Ignacio Miranda

The objective is to describe a technique for treating lunotriquetral ligament (LTL) injuries through an arthroscopic reinsertion of the volar or dorsal LTL and reinforce with capsulodesis and to present the results obtained. A retrospective, analytical, clinical study was conducted on 13 consecutive patients with LTL injuries. Range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score, and the QuickDASH Score, as well as complications and reinterventions, were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. Thirteen patients with European Wrist Arthroscopy Society type IIIA or IIIC LTL injuries were evaluated. The mean age was 39.15 ± 3.43 years (range: 16–59), and 54% were male. Overall, 54% had type 3A lesions and 46% 3C. All underwent arthroscopic reinsertion with capsulodesis reinforcement. Significant improvements in pain, grip strength, range of motion, and functional scores were observed at 3, 6, and 12 months postoperatively, with excellent results. From the sixth month onward, no statistically significant differences were observed when compared with the contralateral wrist. All-inside arthroscopic LTL repair is a safe and effective treatment option for acute injuries and certain early chronic injuries without nonreducible instability or chondral degeneration. This procedure allows for the simultaneous assessment and repair of volar, dorsal, or combined tears while preserving joint mobility and minimizing morbidity. Compared with open repair, this minimally invasive approach may enable faster recovery and fewer complications though larger comparative studies are needed to confirm its long-term benefits.

Introduction There is concern in the scientific community that patients implanted years ago with metal-on-metal (M-M) bearings for total hip arthroplasty (THA) may still have persistent and potentially toxic levels of chromium (Cr) and cobalt (Co). Studies suggest that blood metal levels may be elevated in both ceramic-on-metal (C-M) and M-M bearings. The objective of this study was to establish whether patients with THA and C-M bearing surfaces require the same follow-up as those with M-M THA and to evaluate the long-term survival of THAs with M-M and C-M bearing surfaces, blood Cr and Co levels and complications (especially metallosis). Materials and Methods A retrospective, observational, analytical, descriptive cohort study was conducted on the patients who underwent THA at a single centre with the use of M-M (64) and C-M (76) bearings and a control group (44 THA: 23 ceramic-on-ceramic, 8 metal-on-polyethylene, 13 ceramic-on-polyethylene) between 2005 and 2009 (an additional 12 THAs performed with the same implants between 2010 and 2012 were also included). The median follow-up period was 14.41 (interquartile range 11.6–15.7) years. The primary outcomes were blood levels of Cr and Co, complications, implant survival and patient survival (Kaplan Meier analysis). Multivariate binary logistic regression was performed to examine the risk of metallosis, prosthesis replacement and death between groups, adjusting for potential confounders. Results THA with M-M bearings produce more metallosis (47%, p < 0.001) than C-M bearings (16%). Thirty-one THA revisions were performed (17%), with significantly more revisions in the M-M group (33%) compared to both the C-M group (11%, p = 0.002) and the control group (4%, p = 0.003). There were no significant differences in 15-year patient survival between the groups. Conclusions Routine monitoring of C-M bearings should be recommended, similar to the protocols for M-M. In the long term, both metallosis and revision rates are unacceptably high for both types of bearings, with M-M bearings performing worse. Therefore, neither implant type is recommended for THA.

Aim and hypothesis To compare antibiotic prophylaxis with a single or multiple doses in total knee arthroplasty surgery. To assess whether the use of a multiple dose is justified in routine clinical practice. The starting hypothesis is that the use of multiple doses of prophylactic antibiotics does not reduce surgical infection and may increase costs, hospital stay and antibiotic resistance. Methods A systematic review and meta-analysis of the literature was carried out following the PRISMA guidelines. The search was carried out on 5 April 2024 in the PubMed and Cochrane Library databases by entering the terms: (antibiotic prophylaxis) AND ((total knee arthroplasty) OR (knee prosthesis)) and the Joanna Briggs Institute quality assessment tool was used to evaluate the quality of the included studies. Results Four articles have been included, all of which are retrospective cohort studies comparing the use of single-dose antibiotic prophylaxis with multiple-dose prophylaxis in total knee arthroplasty. No significant differences have been observed in terms of postsurgical infection rate between single- and multiple-dose prophylaxes. Conclusions The use of multiple-dose antibiotic prophylaxis in total knee arthroplasty has not been shown to reduce infections or other complications compared to single-dose antibiotic prophylaxis. No evidence has been found to justify the use of multiple-dose antibiotic prophylaxis in knee arthroplasty surgery.

Introducción: la utilización de plasma rico en plaquetas (PRP) como coadyuvante de reparación quirúrgica de las roturas agudas del tendón de Aquiles puede acelerar la recuperación y mejorar los resultados funcionales. Material y métodos: se realiza una revisión sistemática de la literatura siguiendo las normas de la guía PRISMA. Se realizó una búsqueda el 12 de febrero de 2024 en las bases de datos PubMed y Cochrane Library con los términos: (platelet rich plasma) AND (therapy OR treatment) AND (surgery) AND (Achilles tendon). Resultados: se han incluido 5 artículos, 3 ensayos clínicos y 2 estudios comparativos. Se han obtenido buenos resultados funcionales y radiológicos para ambos grupos. No se han podido objetivar diferencias significativas en los resultados funcionales (vuelta a la actividad, rango de movilidad, escalas de valoración), las complicaciones ni en las pruebas de imagen que muestren una superioridad de los resultados añadiendo PRP como coadyuvante en la reparación quirúrgica de las roturas agudas del tendón de Aquiles. Conclusión: no se han encontrado evidencias científicas y clínicas sólidas que justifiquen el uso de PRP como adyuvante a la cirugía en el tratamiento de la rotura aguda del tendón de Aquiles en la práctica clínica habitual.

Background There is a broad consensus among orthopedic surgeons in the treatment of Gartland type I supracondylar humerus fractures (conservative) and Gartland type III (surgical) fractures, but there is controversy regarding the treatment of choice for Gartland type II fractures. The aim was to analyze the existing current evidence on the choice of surgical or conservative treatment of Gartland type II supracondylar humerus fractures. Methods A systematic review was carried out following the PRISMA guidelines. The search was conducted on May 24, 2023, in PubMed and Cochrane Central, introducing the terms (“humerus” AND “supracondylar”) AND (“Gartland II” OR “Gartland 2”). The selected studies were evaluated with the JBI checklist for quasi-experimental studies. Results 5 retrospective comparative studies were included (evidence level III). Radiological and functional results were good with both treatments. Only one study obtained a better result with surgical treatment (with n = 4 in the conservative group); the other four studies did not find significant differences between the two types of treatment. There are risks of bias in all studies. Conclusions Both types of treatment (conservative and surgical) are valid for type II Gartland supracondylar humerus fractures, and provide good results, both functional and radiological. There is not enough scientific evidence to be able to affirm that one of the two treatments (surgical or conservative) is superior to the other for the treatment of these fractures. Findings on the initial radiograph, such as rotational deformity, coronal malalignment, or a severely angulated distal humeral fragment, can assist in the decision-making process.