Patellofemoral ankylosis: case report and technical note.

INTRODUCTION: It is our understanding that there is no consensual solution for the treatment of post-traumatic patellar ankylosis; therefore, the purpose of this work is to present two cases of patellofemoral retinacular interposition arthroplasty, and its corresponding technical note. CASE 1: Female, 24, patellar ankylosis secondary to supratranscondylar fracture, associated with comminuted diaphyseal tibia fracture. CASE 2: Female, 48, patellar ankylosis secondary to femoral diaphysis and lateral femoral condyle fracture. RESULTS: After going through a patellofemoral retinacular interposition release, both patients were satisfied with the results, presenting with significantly improved knee range of motion. CONCLUSION: Using our surgical technique, we were not able to restore normal function to our patients, but their improvement was certainly impressive relative to their initial clinical situation.

Simultaneous Bilateral Knee Varus Stress Radiographic Technique.

Varus stress radiographs are reported as an effective and cost-beneficial diagnostic and decision-making tool for lateral knee injuries, both in the acute and chronic settings. The opening of the lateral compartment is reported to vary according to the number of structures injured, helping to differentiate isolated fibular collateral ligament injury from grade-III posterolateral corner injury. The conventional technique requires the physician or another healthcare provider to apply manual varus stress while obtaining the radiograph on one knee at a time. The present study aimed to describe, in detail, the preferred method of the authors to assess the opening of the lateral compartment in both knees simultaneously, which also avoids the need for the examiner to be present in the imaging room.

Simultaneous Bilateral Knee Varus Stress Radiographic Technique / Técnica radiográfica de estresse em varo bilateral simultâneo

Abstract Varus stress radiographs are reported as an effective and cost-beneficial diagnostic and decision-making tool for lateral knee injuries, both in the acute and chronic settings. The opening of the lateral compartment is reported to vary according to the number of structures injured, helping to differentiate isolated fibular collateral ligament injury from grade-III posterolateral corner injury. The conventional technique requires the physician or another healthcare provider to applymanual varus stresswhile obtaining the radiograph on one knee at a time. The present study aimed to describe, in detail, the preferred method of the authors to assess the opening of the lateral compartment in both knees simultaneously, which also avoids the need for the examiner to be present in the imaging room.

Resumo As radiografias de estresse em varo são descritas como uma técnica efetiva e econômica de diagnóstico e tomada de decisão em lesões laterais do joelho, tanto no contexto agudo quanto crônico. A abertura do compartimento lateral varia de acordo com o número de estruturas danificadas, ajudando a diferenciar lesões isoladas do ligamento colateral fibular das lesões do canto posterolateral de grau III. A técnica convencional exige que o médico ou outro profissional de saúde aplique estresse em varo manual ao obter a radiografia em um joelho de cada vez. O presente estudo teve como objetivo descrever, em detalhes, o método preferido dos autores para avaliar a abertura do compartimento lateral em ambos os joelhos simultaneamente, o que também evita a necessidade da presença do examinador na sala de imagem.

Meniscus Repair in Children and Adolescents: A Systematic Review of Treatment Approaches, Meniscal Healing, and Outcomes.

Although the consequences of traumatic meniscus tears and the importance of meniscal repair are well-established in adults, the same cannot be said for the young population. Better evidence regarding the outcomes following traumatic meniscal tears in children would improve our understanding of this increasing pathology and help define important factors in deciding the best treatment option. A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines using the Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, and MEDLINE PubMed databases. Inclusion criteria were as follows: studies reporting the outcomes of meniscal repair in patients 18 years old or younger, with a minimum mean follow-up of 12 months, Portuguese, Spanish, or English languages, and human studies including 10 or more patients. Our search identified 2,534 individual titles. After application of the inclusion and exclusion criteria, 8 studies were included, evaluating 287 patients with repaired meniscal tears. All eight studies were classified as level of evidence IV. The mean methodological index for nonrandomized studies score was 8.6 ± 1.4. Meniscal repair included all meniscal zones and tear patterns. Anterior cruciate ligament tear was the most common associated injury. The all-inside and inside-out techniques were predominantly reported. The majority of the patients reported good to excellent outcomes and had clinical signals of meniscal healing; meniscectomies following meniscal repair were performed in just 44 cases. In conclusion, meniscal tears in pediatrics are not uncommon. Repairs of this injury were associated with good to excellent outcomes in most patients, regardless of the injury pattern, zone, or technique. Reported complications were minimal; however, higher quality studies are needed to confirm the findings of this systematic review. This is a systematic review study with Level IV.

Understanding posterior meniscal roots lesions: from basic science to treatment.

