Crecimiento guiado en extremidades inferiores / Guided growth in lower extremities

El crecimiento guiado es una opción quirúrgica de uso creciente para la corrección de las deformidades angulares de extremidades inferiores en pacientes esqueléticamente inmaduros. Es posible de realizar en múltiples planos o segmentos, con excelentes resultados. Su uso más frecuente es en deformidades del plano coronal alrededor de la rodilla. La epifisiodesis permanente se puede realizar en pacientes dentro de los dos años previos al término del crecimiento longitudinal del segmento a tratar, considerando la epifisiodesis temporal para los pacientes con más de 2 años de crecimiento restante.En casos leves a moderados las tasas de éxito llegan incluso al 100% en algunas series, en tanto, pacientes con enfermedad de Blount, obesidad, edad esquelética avanzada o deformidades severas, tienen menos posibilidades de lograr una corrección completa.Independientemente de la técnica quirúrgica, es necesario una adecuada planificación preoperatoria, educación familiar y un seguimiento estricto para así minimizar las complicaciones y permitir una excelente corrección de la deformidad con una morbilidad mínima.

Guided Growth is a surgical option of increasing use for the correction of angular deformities of the lower extremities in skeletally immature patients. It is possible to perform in multiple planes or segments, with excellent results. Its most frequent use is in deformities of the coronal plane around the knee. Permanent epiphysiodesis can be performed in patients within 2 years before the end of longitudinal growth of the segment to be treated, considering temporary epiphysiodesis for patients with more than 2 years of remaining growth.In mild to moderate cases, the success rates reach even 100% in some series, while patients with Blount's disease, obesity, advanced skeletal age or severe deformities are less likely to achieve a complete correction.Regardless of the surgical technique, adequate preoperative planning, family education and strict follow-up are necessary to minimize complications and allow excellent correction of the deformity with minimal morbidity

Dynamic Knee Alignment and Pelvic Balance: Comparison Regarding Gender in Young Soccer Athletes / Alinhamento dinâmico do joelho e equilíbrio pélvico: Comparação entre os sexos em atletas de futebol de base

Abstract Objective To evaluate knee alignment in the frontal plane and pelvic balance during the step-down test in female and male soccer players. Methods Cross-sectional study carried out with male and female soccer players from under-15 and under-17 teams of a professional club in Southern Brazil. The step-down test was performed, filmed with a video camera, and evaluated according to the angular measurements obtained during movement using the Kinovea software (open source), version 0.8.24. Results The sample consisted of 38 individuals, 19 males and 19 females. Female athletes had a greater varus angle (9.42º ± 1.65º) compared to male athletes (3.91º ± 2.0º; p = 0.04). There was no difference regarding the unilateral pelvic drop between the groups. In addition, the association between the hip-related pelvic drop and the projection angle on the frontal plane of the knee was weak in both genders. Conclusion Even though the pelvic drop was observed in both genders, young female athletes had greater varus knee angles on the step-down test, which require greater attention to minimize the risk of injury.

Resumo Objetivo Avaliar o alinhamento do joelho no plano frontal e o equilíbrio pélvico durante a descida de um degrau comparando atletas de futebol feminino e masculino. Métodos Estudo transversal, realizado com atletas de futebol das categorias sub-15 e sub-17, de ambos os sexos, de um clube profissional do Sul do Brasil. Foi realizado o teste de descida de um degrau, o qual foi filmado por uma câmera de vídeo, e, em sua avaliação, traçaram-se as medidas angulares durante o movimento por meio do software Kinovea (código aberto), versão 0.8.24. Resultados A amostra foi composta por 38 indivíduos, 19 do sexo masculino e 19 do sexo feminino. As atletas do sexo feminino apresentaram maior ângulo em varo (9,42º ± 1,65º) quando comparadas com os atletas masculinos (3,91º ± 2,0º; p = 0,04). Não houve diferença em relação à queda unilateral da pelve (drop pélvico) entre os grupos, e a associação entre o drop pélvico do quadril e o ângulo de projeção no plano frontal do joelho foi fraca em ambos os sexos. Conclusão Apesar de ambos os sexos terem apresentado queda pélvica, as atletas de base do sexo feminino apresentaram maior angulação do joelho em varo no teste de descida do degrau, e necessitam maior atenção para minimizar o risco de lesão.

Análise do exercício agachamento com e sem o uso de physioball e banda elástica em diferentes intensidades / Analysis of the squat exercise with and without physioball and elastic band in different intensities

RESUMO O objetivo do presente estudo foi analisar a atividade mioelétrica (EMG), o tempo sob tensão (TST) e a projeção dos joelhos no exercício agachamento sem o uso de implementos (SI) e com o uso de physioball (PH) e banda elástica (BE) em diferentes intensidades de esforço. Dez homens realizaram o exercício nos três protocolos com a intensidade de 50 e 100% de 10 RM. A distância entre joelhos no protocolo controle (51,25cm) foi menor quando comparada com o SI 50% (84,38cm; p < 0,001), com o SI 100% (88,80cm; p < 0,001) e com BE 100% (67,41cm; p = 0,014). A distância entre os joelhos também foi menor para os protocolos PH 100% (53,10cm; p < 0,001) e BE 100% (67,41cm; p < 0,001) comparada ao SI 100% (88,80cm). O Vasto Medial Oblíquo (VMO) apresentou maior ativação nos protocolos SI 50% (p = 0,035) e PH 50% (p = 0,028) quando comparados ao protocolo BE 50%. A realização do agachamento com cargas submáximas parece aumentar e diminuir a ativação do VMO quando realizado com PH e BE, respectivamente.

