Multimodal benefits of hypnosis on pain, mental health, sleep, and quality of life in patients with chronic pain related to fibromyalgia: A randomized, controlled, blindly-evaluated trial.

BACKGROUND AND PURPOSE: Fibromyalgia is a chronic syndrome marked by intense musculoskeletal pain often refractory to pharmacological treatment. Although studies have shown that hypnosis improves fibromyalgia pain, gaps in experimental design limit their reliability. This work aimed to evaluate the effects of hypnosis on pain, mental health, sleep, and quality of life in participants with fibromyalgia chronic pain. METHODS: In this prospective, parallel, randomized, controlled, blindly-evaluated trial, participants of both sexes (n = 49) diagnosed with fibromyalgia and with moderate to severe chronic pain attended 8 weekly 1-h sessions with a hypnotherapist. For the hypnosis group (n = 24), sessions consisted in induction of hypnotic trance followed by suggestions to promote analgesia. For the control group (n = 25), sessions consisted in casual unscripted conversation. Participants were assessed at baseline (7 days before), post-intervention (7 days after), and follow-up (3 months after). The primary outcome was pain intensity. The secondary outcomes were the sensory and affective dimensions of pain; pain unpleasantness; pain catastrophizing; anxiety and depression; sleep quality; fibromyalgia impact; and quality of life. RESULTS: Hypnosis significantly reduced pain scores both at post-intervention and follow-up in comparison with baseline. The analgesic effect of hypnosis combined with pharmacological treatment lasted for at least 3 months and was superior to analgesia promoted by first- and second-line pharmacological treatment alone. Hypnosis significantly improved all parameters evaluated as secondary outcomes both at post-intervention and follow-up without inducing adverse events. CONCLUSION: Our results corroborate that clinical hypnosis is an effective and feasible tool for managing chronic pain and other symptoms of fibromyalgia.

Ayahuasca and its major component harmine promote antinociceptive effects in mouse models of acute and chronic pain.

ETHNOPHARMACOLOGICAL RELEVANCE: Ayahuasca (AYA) is a psychedelic brew used in religious ceremonies. It is broadly used as a sacred medicine for treating several ailments, including pain of various origins. AIM OF THE STUDY: To investigate the antinociceptive effects of AYA and its mechanisms in preclinical models of acute and chronic pain in mice, in particular during experimental neuropathy. MATERIALS AND METHODS: The antinociceptive effects of AYA administered orally were assessed in the following models of pain: formalin test, Complete Freund's Adjuvant (CFA)-induced inflammation, tail flick test, and partial sciatic nerve ligation model of neuropathic pain. Antagonism assays and Fos immunohistochemistry in the brain were performed. AYA-induced toxicity was investigated. AYA was chemically characterized. The antinociceptive effect of harmine, the major component present in AYA, was investigated. RESULTS: AYA (24-3000 µL/kg) dose-dependently reduced formalin-induced pain-like behaviors and CFA-induced mechanical allodynia but did not affect CFA-induced paw edema or tail flick latency. During experimental neuropathy, single treatments with AYA (24-3000 µL/kg) reduced mechanical allodynia; daily treatments once or twice a day for 14 days promoted consistent and sustained antinociception. The antinociceptive effect of AYA (600 µL/kg) was reverted by bicuculline (1 mg/kg) and methysergide (5 mg/kg), but not by naloxone (5 mg/kg), phaclofen (2 mg/kg), and rimonabant (10 mg/kg), suggesting the roles of GABAA and serotonergic receptors. AYA increased Fos expression in the ventrolateral periaqueductal gray and nucleus raphe magnus after 1 h, but not after 6 h or 14 days of daily treatments. AYA (600 µL/kg) twice a day for 14 days did not alter mice's motor function, spontaneous locomotion, body weight, food and water intake, hematological, biochemical, and histopathological parameters. Harmine (3.5 mg/kg) promoted consistent antinociception during experimental neuropathy. CONCLUSIONS: AYA promotes consistent antinociceptive effects in different mouse models of pain without inducing detectable toxic effects. Harmine is at least partially accountable for the antinociceptive properties of AYA.

The FIFA 11+ injury prevention program for soccer players: a systematic review.

