawsuits (p < 0.001), weariness at the end of a workday (p = 0.016), and anhedonia (p = 0.019) were those variables with stronger direct associations with self-reported burnout. A healthy diet was the strongest protective variable (p < 0.001). Conclusion: Over 50 % of the Latin American orthopaedic surgeons who participated in the survey reported experiencing burnout episodes more than once a year, along with depersonalization when treating their patients at least once a year. Additionally, nearly 10 % of respondents experienced weekly depressive symptoms. Among the noteworthy risk factors for self-reported burnout were fear of lawsuits, weariness at the end of the workday, and anhedonia. Conversely, maintaining a healthy diet emerged as the most potent protective factorItem Patellar Tendinopathy: Diagnosis and Treatment(American Academy of Orthopaedic Surgeons, 2016) Figueroa, David; Figueroa, Francisco; Calvo, RafaelPatellar tendinopathy is a common cause of pain in athletes' knees. Historically, it has been related to jumping sports, such as volleyball and basketball. Repetitive jumping generates a considerable load of energy in the extensor mechanism, leading to symptoms. The main pathophysiologic phenomenon in patellar tendinopathy is tendinosis, which is a degenerative disorder rather than an inflammatory disorder; therefore, the other popular term for this disease, tendinitis, is not appropriate. The nonsurgical treatment of patellar tendinopathy is focused on eccentric exercises and often has good results. Other experimental options, with variable levels of evidence, are available for recalcitrant cases. Surgical treatment is indicated for cases that are refractory to nonsurgical treatment. Open or arthroscopic surgery can be performed; the two methods are comparable, but arthroscopic surgery results in a faster recovery time.