Fixation of the Anterior Ligament Graft at the Tibial Pole: Biomechanical Analysis of Three Methods.

Objective Comparative biomechanical analysis of tibial fixation strength for ligament reconstruction with interference screw compared with screw post and washer, and compared with the associated fixation of both methods (hybrid fixation). Method A total of 54 specimens were used (porcine tibias and bovine flexor digital tendons), which were divided into three groups with fixation types similar to those used in anterior cruciate ligament (ACL) reconstruction: 1) fixation with interference screw; 2) fixation with screw post and toothed washer over knot and suture strand; and )- fixation with screw post and washer combined with interference screw (hybrid fixation). The analyses were performed through pull-out biomechanical tensile tests to determine the stiffness and load to system failure (yield load). Results The hybrid fixation group presented a significantly higher final stiffness (59.10 ± 3.45 N/mm) in comparison to the other groups ( p < 0.05) and a higher yield load (581.34 ± 33.48 N) compared to the interference screw group ( p < 0.05). Conclusion Hybrid fixation had biomechanical advantages over the bovine digital flexor graft fixation system in swine tibia during tensile tests.

Fixation of the Anterior Ligament Graft at the Tibial Pole: Biomechanical Analysis of Three Methods / Fixação do enxerto do ligamento cruzado anterior no polo tibial: Análise biomecânica de três métodos

Abstract Objective Comparative biomechanical analysis of tibial fixation strength for ligament reconstruction with interference screw compared with screw post and washer, and compared with the associated fixation of both methods (hybrid fixation). Method A total of 54 specimens were used (porcine tibias and bovine flexor digital tendons), which were divided into three groups with fixation types similar to those used in anterior cruciate ligament (ACL) reconstruction: 1) fixation with interference screw; 2) fixation with screw post and toothed washer over knot and suture strand; and )- fixation with screw post and washer combined with interference screw (hybrid fixation). The analyses were performed through pull-out biomechanical tensile tests to determine the stiffness and load to system failure (yield load). Results The hybrid fixation group presented a significantly higher final stiffness (59.10 ± 3.45 N/mm) in comparison to the other groups (p < 0.05) and a higher yield load (581.34 ± 33.48 N) compared to the interference screw group (p < 0.05). Conclusion Hybrid fixation had biomechanical advantages over the bovine digital flexor graft fixation system in swine tibia during tensile tests.

Resumo Objetivo Análise biomecânica comparativa da resistência da fixação tibial para reconstrução ligamentar com parafuso de interferência, comparada com parafuso do tipo poste com arruela, e com fixação associada entre os métodos (fixação híbrida). Métodos Foram utilizados 54 corpos de prova (tíbia suína e tendão digital bovino), que foram divididos em 3 grupos com tipos de fixação semelhantes àqueles utilizados na reconstrução do ligamento cruzado anterior: 1) fixação com parafuso de interferência; 2) fixação com parafuso do tipo poste com arruela dentada sobre nó e fios de sutura; e 3) fixação com parafuso do tipo poste com arruela combinada com parafuso de interferência (fixação híbrida). Os testes foram realizados por meio de ensaios biomecânicos de tração tipo pull-out para determinação da rigidez e carga para falha (yield load) do sistema. Resultados O grupo com fixação híbrida apresentou maior rigidez final (59,10 ± 3,45 N/mm) do que os demais grupos (p < 0,05), e carga superior para falha (581,34 ± 33,48 N) em relação ao grupo com parafuso de interferência (p < 0,05). Conclusão A fixação híbrida apresentou vantagens biomecânicas com relação ao sistema de fixação do enxerto de flexor digital bovino em tíbia suína durante os ensaios de tração.

Questionnaires Designed to Assess Knowledge of Heart Failure Patients: A Systematic Review.

BACKGROUND: The objectives of this systematic review were (1) to describe the psychometric properties of questionnaires designed to assess knowledge of heart failure (HF) patients and (2) to identify the most applicable questionnaire to assess knowledge of HF patients. METHODS: A literature search of electronic databases was conducted from database inception to March 2014. Eligible articles included studies describing the development and psychometric testing of questionnaires designed to assess HF patients' knowledge. Outcomes were based on the quality criteria for measurement properties of health status questionnaires. Articles were considered for inclusion by 2 authors independently. RESULTS: Overall, 12 articles were included, of which 4 (33.33%) were considered "good" quality. Twelve original English-language instruments were identified. Content validity was described in 10 studies and presented positive ratings in all of them (83.33%); internal consistency in 10 studies and positive ratings in 5 (41.66%); construct validity in 5 and positive ratings in 4 (33.33%); responsiveness in 3 and positive ratings in 2 (16.66%); and reproducibility and floor effects in 1 with positive ratings. Based on our criteria, the Atlanta HF Knowledge Test was identified as the most applicable questionnaire to assess knowledge of HF patients. CONCLUSION: Psychometric properties of questionnaires assessing HF patients' knowledge are poorly described in the literature. Although we identified the Atlanta HF Knowledge Test as the most promising instrument, it has methodological limitations. We recommend the researchers to use the questionnaire that best serves their research question and context.

Knowledge and exercise behavior maintenance in cardiac rehabilitation patients receiving educational interventions.

