Optimised return to play: high treatment success rate in core muscle injury with surgical release of the anterior tendon of the rectus abdominis muscle and proximal tenotomy of the adductor longus muscle.

OBJECTIVES: Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain in the inguinal region and can lead to a significant number of absences from high-intensity physical activity. It is caused by repetitive overload without proper counterbalance from the abdominal muscles, hip flexors, and adductors in susceptible athletes. Surgical indications for core muscle injury consider cases where non-surgical treatments have not provided sufficient relief. The aim of this study was to assess the results of surgical intervention for core muscle injury using the technique employed by the Sports Medicine Group of (Institute of Orthopedics and Traumatology of Hospital das Clínicas - Universidade de São Paulo). The procedure involves releasing the anterior portion of the tendon of the rectus abdominis muscle near the pubic symphysis, along with proximal tenotomy of the adductor longus muscle tendon. METHODS: This study utilised a consecutive historical cohort analysis of the medical records of 45 male athletes, of which, 75.6% were professional soccer players, who underwent surgical treatment between January 1, 2002, and December 31, 2021. The participants included active athletes aged between 18 and 40 years, with a mean age of 23.9 years, and were diagnosed with myotendinous core muscle injury. These athletes experienced pain in the pubic symphysis and adductor tendon region and had previously undergone medical treatment and physical therapy for a duration of three to six months without significant improvement. RESULTS: The average time for athletes to return to sport after surgery was 135 days, with a majority of participants being soccer and futsal players. The surgical intervention yielded promising results, with a positive correlation between unilateral injuries and the time taken to return to sport. The complication rate was low, at 6.7%. Notably, the rate of symptom resolution was high, at 93.3%. Furthermore, the analysis indicated that the player's position on the field significantly influenced the discharge period, suggesting that the game position plays a role in the recovery process. CONCLUSION: The combined surgical procedure involving the release of the rectus abdominis tendon and adductor longus muscle tenotomy demonstrates favourable outcomes for athletes with core muscle injury. This study provides strong support for the effectiveness of this surgical approach in managing the condition and offers a potential path to recovery and return to sports activities. STUDY DESIGN: Cross-sectional study.

Intracellular and extracellular water content with carbohydrate-loading diets / Contenido de agua intracelular y extracelular con dietas de carga de carbohidratos / Conteúdo de água intracelular e extracelular com dietas de carregamento de carboidratos

ABSTRACT Introduction: In prolonged physical activities, water replacement and muscle glycogen content are limiting factors in marathon runners. Carbohydrate-loading (CHO) in the days prior to endurance competition is a commonly employed method to optimise muscle glycogen stores and optimise exercise performance. Since each gram of muscle glycogen binds ∼2.7-4 grams of water, water retention may occur during carbohydrate-loading diets. Objective: To evaluate differences between CHO loading strategies (Bergström and Sherman) on intracellular (ICW) and extracellular (ECW) water content. Methods: Twenty-three runners were randomly allocated to two interventions (Bergström and Sherman) in a crossover design. Participants underwent a baseline evaluation before 3 days of glycogen depletion followed by 3 days of carbohydrate loading with a washout of 30 days consisting of normal diet and training. Multifrequency bioimpedance (BIS) was used to assess ICW and ECW at Baseline, Post-depletion and Post-CHO to determine any differences between Bergström and Sherman protocols. Blood samples were also obtained to assess potassium levels. Associations between ICW and ECW and muscle glycogen were determined. Results: There were no differences in ICW or ECW content between the two interventions at any moment. There was an effect of time for ICW, with an increase from Post-depletion to Post-CHO without any difference between interventions. Plasma potassium decreased from Baseline to Post-depletion in both conditions. There was no difference in muscle glycogen content between interventions or moments. Conclusion: There were no differences in ICW and ECW content between the Bergström and Sherman interventions at any moment. Level of Evidence I; Tests of Previously Developed Diagnostic Criteria.

RESUMEN Introducción: En actividades físicas prolongadas, la reposición de agua y el glucógeno muscular son factores limitantes en los corredores de maratón. La carga de carbohidratos (CHO) en los días previos a la competencia de resistencia es un método empleado para optimizar las reservas de glucógeno muscular y el rendimiento del ejercicio. Cómo cada gramo de glucógeno muscular se une a ≈ 2,7 a 4 gramos de agua, puede producirse retención de agua durante las dietas ricas en carbohidratos. Objetivo: Evaluar las diferencias entre las estrategias de carga de carbohidratos (Bergström y Sherman) en el contenido de agua intracelular (AIC) o extracelular (AEC). Métodos: Veintitrés corredores fueron asignados aleatoriamente a dos intervenciones (Bergström y Sherman) en un diseño cruzado. Los participantes se sometieron a una evaluación inicial antes de los 3 días de agotamiento del glucógeno, seguido de 3 días de carga de carbohidratos con un tiempo de "washout" de 30 días que consistía en una dieta y entrenamiento normales. Se utilizó bioimpedancia multifrecuencia (BIS) para evaluar AIC y AEC al inicio, después del agotamiento y después de CHO para determinar cualquier diferencia entre las dos intervenciones. También se obtuvieron muestras de sangre para evaluar el potasio. Se determinaron asociaciones entre AIC, AEC y glucógeno muscular. Resultados: No hubo diferencias en el contenido de AIC o AEC entre las dos intervenciones en ningún momento. Hubo un efecto de tiempo para AIC, con un aumento desde Post-agotamiento hasta Post-CHO sin ninguna diferencia entre las intervenciones. El potasio plasmático disminuyó entre el inicio y el post-agotamiento en ambas condiciones. No hubo diferencia en el contenido de glucógeno muscular entre las intervenciones o momentos. Conclusión: No hubo diferencias en el contenido de AIC y AEC entre las dos intervenciones en ningún momento. Nivel de Evidencia I; Pruebas de Criterios Diagnóstico Desarrollados Previamente.

