El ligamento anterolateral de la rodilla / The Knee Anterolateral Ligament

Este artículo es originalmente publicado en:
http://www.arthroscopyjournal.org/article/S0749-8063%2814%2900705-1/fulltext#/article/S0749-8063%2814%2900705-1/fulltext

http://www.arthroscopyjournal.org/article/S0749-8063(14)00705-1/abstract

November 2014 Volume 30, Issue 11, Pages 1385–1388

The Knee Anterolateral Ligament

James H. Lubowitz, M.D. (Editor-in-Chief)

, 

Matthew T. Provencher, M.D. (Assistant Editor-in-Chief)

, 

Jefferson C. Brand, M.D. (Deputy Editor)

, 

Michael J. Rossi, M.D. (Deputy Editor)

DOI: http://dx.doi.org/10.1016/j.arthro.2014.08.007

 

 

“Your Knee Bone's Connected to Your…What?

Scientists Discover New Body Part:

You'd think we'd know basic anatomy by 2013.”¹

When we woke on November 6, 2013, Time magazine reported: “In an age filled with advanced medical techniques like MRIs, artificial hearts, and laser eye surgery, one could be forgiven for believing doctors are also at least vaguely familiar with every one of your body parts. However, a new discovery by Belgian physicians has proved this assumption wrong…two surgeons at University Hospitals Leuven have located a new ligament in the human knee, and their findings may mean a revolution in how we treat ACL injuries.”¹

A new knee ligament?

It was hard for us to believe this was true. However, “A press release, issued by the university (University Hospitals Leuven in Belgium) and picked up by numerous media outlets around the world, claimed the ligament was previously unknown.”² Thus began the media hype.

Lea el artículo completo AQUÍ 

Estudio: Una alternativa para el control del dolor después de la cirugía de reemplazo de rodilla

Este artículo es publicado originalmente en :
http://www.newswise.com/articles/study-an-alternative-for-pain-control-after-knee-replacement-surgery

Study: An Alternative for Pain Control after Knee Replacement Surgery http://t.co/q9AHPdAS1K
— Victor Ravens (@bibliomanazteca) diciembre 25, 2014

Shoulder Bursitis Surgery

Este artículo es originalmente publicado en:
http://www.arthritis-health.com/types/bursitis/shoulder-bursitis-surgery

una publicación de Arthritis-health.

BREAKING NEWS

http://www.healio.com/orthopedics

BREAKING NEWS     Gender-dependent patterns may identify FAI presentations Distinct differences in the presentation of femoroacetabular impingement (FAI) between men and women could aid clinicians in the identification of typical and atypical FAI presentations by sex, as well as help in diagnostic and treatment decisions, according to study results. Read more           Higher BMI may lead to smaller improvements and higher complication rates after THA Recently published data showed patients with a higher body mass index (BMI) who underwent total hip arthroplasty (THA) experienced marginally smaller improvements and higher complication rates. Read more           Anesthesiologist-led program maintained positive clinical outcomes after TKA Use of the Perioperative Surgical Home helped maintain excellent clinical outcomes among patients who underwent total knee arthroplasty (TKA), with reduced hospital length of stay and increased skilled nursing facility bypass rate, according to recently presented data. Read more

PEER REVIEW
	Viable bone layer  over necrotic bone Orthopedics — November 2014 Initial Experiences With a New MRI Scoring System for Differentiating Advanced Femoral Osteonecrosis From Tubercular Arthritis — by Vasanthakumar Venugopal, MD; et al The purpose of this study was to formulate an MRI–based scoring system for differentiating tuberculous arthritis from advanced osteonecrosis of the femoral head. Read more

http://www.dovepress.com/a-systematic-review-of-the-outcomes-ofnbsposteoporotic-fracture-patien-peer-reviewed-article-TCRM

A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality

Ahmad Shuid Nazrun,¹ Mohd Nizam Tzar,² Sabarul Afian Mokhtar,³ Isa Naina Mohamed<sup>1

1</sup>Department of Pharmacology, ²Department of Medical Microbiology and Immunology, ³Department of Orthopedic, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia


Purpose: Osteoporotic fracture is the main complication of osteoporosis. The current management is to discharge patients as early as possible so they can get back to their daily activities. Once discharged, there are three main issues relating to morbidity, mortality, and risk of a subsequent fracture that need to be addressed and discussed. Therefore, the aim of this systematic review was to summarize and evaluate the evidence from published literature, to determine the outcome of osteoporotic fracture patients after their hospital discharge.
Methods: The MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched, using the terms “osteoporosis”, “fracture”, “osteoporotic fracture”, “hip fracture”, and “vertebral fracture”. We included only human studies published in English between 2004 and 2014. The reference lists of included studies were thoroughly reviewed in search for other relevant studies.
Results: A total of 18 studies met the selection criteria. Most were observational and cohort studies. Out of all the studies, five studies looked into the morbidity, six studies looked into the risk of subsequent fractures, and seven studies looked into mortality. Vertebral fracture caused the greatest health burden, but hip fracture patients were the main users of informal care after hospital discharge. There was an increased risk of a subsequent fracture after a primary fracture compared with the control group, a cohort comparison, or the general population. Osteoporotic fractures, especially hip fractures, are associated with higher mortality rate despite the advances in the management of osteoporotic fracture cases.
Conclusion: There is strong evidence to show that after hospital discharge, osteoporotic fracture patients are faced with higher morbidity, subsequent fractures, and mortality.