ABSTRACT The objective of the present study was to analyze the myoelectric activity (EMG), the time under tension (TST) and the knee projection in the squat exercise without the use of implements (SI) and with the use of physioball (PH) and elastic band (EB) at different intensities of effort. Ten men performed the exercise in the three protocols with the intensity of 50 and 100% of 10 RM. The distance between knees in the control protocol (51.25 cm) was lower when compared to SI 50% (84.38 cm, p <0.001), with SI 100% (88.80 cm, p <0.001) and with EB 100% (67.41cm, p = 0.014). The distance between the knees was also lower for the protocols PH 100% (53.10cm, p <0.001) and EB 100% (67.41, p <0.001) compared to the SI 100% (88.80 cm) protocols. The Vasto Medial Oblique (VMO) presented greater activation in the SI 50% protocols (p = 0.035) and PH 50% (p = 0.028) when compared to the EB 50% protocol. The accomplishment of squatting with submaximal loads seems to increase and decrease the activation of VMO when performed with physioball and BE, respectively.

The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity / O papel das microfraturas associadas a osteotomia tibial no tratamento da gonartrose com geno varo

ABSTRACT Objective: To evaluate the microfracture intervention with tibial valgus osteotomy associated in the treatment of varus gonarthrosis. Methods: From November 2005 to May 2013, 129 patients with medial gonarthrosis, varus deformity (8°-12°), and range of movement greater than 90° were evaluated. Patients with advanced gonarthrosis (Alhbäck 3, 4, and 5), Outerbridge lesion inferior to IV, previous knee surgery, body mass index greater than 35 kg/m2, and/or cruciate ligament injuries were not included. All patients were treated with videoarthroscopy followed by tibial valgus osteotomy. In the group osteotomy associated with microfracture (n = 56, mean age = 39.3), tibial valgus osteotomy and microfracture techniques to address chondral defects were used. In the isolated osteotomy group (n = 73, mean age = 41.4), only this procedure was performed. Post-surgical follow-up was 24 months, with four evaluations in the first 6 months, proceeding to biannual twice-a-year evaluation in the subsequent period. The Lysholm scale was used for functional monitoring. Results: There was a significant improvement in the pain, limping, and squatting domains of the Lysholm scale but only in the isolated osteotomy group. A greater variance of results was observed in the osteotomy group associated to microfracture, in addition to an increased risk of functional deterioration (OR = 8.64). Conclusion: The association of microfractures and tibial valgus osteotomy was correlated to lower functional outcomes than tibial valgus osteotomy alone, and may be related to the risk of worsening in the first two postoperative years.

RESUMO Objetivo: Avaliar a intervenção de microfratura associada a osteotomia tibial valgizante no tratamento de gonartrose medial com geno varo. Métodos: Entre novembro de 2005 e maio de 2013, foram avaliados 129 pacientes portadores de gonartrose medial, geno varo entre 8° e 12° e arco de movimento superior a 90°. Não foram incluídos pacientes com gonartrose avançada (Alhbäck 3, 4 e 5), lesão Outerbridge inferior a IV, cirurgia prévia na articulação, índice de massa corpórea superior a 35 kg/m2 e/ou lesão de ligamentos cruzados. Todos os pacientes foram submetidos a videoartroscopia do joelho seguida de osteotomia tibial valgizante. No grupo osteotomia tibial valgizante associado a microfratura (n = 56, média de idade = 39,3) foram associadas as técnicas de osteotomia tibial valgizante e microfratura nos defeitos condrais. No grupo osteotomia tibial valgizante isolada (n = 73, média de idade = 41,4), apenas esse procedimento foi feito. O acompanhamento pós-cirúrgico foi de 24 meses, com quatro avaliações ambulatoriais nos primeiros seis meses, passou-se a avaliações semestrais no período subsequente. A escala de Lysholm foi usada no acompanhamento funcional. Resultados: Uma melhoria significativa nos domínios dor, claudicação e agachamento da escala de Lysholm foi observada apenas no grupo osteotomia tibial valgizante isolada. Maior variância de resultados foi observada no grupo osteotomia tibial valgizante associada a microfratura e uma razão de chances de pioria de 8,64. Conclusão: A associação das microfraturas e osteotomia tibial valgizante tem resultado funcional inferior à osteotomia tibial valgizante isolada, pode ainda estar relacionada ao risco de pioria nos primeiros dois anos de pós-operatório.

Complicaciones de la ostectomía proximal del peroné en pacientes con genu varo doloroso / Complications of proximal fibular ostectomy in patients with painful genu varum

Introducción: En el proceder quirúrgico del tratamiento del genu varo doloroso, la osteotomía del peroné es un paso común que acompaña a la osteotomía valguizante de la tibia, con un porcentaje de complicaciones conocidas. Los autores del presente trabajo comenzaron a aplicar un nuevo enfoque en el tratamiento de esta afección, con la ostectomía del peroné, donde también se presentan complicaciones. Objetivo: Identificar las complicaciones en pacientes operados mediante ostectomía del peroné. Métodos: Fueron evaluados 116 pacientes portadores de cambios degenerativos del compartimento interno de la rodilla; operados mediante ostectomía del peroné, durante el período de abril del 2016 a abril del 2018. Las complicaciones fueron recogidas desde el momento de la intervención quirúrgica, su evolución y tratamiento, a través del seguimiento por consulta externa. Resultados: En los pacientes obesos se observó el mayor número de complicaciones (9), de ellas 4 referentes a neuropraxia de la rama profunda del nervio peroneo o fibular, 2 con hematomas de la herida y una con infección. Hubo 2 pacientes con linfangitis. Hubo 11 pacientes con 14 complicaciones (9,4 por ciento de los intervenidos). Conclusiones: Las complicaciones más importantes fueron neuropraxia de las ramas superficial y profunda del nervio peroneo, el hematoma e infección de la herida(AU)

Introduction: In the surgical procedure of genu varum pain treatment, the osteotomy of the fibula is a common step that accompanies the valgus tibial osteotomy, with a percentage of known complications. The authors of this work began to apply a new approach in the treatment of this condition, with fibular ostectomy, where complications also occur. Objective: To identify the complications that may appear in the ostectomy of the fibula. Methods: 116 patients with degenerative changes of the internal compartment of the knee were evaluated; operated by fibular ostectomy, during the period from April 2016 to April 2018. Complications were collected from the moment of surgery, its evolution and treatment, through follow-up by external consultation. Result: In the obese patients, the greatest number of complications was observed (9), of which 4 related to neuropraxia of the deep branch of the peroneal or fibular nerve, 2 with wound hematomas and one with infection. There were 2 patients with lymphangitis. There were 11 patients with 14 complications (9.4 percent of those who underwent surgery). Conclusions: The most important complications were neuropraxia of the superficial and deep branches of the peroneal nerve, the hematoma of the wound and infection(AU)