RESUMO Introdução: Em atividades físicas prolongadas a reposição hídrica e o conteúdo de glicogênio muscular são fatores limitantes em corredores de maratonas. O carregamento de carboidrato (CHO) nos dias anteriores à competição de resistência é um método comumente empregado para otimizar os estoques de glicogênio muscular e o desempenho no exercício. Uma vez que cada grama de glicogênio muscular liga-se a ≈2,7 a 4 gramas de água, a retenção hídrica pode ocorrer durante dietas de carregamento de carboidrato. Objetivo: Avaliar diferenças entre as estratégias de carregamento de carboidratos (Bergström e Sherman) no teor de água intracelular (AIC) ou água extracelular (AEC). Métodos: Vinte e três corredores foram alocados aleatoriamente para duas intervenções (Bergström e Sherman) num delineamento em "crossover". Os participantes foram submetidos a uma avaliação inicial antes dos 3 dias de depleção de glicogênio, seguidos por 3 dias de carga de carboidratos com tempo de "washout" de 30 dias consistindo em dieta e treinamento normais. Utilizou-se a bioimpedância multifrequencial (BIS) para avaliar AIC e AEC na Etapa Inicial, Pós-depleção e Pós-CHO para determinar quaisquer diferenças entre os protocolos de Bersgstrom e Sherman. Também foram obtidas coletas de sangue para avaliar o potássio. Foram determinadas associações entre AIC, AEC e glicogênio muscular. Resultados: Não houve diferenças no conteúdo de AIC ou AEC entre as duas intervenções em qualquer momento. Houve um efeito do tempo para AIC, com aumento da etapa Pós-depleção para Pós-CHO sem qualquer diferença entre as intervenções. O potássio plasmático diminuiu entre a Linha de base e Pós-depleção em ambas condições. Não houve diferença no conteúdo de glicogênio muscular entre intervenções ou momentos. Conclusão: Não houve diferenças no conteúdo de AIC e AEC entre as intervenções de Bergström e Sherman em qualquer momento. Nível de Evidência I; Testes de Critérios Diagnósticos Desenvolvidos Anteriormente.

Anteromedial or central anatomic acl reconstruction? a cadaveric hip-to-toe study / Reconstrução anatômica anteromedial ou central do lca? estudo em cadáver completo

ABSTRACT Objective: To compare anatomic anterior cruciate ligament (ACL) reconstruction between two tunnel positions in knees with isolated ligament tears. Methods: Anatomic ACL reconstruction was performed, from hip-to-toe, on 15 fresh cadaveric specimens. No associated lesions were created to enhance knee instability. The protocol was conducted in three states: (1) complete isolated ACL deficiency; (2) anatomic femoral and tibial anteromedial ACL reconstruction (AM REC); and (3) anatomic femoral and tibial central ACL reconstruction (Central REC). The reconstruction protocols were randomly assigned. The continuous mechanized pivot-shift test was recorded dynamically with a tracking system. Results: The Central REC group showed a smaller degree of internal rotation (0.6° ± 0.3° vs. 1.8° ± 0.3°, respectively, P < 0.05) and no difference in anterior translation (4.7 mm ± 0.4 mm vs. 4.5 mm ± 0.4 mm, respectively, P > 0.05) in the pivot-shift test, compared with the AM REC group. Conclusion: The central anatomic ACL reconstruction resulted in greater restriction of internal rotation than the anteromedial anatomic ACL reconstruction. Experimental Study on Cadaver.

RESUMO Objetivo: Comparar a reconstrução anatômica do ligamento cruzado anterior (LCA) entre duas posições de túnel em joelhos com lesões isoladas do ligamento. Métodos: A reconstrução anatômica do LCA foi realizada, do quadril aos pés, em 15 peças anatômicas de cadáveres frescos. Não foram criadas lesões associadas para intensificar a instabilidade do joelho. O protocolo foi realizado em três estados: (1) deficiência isolada completa do LCA; (2) reconstrução anatômica femoral e anteromedial tibial do LCA (AM REC); e (3) reconstrução anatômica femoral e central tibial do LCA (Central REC). Os protocolos de reconstrução foram atribuídos aleatoriamente. O teste de pivot-shift mecanizado contínuo foi registrado dinamicamente com um sistema de rastreamento. Resultados: O grupo Central REC apresentou menor grau de rotação interna (0,6° ± 0,3° vs. 1,8° ± 0,3°, respectivamente, p < 0,05) e nenhuma diferença na translação anterior (4,7 mm ± 0,4 mm vs. 4,5 mm ± 0,4 mm, respectivamente, p > 0,05) no teste de pivot-shift, comparado ao grupo AM REC. Conclusão: A reconstrução anatômica central tibial do LCA resultou em maior restrição da rotação interna do que a reconstrução anteromedial tibial do LCA. Estudo em Cadáver Experimental.

Muscle Injury: Pathophysiology, Diagnosis, and Treatment.

Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides these injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by ultrasound, which is dynamic and cheap, but examiner dependent; and magnetic resonance imaging (MRI), which provides better anatomical definition. The initial phase of the treatment consists in protection, rest, optimal use of the affected limb, and cryotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in the clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.

Muscle Injury: Pathophysiology, Diagnosis, and Treatment / Lesão muscular: Fisiopatologia, diagnóstico e tratamento

Abstract Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides these injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by ultrasound, which is dynamic and cheap, but examiner dependent; and magnetic resonance imaging (MRI), which provides better anatomical definition. The initial phase of the treatment consists in protection, rest, optimal use of the affected limb, and cryotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in the clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.

Resumo O tecido muscular esquelético possui a maior massa do corpo humano, correspondendo a 45% do peso total. As lesões musculares podem ser causadas por contusões, estiramentos ou lacerações. A atual classificação separa as lesões entre leves, moderadas e graves. Os sinais e sintomas das lesões grau I são edema e desconforto; grau II, perda de função, gap e equimose eventual; grau III, rotura completa, dor intensa e hematoma extenso. O diagnóstico pode ser confirmado por ultrassom (dinâmico e barato, porém examinador-dependente); e ressonância magnética (RM) (maior definição anatômica). A fase inicial do tratamento se resume à proteção, ao repouso, ao uso otimizado do membro afetado e crioterapia. Anti-inflamatórios não hormonais (AINHs), ultrassom terapêutico, fortalecimento e alongamento após a fase inicial e amplitudes de movimento sem dor são utilizados no tratamento clínico. Já o cirúrgico possui indicações precisas: drenagem do hematoma, reinserção e reforço musculotendíneos.