BACKGROUND: Soccer is one of the most widely played sports in the world. However, soccer players have an increased risk of lower limb injury. These injuries may be caused by both modifiable and non-modifiable factors, justifying the adoption of an injury prevention program such as the Fédération Internationale de Football Association (FIFA) 11+. The purpose of this study was to evaluate the efficacy of the FIFA 11+ injury prevention program for soccer players. METHODOLOGY: This meta-analysis was based on the PRISMA 2015 protocol. A search using the keywords "FIFA," "injury prevention," and "football" found 183 articles in the PubMed, MEDLINE, LILACS, SciELO, and ScienceDirect databases. Of these, 6 studies were selected, all of which were randomized clinical trials. RESULTS: The sample consisted of 6,344 players, comprising 3,307 (52%) in the intervention group and 3,037 (48%) in the control group. The FIFA 11+ program reduced injuries in soccer players by 30%, with an estimated relative risk of 0.70 (95% confidence interval, 0.52-0.93, p = 0.01). In the intervention group, 779 (24%) players had injuries, while in the control group, 1,219 (40%) players had injuries. However, this pattern was not homogeneous throughout the studies because of clinical and methodological differences in the samples. This study showed no publication bias. CONCLUSION: The FIFA 11+ warm-up program reduced the risk of injury in soccer players by 30%.

Anatomical variant of the meniscus related to posterior junction: a case report.

BACKGROUND: There are several reports on anatomical differences of the meniscus. However, there are only a few reports on abnormalities in both menisci and anatomical differences in anterior cruciate ligament insertions. CASE PRESENTATION: This is a case report of a 36-year-old Hispanic man presenting symptoms, including knee pain, locking, and effusion, with an anatomical abnormality of the menisci corresponding to the fusion of the posterior horns of the menisci in tandem with the insertion of the posterior meniscus fibers in the anterior cruciate ligament. CONCLUSIONS: This is the first study describing a meniscus anatomical variant with isolated posterior junction of the posterior horn with an anomalous insertion to the anterior cruciate ligament. The recognition of meniscus variants is important as they can be misinterpreted for more significant pathology on magnetic resonance images.

Medial patellofemoral ligament and medial patellotibial ligament reconstruction in children: preliminary results.

OBJECTIVE: The aim of this study was to evaluate the reconstruction of the medial patellofemoral ligament associated with the medial patellotibial ligament in skeletally immature patients. METHOD: This is a case series study in patients with patellar instability with open physis. In total, seven patients were evaluated: four males and three females were operated using the proposed technique. Patients with open physis who had more than two episodes of recurring patellar dislocation were included. No patients underwent additional procedures. The distance from the anterior tibial tuberosity to the trochlea grove (TT-TG) was measured in all patients. On physical examination, the inverted J-sign, the apprehension sign, and the knee range of motion parameters were used in the pre- and post-operative period. In addition, the Kujala and Lysholm scores were applied before and 12 months after surgery. The results were analyzed with the Wilcoxon test. RESULTS: The mean age of the patients was 11.28 in both genders. Comparing the data of the pre- and post-operative period, the inverted J-sign was present in six patients (85.7%) vs. absent in one (14.3%). The apprehension sign was absent in cases in the postoperative period; the range of motion was 117.85 ± 8.09 vs. 148.57 ± 3.77. The Kujala score was 42.57 ± 8.9 vs. 88.57 ± 5.09 and the Lysholm scores were classified as excellent or good in 28.6% and 71.4%, respectively. CONCLUSION: The combined reconstruction of the medial patellofemoral ligament combined with the medial patellotibial ligament in skeletally immature patients with predisposing factors, presents satisfactory results without episodes of recurrence or residual subluxation; according to these preliminary results, it should be considered as a treatment option.

OBJETIVO: Avaliar a reconstrução do ligamento patelofemoral medial associado ao ligamento patelotibial medial em pacientes com esqueleto imaturo. MÉTODO: Estudo de série de casos em pacientes com instabilidade da patela com fise aberta. Foram avaliados sete pacientes, quatro do sexo masculino e três do feminino, operados pela técnica proposta. Foram incluídos pacientes com esqueleto imaturo com luxação da patela acima de dois episódios com queixas de instabilidade. Nenhum paciente foi submetido a tratamento adicional. A distância da TA-GT (tuberosidade anterior da tíbia ao sulco da tróclea) foi medida em todos os pacientes. No exame físico, foram avaliados os sinais do J invertido, sinal da apreensão e amplitude de movimento, como parâmetros pré- e pós-operatórios de 12 meses, além dos escores de Kujala e Tegner Lysholm. Os resultados foram calculados pelo teste dos sinais de Wilcoxon. RESULTADOS: A média de idade dos pacientes foi de 11,28 em ambos os gêneros. Na comparação dos dados do período pré- e pós-operatório, o sinal do J invertido estava presente em seis (85,7%) pacientes vs. um (14,3%) no pós-operatório. O sinal da apreensão estava ausente em 100% dos casos no pós-operatório. A amplitude de movimento foi de 117,85 ± 8,09 vs. 148,57 ± 3,77. O escore de Kujala foi de 42,57 ± 8,9 vs. 88,57 ± 5,09 e no escore de Lysholm foram classificados como excelentes ou bons 28,6% e 71,4% respectivamente. CONCLUSÃO: A reconstrução do ligamento patelofemoral medial combinada com o ligamento patelotibial medial, em pacientes esqueleticamente imaturos na presença de fatores predisponentes, apresenta resultados satisfatórios, sem episódios de recidiva ou de subluxação residual, devendo ser considerada como uma opção de tratamento a partir destes resultados preliminares.

