Browsing by Author "Reinares, Felipe"
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Item Análisis comparativo de tres modelos de prótesis reversa de hombro basados en los nuevos ángulos de distalización y lateralización(2021) Bernal, Nora; Paccot, Daniel; Reinares, Felipe; Franz, PaterComparar resultados funcionales e imagenológicos de tres modelos protésicos según el índice de lateralización y distalización. En un grupo heterogéneo de diagnósticos (fractura, artropatía de manguito, secuela de fractura y artrosis glenohumeral). Material y métodos: Cohorte prospectiva de 33 pacientes sometidos a prótesis reversa de hombro entre Diciembre 2014 y Julio 2017 con un seguimiento mínimo de un año. Se definieron tres grupos, G: 10 pacientes con Grammont clásico (155o, Glena medializada); B: nueve pacientes con Bio-RSA (155o, glena lateralizada ósea); y A: 14 con Arrow (135o, glena lateralizada metálica). Las variables fueron: datos demográficos, clínicos, funcionales y radiológicos (ángulo de lateralización y distalización). Para el análisis estadístico se utilizaron pruebas de ANOVA, T-test y regresión lineal, con una significancia estadística de 5%. Resultados: El ángulo de lateralización del hombro (LSA) fue significativamente mayor en el grupo A (98o A, 79oG, 80o B) (p < 0.05). El ángulo de distalización del hombro (DSA) del grupo B fue significativamente superior al A (52o B, 39o A) (p < 0.05) y no significativamente superior al G (48o G) (p = 0.06). No se demostró una correlación entre el LSA y DSA con la rotación externa (p = 0.51) y elevación activa (p = 0.41), respectivamente. En índices clínicos (elevación anterior, rotación externa, rotación interna) y funcionales (índice Constant ajustado y evaluación subjetiva de hombro) no encontramos diferencias significativas entre los distintos modelos protésicos (p > 0.05). Conclusiones: El ángulo de lateralización fue mayor en el modelo Arrow y distalización en el modelo Bio-RSA. No encontramos correlación clínica-radiológica en esta serie heterogénea de pacientes.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.Item Arthroscopy-Assisted Latissimus Dorsi Transfer for Irreparable Subscapularis Tears(2021) Reinares, Felipe; Calvo, Andrés; Reyes, José; Moreno, José; Paccot, DanielIrreparable tears of the subscapularis (SS) tendon are difficult to manage and represent a challenge for the surgeon, especially in young and active patients. They are associated with a horizontal imbalance of the shoulder, causing pain and limitation of active internal rotation. Historically, the alternative for these patients has been transfer of the pectoralis major, with all its variations, total or partial, up or under the conjoint tendon. However, this transfer has mechanical disadvantages, especially related to the vector of traction, because it originates in the anterior region of the chest. In 2013, Elhassan and colleagues demonstrated in cadavers the technical feasibility and neurological safety of performing transfers of the latissimus dorsi (LD) to the lesser tuberosity to reconstruct irreparable lesions of the subscapularis. This option, compared with alternatives, has superior biomechanical advantages such as a similar vector of traction, originating from lower and posterior to the thorax, in addition to involving a synergistic muscle in action. In early 2016, Kany and colleagues first published a study of 5 patients undergoing arthroscopic assisted LD to SS transfer, with promising results. Our purpose is to present an arthroscopically assisted latissimus dorsi transfer technique in patients with irreparable subscapularis rupture.Publication Functional and radiologic results of the crimson duvet procedure in rotator cuff treatment: a randomized controlled clinical trial(2022) Toro, Felipe; Pinochet, Fernando; Ruiz, Francisco; Moraga, Claudio; Pozo, Rene; Oliva, Juan; Reinares, Felipe; Mardones, PaulaBackground: Rotator cuff tears are one of the more frequent pathologies of the shoulder. Arthroscopic techniques and biologic augmentation have been developed to improve the rate and quality of healing. The crimson duvet procedure (CDP) theoretically provides mesenchymal stem cells through microfracture treatment of the footprint. The aim of this research was to evaluate the effect of CDP in patients who had undergone arthroscopic surgery for complete rotator cuff repair. Methods: A prospective randomized clinical trial was performed in a total of 123 patients, consisting of 59 women and 64 men, with a mean age of 58 years. We included patients with a clinical and radiologic diagnosis of a complete rotator cuff tear. All patients were treated with arthroscopic rotator cuff repair. In group 1, the surface of the footprint was débrided; in group 2, the footprint underwent microfracture. The primary outcome was the nonhealing rate, which was detected by magnetic resonance imaging (MRI) or ultrasonography, and the secondary outcome was the functional result. A Sugaya classification of I to III was considered to indicate healing. For clinical evaluation, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Constant scores were evaluated, along with the range of motion. The functional evaluation was performed preoperatively and at 6 months and 1 year postoperatively. The radiologic (MRI or ultrasonography) evaluation was performed at 6 months. Neither the patients nor the radiologists and physical therapists who performed the postoperative evaluations were informed of the random selection. Results: We observed a healing rate of 85.11% in the control group and 93.7% in the CDP group, which was not significant (P = .19). However, a significant improvement in function was observed in all patients. The ASES score improved from 68.9 (SD 13.8) preoperatively to 92.2 at 6 months and to 96.4 (SD 6.2) at 12 months (P < .05), but no difference was observed between the groups. A similar level of improvement was observed in the Constant score. Conclusion: The arthroscopic repair of complete rotator cuff tears presents good and excellent clinical