Is 12 months enough to reach function after athletes' ACL reconstruction: a prospective longitudinal study

Abstract Context: Anterior Cruciate Ligament (ACL) injury is disabling in several sports because it causes knee instability and functional deficit. Usually, surgical treatments produce the best functional outcomes, however, sometimes they are not always able to fully restore stability and function. Objective: The objective of this study was to evaluate postural balance, muscle strength, and functional performance of young athletes with an ACL injury before and after ACL reconstruction. Design: This was a longitudinal observational prospective study. Method: 74 athletes, 60 men, and 14 women, aged between 16 and 45, divided into two groups: the Group-Lesion of ACL with 34 athletes (24.1 years) and the Group-Control with 40 athletes without ACL lesion (27.7 years old). All volunteers performed posturography, isokinetic dynamometry, and the Hop-Test. The ACL-Group was evaluated before and 12 months after the reconstruction and the control group was evaluated once. Results: The Postoperative ACL Group presented greater limb symmetry, 0.96 (± 0.12), than the preoperative ACL Group, 0.87 (± 0.17), p < 0.01 in the Hop-Test. In the posturography, the displacement area was smaller in the postoperative ACL Group, 19.85 (± 5.74), compared to the preoperative ACL Group, 24.20 (± 8.97), p < 0.01. In isokinetic dynamometry the torque peak was greater in the postoperative ACL Group, 0.91 (± 0.14), than in the preoperative ACL Group, 0.74 (± 0.15), p < 0.01. Conclusion: The functional outcomes increased in ACL reconstruction athletes after 12 months, but not at the same level as in the Control Group. The result indicates an incomplete functional recovery, adaptive changes in postural control after injury, reconstruction, and return to sport.

Increased risk of sports injuries among medical students: cross-sectional study / Elevado risco de lesões esportivas em alunos de medicina: estudo transversal

ABSTRACT Objective: To evaluate the nature and rate of sports injuries in medical students, as well as the risk factors at these events. Methods: All student-athletes (218) from a Medical School, integrated in at least one of the six team sport modalities (soccer, rugby, indoor soccer, handball, basketball, and volleyball) in 2017, were included. Injuries affecting their performance, regardless of time loss, were included. Athlete-exposure (A-E) was defined as one student-athlete participating in one practice or game. Results: Injury rates were significantly higher in junior medical students (1st - 3rd year) (7.58 per 1000 A-E, 95%CI = 6.11-9.06) than in senior medical students (4th - 6th year) (4.49 per 1000 A-E, 95%CI = 3.26-5.73) (p < 0.001). Multi-sports athletes had higher injury rates (10.69 per 1000 A-E, 95%CI = 8.22-13.17) than single-sport athletes (4.49 per 1000 A-E, 95%CI = 3.51-5.47) (p = 0.002). More than 60% of reported injuries occurred in the lower limbs and the mechanism that accounted for most injuries in games was player contact (51%); whereas in practice, it was non-contact (53%). Conclusion: Junior medical students present a higher injury rate than seniors. Medical students practicing more than one modality had a higher injury rate than those involved in just one sport modality. Level of Evidence IV, Cross-Sectional Study.

RESUMO Objetivo: Avaliar a incidência e as características das lesões esportivas em alunos de medicina, assim como os fatores de risco envolvidos. Métodos: Todos os alunos (218) da Faculdade de Medicina da Universidade de São Paulo que integravam seis modalidades esportivas (futebol, rugby, futsal, handebol, basquete e vôlei) em 2017 foram incluídos. Foram incluídas as lesões que afetaram a performance, independente do tempo de afastamento. Uma exposição-atleta (E-A) foi definida como a participação de um aluno em um jogo ou treino. Resultados: A taxa de lesão foi maior em alunos do 1º ao 3º ano (7,58 por 1000 E-As 95% IC = 6,11-9,06) do que em alunos do 4º ao 6º ano (4,49 por 1000 E-As 95% IC = 3,26-5,73) (p < 0.001). Alunos praticantes de mais de uma modalidade apresentaram maior taxa de lesão (10,69 por 1000 E-As, 95% IC 8,22-13,17) do que alunos praticantes de apenas uma modalidade (4.49 por 1000 E-As, 95% IC 3,51-5,47) (p = 0.002). Mais de 60% das lesões ocorreram nos membros inferiores e o principal mecanismo em jogos foi contato com outro jogador (51%), e em treinos foi lesão sem contato (53%). Conclusão: Alunos do 1 ˚ ao 3 ˚ ano apresentaram maior taxa de lesão do que alunos do 4º ao 6º ano. Alunos praticantes de mais de uma modalidade apresentaram maior taxa de lesão do que alunos praticantes de apenas uma modalidade. Nível de Evidência IV, Estudo Transversal.

A biomechanical comparison of matched four-strand and five-strand semitendinosus-gracilis grafts / Estudo biomecânico comparativo entre enxertos quádruplos e quíntuplos pareados de tendões dos músculos semitendíneo e grácil / Estudio biomecânico comparativo entre injertos de tendones semitendinoso e gracilis cuádruple e quíntuple

ABSTRACT Introduction: Recent studies have shown that the likelihood of semitendinosus-gracilis graft rupture is inversely correlated to its diameter. A graft can be prepared in a five-strand or four-strand fashion to increase its diameter. However, the biomechanical superiority of five-strand semitendinosus-gracilis grafts is still under debate. Objective: This study aimed to evaluate the biomechanical characteristics of matched four-strand and five-strand human semitendinosus-gracilis grafts. Methods: We evaluated semitendinosus-gracilis tendons harvested from ten fresh human male and female cadavers, aged 18-60 years. Four-strand or five-strand grafts were prepared with the tendons and fixed to wooden tunnels with interference screws. Each graft was submitted to axial traction at 20 mm/min until rupture; the tests were donor matched. Data were recorded in real time and included the analysis of the area, diameter, force, maximum deformation and stiffness of the grafts. Results: The diameter, area and tunnel size were significantly greater in the five-strand grafts than in the four-strand grafts. There were no significant differences in biomechanical properties. The area and diameter of the graft were positively correlated to stiffness, and inversely correlated to elasticity. There was no significant correlation between graft size and maximum force at failure, maximum deformation or maximum tension. Conclusion: Five-strand hamstring grafts have greater area, diameter and tunnel size than four-strand grafts. There were no significant differences in biomechanical properties. In this model using interference screw fixation, the increases in area and diameter were correlated with an increase in stiffness and a decrease in elasticity. Level of evidence V; biomechanical study.

