Anatomy of the Medial Meniscotibial Ligament of the Knee: A Systematic Review / Anatomia do ligamento meniscotibial medial do joelho: Uma revisão sistemática

Abstract Objectives To perform a systematic review of the literature on the anatomy of the medial meniscotibial ligaments (MTLs), and to present the most accepted findings, as well as the evolution of the anatomical knowledge on this structure. Materials and Methods An electronic search was conducted in the MEDLINE/PubMed, Google Scholar, EMBASE and Cochrane library databases with no date restrictions. The following index terms were used in the search: anatomy AND meniscotibial AND ligament AND medial. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We included anatomical studies of the knee were included, such as cadaver dissections, histological and/or biological investigations, and/or imaging of the medial MTL anatomy. Results Eight articles that met the inclusion criteria were selected. The first article was published in 1984 and the last, in 2020. The total sample in the 8 articles was of 96 patients. Most studies are purely descriptive in terms of the macroscopic morphological and microscopic histological findings. Two studies evaluated the biomechanical aspects of the MTL, and one, the anatomical correlation with the magnetic resonance imaging examination. Conclusion The main function of the medial MTL, a ligament that originates in the tibia and is inserted in the lower meniscus, is to stabilize and maintain the meniscus in its position on the tibial plateau. However, there is a limited amount of information regarding medial MTLs, primarily in terms of anatomy, especially vascularization and innervation.

Resumo Objetivos Fazer uma revisão sistemática da literatura sobre a anatomia dos ligamentos meniscotibiais (LMTs) mediais, e apresentar os achados mais aceitos e a evolução das informações anatômicas sobre essa estrutura. Materiais e Métodos A busca eletrônica foi realizada nos bancos de dados MEDLINE/PubMed, Google Scholar, EMBASE e Cochrane, sem restrições de data. Os seguintes termos de indexação foram utilizados: anatomy AND meniscotibial AND ligament AND medial. A revisão seguiu as recomendações da declaração de Principais Itens para Relatar Revisões Sistemáticas e Metanálises (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA, em inglês). Foram incluídos estudos anatômicos do joelho, como dissecções de cadáveres, investigações histológicas e/ou biológicas, e/ou imagens da anatomia do LMT medial. Resultados Oito artigos atenderam aos critérios de inclusão e foram selecionados. O primeiro foi publicado em 1984, e o último, em 2020. A amostra total nos 8 artigos foi de 96 pacientes. A maioria dos estudos é puramente descritiva em relação aos achados morfológicos macroscópicos e histológicos microscópicos. Dois estudos avaliaram os aspectos biomecânicos do LMT, e um analisou a correlação anatômica com o exame de ressonância magnética. Conclusão A principal função do LMT medial, ligamento que se origina na tíbia e se insere no menisco inferior, é estabilizar e manter a posição do menisco no platô tibial.

Anatomical Study of the Medial Region of the Knee: Qualitative, Quantitative Analysis and Description of the Anterior Oblique Ligament / Estudo anatômico da região medial do joelho: Análise qualitativa, quantitativa e descrição do ligamento oblíquo anterior

Abstract Objective To describe all ligamentous, capsular, tendinous and bone landmarks structures of the medial region of the knee, as well as a new ligamentous structure identified in a series of anatomical dissections of cadaveric specimens. Methods Twenty cadaver knees were dissected to study the medial compartment. The main structures of this region were identified during dissection. The morphology of the structures and their relationship with known anatomical parameters were determined both qualitatively and quantitatively. The collected data were analyzed and interpreted using descriptive statistics. Results In the dissection of all specimens, all ligamentous structures previously described in the anatomical study of the medial part of the knee were identified, and objective measures that can help as parameters for surgical ligament reconstruction were identified. When dissecting the medial collateral ligament, a bony prominence immediately distal to its proximal tibial insertion was observed and described, as well as a bursa below the ligament, in which it was not inserted. We also described a ligamentous structure with extracapsular location, originated anteriorly to the medial epicondyle and following obliquely towards the tibia. These structures were named, respectively, interinsertional tubercle, interinsertional bursa and anterior oblique ligament. Conclusion In addition to the description and measurement of the structures and parameters already existing in the anatomical study of the medial part of the knee, it was possible to describe three new structures not yet described in the literature: the interinsertional tubercle, the interinsertional bursa, and the anterior oblique ligament. These structures were found in all dissections performed.