Keywords: osteoporosis; hip fracture, vertebral fracture

Download Article [PDF] 

  

This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available athttp://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:http://www.dovepress.com/permissions.php

http://www.saludablemente.es/laimportanciadelpsoas.php

La importancia del Psoas

En lo más profundo de nuestro cuerpo se encuentra el psoas, un pequeño músculo que conecta la parte superior e inferior del cuerpo. Aprender a relajarlo, por lo tanto, ayuda a ganar una mayor estabilidad.

El cuerpo presenta una serie de capas o niveles: primero la piel, luego los músculos, después los órganos y, finalmente, el esqueleto. Sin embargo, hay algunas excepciones. Por ejemplo, las costillas y el cráneo: unos huesos que cubren y protegen órganos, en vez de ser su soporte central. El psoas es una excepción similar: es un músculo que se encuentra en lo más profundo del centro mismo del cuerpo humano, entre los intestinos y la columna vertebral.

Este músculo actúa como una especie de puente colgante entre el tronco y las piernas, transfiriendo el peso de arriba abajo y transmitiendo flujos energéticos en ambas direcciones. Al mismo tiempo, un psoas sano realiza una función de estabilización de la columna vertebral.

Por otro lado, el psoas también actúa como soporte interno del abdomen, una especie de “repisa” en diagonal sobre la que se asientan los órganos vitales de esta zona. Este músculo interno, además, actúa en armonía con el diafragma, vinculando los ritmos del movimiento del cuerpo con los ritmos respiratorios, y entre ambos realizan un continuo masaje sobre la columna vertebral, los órganos, los vasos sanguíneos y los nervios del tronco, estimulando el movimiento de los fluidos por todo el cuerpo, a modo de bomba hidráulica.

Sentirse centrado:

El psoas es, pues, el eje físico de un cuerpo equilibrado y estable. Es un músculo vital en todo movimiento que implique equilibrio, rotación del tronco y de las piernas y en definitiva, cualquier movimiento general del cuerpo. Por eso, los movimientos inadecuados y las malas posturas tienden a forzar el funcionamiento del psoas, por ejemplo en una actividad motora aparentemente tan sencilla como caminar. Muchos de nosotros pensamos erróneamente que el movimiento de las piernas empiezan en la cintura, es decir, que el tronco acaba donde empieza la cadera. Sin embargo, estructuralmente las piernas empiezan en las articulaciones del fémur con la cadera, y para que el cuerpo mantenga un equilibrio armónico es necesario que la pelvis funcione como parte del tronco y no como parte de las piernas. Si al caminar movemos la pelvis como si fuera parte de las piernas, en un contoneo excesivo o empujándola hacia delante o hacia atrás, el psoas se verá obligado a realizar una tensión antinatural para proteger y estabilizar la columna vertebral.

El psoas puede tensarse en muchas situaciones diferentes, ya que es capaz de contraerse o relajarse de forma independiente, en cada unión vertebral.

Pero si este músculo se usa constantemente para corregir la estabilidad interna, al cabo del tiempo puede empezar a perder flexibilidad y a acortarse de forma crónica. Y una contracción o endurecimiento crónico del psoas conlleva una serie de problemas, porque hace que otros músculos del abdomen y de la espalda se vean obligados a compensar el equilibrio y empiecen a endurecerse también. Por ejemplo: los huesos pélvicos tienden a adelantarse, disminuyendo la distancia entre las crestas ilíacas y las piernas, comprimiendo la cabeza del fémur en su articulación.

Esta compresión hace que los muslos se desarrollen excesivamente y el fémur pierde capacidad de rotación, un movimiento que es asumido por las rodillas y la espina lumbar.

Estos trastornos pueden provocar, a la larga, lesiones crónicas en la espalda, la cabeza del fémur o las rodillas.

El corazón de las emociones:

Con un abdomen habitualmente en tensión y comprimido, una vitalidad disminuida y una respiración alterada, es comprensible que la atrofia del psoas conlleve alteraciones emocionales.

Puede que mucha de esa ansiedad que nos atenaza, o parte de esa apatía crónica que nos oprime esté relacionada con un psoas inhibido. Igualmente, la sensación permanente de inseguridad que algunas personas experimentan puede estar directamente conectada con el sobreesfuerzo continuo por mantener el equilibrio del esqueleto.