results in most patients. Nevertheless, nonhealing occurs at a rate that depends mainly on the age of the patient and the size of the tear. The addition of CDP did not improve the functional results or the healing rate.Publication Nanoscopic Distal Biceps Repair With Cortical Button and Interference Screw(2023) Reinares, Felipe; De la Maza, Francisca; De la Paz; Joaquin; Angulo, Manuela; Lecaros, Juan; Ruiz, FranciscoDistal biceps pathology can be addressed using different techniques, each with its advantages and disadvantages. The current trend is to move toward minimally invasive procedures based on feasibility and known clinical benefits. Endoscopy for distal biceps pathology is a safe procedure. Through the NanoScope, this procedure is even more effective and safer.Item Reparación del tendón del supraespinoso con técnica transósea equivalente en población sujeta a compensación laboral. ¿Cuál es el porcentaje de cicatrización?(2021) Calvo, Andrés; Valenzuela, Alfonso; Montenegro, Diego; Reinares, FelipeIntroduction: the objective of this work was to evaluate the healing rate and functional results in a retrospective cohort of patients undergoing arthroscopic repair of the supraspinatus tendon, using a double row transosseous equivalent technique. Materials and methods: during the period from January 2015 to December 2017, an arthroscopic repair of the supraspinatus was performed on forty-eight patients, using a transosseous technique, by the same surgeon. We evaluated the healing rate by an ultrasound exam at the fourth month of evolution. Functional results were evaluated using the Constant-Murley scale (CS), subjective shoulder assessment (SSV) and the visual analog scale (VAS) to objectify the pain. For the statistical analysis, t-tests were used for paired samples. This cohort of patients is subject to workers compensation. Results: the ultrasound follow-up showed a 6% re-rupture rate. The average increase in the Constant scale was 55 points, the SSV had a mean increase of 55% and the VAS score decrease 6 points. All these changes were statistically significant (p < 0.05). Conclusions: the supraspinatus tendon repair, using an equivalent transosseous technique, improves the clinical and functional results of patients, objectified with the Constant-Murley and SSV scores. In our series we obtained a healing rate on 94% of the patientsItem Results of standardized treatment of elbow fracture dislocations as per their injury pattern: a retrospective cohort of 89 patients(2021) Reinares, Felipe; Rojas, Nicolás; Calvo, Andrés; Aravena, Cristian; Rieutord, Juan Pablo; Callejas, Orlando; Montegu, Roberto; Paccot, DanielBackground: Elbow fracture dislocations represent difficult injuries to treat, with a high percentage ofcomplications. Classically, they are divided into posterolateral, posteromedial and transulnar pattern. It isessential to distinguish them to guide intraoperative treatment to achieve an anatomic and stablereduction that allows early mobility. Methods: A retrospective study of 89 adult patients diagnosed with elbow fracture dislocations whounderwent a standardized surgery between 2013 and 2018 with a minimum follow-up of 12 months. Demographic data, characteristics of the injury, and associated procedures were collected. Patients wereevaluated with functional scores (Mayo elbow performance score/Broberg and Morrey score) and ranges of movement at the end of the follow-up. Results: The mean age was 41 ± 12 years, mostly men (82%), with an average follow-up of 29 months. We present 42 patients with posterolateral fracture dislocation (47%), 21 posteromedial (24%) and 26 transulnar (29%). The average range of motion at the end of follow-up was 12 ± 11 extension, 124 ± 20 flexion, 76 ± 16 pronation, and 73 ± 20 supination, with a Mayo elbow performance score of 88.7 ± 12 points and 87.2 ± 12 points in the Broberg and Morrey scale. Reoperation rate was 23%, with no infection or heterotopic ossification cases. Transulnar fracture dislocations have significantly worse extension and supination. As per the functional result (Mayo elbow performance score/Broberg and Morrey scale), there are no significant differences between the different patterns. Conclusion: Proper injury pattern recognition and a standardized surgical management lead to a stable joint and good results in range of motion. Functional results are encouraging at least at short term, despite the high reoperations rate.Item Transferencia artroscópica del trapecio inferior en pacientes con rotura irreparable del manguito rotador posterosuperior. Resultados preliminares de ocho pacientes(2021) Calvo, Andrés; Lecaros, Juan José; Rojas, Nicolás; Paccot, Daniel; Toro Saelzer, Felipe; Reinares, FelipeIntroduction: the purpose of this study is to compare clinical and functional outcomes of patients with irreparable posterosuperiorrotator cuff tears treated by arthroscopic assisted lower trapezius transfer. Materials and methods: retrospective cohort design of patients with irreparable rotator cuff tear, treated by arthroscopy-assisted lower trapezius transfer. The clinical evolution was evaluated according to the gain in the range of shoulder movement and the decrease of pain. Functional outcomes were evaluated using the Constant-Murley score and the subjective shoulder value (SSV). Results: eight patients were included, with average follow-up of twenty-two months. We obtained a statistically significant gain in active external rotation of 32°, 5-point decrease in the pain scale (VAS), a 31-point increase in the Constant score, and a 38% increase in SSV. There was a 12° increase in active forward elevation, however this was not statistically significant. Two patients had a seroma at the trapezius harvest site, which resolved with conservative treatment. Conclusion: arthroscopically assisted lower trapezius transfer in patients with irreparable posterosuperior rotator cuff tears were a safe technique that significantly improves external rotation and functional scores in patients. Type of study: Case series (IV