Variación del espacio articular externo de la rodilla posterior a la ostectomía del peroné / Change of the external intra joint space of posterior knee after fibular ostectomy

RESUMEN Introducción: en el diagnóstico y tratamiento del genu varo doloroso es importante el estudio radiográfico de la rodilla, se pueden visualizar los cambios estructurales que aparecen en las superficies articulares de la rodilla. Objetivo: demostrar desde el punto de vista radiológico la variación que ocurre posterior a la ostectomía del peroné en los pacientes operados de genus varos. Materiales y métodos: se realiza un estudio descriptivo, prospectivo y lineal en el Hospital Militar Dr. Mario Muñoz Monroy de Matanzas desde abril del 2016 -2017 donde se aplica la técnica de ostectomía del peroné, del Dr. Zhang Ying-Ze, se presentan los primeros 51 pacientes operados, un total de 57 rodillas, a los cuales se les realizó radiografía previa a la operación y posterior a ella al cabo de los 6 meses, donde se midió la altura del espacio articular externo. Resultados: el promedio de edad es de 67,2 años (50 años el menor y 84 años el mayor), de los cuales 23 eran hombres y 28 mujeres, previo al tratamiento quirúrgico el promedio de este espacio fue de 8,84 mm±1,01 mm (18 mm el mayor y el menor 2 mm) y al cabo de los 6 meses fue de 6,08 mm±0,9 mm(el mayor 10 mm y el menor 2 mm), en 6 pacientes no hubo variación de esta medida. Conclusiones: con la ostectomía proximal del peroné se logra disminuir el espacio articular externo modificando el eje mecánico y anatómico del miembro inferior, lo que se traduce por una disminución de la compresión interna articular (AU).

ABSTRACT Background: the radiographic study of the knee is very important in the painful genu varum diagnosis and treatment: structural changes appearing in the knee joint surfaces may be observed. Objective: to show the changes taking place after fibular ostectomy in the patients surgically treated of genu varum from the radiological point of view. Material and methods: a lineal, prospective, descriptive study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy" of Matanzas from April 2016 to April 2017, in 51 patients operated on applying Dr Zhang Ying-Ze's fibular ostectomy technique: a total of 57 knees. X-rays were taken before the surgery and six months after it, measuring the height of the external intra joint space. Results: the average age was 67.2 years (50 years the youngest and 84 the eldest patients); 23 were men and 28 women. Before the surgical treatment the average space was 8.84 mm±1.01 mm (18 mm the biggest and 2 mm the smallest); six months after surgery, it was 6.08 mm±0.9 mm (10 mm the biggest and 2 mm the smallest); six patients did not showed changes of the space. Conclusions: with the proximal fibular ostectomy we achieved the reduction of the external fibular space, modifying the anatomical and mechanical axis of the lower limb, what leads to a reduction of the internal joint compression (AU).

Ostectomía del peroné en el genu varo doloroso de rodilla. Resultados preliminares al año de operado / Fibula ostectomy in painful genu varum of the knee. Preliminary results after a year of the surgery

Introducción: la artrosis de rodilla puede llegar a ser una patología muy invalidante por sus síntomas, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa que ha aumentado su prevalencia en las últimas décadas, muy ligada al envejecimiento poblacional. Objetivo: validar la técnica de la ostectomía del peroné en el genu varo doloroso como nueva opción de tratamiento. Materiales y Métodos: se realizó un estudio, prospectivo y lineal en el Hospital Militar "Dr. Mario Muñoz Monroy" de Matanzas, desde abril del 2016 hasta agosto del 2017. Se aplicó la nueva técnica del Dr. Ying-Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China. En la actualidad ya existe una casuística de 75 pacientes, con 84 rodillas operadas de los cuales se presentan los resultados de los primeros 11 pacientes, posterior al año de operado. Resultados: el promedio de edad fue de 64,3 años, (45 años el menor y 84 años el mayor); de los cuales 8 eran hombres y 3 mujeres. Se aplicó la escala visual analógica para el dolor pre y post-operatorio en cuanto a la marcha y al subir escalones; estando todos los pacientes al caminar, por encima de 6 y al subir escaleras por encima de 7. Después de un año de operados 10 pacientes se encontraban evaluados al caminar entre 0 y 3 puntos, y al subir escalones 9 en igual puntuación; 1 en 5, y solamente 1 paciente mantuvo igual puntuación antes de operarse. Valorando estas puntuaciones se evaluaron 9 pacientes de bien, 2 de regular, y se presentaron 3 complicaciones. Conclusiones: al año de seguimiento ocurre gran mejoría del dolor, mejorando la seguridad del paciente durante la marcha (AU).

Introduction: the fibular osteoarthritis could be a very invalidating disease due to its symptoms, characterized by pain, insecurity and functional loss. It is a degenerative disease whose prevalence has increased during the last decades, tightly linked to population ageing. Objective: to validate the technique of fibular ostectomy in the painful genu varum as a new treatment option. Materials and Methods: a prospective, lineal study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy", of Matanzas, from April 2016 to August 2017. It was used the new technique of Dr. Ying-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of Hebei Medical University in Shijiazhuang, China. Currently there is a series of cases of 75 patients, with 84 operated knees; the results of the first 11 operated patients, are presented here after a year of the surgery. Results: the average age was 64.3 years, 45 years the youngest and 84 years the eldest; from them, 8 were men and 3 women. The analogical visual scale for the pre and post-surgical pain was applied during the gait and when going upstairs. During the gait all the patients were above 6, and when climbing upstairs above 7. After a year from the operation 10 patients got an evaluation between 0 and 3 points during the gait, and 9 got the same score when climbing steps; one got 5, and only 1 patient kept the same score than before the operation. Taking into account these scores, 9 patients were evaluated as good, 2 regular, and there were 3 complications. Conclusions: after a one-year follow-up, the pain greatly improves, improving patients' security during the gait (AU).