Medial patellofemoral ligament and medial patellotibial ligament reconstruction in children: preliminary results / Reconstrução do ligamento patelofemoral medial e ligamento patelotibial medial em crianças

ABSTRACT OBJECTIVE: The aim of this study was to evaluate the reconstruction of the medial patellofemoral ligament associated with the medial patellotibial ligament in skeletally immature patients. METHOD: This is a case series study in patients with patellar instability with open physis. In total, seven patients were evaluated: four males and three females were operated using the proposed technique. Patients with open physis who had more than two episodes of recurring patellar dislocation were included. No patients underwent additional procedures. The distance from the anterior tibial tuberosity to the trochlea grove (TT-TG) was measured in all patients. On physical examination, the inverted J-sign, the apprehension sign, and the knee range of motion parameters were used in the pre- and post-operative period. In addition, the Kujala and Lysholm scores were applied before and 12 months after surgery. The results were analyzed with the Wilcoxon test. RESULTS: The mean age of the patients was 11.28 in both genders. Comparing the data of the pre- and post-operative period, the inverted J-sign was present in six patients (85.7%) vs. absent in one (14.3%). The apprehension sign was absent in cases in the postoperative period; the range of motion was 117.85 ± 8.09 vs. 148.57 ± 3.77. The Kujala score was 42.57 ± 8.9 vs. 88.57 ± 5.09 and the Lysholm scores were classified as excellent or good in 28.6% and 71.4%, respectively. CONCLUSION: The combined reconstruction of the medial patellofemoral ligament combined with the medial patellotibial ligament in skeletally immature patients with predisposing factors, presents satisfactory results without episodes of recurrence or residual subluxation; according to these preliminary results, it should be considered as a treatment option.

RESUMO OBJETIVO: Avaliar a reconstrução do ligamento patelofemoral medial associado ao ligamento patelotibial medial em pacientes com esqueleto imaturo. MÉTODO: Estudo de série de casos em pacientes com instabilidade da patela com fise aberta. Foram avaliados sete pacientes, quatro do sexo masculino e três do feminino, operados pela técnica proposta. Foram incluídos pacientes com esqueleto imaturo com luxação da patela acima de dois episódios com queixas de instabilidade. Nenhum paciente foi submetido a tratamento adicional. A distância da TA-GT (tuberosidade anterior da tíbia ao sulco da tróclea) foi medida em todos os pacientes. No exame físico, foram avaliados os sinais do J invertido, sinal da apreensão e amplitude de movimento, como parâmetros pré- e pós-operatórios de 12 meses, além dos escores de Kujala e Tegner Lysholm. Os resultados foram calculados pelo teste dos sinais de Wilcoxon. RESULTADOS: A média de idade dos pacientes foi de 11,28 em ambos os gêneros. Na comparação dos dados do período pré- e pós-operatório, o sinal do J invertido estava presente em seis (85,7%) pacientes vs. um (14,3%) no pós-operatório. O sinal da apreensão estava ausente em 100% dos casos no pós-operatório. A amplitude de movimento foi de 117,85 ± 8,09 vs. 148,57 ± 3,77. O escore de Kujala foi de 42,57 ± 8,9 vs. 88,57 ± 5,09 e no escore de Lysholm foram classificados como excelentes ou bons 28,6% e 71,4% respectivamente. CONCLUSÃO: A reconstrução do ligamento patelofemoral medial combinada com o ligamento patelotibial medial, em pacientes esqueleticamente imaturos na presença de fatores predisponentes, apresenta resultados satisfatórios, sem episódios de recidiva ou de subluxação residual, devendo ser considerada como uma opção de tratamento a partir destes resultados preliminares.