Resumo Objetivo Descrever todas as estruturas ligamentares, capsulares, tendinosas e marcos ósseos da região medial do joelho, assim como uma nova estrutura ligamentar identificada em uma série de dissecções anatômicas de espécimes cadavéricos. Métodos Vinte joelhos de cadáveres foram dissecados para estudar o compartimento medial. As principais estruturas dessa região foram identificadas durante a dissecção. A morfologia das estruturas e sua relação com parâmetros anatômicos conhecidos foram determinados tanto de forma qualitativa quanto de forma quantitativa. Os dados coletados foram analisados e interpretados por meio de estatística descritiva. Resultados Na dissecção de todos os espécimes, foram identificadas todas as estruturas ligamentares já descritas anteriormente no estudo anatômico da porção medial do joelho, e foram realizadas medidas objetivas que podem auxiliar como parâmetros para a reconstrução ligamentar cirúrgica. Foram observados e descritos, ainda, ao se desprender o ligamento colateral medial superficial, uma proeminência óssea imediatamente distal à sua inserção tibial proximal, uma bursa abaixo do ligamento, na qual o mesmo não se mostrava inserido, assim como uma estrutura ligamentar localizada extracapsularmente e com origem na face anterior do epicôndilo medial, seguindo obliquamente em direção à tíbia, aos quais foram dados os nomes, respectivamente, de tubérculo interinsercional, bursa interinsercional e ligamento oblíquo anterior. Conclusão Além da descrição e medida das estruturas e parâmetros já existentes no estudo anatômico da porção medial do joelho, foi possível a descrição de três novas estruturas: o tubérculo interinsercional a bursa interinsercional e o ligamento oblíquo anterior, ainda não descritos na literatura. Essas estruturas foram encontradas em todas as dissecções realizadas.

Assessing the racial differences in Q angle measurements in relevance to articular cartilage of the femoral condyle: a retrospective ultrasound study / Evaluación de las diferencias raciales en las mediciones del ángulo Q en relación con el cartílago articular del cóndilo femoral: un estudio ecográfico retrospectivo

SUMMARY: The Q-angle is defined as the acute angle formed by the vectors for combined pull of the quadriceps femoris muscle and the patellar tendon. This study aimed to investigate the variations in Q angle with respect to race. Moreover, this study performed ultrasound to evaluate of the thickness of articular cartilage covering the medial and lateral femoral condyle in volunteers with an increased Q angle. The study included 487 Jordanian and 402 Malaysians with age range 18-23 years. Moreover, the study included 30 participants aged between 18 and 22 years, with a total of 15 volunteers with Q >14° and 15 patients with Q ≤14°. Both Q angle and condylar distance were measured by well-trained medical practitioners according to a well-established protocol. The thickness of articular cartilage covering the medial and lateral femoral condyle of the femoral bone was measured using ultrasound. Regardless of race, Q angle was greater in females. Furthermore, Q angle was significantly greater in Arab volunteers compared to Malay volunteers. Q angle significantly increase with increasing condylar distance in both races. Finally, the statistical analysis showed a significantly reduced thickness of articular cartilage on both medial and lateral femoral condyle (P = 0.05) in the Q >14° group. Multiple factors including race and condylar distance and even the articular cartilage of femoral condyle should be considered during the examination and management of knee fractures and condylar diseases.