Osteotomía del peroné, nueva técnica quirúrgica en el genu varo doloroso. Proceder y presentación de dos casos / Fibular osteotomy, new surgical technique in the painful genu varum: procedure and two-case presentation

La artrosis de rodilla puede llegar a ser una patología muy invalidante por los síntomas que produce, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa cuya prevalencia ha ido en aumento en las últimas décadas. Está muy ligada al aumento de las expectativas de vida de la población, fenómeno que ocurre en países del primer mundo con un alto nivel de salud y que ocurre igualmente en nuestro país dado el desarrollo de nuestro sistema de salud. Existen múltiples técnicas quirúrgicas para corregir la deformidad y aliviar el dolor; van desde osteotomías correctoras hasta las artroplastias, todas encaminadas al alivio del dolor en primer lugar y a corregir las deformidades, pero las últimas conllevan mayor tiempo de rehabilitación y son más costosas. Este trabajo va encaminado a la presentación de dos pacientes operados con la nueva técnica del Dr. Ying Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China, con la cual, a través de una osteotomía, se descomprime el compartimento interno y se quita tensión ósea en el externo por la resección peronea. Sus objetivos son actuar sobre el dolor, mejorar la función y la marcha como beneficios de este proceder de mínima acción sobre las partes articulares y lograr la rápida incorporación del paciente a su vida social; esto es tema para la obtención del doctorado por parte del autor principal del presente trabajo (AU).

Knee osteoarthritis could be a very disabling disease due to the symptoms it produces, characterized by pain, insecurity and functional loss. It is a degenerative disease which prevalence has increased in the last decades tightly related to the increment of the population's life expectancy, phenomenon occurring in the developed countries with a high life level and also occurring in our country because of the development of our health system. There are several surgical techniques to correct deformation and to relieve pain. They go through correcting osteotomies to arthroplasties, all of them aimed, firstly to pain relieving and also to correcting deformations. The last ones need more rehabilitation time and are more expensive. This work is devoted to presenting two patients operated with the new technique of Dr. Yin-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of the Medical University of Hebei, in Shijiazhuang, China, with which, through an osteotomy, the internal compartment is decompressed and the bone tension in the external one is finished due to the peroneal excision. Its aims are acting upon the pain, improving function and gait as a benefit of this minimal action procedure on the articular parts and achieving the faster incorporation of the patient to his social life; this is the theme the main author of this article is going to develop for obtaining the doctorate in sciences (AU).

Tratamiento quirúrgico de las dismetrías y deformidades angulares de miembros inferiores mediante epifisiodesis con tornillos transfisarios (técnica de Metaizeau) / Surgical treatment of lower limb length discrepancy and angular deformity by epiphysiodesis with transphyseal screw (Metaizeau technique) / Tratamento cirúrgico das dismetrias e deformidades angulares de membros inferiores mediante epifisiodese com parafusos transfisários (técnica de Metaizeau)

Evaluamos los niños con dismetrías y deformidades angulares operados mediante la Técnica de Metaizeau en el período 2010-2014, mediante un estudio retrospectivo de 11 pacientes, analizados en 2 Grupos. Grupo 1 (Dismetrías), formado por 5 pacientes, de los cuales 3 fueron operados solamente mediante esta técnica, mientras que 2 requirieron adicionalmente procedimientos de alargamiento femoral, valoramos dismetría inicial, dismetría por predicción para el último control y para el final de la madurez, y dismetría final. Grupo 2 (Deformidades Angulares), formado por 6 pacientes, de los cuales 1 presentaba genu varo, 4 genu valgo y 1 valgo de tobillo, valoramos el ángulo femorotibial anatómico, ángulo femoral distal lateral anatómico, ángulo tibial proximal medial, y ángulo tibioastragalino. En ambos Grupos se valoraron las complicaciones. El seguimiento promedio fue de 2 años y 5 meses. En el Grupo 1 obtuvimos dismetría promedio inicial 7,64 cm., dismetría promedio por predicción para el último control 8,54 cm., dismetría promedio final 7,62 cm., corrección promedio lograda 0,91 cm. En el Grupo 2 el promedio de corrección del ángulo femorotibial anatómico 16,85˚, promedio de corrección del ángulo femoral distal lateral anatómico 16,85˚, promedio de corrección del ángulo tibial proximal medial 7,62˚. No detectamos complicaciones en ningún paciente. En 8 (72,72%) pacientes la Técnica fue efectiva, mientras que en 3 (27,27%) los resultados fueron malos por errores técnicos o error en la predicción. La Técnica de Metaizeau, respetando los detalles quirúrgicos y realizando una adecuada predicción, es una buena opción para el tratamiento de dismetrías y deformidades angulares.

We evaluated children with lower limb length discrepancy and angular deformity operated by the Metaizeau technique in the 2010-2014 period through a retrospective study of 11 patients analyzed in 2 groups. Group 1 (Lower limb length discrepancy), consisted of 5 patients, among whom 3 were operated only by Metaizeau technique, whereas the other 2 additionally required procedures for femoral elongation. We evaluated initial discrepancy, predicted discrepancy for ultimate control and at maturity, and final discrepancy. Group 2 (Angular deformity), consisted of 6 patients, among whom 1 had genu varum, 4 genu valgum and, 1 ankle valgus. We evaluated anatomic femorotibial angle, anatomic lateral distal femoral angle, medial proximal tibial angle, and tibio talar angle. In both groups the complications were assessed. The average follow-up was 2 years and 5 months. In Group 1 we obtained the following values: average initial discrepancy, 7.64 cm; average discrepancy predicted for ultimate control, 8.54 cm; average final discrepancy, 7.62 cm and average correction achieved, 0.91 cm. In Group 2 the values were: average correction anatomic femorotibial angle, 16.85˚; average correction anatomic lateral distal femoral angle, 16.85˚ and average correction medial proximal tibial angle, 7.62˚. We found no complications in any patient. In 8 patients (72.72%) the technique was effective, while in 3 (27.27%) the results were poor due to technical errors or prediction errors . Metaizeau Technique, respecting the surgical details and making an accurate prediction is an effective, simple and uncomplicated procedure.

