Browsing by Author "Tuca, Maria"

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    Anterior and distal tunnel orientation for anatomic reconstruction of the medial patellofemoral ligament is safer in patients with open growth plates
    (SPRINGER, 2020) Irarrazaval, Sebastian; Besa, Pablo; Fernandez, Francisco; Fernandez, Tomas; Tuca, Maria; Lira, Maria J.; Orrego, Mario
    Purpose In patients with open growth plates, the direction of tunneling that avoids distal femoral physis (DFP) damage in anatomic reconstructions of the medial patellofemoral ligament (MPFL) has been a topic of discussion. The objective of this study was to determine the ideal orientation for anatomic reconstructions of MPFL tunneling that minimized DFP damage while avoiding breaching the intercondylar notch. Methods Eighty magnetic resonance images of patients aged 10 through 17 were obtained, randomly sampled from the institutional database. A de novo software was developed to obtain 3D models of the distal femur and DFP. In each model, the anatomical insertion point of the MPFL was determined as defined by Stephen. A 20-mm-depth drilling was simulated, starting from the insertion point at every possible angle within a 90 degrees cone using 5-, 6- and 7-mm drills. Physeal damage for each pair of angles and each drill size was determined. Damage was expressed as a percentage of total physis volume. Statistical analysis was conducted using Student'sttest and one-way ANOVA. Results Maximum physeal damage (5.35% [4.47-6.24]) was obtained with the 7-mm drill when drilling 3 degrees cephalic and 15 degrees posterior from insertion without differences between sexes (n.s.). Minimal physeal damage (0.22% [0.07-0.37]) was obtained using the 5-mm drill aimed 45 degrees distal and 0 degrees anteroposterior, not affected by sex (n.s.). Considering intra-articular drilling avoidance, the safest zone was obtained when aiming 30 degrees-40 degrees distal and 5 degrees-35 degrees anterior, regardless of sex. Conclusion Ideal femoral tunnel orientation, avoiding physeal damage and breaching of the intercondylar notch, was obtained when aiming 30 degrees-40 degrees distal and 5 degrees-35 degrees anterior, regardless of sex. This area is a safe zone that allows anatomic MPFL reconstruction of patients with an open physis.
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    Current trends in anterior cruciate ligament surgery. A worldwide benchmark study
    (2023) Tuca, Maria; Valderrama, Ignacio; Eriksson, Karl; Tapasvi, Sachin
    Objectives: To benchmark current trends on anterior cruciate ligament reconstruction (ACLR) surgery.Methods: The largest worldwide ACLR survey to date was performed during May 2020, targeted to reach repre-sentation of all continents. It was submitted electronically to all International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports surgeons (n = 3,026), asking those who perform ACLR to respond.Results: With a final sample size of 2,107, the overall response rate was 69.6%. Median years of practice as orthopaedic surgeon was 15 (range 1-52) and 49.6% of all respondents were defined as high-volume sur-geons (>50 ACLR annually). Hamstrings tendon autograft was the preferred graft for primary ACLR (80.3% ) and the medial portal femoral drilling was the most frequently used technique (78.5%). Cortical buttons (82.7%) and bioabsorbable screws (62.7%) were the preferred fixation methods for hamstring tendon autograft ACLR in femur and tibia, respectively. Metallic screws (45.2%) were the preferred fixation methods for bone patellar tendon bone autograft in femur and tibia. Most of the respondents routinely used pre-tensioning techniques for their graft preparation (63.8%), but less than half of surgeons preferred antibiotic soaking of the grafts (45.3% ). The preferred knee position for graft fixation was 10-30 degrees of knee flexion and neutral rotation (57 .0%). The addition of anterolateral augmentation (or extra-articular tenodesis) was infrequent in primary and isolated ACLR (10.0%), but a statistically significant raise was seen for revision surgeries (20. 0%). Most used brace in the initial postoperative rehabilitation (54.9% ) and the time to allow patients to fully resume sports was at an average of 8.9 +/- 2.0 months. Treatment algorithm of paediatric ACL injuries exhibited a low consensus among the respondents.Conclusion: This worldwide survey benchmarks the current trends in ACL reconstruction, achieving the largest participation of surgeons to date. Among the great variety of options available for ACL re-constructions, surgeons' preferences showed some differences according to their location and expertise. Reporting trends in practice, and not only the evidence, is important to medical education and providing patients the safest care possible.This is a Level V, expert opinion study.
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    Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation
    (2024) Murray, Iain Robert; Makaram, Navnit S.; Geeslin, Andrew G.; Chahla, Jorge; Moatshe, Gilbert; Crossley, Kay; Kew, Michelle E.; Davis, Aileen; Tuca, Maria; Potter, Hollis; van Rensburg, Dina C. Janse; Emery, Carolyn A.; Eun, Seungpyo; Grindem, Hege; Noyes, Frank R.; Marx, Robert G.; Harner, Chris; Levy, Bruce A.; King, Enda; Cook, James L.; Whelan, Daniel B.; Wahl, Christopher J.; Thorborg, Kristian; Irrgang, James J.; Pujol, Nicolas; Medvecky, Michael J.; Stuart, Michael J.; Hatch III, George F.; Krych, Aaron J.; Engebretsen, Lars; Stannard, James P.; MacDonald, Peter; Seil, Romain; Fanelli, Gregory C.; Maak, Travis G.; Shelbourne, K. Donald; Verhagen, Evert; Musahl, Volker; Hirschmann, Michael T.; Miller, Mark D.; Schenck, Robert C.; LaPrade, Robert F.
    Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined 'a priori' if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.
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    The Dejour classification for trochlear dysplasia shows slight interobserver and substantial intraobserver reliability
    (2024) Martinez-Cano, Juan Pablo; Tuca, Maria; Gallego, Alejandro; Rodas-Cortes, Yorlany; Post, William R.; Hinckel, Betina
    PurposeTrochlear dysplasia is one of the main risk factors for recurrent patellar dislocation. The Dejour classification identifies four categories that can be used to classify trochlear dysplasia. The purpose of this study is to evaluate the inter- and intraobserver reliability of the Dejour classification for trochlear dysplasia. The hypothesis was that both intra- and interobserver reliability would be at least moderate.MethodsThis is a cross-sectional, reliability study. Twenty-eight examiners from the International Patellofemoral Study Group 2022 meeting evaluated lateral radiographs of the knee and axial magnetic resonance images from 15 cases of patellofemoral instability with trochlear dysplasia. They classified each case according to Dejour's classification for trochlear dysplasia (A-D). There were three rounds: one with only computed radiograph (CR), one with only magnetic resonance imaging (MRI) and one with both. Inter- and intraobserver reliability were calculated using kappa coefficient (0-1).ResultsThe mean age of patients was: 14.6 years; 60% were female and 53% had open physis. The interobserver reliability kappa probabilities were 0.2 (CR), 0.13 (MRI) and 0.12 (CR and MRI). The intraobserver reliability kappa probabilities were 0.45 (CR), 0.44 (MRI) and 0.65 (CR and MRI).ConclusionThe Dejour classification for trochlear dysplasia has slight interobserver reliability and substantial intraobserver reliability.Level of EvidenceLevel I.