The variability of symptoms and the fact that they are not easily recognized in imaging studies make the diagnosis and treatment of posterior meniscal roots lesions a challenging task to the orthopedist. In recent years, a more precise understanding of the anatomy and biomechanical impair of the knee joint in these cases has enabled great advances in therapeutic approaches. Well-documented studies have shown that the repair of these lesions presents superior functional and clinical improvement when compared with meniscectomy. However, the progression of degenerative joint changes in the long-term still exhibits conflicting results.

A variabilidade da sintomatologia e o fato de não serem facilmente reconhecidas nos exames de imagem tornam o diagnóstico e o tratamento das lesões das raízes posteriores dos meniscos tarefas desafiadoras para o ortopedista. Nos últimos anos, uma compreensão mais precisa da anatomia e do comprometimento biomecânico da articulação do joelho nessas lesões têm possibilitado grandes avanços nas abordagens terapêuticas. Estudos bem documentados demonstram que o reparo dessas lesões oferece uma melhoria clínica e funcional superior à meniscectomia. Entretanto, os resultados da progressão das alterações degenerativas articulares em longo prazo ainda são conflitantes.

Understanding posterior meniscal roots lesions: from basic science to treatment / Compreendendo as lesões das raízes posteriores dos meniscos: da ciência básica ao tratamento

ABSTRACT The variability of symptoms and the fact that they are not easily recognized in imaging studies make the diagnosis and treatment of posterior meniscal roots lesions a challenging task to the orthopedist. In recent years, a more precise understanding of the anatomy and biomechanical impair of the knee joint in these cases has enabled great advances in therapeutic approaches. Well-documented studies have shown that the repair of these lesions presents superior functional and clinical improvement when compared with meniscectomy. However, the progression of degenerative joint changes in the long-term still exhibits conflicting results.

RESUMO A variabilidade da sintomatologia e o fato de não serem facilmente reconhecidas nos exames de imagem tornam o diagnóstico e o tratamento das lesões das raízes posteriores dos meniscos tarefas desafiadoras para o ortopedista. Nos últimos anos, uma compreensão mais precisa da anatomia e do comprometimento biomecânico da articulação do joelho nessas lesões têm possibilitado grandes avanços nas abordagens terapêuticas. Estudos bem documentados demonstram que o reparo dessas lesões oferece uma melhoria clínica e funcional superior à meniscectomia. Entretanto, os resultados da progressão das alterações degenerativas articulares em longo prazo ainda são conflitantes.

The Proximal Tibiofibular Joint: A Biomechanical Analysis of the Anterior and Posterior Ligamentous Complexes.

BACKGROUND: Dislocation of the proximal tibiofibular joint is a complex injury that is often overlooked or misdiagnosed. Surgical management is recommended for severe acute or for chronic symptomatic instability of the proximal tibiofibular joint. Although the anterior ligamentous complex has been reported to be stronger than the posterior complex, biomechanical data are lacking. PURPOSE: To determine the ultimate load of the anterior and posterior ligamentous complexes of the proximal tibiofibular joint to determine optimal graft selection. STUDY DESIGN: Controlled laboratory study. METHODS: Ten nonpaired, fresh-frozen knee specimens were dissected to expose the anterior and posterior proximal tibiofibular ligamentous complexes. The tibia was split in the coronal plane to separate the anterior and posterior ligamentous complexes, and the fibula was left intact. Specimens were secured in a dynamic testing machine and preconditioned for 10 cycles between 2 and 10 N at 0.1 Hz followed by loading to failure at a rate of 25 mm/min. RESULTS: The mean (±SD) ultimate load of the anterior complex (517 ± 144 N) was significantly greater than the mean ultimate load of the posterior complex (322 ± 160 N) ( P = .012). The mean surface areas of the anterior and posterior complexes were 761 ± 174 mm2 and 565 ± 103 mm2, respectively ( P = .008). The mean values for stiffness of the anterior (133 N/mm) and posterior (109 N/mm) complexes were similar ( P = .250). CONCLUSION: The ligaments of the human proximal tibiofibular joint were able to withstand a mean ultimate failure load of 517 ± 144 N for the anterior complex and 322 ± 160 N for the posterior complex. In this regard, it is recommended that the strengths of grafts chosen for proximal tibiofibular reconstructions meet or exceed these values. CLINICAL RELEVANCE: The optimal surgical treatment for addressing residual proximal tibiofibular instability is not well defined. Before an anatomic reconstruction of the proximal tibiofibular ligament is developed, the individual biomechanical properties of the anterior and posterior ligamentous structures of the proximal tibiofibular joint need to be considered to facilitate an optimal reconstruction design.

Intra-articular Anterior Cruciate Ligament Reconstruction With Extra-articular Lateral Tenodesis of the Iliotibial Band.