Avaliamos as crianças com dismetrias e deformidades angulares operadas pela técnica de Metaizeau no período de 2010 até 2014, mediante um estudo retrospectivo de 11 pacientes analisados em dois grupos. Grupo 1 (Dismetrias), constituído por cinco pacientes, dos quais 3 foram operados apenas por esta técnica, enquanto que os outros dois precisaram de procedimentos adicionais de alongamento femoral. Avaliamos a dismetria inicial, a dismetria por predição para o último controle e para o final da maturação, e a dismetria final. Grupo 2 (deformidades angulares), constituído por 6 pacientes, entre os quais um apresentava genu varo, 4 genu valgo e um, valgo do tornozelo. Avaliamos o ângulo femorotibial anatômico, o ângulo femoral distal anatômico o ângulo femoral distal lateral anatômico, o ângulo tibial proximal medial, e o ângulo tibioastragalino. Em ambos os grupos foram avaliadas as complicações. O seguimento médio foi de 2 anos e 5 meses. No Grupo 1, obtivemos dismetría inicial média de 7,64 cm, dismetria média por previsão para o último controle de 8,54 cm, dismetría final média de 7,62 cm e correcção média atingida de 0,91 cm. No Grupo 2, a correção de ângulo tibiofemoral anatómica média 16,85˚, correção média do ângulo femoral distal lateral anatómico 16,85˚, e correção média de ângulo tibial proximal medial de 7,62˚. Não detectamos complicações em nenhum paciente. A técnica foi efetiva em 8 (72,72%) pacientes, mas em 3 (27,27%) os resultados foram insatisfatórios por erros técnicos ou na predicção. A técnica de Metaizeau, desde que sejam respeitados os detalhes cirúrgicos e seja feita uma predicção adequada, é uma boa escolha para o tratamento de dismetrías e deformidades angulares.

Genu varo artrósico inestable: seguimiento a 2 años / Unstable varus osteoarthritic knee. Follow-up of two years

Introducción: La osteotomía tibial valguizante de apertura es un procedimiento ampliamente realizado para tratar la gonartrosis unicompartimental medial. Existen pacientes que se encuentran al límite de la indicación de dicha técnica quirúrgica. El objetivo del presente trabajo es comunicar nuestro algoritmo diagnóstico terapéutico y técnica quirúrgica empleada. Material y métodos: Estudio observacional, serie de casos, retrospectivo. Población de 14 pacientes (15 rodillas) sometidos a osteotomía valguizante aditiva de tibia asociada a plástica ligamentaria de LCA (mismo tiempo quirúrgico) durante el año 2015. Seguimiento promedio de 24 meses. Se evaluaron parámetros pre y postoperatorios. Resultados: Parámetros postoperatorios (14 rodillas): Dolor (EVA) 0.45/10; Lachman 40% negativos (-) y 60% una cruz (+); Lysholm 98,77 puntos y trofismo muscular cuadricipital 1,05 cm (negativo). En todos los casos, volvieron a la práctica deportiva recreacional. Se registró un caso con evolución negativa (6.66% de la población). Conclusión: La osteotomía tibial de apertura asociada a reconstrucción artroscopia de LCA la indicamos en aquellos pacientes que presentan un síndrome de inestabilidad (ruptura crónica de LCA) con deseje en varo independientemente de la presencia o no de dolor; o en presencia de un síndrome osteoartrítico (artrosis con predominio en compartimiento medial) con deseje en varo e inestabilidad. Obtuvimos buenos resultados a corto y mediano plazo, sin complicaciones médicas, en donde los pacientes regresan a la práctica recreacional deportiva previa, con un alto porcentaje de satisfacción en nuestra serie presentada (mayor al 93%). Nivel de evidencia: IV (serie de casos).

Introduction: The tibial valgus aperture osteotomy is a procedure widely used to treat medial unicompartmental gonarthrosis. There are patients who are at the limit of the indication of said surgical technique. The objective of the present work is to communicate our therapeutic diagnostic algorithm and surgical technique used. Material and Methods: Observational study, case series, retrospective. Population of 14 patients (15 knees) submitted to additive valgus osteotomy of tibia associated with ligamentous plastic of ACL, during the year 2015. Average follow-up of 24 months. Pre and postoperative parameters were evaluated. Results: Postoperative parameters (14 knees): Pain (EVA) 0.45 / 10; Lachman 40% negative (-) and 60% one cross (+); Lysholm 98,77 points and quadricipital muscle trophy 1.05 cm (negative). In all cases, they returned to recreational sports. There was a case with a negative evolution (6.66% of the population). Conclusion: The tibial opening osteotomy associated with ACL arthroscopy reconstruction is indicated in those patients who present with an instability syndrome (chronic ACL rupture) with varus malalignment independently of the presence or absence of pain; or in the presence of an osteoarthritic syndrome (osteoarthritis with predominance in medial compartment) with varus desire and instability. We obtained good results in the short and medium term, without medical complications, where patients return to previous recreational sports practice, with a high percentage of satisfaction in our presented series (greater than 93%). Level of evidence: IV (case series).

