Browsing by Author "Figueroa, Francisco"
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Publication Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients(2023) Sánchez, Enrique; Lozano, Beatriz; Zijl, Jacco; Wolterbeek, Nienke; Passarelli, Luis; Janson, Fabio; Verdonk, Peter; Vuylsteke, Kristien; Espregueira, Joao; Valente, Cristina; Figueroa, Francisco; Maestro, Antonio; Figueroa, David; Andrade, RenatoBackground: Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries. Hypothesis: The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI. Study design: Cohort study; Level of evidence, 3. Methods: All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed. Results: A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament. Conclusion: The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures.Item Aloinjertos óseos y la función del banco de huesos(2011) Calvo R., Rafael; Figueroa, David; Díaz Ledezma, Claudio; Vaisman, Alex; Figueroa, FranciscoThe use of bone grafts is a common practice in musculoskeletal surgery to provide mechanical stability where there is a defect and it allows skeletal reconstruction. Classically auto and allografts have been used. The latter are the choice in large, complex defects. Allografts can be transplanted despite cell death, have osteoconduction and osteoinduction capacity, low antigenicity and biomechanical properties similar to the original bone. They can be obtained from living and death donors. They are stored by cryopreservation and lyophilization in entities called bone banks. This is a reviw about bone allografts and the organization and function of the bone banks.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 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 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 Comparison between navigated reported position and postoperative computed tomography to evaluate accuracy in a robotic navigation system in total knee arthroplasty(2019) Figueroa, Francisco; Wakelin, Edgar; Twiggs, Joshua; Fritsch, BrettBackground: Computer navigation increases reproducibility compared to non-navigated total knee arthroplasty (TKA). Robotics navigation is a branch of computer navigation technology that might further improve accuracy of implant placement. The aim of this study is to assess the accuracy achieved in TKA with a robotic navigation system. Methods: One hundred seventy three knees. System studied: Omni navigation System (OMNI, Raynham, MA). Navigated femoral and tibial cuts were compared to postoperative computed tomography (CT). Measurements reviewed: femoral coronal alignment (FCA), femoral sagittal alignment (FSA), femoral rotational alignment (FRA), tibial coronal alignment (TCA), tibial sagittal alignment (TSA) and hip-knee-ankle (HKA) angle. Statistical analysis was made using R. Results: The mean differences between the navigated reported and the CT positions were: FCA: 0.1 ± 1.2° more varus (P = 0.58), FSA: 1.5 ± 0.3° more flexed (P < 0.001), FRA: 0.0 ± 1.7° (P = 0.93), TCA: 0.7 ± 1.1° more varus (P < 0.001), TSA: -1.3 ± 1.5 more negative slope (P < 0.001), HKA angle: 0.4 ± 2.4 more varus (P < 0.049). The percentages of concordance inside a three degree difference were: FCA: 98% (169 knees), FSA: 100% (173 knees), FRA: 94% (162 knees), TCA: 99% (171 knees), TSA: 93% (161 knees) and HKA angle: 83% (144 knees). Conclusions: The current study showed that the robotic navigation system studied is highly accurate regarding final implant positioning for FCA, FRA and TCA. It has less accuracy in FSA, TSA and the HKA angle.Publication Cross-cultural adaptation and validation of the KOOS, JR questionnaire for assessing knee osteoarthritis in Spanish-speaking patients(2023) Guiloff, Rodrigo; Iñiguez, Magaly; Prado, Tomás; Figueroa, Francisco; Olavarría, Nicolás; Carrasco, Eduardo; Ergas, Enrique; Salgado, Martín; Lyman, StephenPurpose The present study aims to translate, adapt and validate a Spanish version of the Knee Injury and OsteoarthritisOutcome Score, Joint Replacement (KOOS, JR), including a reliability and validity analysis in patients with knee osteoar-thritis (OA).Methods This study conducted a prospective validation study following the six stages of the “Guidelines for the Process ofCross-Cultural Adaptation of Self-Report Measures”. Psychometric testing was conducted in patients with knee osteoarthritis.Subjects answered the Spanish KOOS, JR (S-KOOS, JR) and a validated Spanish Oxford Knee Score (S-OKS). Retest wasconducted at 10 days. Acceptability, floor and ceiling effect, internal consistency (Cronbach’s α), reproducibility (mixed-effect model coefficient [MEMC]) and construct validity (Spearman’s correlation; p = 0.05) were assessed.Results Forty-one patients (mean age: 65.6 ± 5.39; 48.8% female) participated in the study. All patients (100%) answeredboth scores during the first assessment and 38 (92.7%) during the second assessment. All patient-reported outcomes measureswere answered completely (100%). The S-KOOS, JR resulted in 100% acceptability when answered. There were no ceilingor floor effects detected. The Cronbach’s α for the S-KOOS, JR was 0.927 and its MEMC was 0.852 (CI 95% 0.636–1.078).The Spearman’s correlation between the S-KOOS, JR and the S-OKS was 0.711 (CI 0.345–0.608; p < 0.001) and 0.870 (CI0.444–0.651; p < 0.001) for the first and second assessments, respectively.Conclusion The S-KOOS, JR has very high internal consistency and reproducibility, with a high correlation with the S-OKS;it is a reliable and valid instrument for characterising Spanish-speaking patients suffering from knee OA.Level of evidence IV.