Además, el complejo de músculos iliopsoas está íntimamente conectado con la atávica reacción de “lucha-huida” que permite a los animales defenderse en una situación de peligro, cuando deben enfrentarse a un agente externo. Tanto si nos encogemos en una posición fetal protectora, como si saltamos desde el suelo para correr, el psoas es el corazón de los músculos implicados, el primero en reaccionar. Por ello, un psoas crónicamente contraído está enviando al resto del cuerpo, lo que afecta al sistema nervioso, agota a las glándulas suprarrenales y debilita el sistema inmunitario. Si nos sentimos agresivos a menudo, y sin razón aparente, es posible que una atrofia del psoas tenga mucho que ver.

Al relajar el psoas, debemos desarrollar la confianza en el equilibrio de nuestro esqueleto, en vez de buscar el equilibrio mediante tensiones musculares. Un cuerpo relajado sostiene su peso de manera natural sobre su propia estructura ósea: los músculos están para mover los huesos, no para apuntalar el peso del cuerpo. Cuando aprendemos a repartir el peso sobre el esqueleto y a sostenerlo sin esfuerzo, la sensación se traduce en una actitud emocional de seguridad y equilibrio. Las articulaciones devienen sutiles nodos de fluir energético, dando a todo movimiento una sensación de continuidad y armonía.

Inestabilidad pasajera:

Sin embargo, liberar el psoas, al principio puede ser problemático. Al intentar “dejar ir” los huesos y relajar la musculatura, puede invadirnos una sensación de vértigo. Acostumbrados a sostenernos mediante contrafuerzas musculares, hemos perdido la confianza en nuestra estructura ósea, y podemos creer que nos vamos a desmoronar. Los primeros ejercicios de relajación pueden dar una primera impresión de inestabilidad, que es pasajera. Asimismo, una vez que hayamos aprendido a sentir nuestros músculos iliopsoas, y empecemos a relajarlos, podremos atravesar una etapa de emociones confusas. Es normal, ya que la atrofia del psoas suele estar relacionada con problemas emocionales, y para liberar este músculo, como en cualquier tratamiento o cura, primero hay que abandonar los viejos esquemas y depurar los elementos dañinos, permitiendo que afloren. Con el tiempo, la consciencia y el cuidado de los iliopsoas nos conducirá a mejorar tanto la salud física, como la emocional.

Autoestiramientos:

Consejo: Si eres deportista o paciente, procura estirar. Si eres un profesional, procura valorar y tratar.

	Alexis Alonso. Osteópata.
	Editor de Saludablemente.es

http://www.healio.com/orthopedics/journals/ortho/2014-10-37-10/%7B5eb0fc21-d355-4364-a0b4-c81c0792b6f8%7D/total-knee-arthroplasty-in-a-patient-with-thrombocytopenia-absent-radius-syndrome?ecp=318F9B42-3E81-E311-ADF0-A4BADB296AA8

CASE REPORT 

Total Knee Arthroplasty in a Patient With Thrombocytopenia-Absent Radius Syndrome

Daniel B. Reid, BS; Vito L. Pugliano, MD; Eric L. Smith, MD

• Orthopedics
• October 2014 - Volume 37 · Issue 10: e946-e951
• DOI: 10.3928/01477447-20140924-93

PEER REVIEW
	Extramedullary tibial alignment guide Orthopedics — October 2014 Total Knee Arthroplasty in a Patient With Thrombocytopenia-Absent Radius Syndrome — by David B. Reid, BS; et al Thrombocytopenia-absent radius syndrome is a rare genetic condition with a complex inheritance pattern. This syndrome is classically characterized by hypomegakaryocytic thrombocytopenia as well as bilateral absent radii, shortened ulna, and radially deviated five-digit hands. Read more

BREAKING NEWS

http://www.healio.com/orthopedics

BREAKING NEWS     Undergoing TJA earlier in week reduced length of hospital stay Patients who underwent total joint arthroplasty (TJA) early in the week experienced shorter postoperative length of stay and faster overall recovery, according to study results. Read more           Positive results seen in TKA using mobile-, fixed-bearing prostheses Recently published data indicated the utilization of both mobile- and fixed-bearing prostheses in total knee arthroplasty (TKA) can yield positive clinical and radiographic outcomes for patients. Read more           Shoulder arthroplasty for treatment of infected shoulder had low risk of reinfection Shoulder arthroplasty can be performed for the treatment of the sequelae of an infected shoulder with low risk of reinfection, according to study results. Read more

COMMENTARY
	Anthony A. Romeo Be part of disruptive innovation to control costs, transform health care In this month’s Commentary, Anthony A. Romeo, MD, discusses how orthopedic surgeons need to participate in a disruptive innovation to transform health care. Read more