RESUMEN Introducción: Estudios recientes demostraron que la probabilidad de ruptura de los injertos semitendinoso y gracilis (STG) durante el pos operatorio de reconstrucción de ligamento cruzado anterior (LCA) está inversamente correlacionada a su diámetro. Un injerto puede ser preparado para obtener cuatro o cinco hebras para aumentar su diámetro, pero la superioridad biomecanica de los injertos STG de cinco hebras aún se mantiene en discusión. Objetivo: Evaluar las características biomecánicas de los injertos STG de humanos de cuatro o cinco hebras por pares. Métodos: Fueron evaluados tendones STG de diez cadaveres masculinos y diez cadaveres femeninos frescos, entre los 18 y 60 años. Los injertos de cuatro y cinco hebras fueron fijados en túneles de madera con tornillos de interferencia. Cada injerto fue sometido a una tracción axial de 200mm/min hasta su ruptura; estos tendones fueron separados por pares de acuerdo con sus donadores. Los datos fueron registrados en tiempo real y incluyeron el análisis del área del injerto, diámetro, fuerza, deformación máxima y rigidez. Resultados: Los resultados sobre el diámetro, el área y el tamaño del túnel fueron significativamente mayores en los injertos de cinco hebras que en los de cuatro. No existieron diferencias significativas en las propiedades biomecánicas. El área y el diámetro del injerto fueron correlacionados positivamente con la rigidez e inversamente con la elasticidad. No existió correlación significativa entre el tamaño del injerto y la fuerza máxima al momento de la falla, Máxima deformación o máxima tensión. Conclusión: Los injertos de isquiotibiales de cinco hebras tienen una área, diámetro y tamaño de túnel más grande que los injertos de cuatro hebras. No hubieron diferencias biomecánicas significativas. Los aumentos de área y diámetro en este modelo con la fijación de tornillo de interferencia fueron correlacionados con aumento de en la rigidez y una disminución en la elasticidad. Nivel de evidencia V; estudio biomecánico.

RESUMO Introdução: Estudos recentes demonstraram que a probabilidade de ruptura do enxerto dos tendões do semitendíneo e do grácil (STG) é correlacionada inversamente com seu diâmetro. Um enxerto pode ser preparado de forma quádrupla ou quíntupla para se aumentar o diâmetro. No entanto, a superioridade biomecânica dos enxertos STG quíntuplos ainda está em debate. Objetivo: Este estudo teve como objetivo avaliar as características biomecânicas dos enxertos STG humanos quádruplos ou quíntuplos pareados. Métodos: Foram avaliados tendões STG retirados de dez cadáveres masculinos e femininos frescos, com idades entre 18 e 60 anos. Os enxertos quádruplos ou quíntuplos foram preparados com os tendões e fixados em túneis de madeira com parafusos de interferência. Cada enxerto foi submetido à tração axial a 20 mm/min. até a ruptura; os testes foram pareados de acordo com os doadores. Os dados foram registrados em tempo real e incluíram a análise de área, diâmetro, força, deformação máxima e rigidez dos enxertos. Resultados: O diâmetro, a área e o tamanho do túnel foram significativamente maiores nos enxertos quíntuplos do que nos enxertos quádruplos. Não houve diferenças significativas nas propriedades biomecânicas. A área e o diâmetro do enxerto foram correlacionados positivamente com a rigidez e inversamente com a elasticidade. Não houve correlação significativa entre o tamanho do enxerto e a força máxima na falha, deformação máxima ou tensão máxima. Conclusão: Os enxertos quíntuplos dos músculos isquiotibiais têm maior área, diâmetro e tamanho do túnel do que os enxertos quádruplos. Não houve diferenças significativas nas propriedades biomecânicas. Neste modelo de fixação com parafuso de interferência, aumentos da área e do diâmetro foram correlacionados com o aumento da rigidez e a diminuição na elasticidade. Nível de evidência V; Estudo Biomecânico.

Macrophage: A Potential Target on Cartilage Regeneration.

Cartilage lesions and osteoarthritis (OA) presents an ever-increasing clinical and socioeconomic burden. Synovial inflammation and articular inflammatory environment are the key factor for chondrocytes apoptosis and hypertrophy, ectopic bone formation and OA progression. To effectively treat OA, it is critical to develop a drug that skews inflammation toward a pro-chondrogenic microenvironment. In this narrative and critical review, we aim to see the potential use of immune cells modulation or cell therapy as therapeutic alternatives to OA patients. Macrophages are immune cells that are present in synovial lining, with different roles depending on their subtypes. These cells can polarize to pro-inflammatory (M1) and anti-inflammatory (M2) phenotypes, being the latter associated with wound-healing by the production of ARG-1 and pro-chondrogenic cytokines, such as IL-10, IL-1RA, and TGF-b. Emerging evidence reveals that macrophage shift can be determined by several stimuli, apart from the conventional in vitro IL-4, IL-13, and IL-10. Evidences show the potential of physical exercise to induce type 2 response, favoring M2 polarization. Moreover, macrophages in contact with oxLDL have effect on the production of anabolic mediators as TGF-b. In the same direction, type II collagen, that plays a critical role in development and maturation process of chondrocytes, can also induce M2 macrophages, increasing TGF-b. The mTOR pathway activation in macrophages was shown to be able to polarize macrophages in vitro, though further studies are required. The possibility to use mesenchymal stem cells (MSCs) in cartilage restoration have a more concrete literature, besides, MSCs also have the capability to induce M2 macrophages. In the other direction, M1 polarized macrophages inhibit the proliferation and viability of MSCs and impair their ability to immunosuppress the environment, preventing cartilage repair. Therefore, even though MSCs therapeutic researches advances, other sources of M2 polarization are attractive issues, and further studies will contribute to the possibility to manipulate this polarization and to use it as a therapeutic approach in OA patients.

Systematic Review of Human Dental Pulp Stem Cells for Cartilage Regeneration.