RESUMEN: El ángulo Q se define como el ángulo agudo formado por los vectores de tracción combinada del músculo cuádriceps femoral y el tendón patelar. Este estudio tuvo como objetivo investigar las variaciones en el ángulo Q con respecto a la raza. Además, se realizó una ecografía para evaluar el grosor del cartílago articular que cubre los cóndilos femorales medial y lateral en voluntarios con un ángulo Q aumentado. El estudio incluyó a 487 jordanos y 402 malayos con un rango de edad de 18 a 23 años. Además, el estudio incluyó a 30 participantes con edades comprendidas entre 18 y 22 años, 15 voluntarios con Q> 14 ° y 15 pacientes con Q ≤ 14 °. Tanto el ángulo Q como la distancia condilar fueron medidos por médicos bien entrenados de acuerdo con un protocolo establecido. El grosor del cartílago articular que cubre los cóndilos femorales medial y lateral del fémur se midió mediante ecografía. Independientemente del grupo racial, el ángulo Q fue mayor en las mujeres. Además, el ángulo Q fue significativamente mayor en los voluntarios árabes en comparación con los voluntarios malayos. El ángulo Q se aumenta significativamente al incrementarse la distancia condilar en ambas grupos raciales. Finalmente, el análisis estadístico mostró una reducción significativa del grosor del cartílago articular en los cóndilos femorales medial y lateral (P = 0,05) en el grupo Q> 14. Durante la exploración y el tratamiento de las fracturas de rodilla y de las enfermedades condilares, se deben considerar múltiples factores, incluida la raza y la distancia condilar e incluso el cartílago articular del cóndilo femoral.

Unique morphology of intraoperative measurement of distal femur in northern malaysian females and its correlation with total knee arthroplasty implant sizing / Morfología única de la medición intraoperatoria del fémur distal en mujeres del norte de malasia y su correlación con el tamaño del implante en artroplastia total de rodilla

SUMMARY: Accurate implant sizing is one of the major determinants in defining the success of total knee arthroplasty (TKA). Current TKA implants are based on Caucasian knee morphometry which is well documented to be larger than Asian knees. Even more, with regards to sizing, implant mismatch tends to be more evident in the female population. This study was designed to evaluate the distal femur dimensions of Malaysian female patients who underwent TKA in our institution and to compare them with the current prosthetic system in use. A total of 199 female patients (207 knees) who underwent TKA were enrolled in this study. Intraoperatively, the AP dimensions (medial and lateral condyles) and mediolateral (ML) width were measured. Known dimension of the femoral component of the prosthetic knee system currently in use were compared with the morphological data. The average femoral component overhang was 2.11 mm (SD 3.94 mm). There was significant difference between the mean ML width of the resected femur and the femoral component (p<0.01). Analysis also revealed a significant positive and weak relationship between both, AP (medial and lateral) and ML dimension. The aspect ratio (ML/AP) of the native femur was generally smaller than the implant aspect ratio which is likely to cause overhang in our population. In general, this study shows that the knees of our female sub-population are even narrower than the other Asian female knees from previous studies. Implants should be designed based on the morphological data of the local population. Implant manufactures should tailor them to accommodate a smaller change in ML width for an increment in the AP length and provide several ML widths for one AP length to obtain a better fitting prosthesis hence curbing the problem of ML overhang.

RESUMEN: El tamaño exacto del implante es uno de los principales determinantes para definir el éxito de la artroplastía total de rodilla (ATR). Los implantes de TKA se basan en la morfometría de rodilla caucásica, cuyo tamaño está reportado como mayor que las rodillas asiáticas. Más aún, en lo que respecta al tamaño, el desajuste de los implantes tiende a ser más evidente en la población femenina. Este estudio fue diseñado para evaluar las dimensiones del fémur distal de pacientes mujeres malasias que se sometieron a ATR en nuestra institución y compararlas con el sistema protésico actual. En este estudio se incluyeron un total de 199 pacientes (207 rodillas) que se sometieron a ATR. Intraoperatoriamente, se midieron las dimensiones AP (cóndilos medial y lateral) y el ancho mediolateral (ML). Se comparó la dimensión conocida del componente femoral del sistema protésico de rodilla actualmente en uso con los datos morfológicos. El voladizo o sobresaliencia del componente femoral fue de 2,11 mm (DE 3,94 mm). Hubo una diferencia significativa entre el ancho ML medio del fémur resecado y el componente femoral (p <0,01). El análisis también reveló una relación significativa positiva y débil entre las dimensiones AP (medial y lateral) y ML. La relación de aspecto (ML / AP) del fémur nativo fue más pequeña que la relación de aspecto del implante, lo que probablemente cause un voladizo en nuestra población. En general, este estudio muestra que las rodillas de nuestra subpoblación femenina son incluso más estrechas que otras rodillas de mujeres asiáticas reportadas en estudios anteriores. Los implantes deben ser diseñados en base a los datos morfológicos de la población local. Los fabricantes de implantes deben adaptarlos a un cambio más pequeño en el ancho de ML para un incremento en la longitud AP y proporcionar varios anchos ML para una longitud AP con el objetivo de obtener una prótesis de mejor ajuste y frenar el problema del voladizo ML.

