Sutura Meniscal en Niños. ¿En Qué Hemos Avanzado?
Palabras clave:
Niños, Adolescentes, Rotura Meniscal, Reparación Meniscal, Rodilla PediátricaResumen
La real incidencia de las lesiones meniscales en niños y adolescentes sigue siendo desconocida, aunque se estima que estas han aumentado en los últimos años. En este grupo de pacientes, tanto el examen físico como la resonancia magnética han reportado un menor rendimiento, por lo que la sospecha clínica debe ser alta. Aunque la literatura es escasa en niños y las bases del manejo de estas lesiones se extrapolan del manejo en adultos, la tendencia actual es la preservación meniscal. Dado el alto potencial de cicatrización y la mayor vascularización del menisco pediátrico, se extiende la indicación de sutura meniscal a toda aquella lesión reparable, independiente del patrón, extensión o tiempo de evolución en este grupo étareo.
La literatura reporta buenos resultados tras la reparación meniscal en pacientes pediátricos, con tasas de cicatrización promedio por sobre el 70%, que son al menos comparable a lo reportado en adultos. A la fecha, la técnica todo-dentro es la más utilizada por su fácil utilización y menor tiempo quirúrgico. Sin embargo, debemos ser especialmente cuidadosos para evitar una lesión neurovascular iatrogénica dado el menor tamaño y proximidad del paquete neurovascular en rodillas pediátricas. La principal complicación es la falla de la sutura, reportándose tasas comparables a la población adulta a pesar de su indicación extendida en niños y adolescentes. Se han identificado como factores protectores para la reparación meniscal la menor edad, la fisis abierta, roturas de patrones simples y la reconstrucción concomitante de ligamento cruzado anterior.
En el presente artículo realizamos una detallada revisión de la literatura disponible sobre reparación meniscal en niños y adolescentes, enfatizando las diferencias versus población adulta. También presentamos nuestra experiencia y protocolo de rehabilitación para sutura meniscal en pacientes pediátricos.
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Derechos de autor 2020 María Tuca, Tomás Pineda, Nazira Bernal, Rafael Calvo
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Esta obra se publica bajo una Licencia Creative Commons Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0). Los autores conservan los derechos de autor.