Background: Symptomatic cartilage lesions and early osteoarthritis produce significant clinical and economic burdens. Cartilage repair can improve the symptoms and delay arthroplasty. The complete healing of damaged cartilage with the consistent reproduction of normal hyaline cartilage has not yet been achieved. The choice of harvesting site might influence the cells' abilities to modulate immunologic and inflammatory responses. Recently, dental pulp has been shown to contain a stem cell niche consisting of dental pulp stem cells (DPSCs) that maintain their self-renewal capacity due to the active environment in the dental pulp of deciduous teeth. Objective: The aim of this study was to critically review the current literature on the potential and limitations of the use of dental pulp-derived mesenchymal stem cells in cell-based therapies for cartilage regeneration. Methods: An electronic, customized search of scientific articles was conducted using the PubMed/MEDLINE and EMBASE databases from their inception to December 2018. The inclusion criteria were applied, and the articles that described the use of DPSC in cartilage treatment were selected for complete evaluation. The articles were classified according to the scaffold used, experimental model, chondrogenic differentiation features, defect location, cartilage evaluation, and results. After the application of the eligibility criteria, a total of nine studies were selected and fully analyzed. Results: A variety of animal models were used, including mice, rats, rabbits, and miniature pigs, to evaluate the quality and safety of human DPSCs in the repair of cartilage defects. Among the articles, two studies focused on preclinical models of cartilage tissue engineering. Five studies implanted DPSCs in other animal sites. Conclusion: The use of DPSCs is a potential new stem cell therapy for articular cartilage repair. The preclinical evidence discussed in this article provides a solid foundation for future clinical trials. Impact statement Osteoarthritis presents an ever-increasing clinical and socioeconomic burden. While cartilage repair has the potential to improve symptoms and delay joint replacement, complete regeneration of hyaline cartilage has been an elusive goal. Dental pulp has been shown to contain a niche that protects dental pulp stem cells (DPSCs) from the cumulative effects of genetic and environmental factors and maintains their self-renewal capacity due to the active environment. Transplantation and preclinical trials have demonstrated the strong potential of regenerative tissue-engineering protocols using DPSCs.

Clinical application of thermography for energy balance in athletes - state of the art and new paradigms / Aplicação clínica da termografia para equilibrio energético em atletas - estado da arte e novos paradigmas / Aplicación clínica de la termografia para equilibrio energético en atletas - estado del arte y nuevos paradigmas

This article aims to describe the evolution of techniques that have enabled the proper application of the Laws of Thermodynamics for physical activity and athletes. The objective is to propose performance indicators to help add information to the current indices used in medicine and sports, such as the lactate threshold and maximum oxygen consumption. A number of analyses of the results obtained by the group were carried out for this purpose. Moreover, a discussion regarding which techniques would provide a better response to the measurements was analyzed. Some examples are the substitution of the treadmill running test with the stationary bicycle (known performed work), and a literature search in order to measure internal temperature more accurately. Level of Evidence V; Expert opinion.

Este artigo descreve a evolução de técnicas que possibilitaram a aplicação adequada das Leis da Termodinâmica às atividades físicas e aos atletas. O objetivo é propor indicadores de desempenho que ajudem a acrescentar informações aos índices atuais usados em medicina e nos esportes, como o limiar de lactato e o consumo máximo de oxigênio. Diversas análises dos resultados obtidos pelo grupo foram realizadas com essa finalidade. Além disso, procedeu-se à análise da discussão sobre quais técnicas proporcionariam resposta melhor às medições. Alguns exemplos são a substituição do teste de corrida em esteira pela bicicleta ergométrica (que sabidamente, pode ser usada para o trabalho), e a pesquisa da literatura para medir a temperatura interna com maior precisão. Nível de Evidência V; Opinião de especialista.

Este artículo describe la evolución de técnicas que posibilitaron la aplicación adecuada de las Leyes de la Termodinámica a las actividades físicas y a los atletas. El objetivo es proponer indicadores de desempeño que ayuden a acrecentar informaciones a los índices actuales usados en medicina y en los deportes, como el umbral de lactato y el consumo máximo de oxígeno. Fueron realizados diversos análisis de los resultados obtenidos por el grupo con esa finalidad. Además, se procedió al análisis de la discusión sobre qué técnicas proporcionarían respuesta mejor a las mediciones. Algunos ejemplos son la sustitución del test de carrera en cinta por la bicicleta ergométrica (que sabidamente, puede ser usada para el trabajo), y la investigación de la literatura para medir la temperatura interna con mayor precisión. Nivel de Evidencia V; Opinión de especialista.

Human Synovial Mesenchymal Stem Cells Good Manufacturing Practices for Articular Cartilage Regeneration.

Background: Cartilage restoration is a desperately needed bridge for patients with symptomatic cartilage lesions. Chondral lesion is a pathology with high prevalence, reaching as much as 63% of general population and 36% among athletes. Despite autologous chondrocyte implantation versatility, it still fails to fully reproduce hyaline articular cartilage characteristics. Mesenchymal stem cells (MSCs) may be isolated from various known tissues, including discarded fragments at arthroscopy such as synovial membrane. Choice of harvesting site is motivated by MSCs' abilities to modulate immunologic and inflammatory response through paracrine communication. Synovial MSCs have a greater proliferation and strong chondrogenic potential than bone and adipose MSCs and a less hypertrophic differentiation than bone MSCs. Good manufacturing practice (GMP) laboratory techniques for human clinical trials are still novel. To our knowledge, there are only two clinical trials in humans published since today. Purpose: Therefore, this work aimed to isolate and characterize synovial MSCs and evaluated their differentiation properties according to GMP standards. Materials and Methods: One-gram tissue sample from three patients of synovia was harvested at the beginning of arthroscopy surgery. MSCs were isolated, expanded, and characterized by flow cytometry. Results: It was possible to isolate and expand MSCs cultures from synovia, characterize MSCs by flow cytometry using proper monoclonal antibodies, and differentiate MSCs by coloring technique after chondrogenic, adipogenic, and osteogenic differentiations. Cartilage treatment may benefit from these tissue engineering protocols since arthroscopic procedures are routinely performed for different purposes in a previous stage and a favorable chondronegic differentiation cell lineage may be collected and stored in a less invasive way. Conclusion: Laboratory protocols established according to presented GMP were able to isolate and characterize MSCs obtained from synovia. Impact Statement Articular cartilage restoration is a desperately needed bridge for patients with symptomatic cartilage lesions and it rises as a socioeconomic issue with a considerable economic burden. Synovial mesenchymal stem cells (MSCs) have a greater proliferation rate and strong chondrogenic potential than bone and adipose MSCs and a less hypertrophic differentiation than bone MSCs. To our knowledge, there are only two human clinical trials with good manufacturing practice laboratory techniques for synovial MSCs harvesting and differentiation. Cartilage treatment may benefit from these tissue engineering protocols since arthroscopic procedures are routinely performed for different purposes in a previous stage.