Morphological measurements of the normal distal femur and proximal tibia between han Chinese and Mongolian Chinese in a healthy Chinese population / Mediciones morfológicas del fémur distal normal y la tibia proximal entre chinos han y mongoles en una población china sana

This study aims to compare the knee morphological difference between Han and Mongolian Chinese in China. This will improve the knee prostheses design. A total of 37 natural knees of Han Chinese (13 males, 9 females) and Mongolian Chinese (8 males, 7 females) were measured used Mimics medical imaging program, and the parameters included fML (the femoral mediolateral length), fLAP (the femoral lateral condyle anteroposterior length), fMAP (the femoral medial condyle anteroposteriorlength), tML (The tibial mediolateral length ) , tLAP (The tibial lateral anteroposteriorlength) and tMAP (the tibial medial anteroposterior length), The aspect ratio (defined as fML/fAP and tML/tAP;). The sizes of femur and tibia of the males were larger than those of the female for Han Chinese (fML, fLAP and fMAP) mean ± standard deviation: 84.57 ± 4.70 vs.76.52 ± 3.56, 65.75 ± 2.70 vs. 60.53 ± 3.81 and 67.10 ± 3.67vs. 62.1 2± 3.55; tML, tLAP and tMAP: 74.68 ± 4.27 vs. 65.82 ± 3.51 , 36.13 ± 2.96 vs. 31.12 ± 2.91 and 44.54 ± 3.02 vs. 40.11 ± 3.80 and Mongolian Chinese (fML, fLAP and fMAP) : 88.20 ± 4.57 vs. 77.92 ± 2.97, 68.82 ± 4.22 vs. 61.31 ± 1.92 and 69.81 ± 3.53 vs. 62.13 ± 1.63; tML, tLAP and tMAP: 78.00 ± 3.80 vs. 66.71 ± 3.52, 40.17 ± 3.09 vs. 32.91 ± 1.68 and 48.65 ± 3.00 vs. 41.97 ± 2.48). The aspect ratio of the knee in Mongolian Chinese was smaller than those of Han Chinese (fML/fAP:1.28±0.04 vs.1.29±0.03 for males;1.27±0.04 vs.1.27±0.05; tML/tAP: 1.60±0.04 vs. 1.68±0.10 for the males, 1.59±0.13 vs. 1.65±0.10 for the females). The effects of nationality and sex on the size and shape of knee were significant (p<0.05). The results suggest that an anatomic matched knee prosthesis should be taken into account different nationalities even in the same race.