Tratamento da tíbia vara de blount com órteses moldadas: uma nova perspectiva / Management of infantile blount’s disease with molded orthoses: a new perspective

Objetivo: Este estudo retrospectivo visa avaliar o tratamento com órteses moldadas individualmente em estágios precoces da doença.Métodos: Foram avaliados os prontuários de pacientes submetidos a tratamento da tíbia vara de Blount com órteses moldadas para descompressão medial entre 2010 e 2014. O ângulo de deformidade(ângulo meta-diafisário de Drennan) e a classificação Langenskiõldforam aferidos antes e após o tratamento por médico ortopedista especialista com mais de 5 anos de prática, no modo cego em relação a o estudo e aos pacientes. Resultados: A média de idade dos pacientes foi de 2,57 anos. Quatro eram do sexo feminino e seis do sexo masculino. Metade da amostra apresentava doença bilateral.O ângulo de deformidade dos pacientes apresentou redução média estatisticamente significativa após o tratamento (p < 0,001). Sexo e lateralidade não influenciaram estatisticamente na alteração do ângulo de deformidade após o tratamento (p > 0,05). Conclusão:O uso noturno de órteses moldadas para descompressão medial foi efetivo para redução do ângulo meta-diafisário na Doença de Blountem pacientes menores de 3 anos de idade, independente do sexo e bi lateralidade da doença. Pacientes com mais de 3 anos não se beneficiaram do uso da órtese. Nível de EvidênciaIV, Serie de Casos

Objective: This retrospective study evaluated treatment with individuallycontoured molded bracing at early stages of the disease.Methods: We evaluated the medical records of patients undergoingtreatment of Blount’s disease with molded orthoses formedial decompression between 2010 and 2014. The deformityangle (Drennan’s metaphyseal-diaphyseal angle) and Langenskiõldclassification were measured before and after treatment by a pediatricorthopedic surgeon with over 5 years of practice, blinded forthe study and patients. Results: The mean age was 2.57 years old.Four patients were female and six male. Half of the total sample hadbilateral disease. The average deformity angle showed a statisticallysignificant reduction after treatment (p <0.001). Gender and lateralitydid not statistically influence the change of the deformity angleafter treatment (p> 0.05). Conclusion: The nightly use of moldedorthoses for medial decompression was effective in reducing themetaphyseal-diaphyseal angle in Blount’s disease in children under3 years of age, regardless of gender and bilateral disease. Patientsover 3 years old did not benefit from bracing. Level of EvidenceIV, Case Series.

Osteogénesis imperfecta corrección de Varo con Osteotomías en paciente adulto reporte de un caso / Osteogenesis imperfecta varus correction in adult patient: case report

Introducción: La osteogénesis imperfecta (OI) es una enfermedad genética, que se caracteriza por la alteración de la formación de colágeno tipo 1 (COL1A1 Y COL1A2), que causa fragilidad, ósea y dentaria. Según el grado de afectación el Dr. Sillence en 1979 la clasificó en cuatro tipos; el Dr. Glorieux añadió un tipo (OI-V), y el Dr. Horacio Plotkin subdividió el grupo OI-IV, el más heterogéneo, en cinco subtipos. Materiales y Métodos: Se presenta el caso de una paciente de sexo femenino de 23 años de corta estatura (115cm) que consulta por presentar deformidad en varo de miembros inferiores, que dificulta la marcha. Se le practicó varias osteotomías en fémures y tibias fijándoles con clavos rígidos de kuntscher, en 2 tiempos, se da tratamiento coadyuvante con bifosfonatos. Discusión: Se puede realizar la corrección quirúrgica del genuvaro mediante múltiples osteotomías en el mismo hueso con posterior realineación.

Introduction: Osteogenesis imperfecta (OI) is a genetic disease characterized by impaired formation of type 1 collagen (COL1A1 and COL1A2), causing bone and teeth fragility, According to the degree of impact, Dr. Sillence in 1979 published his classification consisting of four types; Dr. Glorieux added a new group (OI-V), and Dr. Horacio Plotkin divided the OI-IV, the most heterogeneous group, in five subtypes. Case report: This is the case of a 23 year-old female patient with short stature (115cm) that came to our hospital complaining of limb deformation and wlaking problems. Osteotomy was performed along both femurs and tíbias, fixing them later, in a second time, with Kuntscher nails. Adjuvant treatment with biphosphonates was also prescribed.

Displasia fibrocartilaginosa focal de femur. Un caso de correccion espontanea / Focal fibrocartilaginous dysplasia of the femur. A case with spontaneous resolution

La displasia fibrocartilaginosa focal es una enfermedad rara que genera una deformidad localizada en los huesos largos de los niños. Algunos autores recomiendan la cirugía como tratamiento inicial. El objetivo de este trabajo es comunicar un caso de displasia fibrocartilaginosa en el fémur que tuvo una resolución espontánea y revisar la bibliografía. Se comunica el caso de una niña de 2 meses de edad con deformidad en varo del fémur izquierdo y discrepancia de longitud de los miembros inferiores. La radiografía mostró una imagen en la diáfisis femoral radiolúcida de bordes escleróticos y deformidad en varo de 30º. En un período de 22 meses, se observó la corrección espontánea completa de la deformidad. Se han publicado 20 casos de localización femoral, 17 tratados con cirugía y tres, con corrección espontánea. Se aconseja mantener una conducta expectante durante un período más prolongado que el recomendado en la literatura para evitar procedimientos invasivos innecesarios.

Focal fibrocartilaginous dysplasia is a condition of unknown etiology associated with long bone deformities in children. Some authors recommend surgery as the initial treatment. The aim of this paper is to report a case of focal fibrocartilaginous dysplasia of the femur with spontaneous resolution and to review the literature. A case of a 2-month-old girl with varus deformity of the left femur and leg length discrepancy is reported. Radiographs showed a radiolucent area with marginal sclerosis and a varus deformity of 30º. Over a period of 22 months, complete spontaneous correction of the deformity was noticed. Twenty cases of femoral focal fibrocartilaginous dysplasia have been reported in the literature, 17 were treated surgically, three showed spontaneous correction. Patients should be monitored during a period longer than that recommended to avoid unnecessary invasive procedures.

