Revista de Medicina Desportiva Julho 2020 - Page 25

de desportos de pivot, sem lesões concomitantes e que respondam positivamente a um plano inicial de reabilitação (copers). Na seleção destes pacientes, o PKTD tem um papel importante para identificar aqueles sem laxidez rotacional patológica. O complemento da reconstrução do LCA com tenodese externa tem vantagens claras no controlo da rotação interna do joelho e na proteção do enxerto e deve ser usada em casos de revisão, pacientes jovens, hiperlaxidez generalizada, presença de um pivot-shift explosivo, laxidez rotacional patológica (PKTD) e em casos de morfologia óssea que constitua risco aumentado (Porto ratio). Novas abordagens cirúrgicas têm surgido nas últimas duas décadas, incluindo a preservação do remanescente do LCA e a reparação com complementação sintética e/ou biológica, mas até que se verifique a superioridade destas abordagens, a reconstrução anatómica com enxertos autólogos permanece como gold standard. A maioria dos estudos destas novas abordagens têm limitações importantes – maioritariamente séries de casos e com um tamanho amostral baixo – e é necessária mais investigação sobre o seu potencial papel no tratamento do LCA. Estudos futuros irão revelar se estas novas abordagens terão um papel (ou não) no tratamento de roturas do LCA. Bibliografia 1. Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 2011;45(7):596-606. 2. Wiggins AJ, Grandhi RK, Schneider DK, et al. Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2016;44(7):1861-1876. 3. Cinque ME, Dornan GJ, Chahla J, et al. High Rates of Osteoarthritis Develop After Anterior Cruciate Ligament Surgery: An Analysis of 4108 Patients. Am J Sports Med 2018;46(8):2011-2019. 4. 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Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy 2009;25(6):653- 685. 13. Borchers JR, Pedroza A, Kaeding C. Activity level and graft type as risk factors for anterior cruciate ligament graft failure: a case-control study. Am J Sports Med 2009;37(12):2362- 2367. 14. Lind M, Strauss MJ, Nielsen T, et al. Quadriceps tendon autograft for anterior cruciate ligament reconstruction is associated with high revision rates: results from the Danish Knee Ligament Registry. Knee Surg Sports Traumatol Arthrosc 2019. DOI:10.1007/s00167- 019-05751-5. 15. Irarrázaval S, Kurosaka M, Cohen M, et al. Anterior cruciate ligament reconstruction. J ISAKOS 2016;1(1):38-52. 16. Grassi A, Carulli C, Innocenti M, et al. New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years. Joints 2018;6(3):177-187. 17. Mohtadi NG, Chan DS, Dainty KN, et al. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 2011;2011(9):CD005960-CD005960. 18. Samuelsen BT, Webster KE, Johnson NR, et al. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? A Meta-analysis of 47,613 Patients. Clin Orthop Relat Res 2017;475(10):2459-2468. 19. Slette EL, Mikula JD, Schon JM, et al. Biomechanical Results of Lateral Extra-articular Tenodesis Procedures of the Knee: A Systematic Review. Arthroscopy 2016;32(12):2592-2611. 20. Engebretsen L, Lew WD, Lewis JL, et al. The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion. Am J Sports Med 1990;18(2):169-176. 21. Devitt BM, Bouguennec N, Barfod KW, et al. Combined anterior cruciate ligament reconstruction and lateral extra-articular tenodesis does not result in an increased rate of osteoarthritis: a systematic review and best evidence synthesis. Knee Surg Sports Traumatol Arthrosc 2017;25(4):1149-1160. 22. Getgood AMJ, Bryant DM, Litchfield R, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med 2020;48(2):285-297. 23. Fernandes MS, Pereira R, Andrade R, et al. Is the femoral lateral condyle’s bone morphology the trochlea of the ACL? Knee Surg Sports Traumatol Arthrosc 2017;25(1):207-214. 24. Vasta S, Andrade R, Pereira R, et al. Bone morphology and morphometry of the lateral femoral condyle is a risk factor for ACL injury. Knee Surg Sports Traumatol Arthrosc 2018;26(9):2817-2825. 25. Hu J, Qu J, Xu D, et al. Clinical outcomes of remnant preserving augmentation in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014;22(9):1976-1985. Restante Bibliografia em: www.revdesportiva.pt (A Revista Online) Revista de Medicina Desportiva informa julho 2020· 23