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 Estrategias para minimizar el riesgo de infección posterior a una reconstrucción de ligamento cruzado anterior(2021) Figueroa, Francisco; Nuñez, Marilaura; Montes, VicenteLa artritis séptica es una complicación poco común después de una reconstrucción del ligamento cruzado anterior (LCA), por lo que las estrategias de prevención no han sido estudiadas extensamente. Esta revisión se enfocará en la recopilación de diferentes estrategias publicadas para la prevención de infección del LCA postoperatorio. Hay estudios que muestran aumento del riesgo de infección en consumidores de tabaco. El uso de antibióticos intravenosos preoperatorios profilácticos debería ser parte del manejo habitual de todos los pacientes que se sometan a una artroscopía de rodilla. No existe evidencia de los beneficios del uso de drenajes intraarticulares, por lo que deben evitarse. La literatura sugiere que el autoinjerto del tendón patelar tiene menor riesgo de infección que los otros injertos, por lo tanto, se recomienda su uso si se quiere minimizar la tasa de infección después una reconstrucción del LCA. La implementación de un protocolo clínico mejora significativamente la calidad del cuidado de los pacientes que se someten a una reconstrucción del LCA, disminuyendo las tasas de infección. La irrigación de gentamicina en solución podría tener un efecto protector para el desarrollo de artritis séptica después de la reconstrucción artroscópica del LCA, pero se necesitan más estudios para confirmar su efectividad. La inmersión previa de los injertos con vancomicina ha demostrado reducir drásticamente la tasa de infección después de una reconstrucción del LCA y especialmente cuando se realiza una reconstrucción del LCA con autoinjerto de tendones de los isquiotibialesItem 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 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.Item Graft Preparation Technique to Optimize Hamstring Graft Diameter for Anterior Cruciate Ligament Reconstruction(2017) Fritsch, Brett; Figueroa, Francisco; Semay, BertrandHamstring autografts are frequently used for anterior cruciate ligament reconstruction. The inherent variability in graft diameter has been stated as a disadvantage in its use because the presence of smaller graft diameters has been correlated with increased risk of re-rupture. Several techniques have been described to address this concern. Modifications of the basic Graftlink technique allows for increased control over final graft diameter using a standard harvest of the semitendinosus tendon with or without the gracilis tendon, and results in a graft of adequate length and diameter in all patients with rigid cortical fixation on the femur and tibia.Item Hamstring autograft size importance in anterior cruciate ligament repair surgery(2018) Figueroa, Francisco; Figueroa, David; Espregueira-Mendes, JoãoGraft size in hamstring autograft anterior cruciate ligament (ACL) surgery is an important factor directly related to failure. Most of the evidence in the field suggests that the size of the graft in hamstring autograft ACL reconstruction matters when the surgeon is trying to avoid failures.The exact graft diameter needed to avoid failures is not absolutely clear and could depend on other factors, but newer studies suggest than even increases of 0.5 mm up to a graft size of 10 mm are beneficial for the patient. There is still no evidence to recommend the use of grafts > 10 mm.Several methods - e.g. folding the graft in more strands - that are simple and reproducible have been published lately to address the problem of having an insufficient graft size when performing an ACL reconstruction. Due to the evidence presented, we think it is necessary for the surgeon to have them in his or her arsenal before performing an ACL reconstruction.There are obviously other factors that should be considered, especially age. Therefore, a larger graft size should not be taken as the only goal in ACL reconstruction.Item International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty(2022) Parsons, Thomas; French, Jonathan; Oshima, Takeshi; Figueroa, Francisco; Neri, Thomas; Klasan, Antonio; Putnis, Sven(1) Background: Prophylactic systemic antibiotics are acknowledged to be an important part of mitigating prosthetic joint infections. Controversy persists regarding optimal antibiotic regimes. We sought to evaluate current international antibiotics guidelines for total joint arthroplasty (TJA) of the hip and knee. (2) Methods: 42 arthroplasty societies across 6 continents were contacted and their published literature reviewed. (3) Results: 17 societies had guidelines; of which 11 recommended an antibiotic agent or antibiotic class (10—cephalosporin; 1—cloxacillin); 15 recommended antibiotic infusion within an hour of incision and 10 advised for post-operative doses (8—up to 24 h; 1—up to 36 h; 1—up to 48 h). (4) Conclusions: Prophylactic antibiotic guidelines for TJA are often absent or heterogenous in their advice.Publication Lateral hinge fracture in medial opening wedge high tibial osteotomy: a narrative review(2023) Franulic, Nicolás; Muñoz, José; Figueroa, Francisco; Innocenti, Piero; Gaggero, NicolásLateral hinge fractures (LHF) are one of the most common complications of medial opening wedge high tibial osteotomy (MOWHTO), and are the leading cause of construct instability displacement, non-union, and varus recurrence after this procedure. To date, Takeuchi's classification is the most popular classification to describe this complication, and it can help surgeons to make intra and postoperative decisions. Opening medial gap width is the most recognized factor related to LHF occurrence. Recognizing the implications of LHF in patients' clinical and radiographic results has led many authors to propose surgical tips and the use of osteosynthesis materials such as K-wires and screws for its prevention, which should be considered when identifying risk factors for LHF during preoperative planning. The evidence for determining the optimal management of LHF is scarce and mostly supported by experts' opinions and recommendations; therefore, studies are still needed to identify the most appropriate behavior when dealing with such a complication.Item Ligament Lesions: Biologics(2022) Figueroa, David; Guiloff, Rodrigo; Figueroa, FranciscoIn terms of the latest clinical evidence, the use of PRP for ligament injuries remains controversial. There is insufficient evidence to recommend the use of PRP in ACL-R for improving graft maturation and donor site morbidity or improving functional outcomes. The use of PRP injections for the treatment of partial ACL injuries, MCL injuries, and ankle sprains cannot be recommended. Finally, there is no reported clinical evidence of the use of PRP in other knee ligament injuries such as posterior cruciate ligament, lateral collateral ligament, and posterolateral cornerItem 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 series