OBJECTIVES: To test whether a theoretically-based education curriculum results in more sustained knowledge, higher scores on Health Action Process Approach (HAPA) constructs, and greater exercise behavior 6 months post-cardiac rehabilitation (CR) when compared to traditional CR education. BACKGROUND: Patient education is a core component of CR. No research has examined whether this education results in sustained improvements post-program. METHODS: In this quasi-experimental study, participants exposed to the traditional vs HAPA-based education completed surveys pre, post-CR, and 6 months post-discharge assessing knowledge, HAPA constructs, and exercise. RESULTS: Ninety-three participants completed the final survey. Knowledge increases post-CR were sustained 6 months post-program, with no differences by curriculum. Many improvements in HAPA constructs observed post-CR were sustained, except for some decay in self-efficacy. Minutes of exercise per week were significantly greater in participants exposed to the HAPA-based curriculum 6 months post-program. CONCLUSIONS: HAPA-based education in CR has sustained effects on exercise.

Hamstring tendons insertion - an anatomical study / Estudo anatomico da insercao dos tendoes flexores do joelho

OBJECTIVE: To study the anatomy of the hamstring tendons insertion and anatomical rela-tionships. METHODS: Ten cadaver knees with medial and anterior intact structures were selected. The dissection was performed from anteromedial access to exposure of the insertion of the flexor tendons (FT), tibial plateau (TP) and tibial tuberosity (TT). A needle of 40 × 12 and a caliper were used to measure the distance of the tibial plateau of the knee flexor tendons insertion at 15 mm from the medial border of the patellar tendon and tibial tuberosity to the insertion of the flexor tendons of the knee. The angle between tibial plateau and the insertion of the flexor tendons of the knee (A-TP-FT) was calculated using Image Pro Plus software. RESULTS: The mean distance TP-FT was 41 ± 4.6 mm. The distance between the TT-FT was 6.88 ± 1 mm. The (A-TP-FT) was 20.3 ± 4.9°. CONCLUSION: In the anterior tibial flexor tendons are about 40 mm from the plateau with an average of 20°. .

OBJETIVO: Determinar parâmetros anatômicos para localizar a inserção dos tendões flexores do joelho na tíbia. MÉTODOS: Foram selecionados 10 joelhos de cadáveres com estruturas mediais e anteriores íntegras. A dissecção foi feita por acesso ânteromedial até a exposição adequada da inserção dos tendões flexores (TF), do planalto tibial (PT) e da tuberosidade anterior da tíbia (TAT). Uma agulha 40×12 e um paquímetro digital foram usados para aferir a distância do planalto tibial da inserção dos tendões flexores do joelho a 15 mm da borda medial ao tendão patelar e da tuberosidade anterior da tíbia à inserção dos tendões flexores do joelho. O ângulo o planalto tibial e a inserção dos tendões flexores do joelho (PT-TF) foi calculado com o auxílio do software ImagePro Plus(r). RESULTADOS: A distância PT-TF foi de 41 ± 4,6 mm em média. A distância entre a TAT-TF foi de 6,88 ± 1 mm. A angulação (PT-TF) foi de 20,3 ± 4,9 graus. CONCLUSÃO: Na região anterior da tíbia os tendões flexores estão a cerca de 40 mm do planalto com um ângulo médio de 20 graus. .

Hamstring tendons insertion - an anatomical study.

OBJECTIVE: To study the anatomy of the hamstring tendons insertion and anatomical relationships. METHODS: Ten cadaver knees with medial and anterior intact structures were selected. The dissection was performed from anteromedial access to exposure of the insertion of the flexor tendons (FT), tibial plateau (TP) and tibial tuberosity (TT). A needle of 40 × 12 and a caliper were used to measure the distance of the tibial plateau of the knee flexor tendons insertion at 15 mm from the medial border of the patellar tendon and tibial tuberosity to the insertion of the flexor tendons of the knee. The angle between tibial plateau and the insertion of the flexor tendons of the knee (A-TP-FT) was calculated using Image Pro Plus software. RESULTS: The mean distance TP-FT was 41 ± 4.6 mm. The distance between the TT-FT was 6.88 ± 1 mm. The (A-TP-FT) was 20.3 ± 4.9°. CONCLUSION: In the anterior tibial flexor tendons are about 40 mm from the plateau with an average of 20°.

OBJETIVO: Determinar parâmetros anatômicos para localizar a inserção dos tendões flexores do joelho na tíbia. MÉTODOS: Foram selecionados 10 joelhos de cadáveres com estruturas mediais e anteriores íntegras. A dissecção foi feita por acesso ântero-medial até a exposição adequada da inserção dos tendões flexores (TF), do planalto tibial (PT) e da tuberosidade anterior da tíbia (TAT). Uma agulha 40×12 e um paquímetro digital foram usados para aferir a distância do planalto tibial da inserção dos tendões flexores do joelho a 15 mm da borda medial ao tendão patelar e da tuberosidade anterior da tíbia à inserção dos tendões flexores do joelho. O ângulo formado entre o planalto tibial e a inserção dos tendões flexores do joelho (Â PT-TF) foi calculado com o auxílio do software ImagePro Plus®. RESULTADOS: A distância PT-TF foi de 41 ± 4,6 mm em média. A distância entre a TAT-TF foi de 6,88 ± 1 mm. A angulação (Â PT-TF) foi de 20,3 ± 4,9 graus. CONCLUSÃO: Na região anterior da tíbia os tendões flexores estão a cerca de 40 mm do planalto com um ângulo médio de 20 graus.