Osteotomía de tibia en el genu varo del adulto mayor / Ostéotomie du tibia dans le genu varum chez les personnes âgées / Tibial osteotomy for genu varum in the elderly

Objetivo: demostrar la utilidad de la osteotomía en el genu varo, caracterizar algunas variables demográficas y biomédicas, y mostrar los resultados. Métodos: se realizó un estudio retrospectivo descriptivo en el Centro de Investigaciones en Longevidad, Envejecimiento y Salud con 121 pacientes diagnosticados e intervenidos quirúrgicamente por genu varo en el período de enero 2006 a diciembre 2009. Se les realizó osteotomía valguizante de tibia. La muestra quedó constituida por 84 pacientes (91 rodillas) que cumplían los criterios asumidos. Resultados: el grupo de edades más frecuentes fue de 70 a 79 años y el sexo femenino, predominaron los grados III y IV de la clasificación de Albäck; las complicaciones resultaron pocas y se obtuvo 82 por ciento de buenos resultados. Conclusión: ocurre gran mejoría del dolor y flexión de al menos 90° a los 2 años de seguimiento de pacientes adultos mayores operados con el diagnóstico de genu varo, lo cual produce un alto número de resultados buenos(AU)

Objective: to prove the usefulness of osteotomy for genu varum, characterize some biomedical and demographic variables and show the results. Methods: a descriptive retrospective study was performed in The Research Centre for Healthy Ageing and Longevity in 121 diagnosed patients who were operated on genu varum from January 2006 to December 2009. The patients underwent tibial valgus osteotomy. The sample was composed of 84 patients (91 knees) that fulfilled the assumed criteria. Results: the most frequent age group was women 70-79 years old. Degrees III and IV according to Albach et al classification predominated in the study. There were few complications and the 82 percent of the results were good. Conclusion: improvement in pain relief and at least 90 degrees offlexion occurs at 2-year follow-up in elderly patients that undergo surgery after a diagnosis of genu varum what represents a high figure of good results(AU)

But: démontrer l'utilité de l'ostéotomie dans le genu varum; caractériser quelques variables démographiques et biomédicales, et montrer les résultats. Méthodes: une étude rétrospective descriptive de 121 patients diagnostiqués et opérés de genu varum a été réalisée au Centre de recherches sur la longévité, le vieillissement et la santé, dans la période de janvier 2006 à décembre 2009. Ils ont été traités par ostéotomie valgisante du tibia. L'échantillon a été constitué de 84 patients, en respectant les critères établis. Résultats: la tranche d'âge et le sexe les plus souvent touchés ont été respectivement, 70-79 ans et le sexe féminin; il y a eu peu de complications, et de très bons résultats (82 pourcent). Conclusion: l'usage de l'ostéotomie favorise le soulagement de la douleur et l'amélioration de la flexion au moins 90°en 2 ans de suivi de patients âgés diagnostiqués et opérés de genu varum, en produisant ainsi de très bons résultats(AU)

Osteotomía valguizante de tibia proximal en el tratamiento del genu varo artrósico / Valgus Osteotomy of the Proximal Tibia in the Treatment of Arthritic Genu varo

Fundamento: la asimilación de fuerzas en una rodilla mal alineada implica dolor, deformidad y disminución del rango de movimiento. La corrección quirúrgica retarda la progresión de la afección degenerativa articular y la realización de una artroplastia total. Objetivo: evaluar los resultados de la osteotomía valguizante de tibia proximal en el tratamiento del genu varo artrósico. Métodos: estudio descriptivo sobre 21 pacientes atendidos en el Servicio de Ortopedia del Hospital Territorial Docente Julio Aristegui Villamil, entre enero del 2003 y septiembre del 2008, con el diagnóstico de gonartrosis del compartimiento medial y deformidad angular vara secundaria, a los que se les realizó una osteotomía valguizante de tibia proximal con el uso de fijador externo RALCA®. Resultados: predominaron los pacientes masculinos (71,4 %), con edad media de 56,3±2,01 años, el sobrepeso como factor predisponente (57, 1 %) y 52,3 % de lesiones grado II según criterios de Ahlback. Desde el posoperatorio inmediato hasta los dos años, se logró un promedio de corrección quirúrgica del eje femorotibial de 9±1, 13 grados, con una pérdida de corrección de 2 ± 0,34 grados. La osteítis del alambre fue la complicación más frecuente (19, 04 %). A los dos años de evolución los resultados eran buenos en el 80,9 % de los casos. Se retrasó la artroplastia total o parcial de rodilla, disminuyó el dolor, mejoró la capacidad funcional y la calidad de vida en el 95, 2 % de los pacientes. Conclusiones: la osteotomía valguizante de tibia proximal resultó efectiva en el tratamiento del genu varo artrósico.

Background: the assimilation of forces in a misaligned knee involves pain, deformity and decreased range of motion. Surgical correction delays the progression of degenerative joint affection and the performance of a total arthroplasty. Objective: To assess the results of valgus osteotomy of the proximal tibia in the treatment of arthritic genu varo. Methods: A descriptive study was conducted including 21 patients treated at the Orthopedics Service of the Julio Aristegui Villamil Teaching Territorial Hospital from January 2003 to September 2008, with the diagnosis of medial compartment knee osteoarthritis and angular deformity in the secondary rod. These patients underwent valgus osteotomy of the proximal tibia using an external fixator RALCA ®. Results: Male patients predominated (71.4%) with an average age of 56.3 ± 2.01 years old, as well as overweight as a predisposing factor (57, 1%) and 52.3% of grade II lesions according to Ahlback criteria . From the immediate postoperative period up to two years of evolution, we achieved an average femorotibial axis surgical correction of 9 ± 1.13 degrees, with a loss of correction of 2 ± 0.34 degrees. Wire osteitis was the most common complication (19, 04%). After two years of evolution the results were good in 80.9% of cases: partial or total arthroplasty of the knee was delayed, pain was reduced and functional capacities as well as life quality of patients were improved in 95, 2% of cases. Conclusions: Valgus osteotomy of the proximal tibia was effective in the treatment of arthritic genu varo.