Este estudio tiene como objetivo comparar la diferencia morfológica de rodilla entre los chinos Han y los Mongoles en China. Esto mejorará el diseño de las prótesis de rodilla. Un total de 37 rodillas de chinos Han (13 hombres, 9 mujeres) y Mongoles (8 hombres 7 mujeres) se midieron utilizando el programa de imágenes médicas Mimics, y los parámetros incluyeron fML (la longitud mediolateral femoral), fLAP (la longitud anteroposterior del cóndilo lateral del fémur), fMAP (la longitud anteroposterior del cóndilo medial del fémur), tML (la longitud mediolateral de la tibia), tLAP (la longitud anteroposterior lateral de la tibia) y tMAP (la longitud anteroposterior media de la tibia), la relación de aspecto (definida como fML / fAP y tML / tAP;). Los tamaños de fémur y tibia de los hombres fueron mayores que los de las mujeres para los chinos Han (fML, fLAP y fMAP) [media ± desviación estándar: 84,57±4,70 vs. 76,52±3,56, 65,75±2,70 vs. 60,53±3,81 y 67,10±3,67 vs. 62,12±3,55; tML, tLAP y tMAP: 74,68±4,27 vs. 65,82±3,51, 36,13±2,96 vs. 31,12±2,91 y 44,54±3,02 vs. 40,11±3,80 y Chino Mongol (fML, fLAP y fMAP): 88,20±4,57 vs. 77,92±2,97, 68,82±4,22 vs. 61,31±1,92 y 69,81±3,53 vs. 62,13±1,63; tML, tLAP y tMAP: 78,00±3,80 vs. 6671±3,52, 40,17±3,09 vs. 32,91±1,68 y 48,65±3,00 vs. 41,97±2,48]. La relación de aspecto de la rodilla del Chino Mongol fue menor que la de los chinos Han (fML / fAP: 1,28±0,04 vs.1,29±0,03 para los hombres; 1,27±0,04 vs. 1,27±0,05; tML / tAP: 1,60±0,04 vs. 1,68±0,10 para los hombres, 1,59±0,13 vs. 1,65±0,10 para las mujeres). Los efectos de la nacionalidad y el sexo en el tamaño y la forma de la rodilla fueron significativos (p <0,05). Los resultados sugieren que una prótesis anatómica de rodilla emparejada debe tenerse en cuenta en las diferentes nacionalidades, incluso en la misma raza.

Morphological analysis of articularis genus and involvement in muscle synchronicity with vastus intermedius / Análisis morfológico del músculo articular de la rodilla y su participación en la sincronicidad muscular con el músculo vasto intermedio

The articularis genus, which lies under the vastus intermedius, has been regarded as part of the quadriceps femoris. However, they are well known to have different function because their respective origins and insertions are mutually distinct. These muscles are considered to work almost simultaneously when the knee is extended. The electromyogram has been used to demonstrate muscle co-contraction. However, the articularis genus is deeper than other muscles. Moreover, it is difficult to analyze it by surface electromyogram. The relative proportions of muscle fiber types and the characteristics of these fiber types are important determinants of the surface electromyogram. Furthermore, biomechanical analysis of AG has remained unclear. This study investigated the ratio of muscle fiber types in these muscles. Muscle samples from seven human cadaveric specimens were used with application of immunofluorescence double staining. Results show that in the vastus intermedius and articularis genus, the percentage of Type I fibers was significantly higher than that of Type II fibers. No significant difference was found in the mean percentages of Type I and Type II fiber types. The percentages of Type I and Type II fibers in articularis genus muscle were correlated positively to the percentage in the vastus intermedius. These results suggest that similar muscle fiber compositions of these muscles might reflect their contraction during the same active phase of knee extension, despite their different functions.

El músculo articular de la rodilla, que se encuentra cubierto por el músculo vasto intermedio, se ha considerado como parte del músculo cuádriceps femoral. Sin embargo, es sabido que tienen diferentes funciones debido a que sus respectivos orígenes e inserciones son mutuamente distintas. Se considera que estos músculos trabajan de forma casi simultánea cuando la rodilla está extendida. El electromiograma se ha usado para demostrar la contracción muscular. Sin embargo, el músculo articular de la rodillas es más profundo que otros músculos. Además, es difícil analizarlo por electromiograma de superficie. Las proporciones relativas de los tipos de fibras musculares y las características de estos tipos de fibras son importantes determinantes del electromiograma de superficie. Además, el análisis biomecánico de músculo articular de la rodilla no ha sido claro. Este estudio investigó la proporción de tipos de fibras musculares en estos músculos. Se usaron muestras musculares de siete cadáveres humanos con la aplicación de doble tinción de inmunofluorescencia. Los resultados muestran que en los músculos articular de la rodilla y vasto intermedio, el porcentaje de fibras de Tipo I fue significativamente mayor que el de las fibras de Tipo II. No se encontraron diferencias significativas en los porcentajes medios de los Tipo I y Tipo II. Los porcentajes de fibras Tipo I y Tipo II en el músculo articular de la rodilla se correlacionaron positivamente con el porcentaje en el músculo vasto intermediario. Estos resultados sugieren que las composiciones de las fibras musculares similares de estos músculos podrían reflejar su contracción durante la misma fase activa de la extensión de la rodilla, a pesar de sus diferentes funciones.