An increasing concern has been given to the rotation stability of the knee in the setting of an anterior cruciate ligament (ACL) reconstruction. This growing interest stems from a better understanding of the rotational stability of the knee afforded by the identification of the anterolateral ligament. Previously, a residual abnormal pivot-shift test had been found after an anatomic single-band reconstruction of the ACL because of a lack of rotational stability, which may lead to the development of osteoarthritis. Residual instability affects function, especially in high-demand athletes who perform many flexion-rotation movements during sporting activity. The purpose of this Technical Note is to describe our preferred method of intra-articular ACL reconstruction using a hamstring tendon autograft in combination with an extra-articular iliotibial band tenodesis for reinforcement of rotational stability.

Posterior Capsulotomy of the Knee: Treatment of Minimal Knee Extension Deficit.

The loss of knee extension, even if minimal, is disabling and considerably affects the individual's quality of life. This loss of extension can be a consequence of prior surgery, including a previous anterior cruciate ligament reconstruction. Although this loss of extension may be treated through an isolated arthroscopic procedure, a more severe case may warrant an invasive approach. In these cases, a posterior capsulotomy of the knee may be done if all conservative measures have been exhausted. This procedure has been proven to be safe and effective in the re-establishment of full extension in the setting of a minor flexion contracture of the knee. The purpose of this Technical Note was to describe our preferred technique when performing an open posterior capsulotomy of the knee for the treatment of minimal extension deficit.

Hemocromatose associada a carcinoma hepatocelular e neoplasias extra-hepáticas / Hemochromatosis combined with hepatocellular carcinoma and extrahepatic neoplasms

A hemocromatose caracteriza-se pelo acúmulo excessivo de ferro no organismo, que é depositado redominantemente no fígado, e resulta ou de um defeito genético determinando uma absorção excessiva de ferro ou da administração parenteral deste íon. O ferro em excesso determina alterações celulares através da peroxidação lipídica, estímulo da deposição de colágeno e interação com o oxigênio reativo e DNA. Os autores relatam um caso de hemocromatose em paciente portador de cirrose hepática associada ao desenvolvimento de hepatocarcinoma, hemangioma hepático, adenocarcinoma prostático e carcinoma renal, e apresentam uma discussão geral deste processo, frequentemente associado ao desenvolvimento de neoplasias.

Hemochromatosis is characterized by excessive accumulation of iron in the body, which is deposited primarily in the liver. It results either from a genetic defect determining an excessive absorption of iron or from parenteral administration of this ion. The excess iron determines cellular changes through lipid peroxidation, stimulation of collagen deposition, and interaction with reactive oxygen and DNA. The authors report a case of hemochromatosis in a patient with liver cirrhosis associated with development of hepatocellular carcinoma, hepatic hemangioma, prostate adenocarcinoma and renal cell carcinoma, and provide a general discussion of this process often associated with the development of neoplasias.

Avaliação imuno-histoquímica de 100 casos de metástases encefálicas e correlação com o sítio primário do tumor / Immunohistochemical evaluation of 100 cases of encephalic metastases and correlation with primary site of the tumor

INTRODUÇÃO: As metástases encefálicas correspondem a massas intracranianas avaliadas tanto em procedimentos cirúrgicos quanto em necropsias. Em geral, as metástases comprometem os hemisférios cerebrais de adultos com o diagnóstico prévio de um carcinoma. Usualmente são encontradas como lesões sólidas de crescimento expansivo, sendo o pulmão e a mama os sítios primários mais frequentes. OBJETIVO: Determinar o sítio primário, a topografia, o tipo histológico e o perfil imuno-histoquímico de metástases encefálicas. MÉTODO: Foram avaliados 100 casos distintos de metástases intraparenquimatosas do encéfalo, previamente analisadas entre 1995 e 2009 no Hospital Conceição de Porto Alegre, sendo determinados os tipos histológicos envolvidos e a topografia. Os casos selecionados foram submetidos à técnica imuno-histoquímica a fim de estimar o sítio primário destas lesões. RESULTADOS: A idade média correspondeu a 58,7 anos, sendo encontrados 61 casos (61 por cento) no sexo masculino. O tipo histológico mais comum foi o adenocarcinoma (56 casos [56 por cento]), sendo os hemisférios cerebrais (78 casos [78 por cento]) as topografias mais acometidas. O pulmão (29 por cento), a mama (16 por cento), o tecido hematopoiético (14 por cento) e o rim (12 por cento) corresponderam aos principais sítios primários. A análise estatística não determinou associação entre o tipo histológico ou o sítio primário e a topografia (p = 0,125). Foi encontrada uma concordância de 95 por cento entre o perfil imuno-histoquímico e a informação clínica do sítio primário. CONCLUSÃO: O conjunto dos achados morfológicos associado ao estudo imuno-histoquímico de uma lesão metastática do encéfalo pode sugerir o sítio primário em vários casos, sendo necessária, para isso, a correta escolha do painel de anticorpos.

