Browsing by Author "Gonzalez, Waldo"

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    Dynamic knee valgus as a predictor of graft rerupture after anterior cruciate ligament reconstruction: Influence of sex and graft type
    (2026) Gonzalez, Waldo; Riquelme, Juan; Barba, Diego; Erskine, Daniela; Venegas, Rodrigo; Calvo, Rafael; Figueroa, David
    Introduction: Dynamic knee valgus has been identified as a potential risk factor for anterior cruciate ligament (ACL) injury, but its role in predicting graft failure or contralateral rupture after anterior cruciate ligament reconstruction (ACLR) remains unclear. The purpose of this study was to evaluate dynamic valgus (DV) as a predictor of graft re-rupture and contralateral ACL injury following ACLR, and to explore whether graft type influences this association. Methods: Prospective cohort study was conducted patients who underwent primary ACLR between 2020 and 2024. Patients with multiligament injuries, osteotomies, or revision surgeries were excluded. DV was measured during a standardized return-to-sport (RTS) drop jump test. Logistic regression was performed to assess associations with graft rerupture and contralateral ACL injury, adjusting for age, sex, body mass index (BMI), and graft type. Receiver operating characteristic (ROC) analysis was used to evaluated discriminative ability. Results: A total of 137 patients completed follow-up at a mean of 3.0 ​± ​1.2 years. Most patients were male (75.9%), with a mean age of 26.7 years. Ten patients (7.3%) sustained a graft re-rupture and nine (6.6%) a contralateral rupture. The DV was an independent predictor of graft rerupture (adjusted odds ratio [aOR]: 1.07; 95% confidence interval [CI]: 1.001-1.15). In sex-stratified analyses, this association was statistically significant only among men (aOR: 1.13; 95% CI: 1.02-1.24), with an area under the curve (AUC) of 0.76. A threshold between 18° and 20° yielded a balanced sensitivity and specificity of 71% and 73%, respectively. No statistically significant differences in DV were observed across graft types. Conclusion: DV is an independent predictor of graft rerupture after ACLR, particularly among men, where valgus angles above 18-20° markedly increase the risk of failure. These findings support the integration of DV assessment into postoperative follow-up to identify high-risk patients and to inform graft selection and rehabilitation strategies. Level of evidence: III
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    High satisfaction and functional improvement following robotic‐assisted total knee arthroplasty: A Latin American cohort study
    (2025) Calvo, Rafael; Figueroa, David; Landea, Daniela; Gonzalez, Waldo; Isla, Jorge; Figueroa, Loreto
    Purpose: Total knee arthroplasty (TKA) is a widely performed surgical procedure for patients with severe knee osteoarthritis, aiming to reduce pain, improve function, and enhance quality of life. Patient satisfaction following TKA typically ranges from 85% to 90%, with factors such as malalignment and postoperative instability being common causes of dissatisfaction. Robotic-assisted TKA (RA-TKA) has demonstrated advantages in surgical precision and better functional recovery compared to conventional techniques. The objective of our study is to evaluate and quantify the level of patient satisfaction and functional outcomes after robotic-assisted TKA. Methods: Prospective cohort of patients who underwent TKA using robotic-assisted surgery at a single centre between 2018 and 2020. Demographic data were collected, and patient satisfaction was evaluated at the 1-year follow-up using the Knee Society Scoring (KSS) system. Functionality was assessed through patient-reported outcome measures (PROMs), specifically the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), both preoperatively and postoperatively, with a minimum follow-up period of 3 years. All statistical analyses were performed using STATA version 18.5. Results: A total of 270 patients with complete follow-up were evaluated. 92.6% (n = 250) of patients were satisfied or very satisfied with the surgery, while 7.4% (n = 20) reported dissatisfaction. No statistically significant difference was found in age, sex, BMI, or preoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) between the satisfaction and dissatisfaction groups. However, satisfied patients had a significantly higher postoperative KOOS JR (p = 0.0001). Conclusion: A high level of satisfaction and significant functional improvements were achieved after robotic-assisted TKA in patients with severe osteoarthritis.
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    Impact of body mass index on robotic-assisted total knee arthroplasty outcomes: A retrospective cohort analysis
    (2025) Gonzalez, Waldo; Calvo, Rafael; Figueroa, David; Isla, Jorge; Landea, Daniela; Tapia, Camila
    Introduction: Obesity is a growing global health concern and a known risk factor in total knee arthroplasty (TKA). With an increasing number of obese patients requiring TKA, it is essential to understand how obesity influences clinical outcomes and complication rates. The objective of this study is to investigate the impact of obesity on clinical outcomes and complications in patients undergoing robotic-assisted TKA (RA-TKA). Methods: A retrospective cohort study was conducted on 216 patients aged ≥18 years who underwent RA-TKA between 2019 and 2023, with a minimum postoperative follow-up of one year. Patients were stratified into three body mass index (BMI) categories: <25, 25-29, and ≥30 ​kg/m2. Demographic, intraoperative, and postoperative variables-including tourniquet use and time, implant type, hospital stay, and complications-were compared. Statistical analysis was performed (p < 0.05). Results: Two hundred sixteen patients (91.5% follow-up rate) were evaluated at a mean of 34 months, postoperatively. No statistically significantly difference was found among the BMI groups in terms of age, sex, use of tourniquet, hospital stay, or use of stem implants. A statistically significant difference was observed only in the group of BMI <25 ​kg/m2 regarding arthrofibrosis. When patients were grouped as a BMI <35 vs a BMI ​≥ ​35 ​kg/m2, a higher complication rate was noted in the ≥35 ​kg/m2 group (18.2% versus 7.2%), though the difference was not statistically significant (p ​= ​0.09). Conclusions: This study found that the difference was not statistically significant in the overall rate of postoperative complications among patients with obesity undergoing RA-TKA. However, a nonsignificant trend toward a higher complication rate was observed in patients with severe obesity (BMI ≥35 ​kg/m2). Interestingly, a statistically significant increase in arthrofibrosis was found in patients with BMI <25 ​kg/m2, a finding that contrasts with the current literature. Level of evidence: Level III.