BILATERAL LOCALIZED PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE: CASE REPORT AND REVIEW.

OBJECTIVES: Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary. METHODS: The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor. RESULTS: Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28 -year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1- and T2-weighted images. These were associated with hemosiderin pigmentation. CONCLUSION: The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site. Level of Evidence IV; Case series.

OBJETIVOS: Diversos casos de sinovite vilonodular pigmentada difusa bilateral (SVNP) ou tumor de células gigantes tenossinoviais foram descritos na literatura. Entretanto, algumas apresentações são raras e o diagnóstico diferencial é necessário. MÉTODOS: O objetivo do estudo foi realizar uma revisão da literatura relacionada à SVNP e relatar uma apresentação de forma bilateral e localizada rara na região supra-patelar. Foi realizada uma revisão dos bancos de dados do Pubmed Clinical Queries, MeSH e unitermos relacionados com SVNP e tumor de células gigantes tenossinoviais. RESULTADOS: Dois casos de SVNP bilateral e local foram descritos anteriormente. No entanto, nenhum deles foi localizado no compartimento supra-patelar. Até onde sabemos, este relato é o primeiro caso descrito de SVNP bilateral localizada supra-patelar. Apresentamos uma mulher de 28 anos com SVNP bilateral no recesso supra-patelar do joelho. A RM mostrou baixo sinal dos nódulos nas imagens ponderadas em T1 e T2, associados ao pigmento hemossiderina. CONCLUSÃO: O achado mais importante está relacionado à raridade e localização. A histopatologia confirmou um caso raro de pigmento de hemossiderina no nódulo da cápsula com conteúdo viloso não pigmentado internamente. O diagnóstico diferencial com lipoma arborescens na forma supra-patelar é necessário devido à localização comum. Nível de Evidência IV; Série de casos.

Meniscal repair results comparing mri, arthro-mri, and arthro-ct / Resultados da sutura meniscal comparando rm, artro-rm e artro-ct

ABSTRACT Objective To clinically and radiologically evaluate patients who received meniscal suture using the outside-in technique, comparing magnetic resonance imaging (MRI), arthro-magnetic resonance imaging (arthro-MRI), and arthro-computed tomography (arthro-CT) to evaluate the healing of meniscal sutures. Methods We evaluated eight patients with an average follow-up of 15 months. The evaluation analyzed clinical parameters using the Lysholm and IKDC scores as well as MRI, arthro-MRI, and arthro-CT imaging. Results At the end of the follow-up period, mean Lysholm score was 89.5 and mean IKDC score was 78.6. In the MRI, signs of meniscal healing were observed in 50% of the cases. The arthro-MRI and arthro-CT showed signs of healing in 75% of cases. There was a positive correlation between arthro-MRI and arthro-CT results in all the cases studied (kappa correlation index=1). Conclusion Meniscal suture using the outside-in technique presented good or excellent results in 87.5% of our patients. The arthro-CT and arthro-MRI showed the same level of accuracy in detecting healing of the sutured region of the meniscus. Level of Evidence IV; Case series.

RESUMO Objetivo Avaliar clinicamente e radiologicamente pacientes submetidos a sutura-meniscal pela técnica outside-in, comparando a Ressonância Magnética (RM), Artro-Ressonância Magnética (Artro-RM) e Artro-Tomografia Computadorizada (Artro-CT), quanto a cicatrização da sutura meniscal. Método Avaliamos oito pacientes com um seguimento médio de 15 meses, clinicamente e por meio de score de Lisholm e IKDC, e realizamos RM, Artro-RM e Artro-CT. Resultados A média do score de Lysholm foi de 89.5 e o score médio do IKDC foi de 78,6. A RNM observou sinais de cicatrização meniscal em 50% dos casos, enquanto a artro-RNM e artro-CT evidenciaram sinais de cicatrização em 75% dos casos. Houve uma correlação entre a artro-RNM e a artro-CT em todos os casos. Conclusão A sutura meniscal pela técnica outside-in apresentou bons e excelentes resultados em 87,5% dos nossos pacientes. A artro-CT e a artro-RNM têm acurácia equivalente na detecção da cicatrização da região suturada do menisco. Nível de Evidência IV; Série de casos.

Bilateral localized pigmented villonodular synovitis of the knee: case report and review / Sinovite vilonodular pigmentada localizada e bilateral dos joelhos. relato de caso e revisão

ABSTRACT Objectives Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary. Methods The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor. Results Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28 -year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1- and T2-weighted images. These were associated with hemosiderin pigmentation. Conclusion The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site. Level of Evidence IV; Case series.

RESUMO Objetivos Diversos casos de sinovite vilonodular pigmentada difusa bilateral (SVNP) ou tumor de células gigantes tenossinoviais foram descritos na literatura. Entretanto, algumas apresentações são raras e o diagnóstico diferencial é necessário. Métodos O objetivo do estudo foi realizar uma revisão da literatura relacionada à SVNP e relatar uma apresentação de forma bilateral e localizada rara na região supra-patelar. Foi realizada uma revisão dos bancos de dados do Pubmed Clinical Queries, MeSH e unitermos relacionados com SVNP e tumor de células gigantes tenossinoviais. Resultados Dois casos de SVNP bilateral e local foram descritos anteriormente. No entanto, nenhum deles foi localizado no compartimento supra-patelar. Até onde sabemos, este relato é o primeiro caso descrito de SVNP bilateral localizada supra-patelar. Apresentamos uma mulher de 28 anos com SVNP bilateral no recesso supra-patelar do joelho. A RM mostrou baixo sinal dos nódulos nas imagens ponderadas em T1 e T2, associados ao pigmento hemossiderina. Conclusão O achado mais importante está relacionado à raridade e localização. A histopatologia confirmou um caso raro de pigmento de hemossiderina no nódulo da cápsula com conteúdo viloso não pigmentado internamente. O diagnóstico diferencial com lipoma arborescens na forma supra-patelar é necessário devido à localização comum. Nível de Evidência IV; Série de casos.

Development of a Novel Large Animal Model to Evaluate Human Dental Pulp Stem Cells for Articular Cartilage Treatment.

