Browsing by Author "Mendez, Magdalena"

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    All-Arthroscopic Coracoacromial Ligament Transfer: The Modified Neviaser Procedure for Acromioclavicular Dislocations
    (2022) Velasquez Garcia, Ausberto; Mendez, Magdalena; Abdo, Glen
    Over the course of the years, the topic of optimizing the management of acromioclavicular joint dislocations has gained popularity, remaining a subject of debate. It has been determined that posterior horizontal instability appears to be one of the factors influencing both clinical and radiographic outcomes, postsurgical reconstructions with coracoclavicular techniques. In contrast, the acromioclavicular ligament complex (ACLC) has been experimentally demonstrated to play a crucial role in horizontal translation and rotational stability of the clavicle. Although several strategies have been established, perfect surgical timing, and its potential impact during the healing process, remain poorly defined. Furthermore, appropriate surgical techniques to restore normal acromioclavicular joint kinematics while ensuring an adequate biological environment remain unclear. Due to the existence of multiple features present in acromioclavicular joint reconstruction techniques, an ideal approach involves ACLC and coracoclavicular combination reconstruction, minimal clavicular drilling, and biological enhancement to ensure anatomical reduction and an adequate process of ligament healing. The purpose of this Technical Note is to present a modified surgical technique of the Neviaser procedure. This modified surgical technique combines an all-arthroscopic single tunnel coracoclavicular fixation with the transfer of the coracoacromial ligament to reconstruct the ACLC.
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    Artroplastia total de rodilla en luxación inveterada de patela: Reporte de un caso
    (2024) Vicuña, Bernardita; Mendez, Magdalena; Orrego, Mario; Arteaga, Matías
    Introducción La luxación patelar inveterada (LPI) asociada a artrosis es un problema infrecuente y de difícil manejo, especialmente en pacientes con síndrome de Down (SD). La alteración crónica del funcionamiento patelofemoral (PF) debido a un severo mal alineamiento conduce a una progresiva destrucción articular que puede culminar en artrosis tricompartimental. Se han descrito distintas técnicas para su resolución, desde procedimientos en partes blandas hasta el uso de prótesis total de rodilla (PTR).Presentación del caso Hombre de 29 años con SD consultó por un año de gonalgia derecha atraumática, asociado a episodios de derrame articular. Inicialmente, se diagnosticó como artritis séptica. El examen físico mostró hiperlaxitud (Beighton 8), marcha claudicante, LPI, genu valgo irreductible y artrosis tricompartimental con genu valgo de 13,3° a derecha. Se trató con una PTR y realineamiento del aparato extensor mediante alargamiento del retináculo lateral y avance del vasto medial oblicuo (VMO) con técnica de Insall. A los 8 meses postoperatorios, el paciente está sin dolor, sin nuevos episodios de luxación patelar y es independiente para las actividades básicas de la vida diaria.Discusión Se trata de un caso complejo de gonartrosis e inestabilidad patelar asociado a genu valgo, en un paciente con SD e hiperlaxitud. Junto con la LPI, enfrentamos un valgo de 13,3° y artrosis tricompartimental. Se planificó una PTR primaria estabilizada posterior (PS) con posibilidad de mayor constricción intraoperatoria, junto con realineamiento de partes blandas. La literatura demuestra que este paso es esencial para restaurar la biomecánica PF y lograr buena funcionalidad.
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    Latissimus Dorsi Transfer Combined with Subacromial Balloon Spacer for Bidirectional Rotator Cuff Deficiency
    (2022) Velasquez Garcia, Ausberto; Osorio Valdivia, Pedro; Brito, Cristian; Mendez, Magdalena
    Patients with massive, irreparable rotator cuff tears represent a challenge for treatment, particularly those with loss of external rotation and active elevation. In the cases of glenohumeral arthropathy, reverse shoulder arthroplasty combined with transfer of the latissimus dorsi and teres major tendons has improved active external rotation and overall patient outcomes. However, the reverse shoulder prosthesis could be better used as a second-line treatment in patients without arthropathy. Several joint-preserving surgical approaches have been described for irreparable cuff tears with no substantial differences in results. Although latissimus dorsi transfer has shown long-term clinical reliability and improved functional shoulder function in relatively young patients, isolated tendon transfer appears insufficient to restore range of motion in patients with a bidirectional deficit. The subacromial balloon spacer is an additional new treatment option. This surgical procedure describes an arthroscopic-assisted transfer of the latissimus dorsi tendon followed by the implantation of the subacromial balloon. This combination potentially addresses the bidirectional deficiency by restoring the shoulder external rotational coupling, improving the deltoid load, centering the humeral head, and protecting the transferred tendon from the subacromial compression stresses.
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    Safety and exposure area in three different posteromedial surgical approaches for the treatment of ankle fractures. A cadaveric study
    (Elsevier Ltd, 2024) Urrutia, Tomás; Morales, Sergio; Mendez, Magdalena; Filippi, Jorge; Vidal, Catalina; Palma, Joaquín
    © 2024 European Foot and Ankle SocietyIntroduction: This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision and the NVB using three different posteromedial ankle approaches. Methods: Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB Results: There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches Conclusion: The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.