Presencia, localización y biometría de la fabela en individuos chilenos: estudio radiológico / Presence, location and biometry of the fabella in Chilean individuals: radiological study

RESUMEN: Entre los huesos sesamoideos del cuerpo humano, se encuentra la fabela, hueso asociado al tendón de la cabeza lateral del músculo gastrocnemio. El objetivo del presente estudio fue localizar a este hueso, ya unilateral o bilateral, en relación al género y grupos etarios, además de registrar su longitud y anchura. Se utilizó una muestra de radiografías de 200 personas, de ambos sexos, 44 de sexo masculino y 156 de sexo femenino, cuyas edades fluctuaron entre los 10 y los 90 años. Del total de casos (200 personas), la presencia de la fabela fue observada en 75 (37,5 %), de las cuales 9 (12 %) eran del sexo masculino y 66 (88 %) del femenino. Su mayor presencia se observó en las personas con edades entre los 51 y 60 años, en las cuales se presentaron en 25 casos (18 de sexo femenino) y entre los 61 y 70 años con 29 casos (27 de sexo femenino). Los datos obtenidos complementarán el conocimiento morfológico acerca de este hueso sesamoídeo en la población Chilena.

SUMMARY: Among the sesamoid bones of the human body is fabela, a bone associated with the tendon of the lateral head of the gastrocnemius muscle. The objective of the present study was to locate this bone, either unilateral or bilateral, in relation to gender and age groups, in addition to recording its length and width. A sample of radiographs of 200 people, of both sexes, 44 male and 156 female, whose ages ranged from 10 to 90 years were used. Of the total cases (200 people), the presence of fabela was observed in 75 (37.5%), of which 9 (12%) were male and 66 (88%) female. Their greatest presence was observed in people aged between 51 and 60 years, in which they occurred in 25 cases (18 females) and between 61 and 70 years with 29 cases (27 females). The data obtained will complement the morphological knowledge about this sesamoid bone in the Chilean population.

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.

Proteção pulmonar: intervenção para reduzir o volume corrente em uma unidade de terapia intensiva de ensino / Lung protection: an intervention for tidal volume reduction in a teaching intensive care unit

RESUMO Objetivo: Determinar o efeito do fornecimento de comentários e educação, com relação ao uso do peso corpóreo previsto para ajuste do volume corrente em uma estratégia de ventilação de proteção pulmonar. Métodos: O estudo foi realizado entre outubro de 2014 e novembro de 2015 (12 meses) em uma única unidade de terapia intensiva polivalente universitária. Desenvolvemos uma intervenção combinada (educação e comentários), dando particular atenção à importância do ajuste dos volumes correntes para o peso corpóreo previsto ao pé do leito. Paralelamente, o peso corpóreo previsto foi estimado com base na estatura calculada a partir da altura dos joelhos e incluído nas fichas clínicas. Resultados: Foram incluídos 151 pacientes. O peso corpóreo previsto avaliado pela altura dos joelhos, em vez de avaliação visual, revelou que o volume corrente fornecido era significantemente mais elevado do que o previsto. Após a inclusão do peso corpóreo previsto, observamos redução sustentada do volume corrente fornecido, de uma média (erro padrão) de 8,97 ± 0,32 para 7,49 ± 0,19mL/kg (p < 0,002). Mais ainda, a adesão ao protocolo foi subsequentemente mantida durante os 12 meses seguintes (volume corrente fornecido de 7,49 ± 0,54 em comparação a 7,62 ± 0,20mL/kg; p = 0,103). Conclusão: A falta de um método confiável para estimar o peso corpóreo previsto é um problema importante para a aplicação de um padrão mundial de cuidados durante a ventilação mecânica. Uma intervenção combinada, que se baseou em educação e fornecimento continuado de comentários, promoveu uma redução sustentada do volume corrente durante o período do estudo (12 meses).