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    Lateral extra-articular tenodesis reduces graft failure without affecting functional outcomes after revision anterior cruciate ligament reconstruction: A retrospective comparative study with 6-year follow-up
    (2026) Gonzalez, Waldo; Isla, Jorge; Sandoval , Alfredo; Figueroa, Francisco; Itriago, Minerva; Figueroa, David
    Introduction: Revision anterior cruciate ligament reconstruction (ACLR) is associated with a substantially higher risk of anterior cruciate ligament (ACL) graft failure than primary ACLR. Lateral extra-articular tenodesis (LET) has gained increasing attention as an adjunctive procedure to enhance rotatory stability and potentially reduce the rate of ACL graft failure. The purpose of this study was to compare clinical and functional outcomes between patients undergoing isolated revision ACLR and those undergoing revision ACLR with concomitant LET. We hypothesized that the addition of LET would reduce the incidence of ACL graft failure without compromising functional outcomes or return-to-sport rates. Methods: This retrospective cohort study included skeletally mature patients who underwent first-time revision ACLR with a minimum follow-up of four years. Patients were divided into two groups according to surgical technique: isolated revision ACLR (n ​= ​58) and revision ACLR with LET (n ​= ​65). ACL graft failure was defined as clinically confirmed graft rupture based on a positive pivot-shift or Lachman test, magnetic resonance imaging, or the need for further revision ACLR. Demographic characteristics, surgical details, and patient-reported outcomes (International Knee Documentation Committee [IKDC] and Tegner activity scale) were compared between groups. Results: A total of 123 patients were analyzed (mean age: 27.1 ​± ​8.0 years) with a mean follow-up of 6.0 years (range: 4.5-7.3 years). Functional outcomes were comparable between groups (IKDC score: 80.4 ​± ​9.2 vs 84.1 ​± ​8.8; p ​= ​0.86; Tegner score: 6.6 ​± ​1.3 vs 6.7 ​± ​1.2; p ​= ​0.92). ACL graft failure occurred in 11 patients (18.3%) in the isolated revision ACLR group and in 2 patients (3.3%) in the revision ACLR with LET group (p ​= ​0.03; odds ratio: 0.15; 95% confidence interval: 0.03-0.72). Sixty percent of all patients (74/123) returned to sport, including 50 (40.6%) who reached their preinjury level, with no statistically significant differences between groups (p ​= ​0.41). Conclusion: The addition of an LET to revision ACLR significantly reduced the rate of ACL graft failure without adversely affecting functional recovery or return-to-sport rates. This procedure may serve as a valuable adjunct for selected high-risk patients undergoing revision ACLR
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    Return-to-sport tests: Do they reduce risk of re-rupture after anterior cruciate ligament reconstruction?
    (2026) Figueroa, David; Gonzalez, Waldo; Landea, Daniela; Tapia, Camila; Erskine, Daniela
    Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. Despite the effectiveness of reconstruction, re-rupture rates of up to 15 ​% have been reported. Static and dynamic test of strength and movement control have been used to determine when return to sports (RTS) is appropriate. Objective: To determine whether successfully passing return to sport (RTS) tests reduces the re-rupture rate. Methods: Retrospective cohort study. Patients who underwent ACL reconstruction (ACLR) from June 2018 to May 2023, and who performed RTS tests after rehabilitation, were analyzed. Patients who, in addition to ACLR, underwent extra-articular tenodesis, osteotomy, or multiligament injuries were excluded. RTS tests included the following: repeat sprint ability, dynamic valgus, proagility, unilateral counter movement jump (CMJ), isokinetic, triple hop test, and functional movement screen (FMS). All statistical analyses were performed with STATA version 18.0. Results: Ninety five patients underwent RTS tests after ACLR, with a follow-up time of 27.8 months. 71.6 ​% of patients were men with a mean age of 25.15 ​± ​10.7 years. The overall re-rupture rate was 13.68 ​% (13 patients). When comparing patients who passed and did not pass the RTS tests, there were no differences by sex (p ​= ​0.06) or age (p ​= ​0.11). The only statistically significant difference between the groups was the mean risk score (passed: 11.5 ​± ​0.7 vs. not passed: 15.5 ​± ​2.1; p ​< ​0.001). Patients with re-rupture were more likely to be from the non-passed group (passed: 0 ​% v/s not passed: 18.1 ​%; p ​= ​0.03), with a statistical power of 0.70. Conclusion: Our records show that passing RTS test after an ACLR could guarantee the absence of re-rupture in the medium term

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