LOCAL PERIARTICULAR ANALGESIA IN TOTAL KNEE ARTHROPLASTY.

OBJECTIVE: To evaluate the use of infiltration of periarticular analgesic agents intraoperatively in total knee arthroplasty (TKA), with regard to benefits, reduction of pain, opioid consumption, improvement of range of motion and early ambulation. METHODS: To analyze the benefits of periarticular drug infiltration, the patients submitted to TKA were evaluated, being separated into two groups. One group received the local periarticular infiltration protocol containing 0.5% bupivacaine (400mg/20ml), 1/1000 epinephrine (0.3ml), triamcinolone hexacetonide (20mg/1ml), clonidine (150mcg/1ml) and 20 ml of saline (0.9% SS) and, the other group underwent conventional intravenous analgesia. The results were compared and the variables analyzed were age, sex, BMI, comorbidities, postoperative complications, pain, functional capacity, range of motion, transfusion and rescue opioids for analgesia. RESULTS: The mean age of the patients was 68 years and most were female and presented involvement of the left knee. Postoperatively, patients who had received periarticular infiltration showed improvement of pain as well as functional capacity. CONCLUSION: The analysis of data obtained demonstrated that the periarticular infiltration of analgesic agents is significantly effective for pain control and functional recovery. Level of Evidence II, Prospective Comparative Study.

OBJETIVO: Avaliar a realização da infiltração de solução de agentes analgésicos periarticulares no intraoperatório da artroplastia total do joelho (ATJ), no que tange aos seus benefícios, redução da dor, consumo de opioides, melhora do arco de movimento e deambulação precoce. MÉTODOS: Para avaliar os benefícios da infiltração de agentes periarticulares, foram analisados pacientes submetidos à ATJ, sendo separados em dois grupos. Um grupo recebeu o protocolo de infiltração periarticular local, contendo solução de bupivacaína a 0,5% (400 mg /20 ml), epinefrina 1/1000 (0,3 ml), hexacetonido de triancinolona (20 mg/1 ml), clonidina (150 mcg/1 ml) e 20 ml de solução salina (SF a 0,9%) e outro grupo recebeu analgesia endovenosa convencional. Os resultados foram comparados e as variáveis analisadas foram idade, sexo, IMC, comorbidades, complicações pós-cirúrgicas, dor, capacidade funcional, amplitude de movimento, transfusão e resgate de opioides para analgesia. RESULTADOS: Dos pacientes analisados a média de idade foi de 68 anos e a maioria era do sexo feminino e com acometimento do joelho esquerdo. No pós-operatório os pacientes que haviam recebido infiltração periarticular apresentaram melhora da dor, bem como da capacidade funcional. CONCLUSÃO: A análise dos dados obtidos demonstrou que a infiltração periarticular de agentes analgésicos é significativamente eficaz para o controle da dor e recuperação funcional. Nível de Evidência II, Estudo Prospectivo Comparativo.

Osteoporosis in brazilian patients awaiting knee arthroplasty.

OBJECTIVE: The primary objective of this study was to determine the prevalence of osteoporosis and osteopenia prior to total knee arthroplasty (TKA) in female patients. As a secondary objective, we evaluated the incidence of hip fractures, types of drugs to treat osteoporosis and serum vitamin D levels. METHOD: This is a transversal, descriptive and observational study which evaluated 60 women above age 55 prior to total knee replacement. RESULTS: Mean patient age was 71.4 years. Osteoporosis was present in 16.7% of the sample and osteopenia in 15%. In the patients with osteoporosis, femur fracture (20%) was most frequent. Most of the group with osteopenia did not take any medication to treat this condition (55.6%), while most patients with osteoporosis took alendronate (30%) and 30% did not take any medication. CONCLUSION: The female population awaiting total knee replacement should be considered at risk for osteoporosis, confirming recent findings in the literature. Level of Evidence III, Control Case Study.

OBJETIVO: O objetivo primário do estudo foi determinar a prevalência de osteoporose e osteopenia no pré-operatório de artroplastia total de joelho (ATJ) em pacientes do sexo feminino. Como objetivos secundários, avaliamos a incidência de fraturas de fêmur, o uso de medicações para o tratamento da osteoporose e os níveis da 25-OH vitamina D. MÉTODO: É um estudo transversal, descritivo e observacional. A amostra foi composta por 60 mulheres com idade acima de 55 anos, no climatério, em pré-operatório de ATJ. RESULTADOS: A média de idade foi de 71,4 anos. A osteoporose estava presente em 16,7% e a osteopenia em 15% da amostra estudada. Entre os pacientes com osteoporose, a fratura de fêmur foi a mais frequente (20%). A maioria do grupo com osteopenia não usava medicação para tratar essa afecção (55,6%), enquanto a maior parte dos pacientes com osteoporose usava alendronato (30%) e 30% não usavam nenhum medicamento. CONCLUSÃO: A população do sexo feminino aguardando artroplastia total de joelho deve ser considerada em risco de acometimento pela osteoporose, confirmando dados recentes da literatura. Nível de Evidência III, Estudo de Caso Controle.