INTRODUCTION: Encephalic metastases correspond to intracranial masses evaluated in both surgical procedures and autopsies. Overall, metastases involve the cerebral hemispheres of adults with a previous diagnosis of carcinoma. They are commonly found as solid lesions with an expansive growth, whose most frequent primary sites are lungs and breasts. OBJECTIVE: To determine the primary site, topography, histology and immunohistochemical profile of encephalic metastases. METHOD: 100 cases of intraparenchymal brain metastases, which had been previously analyzed between 1995 and 2009 at Hospital Conceição from Porto Alegre, were evaluated. The topography and the histological types involved were determined. The selected cases were submitted to immunohistochemical analysis to assess the primary site of these lesions. RESULTS: The mean age was 58.7 years old and 61 cases (59.89 percent) were found in males. The most common histological type was adenocarcinoma (56 cases-56 percent) and the most affected topography was the cerebral hemispheres (78 cases, 78 percent). The main primary sites were lungs (29 percent), breasts (16 percent), hematopoietic tissue (14 percent) and kidneys (12 percent). Statistical analysis did not determine association between histological type or primary site in relation to topography (p= 0.125). There was a concordance of 95 percent between the immunohistochemical profile and clinical information from the primary site. CONCLUSION: The set of morphological findings associated with immunohistochemical study of an encephalic metastatic lesion may suggest the primary site in several cases, which, therefore, requires the appropriate choice of antibody panel.

Angiosarcoma arising in an ovarian fibroma: a case report.

Primary ovarian angiosarcoma is a very rare gynaecological sarcoma, with poor prognosis. These tumors are though to arise from carcinosarcomas, teratomas, or the ovarian vasculature and occur at any age. There are only a few cases reported in the international literature, most commonly associated to surface epithelial-stromal or germ cell tumours. Herein, the authors report the clinicopathologic features of an angiosarcoma arising in an ovarian fibroma. A 65-year-old patient was admitted with a palpable mass in the hypogastrium. Grossly, the removed ovary was completely replaced by a solid tumor mass. On histological analysis, the lesion revealed the typical histological features of angiosarcoma with sinusoidal patterns and anaplastic cells, admixed with spindle-shaped cells arranged in fascicles or in a storiform pattern, compatible with a fibroma. The vascular component was strongly immunopositive for CD31 and CD34. The patient was submitted to chemotherapy, and she was alive for two months after surgical proceedings.

Análise da qualidade de vida em Grupo de convivência de Idosos / Quality of lifes analysis in the elderly living together group

Com o crescente número de idosos, um dos desafios da saúde é proporcionar uma melhor qualidade de vida e uma velhice mais digna aos idosos. A qualidade de vida encontra-se associada a inúmeros fatores, nesta fase da vida ocorre um decréscimo do bem estar, devido à diminuição funcional, perda de autonomia, isolamento social, sentimento de inutilidade, insegurança e inferioridade, quadro este que aumenta a chance deste vir a adquirir um quadro de depressão. A dor nesta fase passa a possuir um papel de grande importância, já que esta se encontra intimamente ligada a limitações funcionais, sendo que, o quadro álgico pode gerar comprometimento na autonomia e independência. Este trabalho teve por objetivo verificar a qualidade de vida de idosos praticantes de grupo terapêutico. Foram avaliados dezesseis idosos que participaram de um grupo terapêutico. Antes de iniciar as atividades do grupo os idosos responderam ao questionário genérico SF-36 e após quatro semanas de atividade de integração, trabalhos manuais e exercícios físicos, os idosos foram reavaliados. Notou-se uma melhora no quadro geral dos idosos, sendo que houve um acréscimo estatisticamente significante no estado geral da saúde e diminuição da dor percebida. O presente estudo mostrou que o bem estar físico e emocional pode influenciar na melhora da qualidade de vida em idosos.

With the increase in the number of the elderly, one of the heath care's challenges is to promote a better quality of life and a worthir elderly. The quality of live is related to innumerous factors, in this time of life occur a decrease in the well-being, due to a functional decrease, the lost of autonomy, social isolation, thoughts of inutile, insecure and inferiority, events that increase the chance of getting a depressiona symptom. The pain in this time of life gets a new role with great importance, due to its relationship with functional limitations, seeing that the pain can engage injuries in autonomy and indeoendency. The issue of this study was to verify the quality of life in the elderly. Sixteen elderly people that participated of a therapeutic group were evaluated. Before the beginning of the group's activities, they asnswered the SF-36 questionnaire and four weeks, after hand works, integrate activities and physycal exercises they were reevaluated. Was noticed and increase in the general staff, with a significantly statistic increase in general health and a decrease in the pain. The present study demonstrated that the physical and emotional well-being can influence an improvement in the quality of life in the elderly.