PURPOSE: Chondral lesion is a pathology with high prevalence, reaching as much as 63% of general population and 36% among athletes. The ability of human Dental Pulp Stem Cells (DPSCs) to differentiate into chondroblasts in vitro suggests that this stem cell type may be useful for tissue bioengineering. However, we have yet to identify a study of large animal models in which DPSCs were used to repair articular cartilage. Therefore, this study aimed to describe a novel treatment for cartilage lesion with DPSCs on a large animal model. METHODS: Mesenchymal stem cells (MSC) were obtained from deciduous teeth and characterized by flow cytometry. DPSCs were cultured and added to a collagen type I/III biomaterial composite scaffold. Brazilian miniature pig (BR-1) was used. A 6-mm diameter, full-thickness chondral defect was created in each posterior medial condyle. The defects were covered with scaffold alone or scaffold + DPSCs on the contralateral side. Animals were euthanized 6 weeks post-surgery. Cartilage defects were analyzed macroscopically and histology according to modified O'Driscoll scoring system. RESULTS: Flow cytometry confirmed characterization of DPSCs as MSCs. Macroscopic and histological findings suggested that this time period was reasonable for evaluating cartilage repair. To our knowledge, this study provides the first description of an animal model using DPSCs to study the differentiation of hyaline articular cartilage in vivo. CONCLUSION: The animals tolerated the procedure well and did not show clinical or histological rejection of the DPSCs, reinforcing the feasibility of this descriptive miniature pig model for pre-clinical studies.

Moderate intensity is a better stimulus to induce quadripecs femoris power in elderly adults / Intensidade moderada é o estímulo mais adequado para induzir potência de quadriceps em idosos / Intensidad moderada es el más adecuado para inducir potencia de quadriceps en ancianos

ABSTRACT Introduction: The best strategy for improving knee extensor power, a major functional capacity indicator in older adults, is power training. Nonetheless, the training intensity required to induce optimal gains is yet to be found. Objective: Our purpose was to compare knee extensor peak power responses between low, moderate, and high intensity load conditions (30%, 50% and 70% of 1RM). Methods: Thirteen sedentary elderly women performed six knee extensions in each load condition, calculating knee extensor mechanical work/power output and knee extension peak angular velocity. Results: No difference in peak power was found between the high (207.0 ± 68.1 W) and moderate (206.1 ± 71.6 W) load conditions (p = 0.994), and both had higher values (p ≤0.004) than the low intensity condition (135.6 ± 56.3 W). Conclusion: Moderate load at 50% of 1RM appears to be the preferred strategy for inducing knee extensor power output because in contrast with the high intensity condition, the moderate load yielded higher angular peak velocity, which is also a functional indicator. Level of Evidence ll; Therapeutic studies - Investigating treatment results.

RESUMO Introdução: A melhor estratégia para melhorar a potência dos extensores do joelho, principal indicador da capacidade funcional em idosos, é o treinamento de força. No entanto, a intensidade do treinamento exigida para induzir a maiores benefícios ainda não é conhecida. Objetivo: Nosso objetivo consistiu em comparar as respostas de potência máxima dos extensores do joelho entre as condições de carga baixa, moderada e de alta intensidade (30%, 50% e 70% de uma repetição máxima). Métodos: Treze mulheres idosas sedentárias realizaram seis extensões de joelho em cada condição de carga, sendo calculado o trabalho mecânico/débito de força e a velocidade angular máxima (ou pico) dos extensores do joelho. Resultados: Não houve diferença significativa na potência máxima entre as condições de carga alta ((207,0 ± 68,1 W) e moderada (206,1 ± 71,6 W) (p = 0,994), e ambas apresentaram valores maiores (p ≤ 0,004) do que a condição de baixa intensidade (135,6 ± 56,3 W). Conclusão: A carga moderada a 50% de 1RM parece ser a estratégia preferida para induzir o débito de força dos extensores do joelho, uma vez que quando comparada com a condição de alta intensidade, a carga moderada apresentou um pico de velocidade angular maior, o que também é um indicador funcional. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: La mejor estrategia para mejorar la potencia de los extensores de la rodilla, principal indicador de la capacidad funcional en personas de la tercera edad, es el entrenamiento de fuerza. Sin embargo, la intensidad del entrenamiento exigida para inducir a mayores beneficios aún no es conocida. Objetivo: Nuestro objetivo consistió en comparar las respuestas de potencia máxima de los extensores de la rodilla entre las condiciones de carga baja, moderada y de alta intensidad (30%, 50% y 70% de una repetición máxima). Métodos: Trece mujeres de la tercera edad sedentarias realizaron seis extensiones de rodilla en cada condición de carga, siendo calculado el trabajo mecánico/débito de fuerza y la velocidad angular máxima (o pico) de los extensores de la rodilla. Resultados: No hubo diferencia significativa en la potencia máxima entre las condiciones de carga alta ((207,0 ± 68,1 W) y moderada (206,1 ± 71,6 W) (p = 0,994), y ambas presentaron valores mayores (p ≤ 0,004) que la condición de baja intensidad (135,6 ± 56,3 W). Conclusión: La carga moderada a 50% de 1RM parece ser la estrategia preferida para inducir el débito de fuerza de los extensores de la rodilla, dado que cuando comparada con la condición de alta intensidad, la carga moderada presentó un pico de velocidad angular mayor, lo que también es un indicador funcional. Nivel de Evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.

SPORTS INJURIES AMONG AMATEUR ATHLETES AT A BRAZILIAN UNIVERSITY / LESÕES ESPORTIVAS EM ATLETAS AMADORES DE UMA UNIVERSIDADE BRASILEIRA

ABSTRACT Objective: To obtain information on the incidence and nature of sports injuries at a Brazilian university. Method: Data from 396 student amateur athletes (61% male) playing 15 different sports during the 2013 season were retrospectively evaluated. Subjects completed the National Collegiate Athletic Association Injury Surveillance System questionnaire at the conclusion of the 2013 sports season. Injuries that resulted in at least one day of time lost were included. Exposure was defined as one student amateur athlete participating in one practice or game and is expressed as an athlete-exposure (A-E). Results: Injury rates were significantly greater in games (13.13 injuries per 1000 A-Es, 95% CI = 10.3-15) than in practices (4.47 injuries per 1000 A-Es, 95% CI = 3.9-5.1). The mechanisms that accounted for the most injuries in games and practices were player contact (52.9%) and non-contact (54.5%), respectively. Ankle ligament sprains were the most common injury (18.2% of all reported injuries). A relatively high incidence of anterior cruciate ligament injury was also observed (0.16 injuries per 1000 A-Es). Conclusion: Brazilian student amateur athletes are at great risk of sustaining non-contact injuries such as ankle sprains and anterior cruciate ligament injuries. Level III of Evidence, Study of non consecutive patients; without consistently applied reference ''gold'' standard.