Osteoporosis in brazilian patients awaiting knee arthroplasty / Osteoporose em pacientes aguardando artroplastia de joelho na população brasileira

ABSTRACT OBJECTIVE: The primary objective of this study was to determine the prevalence of osteoporosis and osteopenia prior to total knee arthroplasty (TKA) in female patients. As a secondary objective, we evaluated the incidence of hip fractures, types of drugs to treat osteoporosis and serum vitamin D levels. METHOD: This is a transversal, descriptive and observational study which evaluated 60 women above age 55 prior to total knee replacement. RESULTS: Mean patient age was 71.4 years. Osteoporosis was present in 16.7% of the sample and osteopenia in 15%. In the patients with osteoporosis, femur fracture (20%) was most frequent. Most of the group with osteopenia did not take any medication to treat this condition (55.6%), while most patients with osteoporosis took alendronate (30%) and 30% did not take any medication. CONCLUSION: The female population awaiting total knee replacement should be considered at risk for osteoporosis, confirming recent findings in the literature. Level of Evidence III, Control Case Study.

RESUMO OBJETIVO: O objetivo primário do estudo foi determinar a prevalência de osteoporose e osteopenia no pré-operatório de artroplastia total de joelho (ATJ) em pacientes do sexo feminino. Como objetivos secundários, avaliamos a incidência de fraturas de fêmur, o uso de medicações para o tratamento da osteoporose e os níveis da 25-OH vitamina D. MÉTODO: É um estudo transversal, descritivo e observacional. A amostra foi composta por 60 mulheres com idade acima de 55 anos, no climatério, em pré-operatório de ATJ. RESULTADOS: A média de idade foi de 71,4 anos. A osteoporose estava presente em 16,7% e a osteopenia em 15% da amostra estudada. Entre os pacientes com osteoporose, a fratura de fêmur foi a mais frequente (20%). A maioria do grupo com osteopenia não usava medicação para tratar essa afecção (55,6%), enquanto a maior parte dos pacientes com osteoporose usava alendronato (30%) e 30% não usavam nenhum medicamento. CONCLUSÃO: A população do sexo feminino aguardando artroplastia total de joelho deve ser considerada em risco de acometimento pela osteoporose, confirmando dados recentes da literatura. Nível de Evidência III, Estudo de Caso Controle.

LOCAL PERIARTICULAR ANALGESIA IN TOTAL KNEE ARTHROPLASTY / ANALGESIA LOCAL PERIARTICULAR NA ARTROPLASTIA TOTAL DE JOELHO

ABSTRACT Objective: To evaluate the use of infiltration of periarticular analgesic agents intraoperatively in total knee arthroplasty (TKA), with regard to benefits, reduction of pain, opioid consumption, improvement of range of motion and early ambulation. Methods: To analyze the benefits of periarticular drug infiltration, the patients submitted to TKA were evaluated, being separated into two groups. One group received the local periarticular infiltration protocol containing 0.5% bupivacaine (400mg/20ml), 1/1000 epinephrine (0.3ml), triamcinolone hexacetonide (20mg/1ml), clonidine (150mcg/1ml) and 20 ml of saline (0.9% SS) and, the other group underwent conventional intravenous analgesia. The results were compared and the variables analyzed were age, sex, BMI, comorbidities, postoperative complications, pain, functional capacity, range of motion, transfusion and rescue opioids for analgesia. Results: The mean age of the patients was 68 years and most were female and presented involvement of the left knee. Postoperatively, patients who had received periarticular infiltration showed improvement of pain as well as functional capacity. Conclusion: The analysis of data obtained demonstrated that the periarticular infiltration of analgesic agents is significantly effective for pain control and functional recovery. Level of Evidence II, Prospective Comparative Study.