PEER REVIEW
	Sequestrated lesion on medial end of clavicle Orthopedics — October 2014 Primary Tuberculosis of the Clavicle — by Jatin Prakash, MBBS, MS (Ortho), DNB; et al Tuberculosis of the clavicle is a rare lesion, accounting for less than 1% of all osteoarticular tuberculosis. The lesion can have a varied presentation and the rarity of the lesion, its nonspecific symptoms, and its striking resemblance to common cystic conditions such as bone tumors and metabolic conditions such as rickets make diagnosis difficult.Read more

Desarrollo de un pie protésico para zapatos de taco alto

 http://www.anatomia-fisioterapia.es/es/es/component/content/article/57-articles/systems/various/889-desarrollo-de-un-pie-protesico-para-zapatos-de-taco-alto




una publicación de Anatomía & Fisioterapia - Español.

http://www.sportsmedres.org/2013/12/ACL-Knee-Osteoarthritis.html

ACL Injury May Increase the Likelihood of Knee Osteoarthritis

Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis

Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, And Davies A. Am J Sports Med. 2013; [Epub ahead of print].

http://ajs.sagepub.com/content/early/2013/11/08/0363546513508376.abstract

Take Home Message: Sustaining an ACL rupture increases the likelihood of knee osteoarthritis in a 10-year follow-up period.

The current gold-standard for treating an anterior cruciate ligament (ACL) deficient knee is an ACL reconstruction, which attempts to restore basic biomechanical function and thus delaying knee osteoarthritis (OA). Unfortunately, the prevalence of knee OA after an ACL injury and the efficacy of an ACL reconstruction at preventing knee OA are still unclear. Therefore, Ajuied and colleagues completed a meta-analysis to assess the development and progression of OA at a minimum of 10 years after an ACL injury. They focused on studies that used the Kellgren & Lawrence grading system, which is a commonly used assessment of radiographic OA severity. Relevant articles were identified via the PubMed, Medline, EMBASE, and AMED databases. Two independent reviewers screened the articles for the inclusion criteria, which included surgically and non-surgically treated ACL rupture patients, patients with isolated ACL injuries or in combination with meniscal and/or medial collateral ligament injury, and radiological assessment with the Kellgren & Lawrence grade. The authors identified 9 articles for the systematic review and 6 articles for the meta-analysis. The 9 articles included 615 patients (422 male, 222 female), which included 228 (37%) patients with a known meniscal injury and 520 (85%) patients who received an ACL reconstruction (typically a bone-patellar tendon-bone autograft). At follow-up 309 (52%) out of 596 knees with a history of an ACL injury had radiographic OA (Kellgren-Lawrence Grade > 2). A knee with a prior ACL injury was almost 4 times as likely to have knee OA compared with a contralateral knee that had no ACL injury. Regardless of whether the knee had an ACL reconstruction or not they were 3 to 5 more likely to have knee OA compared with the contralateral uninjured knee.

This study provides clinicians with information supporting the concept that sustaining an ACL rupture increases the risk of OA later in life. Furthermore, performing an ACL reconstruction to restore normal knee mechanics may still leave the knee at greater risk for OA. However, clinicians must cautiously interpret these results because the meta-analysis focused on the contralateral knee as the control knee for comparison and excluded the study with radiographs of the ipsilateral joint at baseline. By excluding this study, the author eliminated the only study able to assess the true risk of disease progression. Meniscal injuries were also not accounted for, which prevents clinicians from truly understanding the long-term implications of an ACL rupture or ACL reconstruction because the meniscus has been shown to play a vital role in the long-term health of the knee joint. Regardless of these limitations this study highlights that despite an ACL reconstruction our patients may still be more likely to have knee OA later in life, which should cause all of us to pause and wonder how we can improve our current treatment strategies to protect the long-term health of the joint.

Questions for Discussion: Do you think the research needs to separate the influence of a meniscal tear with an ACL injury to make the findings more applicable to you?

Written by: Kyle Harris

Reviewed by: Jeffrey Driban

http://www.healio.com/orthopedics/blogs/patellofemoral-update/not-medically-necessary-follow-practical-considerations-for-patellofemoral-cartilage-restoration?ecp=318F9B42-3E81-E311-ADF0-A4BADB296AA8

Patellofemoral Update

‘Not medically necessary’: Follow practical considerations for patellofemoral cartilage restoration

Patellofemoral Update

October 21, 2014

BLOG
	Jack  Farr Seth L. Sherman ‘Not medically necessary’: Follow practical considerations for patellofemoral cartilage restoration Previous Patellofemoral Update blogs have detailed the options and rationale for cartilage restoration in the patellofemoral compartment. In patients who have failed appropriate nonoperative treatment for patellofemoral chondral lesions, these surgical options appear encouraging. Read more