RESUMO Objetivo: Obter a incidência e as características das lesões esportivas em atletas de uma universidade do Brasil. Métodos: Os dados de 396 atletas amadores universitários (61% homens) de 15 modalidades, referentes ao ano de 2013, foram avaliados retrospectivamente. Os atletas responderam o questionário ISS (Injury Surveillance System) adotado pela NCAA (National Collegiate Athletic Association) no final da temporada esportiva de 2013. Foram incluídas as lesões que resultaram em pelo menos um dia de afastamento. A exposição foi definida como um atleta amador universitário participando de um treino ou jogo e foi expressa como uma exposição-atleta (E-A). Resultados: As taxas de lesões em jogos (13,13 lesões por 1000 E-A, 95% IC = 10,3 - 15) foram significantemente maiores do que em treinos (4,47 lesões por 1000 E-A, 95% IC = 3,9 - 5,1). Os mecanismos envolvidos na maioria das lesões em jogos e em treinos foram contato com outro jogador (52,9%) e sem contato (54,5%), respectivamente. A torção de tornozelo foi a lesão mais comum (18,2% entre todas as lesões). Observou-se alta incidência de lesões do ligamento cruzado anterior do joelho (0,16 lesões por 1000 E-A). Conclusão: Os atletas amadores universitários brasileiros têm maior risco de sofrer lesões sem contato, como torção de tornozelo e lesão do ligamento cruzado anterior. Nível de Evidência III, Estudo de pacientes não consecutivos; sem padrão de referência "ouro" aplicado uniformemente.

COMPARISON BETWEEN RENDERING 3D-CT AND TRANSPARENT 3D-CT IN ACL TUNNEL POSITIONING / COMPARAÇÃO ENTRE 3D-TC POR RENDERIZAÇÃO E 3D-TC POR TRANSPARÊNCIA NO POSICIONAMENTO DE TÚNEIS DO LCA

ABSTRACT Objective: To compare the transparent 3D computed tomography (CT) image protocol against conventional 3D-CT image-rendering protocol to assess femoral tunnel position in anatomic anterior cruciate ligament (ACL) reconstructions . Methods: Eight knee CT scans from cadavers were analyzed by image rendering 3D-CT protocol, using Rhinoceros(r) software. The central point of the ACL tunnel was set using the sagittal plane. Same CT scans were analyzed using transparent 3D-CT measurement protocol with OsiriX(r) software. Central point of the ACL tunnel was set using sagittal, coronal and axial planes. The grid system described by Bernard and Hertel was used to compare tunnel positions between protocols, using height and length parameters . Results: There was a significant difference between measurements using image rendering 3D-CT and transparent 3D-CT protocol for height (23.8 ± 7.9mm and 33.0 ± 5.0mm, respectively; p=0.017) and no differences for length (18.6 ± 4.2mm and 18.3 ± 4.5mm, respectively; p=0.560) . Conclusion: Height in transparent CT protocol was different and length was the same as compared to 3D-CT rendering protocol in Bernard and Hertel method for tunnel measurements. Level of Evidence II, Descriptive Laboratory Study.

RESUMO Objetivo Comparar o protocolo de tomografia computadorizada (TC) 3D por transparência com o protocolo TC-3D por renderização de imagem na avaliação do posicionamento de túneis femorais na reconstrução anatômica do ligamento cruzado anterior (LCA) . Método: Oito TC de joelho de cadáveres foram analisadas pelo protocolo de renderização de imagem 3D-TC utilizando o software Rhinoceros(r). O ponto central do túnel do LCA foi definido pelo plano sagital. As mesmas tomografias foram analisadas pelo protocolo 3D-TC por transparência, com o software OsiriX(r). O ponto central do túnel do LCA foi definido pelos planos sagital, coronal e axial. O sistema de grade de Bernard e Hertel foi utilizado para comparar a posição dos túneis entre os protocolos, utilizando parâmetros para comprimento e altura. Resultados: Houve diferença significativa entre as medidas dos protocolos de renderização de imagem 3D-TC e 3D-TC por transparência para altura (23,8 ± 7,9mm e 33,0 ± 5,0mm, respectivamente; p=0,017), sem diferenças para comprimento (18,6 ± 4,2mm e 18,3 ± 4,5mm, respectivamente; p=0,560) . Conclusão: A altura no protocolo de TC por transparência foi diferente e o comprimento foi igual quando comparados com o protocolo 3D-TC por renderização de imagem no método de Bernard e Hertel para mensuração dos túneis. Nível de Evidência II, Estudo Laboratorial Descritivo.

The biomechanical effects of graft rotation on ACL reconstruction tunnel mismatch.

PURPOSE: Bone block protrusion out of the tibial tunnel due to a relatively long graft is a common complication in anterior cruciate ligament surgical reconstruction with a patellar tendon. One possible solution is to shorten the patellar tendon graft already fixed in the femur by applying external rotation. This study aimed to evaluate the degree of shortening and biomechanical changes in porcine patellar grafts subjected to relatively higher degrees of rotation. Data obtained with rotations of 0°, 540°, 720°, and 900° were compared. METHODS: Forty patellar porcine ligaments were subjected to biomechanical tests of degree of shortening, modulus of elasticity and maximum tension in the tendon before rupture. Tests were conducted using a universal mechanical testing machine and a computerized system for acquiring strength and deformation data. RESULTS: Progressive shortening of the patellar ligament occurred with rotations of 0°, 540° and 720°. However, the degree of shortening showed no statistically significant difference as rotation increased from 720° to 900°. Decreased modulus of elasticity was observed compared with the graft rotation at 0° in all groups tested, but no statistically significant differences were observed among 540°, 720° and 900°. The maximum tension of the patellar tendon showed no change before rupture, regardless of the degree of rotation. CONCLUSIONS: Rotating the patellar tendon is an efficient method for shortening a relatively long graft; however, more biomechanical studies are necessary to recommend this technique in clinical practice owing to the resulting decrease in graft stiffness that could compromise knee stability.