RESUMO Objetivo: Avaliar a realização da infiltração de solução de agentes analgésicos periarticulares no intraoperatório da artroplastia total do joelho (ATJ), no que tange aos seus benefícios, redução da dor, consumo de opioides, melhora do arco de movimento e deambulação precoce. Métodos: Para avaliar os benefícios da infiltração de agentes periarticulares, foram analisados pacientes submetidos à ATJ, sendo separados em dois grupos. Um grupo recebeu o protocolo de infiltração periarticular local, contendo solução de bupivacaína a 0,5% (400 mg /20 ml), epinefrina 1/1000 (0,3 ml), hexacetonido de triancinolona (20 mg/1 ml), clonidina (150 mcg/1 ml) e 20 ml de solução salina (SF a 0,9%) e outro grupo recebeu analgesia endovenosa convencional. Os resultados foram comparados e as variáveis analisadas foram idade, sexo, IMC, comorbidades, complicações pós-cirúrgicas, dor, capacidade funcional, amplitude de movimento, transfusão e resgate de opioides para analgesia. Resultados: Dos pacientes analisados a média de idade foi de 68 anos e a maioria era do sexo feminino e com acometimento do joelho esquerdo. No pós-operatório os pacientes que haviam recebido infiltração periarticular apresentaram melhora da dor, bem como da capacidade funcional. Conclusão: A análise dos dados obtidos demonstrou que a infiltração periarticular de agentes analgésicos é significativamente eficaz para o controle da dor e recuperação funcional. Nível de Evidência II, Estudo Prospectivo Comparativo.

Customized footwear for motion control to treat anterior knee pain among runners / Calçado personalizado para controle de movimento para tratar a dor anterior do joelho entre os corredores

BACKGROUND: Street running is extremely popular worldwide. Despite its benefits, there is evidence that stressful physical activity contributes to the development of lesions on the patellofemoral joint, leading, to anterior knee pain. As an attempt to attain pain control and to improve performance, specific footwear is being developed, aiming to suit particular types of foot strike, and therefore to reduce the risk of injury. OBJECTIVE: To evaluate the effectiveness of the use of customized shoes, based on baropodometric test, for the remission of anterior knee pain among amateur street runners. METHODS: This is a cross-sectional study, using questionnaires based on anthropometric and anatomical data of the runner, type of training, individualized footwear based on baropodometric test and diagnosis of anterior knee pain. In total, 40 athletes were studied, which were divided into two groups: Group 1, with 19 athletes who wore specific shoes for their activity, according to the type of foot strike, and, Group 2, with 21 athletes who used neutral shoes, not prescribed by healthcare professionals. All athletes practiced at the same running field. RESULTS: Most of the athletes were female (70%), The pain remission had no overall statistically significant difference between the two groups. However, significant differences were found between groups A and B regarding the time of occurrence and the extent of AKP. CONCLUSION: The data analysis showed that the use of customized running shoes, based exclusively on baropodometric exams, does not reduce anterior knee pain in amateur street runners, which is consistent with current literature. The improvement of pain with customized shoes, when present, appeared to have a short duration of around three month.

FUNDAMENTO: Corrida de rua é extremamente popular em todo o mundo. Apesar dos seus benefícios, há evidências de que o estresse dessa atividade física contribui para o desenvolvimento de lesões da articulação patelofemoral, levando, à dor anterior do joelho. Como uma tentativa de alcançar o controle da dor e para melhorar o desempenho, calçados específicos foram desenvolvidos, visando adequar determinados tipos de impacto do pé, e, por conseguinte, para reduzir o risco de lesões. OBJETIVO: Avaliar a eficácia do uso de sapatos personalizados, com base no teste de baropodometria, para a remissão de dor anterior do joelho entre os corredores de rua amadores. MÉTODOS: Este é um estudo transversal, por meio de questionários com base nos dados antropométricos e anatômicas do corredor, tipo de treinamento, calçado individualizado com base no teste de baropodometria e diagnóstico da dor anterior do joelho. No total, 40 atletas foram estudados, divididos em dois grupos: Grupo 1, com 19 atletas que usavam sapatos específicos para a sua atividade, de acordo com o tipo de ataque de movimento do pé, e, Grupo 2, com 21 atletas que usaram sapatos neutros, não prescritos por profissionais de saúde. Todos os atletas treinaram em um mesmo campo. RESULTADOS: A maioria dos atletas eram do sexo feminino (70%); não houve diferença estatisticamente significativa entre os dois grupos em termos de remissão da dor. CONCLUSÃO: A análise dos dados mostrou que o uso de tênis personalizados, com base exclusivamente em exames baropodométricos, dor anterior do joelho não reduz a dor os corredores de rua amadores, o que é consistente com a literatura atual. A melhora da dor com sapatos personalizados parece ter uma curta duração de cerca de três meses.

Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors.

OBJECTIVE: To evaluate double-bundle reconstruction of the medial patellofemoral ligament (MPFL) using a graft from the semitendinosus tendon and fixation with metal anchors over the medium term. METHODS: This was a prospective cross-sectional study. After approval from the research ethics committee, 31 patients with patellofemoral instability who underwent MPFL reconstruction by means of the anatomical double-bundle technique, with fixation using metal anchors, were analyzed between May 2010 and January 2015. To evaluate the effectiveness of the MPFL reconstruction surgery, the Kujala scale and the Tegner-Lysholm score were assessed before the procedure and one year afterwards, along with clinical data such as pain levels, range of motion and J sign. The data were tabulated in the Excel(®) software and were analyzed using the SPSS Statistics(®) software, version 21. The statistical analysis was performed using the Wilcoxon T test and the McNemar test. RESULTS: The mean preoperative score from the Kujala test was 45.64 ± 1.24 and the postoperative score was 94.03 ± 0.79 (p < 0.001). The preoperative Tegner-Lysholm score was 40.51 ± 1.61 and the postoperative score was 91.64 ± 0.79 (p < 0.001). The preoperative range of motion was 125.96 ± 2.11 and the postoperative range was 138.38 ± 1.49 (p < 0.05). CONCLUSION: MPFL reconstruction by means of the anatomical double-bundle technique is easily reproducible, without episodes of recurrence, with satisfactory results regarding restoration of stability and function of the patellofemoral joint.

OBJETIVO: Avaliar, em médio prazo, a reconstrução do ligamento patelofemoral medial (LPFM) com duplo-feixe com enxerto do tendão semitendíneo e fixação com âncoras metálicas. MÉTODOS: Estudo prospectivo de corte transversal. De maio de 2010 a janeiro de 2015, após aprovação do comitê de ética em pesquisa, foram analisados 31 pacientes com instabilidade patelofemoral, submetidos à cirurgia de reconstrução do ligamento patelofemoral medial (LPFM) com a técnica anatômica do duplo-feixe com fixação com âncoras metálicas. Para avaliar a eficácia da cirurgia de reconstrução do LPFM, foram utilizadas a escala de Kujala e o escore de Tegner-Lysholm, antes do procedimento e após um ano. Foram avaliados os dados clínicos como o arco de movimento, presença do Sinal do J e nível de dor. Os dados foram tabulados no programa Excel® e analisados com o programa SPSS Statistics® versão 21. A análise estatística foi feita com o teste T de Wilcoxon e o teste de McNemar. RESULTADOS: A média dos resultados obtidos no pré-operatório com o teste de Kujala foi de 45,64 ± 1,24 e no pós-operatório de 94,03 ± 0,79 (p < 0,001). O escore do joelho de Tegner-Lysholm alcançado foi de 40,51 ± 1,61 no pré-operatório, para 91,64 ± 0,79 (p < 0,001) no pós-operatório. O arco de movimento obteve média de 12,596 ± 2,11 no pré-operatório e 13,838 ± 1,49 no pós-operatório (p < 0,05). CONCLUSÃO: A reconstrução do LPFM com duplo-feixe é uma técnica de fácil reprodução, sem episódios de recidiva, e com resultados adequados para a restauração da estabilidade.

Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors / Reconstrução do ligamento patelofemoral medial pela técnica anatômica do duplo-feixe com âncoras metálicas

OBJECTIVE: To evaluate double-bundle reconstruction of the medial patellofemoral ligament (MPFL) using a graft from the semitendinosus tendon and fixation with metal anchors over the medium term. METHODS: This was a prospective cross-sectional study. After approval from the research ethics committee, 31 patients with patellofemoral instability who underwent MPFL reconstruction by means of the anatomical double-bundle technique, with fixation using metal anchors, were analyzed between May 2010 and January 2015. To evaluate the effectiveness of the MPFL reconstruction surgery, the Kujala scale and the Tegner-Lysholm score were assessed before the procedure and one year afterwards, along with clinical data such as pain levels, range of motion and J sign. The data were tabulated in the Excel(r) software and were analyzed using the SPSS Statistics(r) software, version 21. The statistical analysis was performed using the Wilcoxon T test and the McNemar test. RESULTS: The mean preoperative score from the Kujala test was 45.64 ± 1.24 and the postoperative score was 94.03 ± 0.79 (p < 0.001). The preoperative Tegner-Lysholm score was 40.51 ± 1.61 and the postoperative score was 91.64 ± 0.79 (p < 0.001). The preoperative range of motion was 125.96 ± 2.11 and the postoperative range was 138.38 ± 1.49 (p < 0.05). CONCLUSION: MPFL reconstruction by means of the anatomical double-bundle technique is easily reproducible, without episodes of recurrence, with satisfactory results regarding restoration of stability and function of the patellofemoral joint.