A prática do futebol acentua os graus de Geno Varo / Does soccer practice stress the degrees of genu varo

Estudos têm mostrado uma varização progressiva entre os períodos de infância e adolescência. Variáveis como idade, peso, ingestão hormonal e vitamínica, ambiente e o treinamento de futebol podem interferir no alinhamento do joelho. OBJETIVOS: A) Comparar o alinhamento do joelho de praticantes e não praticantes de futebol; e B) Determinar associações entre este alinhamento com variáveis antropométricas e neuromotoras da aptidão física. MÉTODOS: A distância intercondilar (DIC) e a intermaleolar (DIM) foram mensuradas em centímetros em 128 adolescentes com idades entre 14 a 17 anos, dentre os quais 65 eram praticantes de futebol e 63 não eram praticantes de tal modalidade. As variáveis antropométricas mensuradas foram peso e estatura, enquanto as neuromotoras inclusas foram agilidade e velocidade. RESULTADOS: Os praticantes de futebol apresentaram graus mais acentuados de joelho varo do que os não jogadores de futebol em todas as idade; entretanto, apenas nos 14 e 17 anos e no grupo total (todas idade juntas) essa diferença foi estatisticamente significativa (p < 0,05). Geno valgo (DIM) tende a ser menor nos praticantes de futebol em todas as idade quando comparados com os não jogadores de futebol; entretanto, tal diferença foi estatisticamente significativa (p < 0,05) apenas nos 17 anos de idade e no grupo total. A DIC nos praticantes de futebol apresentou correlação (p < 0,05) com a agilidade (r = -0,27) e o peso (r = -0,27), enquanto a DIM apresentou correlação (p < 0,05) com o peso (r = 0,26). CONCLUSÃO: Praticantes de futebol mostram um alinhamento do joelho mais acentuado a favor do varismo do que os não praticantes de futebol. Houve associação significativa entre os graus de geno varo e valgo com o peso e a agilidade; nesse sentido, sugere-se mais estudos para explicar essa interessante relação. Os achados do presente estudo suportam a hipótese de que o futebol acentua os graus de geno varo e/ou os sujeitos são selecionados naturalmente para tal prática.

Studies have shown a progressive variation between the childhood and adolescence periods. Variables such as age, weight, vitamin/hormone intake, the environment and soccer training may interfere in the knee alignment. OBJECTIVE: a- to compare the knee alignment in soccer and non-soccer practitioners, and b- to determine associations between this alignment and anthropometric and neuromotor variables. METHODS: The intercondylar (IC) and intermalleolar (IM) distances were measured in centimeters in 128 male aged from 14-17 years, soccer practitioners (n=65) and non-practitioners (n=63). The anthropometric variables measured were: body weight and height, whereas the neuromotor variables included agility and speed. RESULTS: Soccer players revealed a greater degree of genu varum (IC) than non-soccer players in all ages, but just in 14, 17 years-old and total group (all ages together) these differences were statistically significant (p< .05). Genu valgum (IM) tended to be less remarkable in soccer players than in non-soccer players in all ages; however, significant differences were observed only in 17 years and total group (p< .05). The IC distances in soccer players correlated (p< .05) with agility (r= .-27), weight (r= .-27); while IM distances correlated (p< .05) with weight(r=.26). CONCLUSION: Soccer players showed more remarkable genu varum than the non-soccer players. There was a significant association between degrees of varus and valgum with body weight and agility. Such fact deserves further investigation in order to explain this interesting correlation. Present findings support the hypothesis that soccer leads to greater varus and/or this sport naturally selects subjects with a certain degree of varus.

Relação entre genuvaro e aptidão física em crianças e adolescentes / The relationship between genu varum and physical fitness in children and adolescents

Objetivo: Relacionar o genuvaro e variáveis de aptidão física em crianças e adolescentes. Materiais e Métodos: foram avaliados 328 escolares masculinos e femininos com idade entre 6 a 18 (11,6 ± 3,2) anos. O genuvaro foi estimado a partir da distância intercondilar (cm) e as variáveis de aptidão física incluídas foram: estatura (cm), peso (kg), índice de massa corpórea (kg/m2), adiposidade (mm), diâmetro do fêmur (cm), impulsão vertical (cm), agilidade (seg), velocidade (seg) e flexibilidade (cm), segundo a padronização CELAFISCS. As análises estatísticas utilizadas foram: a média, desvio-padrão e o coeficiente de associação pela correlação linear de Pearson. Adotando-se o nível de significância de p<0,05. Resultados: foram observadas associações positivas e significativas (p<0,05) entre genuvaro e variáveis antropométricas, como idade (r=0,34), estatura (r=0,29), peso (r=0,42), IMC (r=0,35) e variáveis neuromotoras, como IVC (r=0,44) e associação negativa e significativa com a velocidade (r= -0,28) no sexo masculino. Entretanto, no sexo feminino não houve associações significativas (p<0,05) entre genuvaro e variáveis antropométricas ou neuromotoras. Conclusões: algum grau de genuvaro, poderia favorecer a performance em esportes que utilizariam a velocidade e impulsão vertical nos escolares masculinos; assim como também o aumento do peso corporal seria conseqüência do mau alinhamento e não causa do varismo.

The purpose of the study was to verify the relationship between genu varum and physical fitness in children and adolescents. Sample consisted of 328 boys and girls from 6 to 18 years old (11.6 ± 3.2) years, who lived in Ilhabela in SP- Brazil. Genu varum was determined by the, intercondilar distances and physical fitness variables measured were body height, body weight, upper limb strength, body adiposity, knee diameter, lower limb strength, agility, speed and flexibility. Statistical analyses used were: mean values, standard deviation and Pearson’s linear correlation. A level of p<.05 was taken as significant. Positive and significant correlations were observed among genu varum and age (r= .34), body height (r= .29), body weight (r= .42), upper limb strength (r= .35), lower limb strength (r= .44) and a negative to speed (r= -.28) in boys. However, no significant correlations (p<.05) were observed among genu varum and anthropometrics or neuromotor variables in girls. Presents findings permit to conclude that some degree of varus may improve sports performance, particularly in situation where velocity and jump skills are of fundamental importance, especially among boys. Authors hypothesized that body weight increase was a consequence the malalignment and not causing of varus.