OBJETIVO: Avaliar, em médio prazo, a reconstrução do ligamento patelofemoral medial (LPFM) com duplo-feixe com enxerto do tendão semitendíneo e fixação com âncoras metálicas. MÉTODOS: Estudo prospectivo de corte transversal. De maio de 2010 a janeiro de 2015, após aprovação do comitê de ética em pesquisa, foram analisados 31 pacientes com instabilidade patelofemoral, submetidos à cirurgia de reconstrução do ligamento patelofemoral medial (LPFM) com a técnica anatômica do duplo-feixe com fixação com âncoras metálicas. Para avaliar a eficácia da cirurgia de reconstrução do LPFM, foram utilizadas a escala de Kujala e o escore de Tegner-Lysholm, antes do procedimento e após um ano. Foram avaliados os dados clínicos como o arco de movimento, presença do Sinal do J e nível de dor. Os dados foram tabulados no programa Excel(r) e analisados com o programa SPSS Statistics(r) versão 21. A análise estatística foi feita com o teste T de Wilcoxon e o teste de McNemar. RESULTADOS: A média dos resultados obtidos no pré-operatório com o teste de Kujala foi de 45,64 ± 1,24 e no pós-operatório de 94,03 ± 0,79 (p < 0,001). O escore do joelho de Tegner-Lysholm alcançado foi de 40,51 ± 1,61 no pré-operatório, para 91,64 ± 0,79 (p < 0,001) no pós-operatório. O arco de movimento obteve média de 125,96 ± 2,11 no pré-operatório e 138,38 ± 1,49 no pós-operatório (p < 0,05). CONCLUSÃO: A reconstrução do LPFM com duplo-feixe é uma técnica de fácil reprodução, sem episódios de recidiva, e com resultados adequados para a restauração da estabilidade.

Effect of tranexamic acid on bleeding control in total knee arthroplasty

OBJECTIVES: To analyze the effectiveness of intravenous (IV) tranexamic acid (TA) in reducing blood loss in total knee arthroplasty (TKA). METHOD: The population sample was composed of patients with a diagnosis of primary knee osteoarthritis. The patients undergoing TKA were divided in two groups. Group A: comprised patients who used IV TA and B group, formed by patients who did not use TA in the intra or post-operative period. For descriptive analysis, quantitative variables were represented by mean and standard deviations when their distribution was normal and interquartile ranges and medians for non-normal variables. RESULTS: The mean age of patients was 68 years old, most of them were female and with involvement of the left knee. Postoperatively patients who had used IV TA showed less bleeding rate and less hemoglobin rate reduction. CONCLUSION: The use of IV TA in TKA reduces blood loss in peri- and postoperative periods. Regarding total blood loss reduction, hemoglobin rate and need for blood transfusions, IV TA should be used routinely during TKA since it has been shown to be safe with no increase in side effects as thromboembolic events. Level of Evidence III. Retrospective Comparative Study

EFFECT OF TRANEXAMIC ACID ON BLEEDING CONTROL IN TOTAL KNEE ARTHROPLASTY.

OBJECTIVES: To analyze the effectiveness of intravenous (IV) tranexamic acid (TA) in reducing blood loss in total knee arthroplasty (TKA). METHOD: The population sample was composed of patients with a diagnosis of primary knee osteoarthritis. The patients undergoing TKA were divided in two groups. Group A: comprised patients who used IV TA and B group, formed by patients who did not use TA in the intra or post-operative period. For descriptive analysis, quantitative variables were represented by mean and standard deviations when their distribution was normal and interquartile ranges and medians for non-normal variables. RESULTS: The mean age of patients was 68 years old, most of them were female and with involvement of the left knee. Postoperatively patients who had used IV TA showed less bleeding rate and less hemoglobin rate reduction. CONCLUSION: The use of IV TA in TKA reduces blood loss in peri- and postoperative periods. Regarding total blood loss reduction, hemoglobin rate and need for blood transfusions, IV TA should be used routinely during TKA since it has been shown to be safe with no increase in side effects as thromboembolic events. Level of Evidence III. Retrospective Comparative Study.