ABSTRACT Objective: To determine the effect of feedback and education regarding the use of predicted body weight to adjust tidal volume in a lung-protective mechanical ventilation strategy. Methods: The study was performed from October 2014 to November 2015 (12 months) in a single university polyvalent intensive care unit. We developed a combined intervention (education and feedback), placing particular attention on the importance of adjusting tidal volumes to predicted body weight bedside. In parallel, predicted body weight was estimated from knee height and included in clinical charts. Results: One hundred fifty-nine patients were included. Predicted body weight assessed by knee height instead of visual evaluation revealed that the delivered tidal volume was significantly higher than predicted. After the inclusion of predicted body weight, we observed a sustained reduction in delivered tidal volume from a mean (standard error) of 8.97 ± 0.32 to 7.49 ± 0.19mL/kg (p < 0.002). Furthermore, the protocol adherence was subsequently sustained for 12 months (delivered tidal volume 7.49 ± 0.54 versus 7.62 ± 0.20mL/kg; p = 0.103). Conclusion: The lack of a reliable method to estimate the predicted body weight is a significant impairment for the application of a worldwide standard of care during mechanical ventilation. A combined intervention based on education and repeated feedbacks promoted sustained tidal volume education during the study period (12 months).

Características biométricas de los ligamentos meniscofemorales en individuos chilenos / Biometrical characteristics of meniscofemoral ligaments in Chilean individuals

El conocimiento de los ligamentos meniscofemorales anterior y posterior (LMFA y LMFP) es de gran importancia para la anatomía y clínica quirúrgica. Con el propósito de efectuar un análisis de su frecuencia y biometría en individuos Chilenos, se disecaron 30 rodillas, de cadáveres de individuos adultos, de sexo no conocido, fijadas en formaldehído al 10 % y pertenecientes a los Laboratorios de Anatomía, de la Facultad de Medicina de la Universidad Católica del Maule, Chile. Utilizando un caliper digital se registraron medidas de longitud, ancho y espesor de los mismos a diferentes niveles. Todas las muestras fueron fotografiadas. En relación a la frecuencia, el LMFP se presentó en 21 casos (70 %) y el LMFA en 13 (43,4 %). La longitud promedio del LMFA fue de 29,04±2,66 mm y la del LMFP de 27,46±3,08 mm; el ancho proximal del LMFA fue de 9,88±4,34 mm y la del LMFP de 6,55±2,14 mm; el espesor promedio del LMFA fue 1,19±0,47 mm y el del LMFP de 1,8±0,68 mm. Los otros resultados registrados se muestran en el texto correspondiente. Los resultados obtenidos son un aporte al conocimiento anatómico de los ligamentos de la articulación de la rodilla en nuestra población.

The knowledge of the meniscofemoral ligaments (MFL) is of great importance to the anatomy and surgical clinic. In order to conduct an analysis of their frequency and biometry in Chilean individuals, 30 knees of corpses of adult individuals, sex unknown, fixed in 10 % formaldehyde and belonging to the Laboratory of Anatomy, Faculty of Medicine of the Universidad Católica del Maule, Chile. Using a digital caliper, measurements of length, width and the thickness to different levels were recorded. All the samples studied were photographed. Regarding frequency, PMFL occurred in 21 cases (70 %) and AMFL in 13 (43.4 %). The average length of AMFL was 29.04±2.66 mm and the PMFL 27.46±3.08 mm; the proximal width of the AMFL was 9.88±4.34 mm and the PMFL of 6.55±2.14 mm and the average thickness of the AMFL was 1.19±0.47 mm and the PMFL of 1.8±0.68 mm. Other measurements are shown in the text. The obtained results are a contribution to the knowledge of ligaments of the knee joint in our population.

Study on the relationship between the thickness of the anterior cruciate ligament, anthropometric data and anatomical measurements on the knee / Estudo da relação entre a espessura do ligamento cruzado anterior, os dados antropométricos e as medidas anatômicas do joelho

OBJECTIVES: To ascertain thickness measurements on the anterior cruciate ligament (ACL) in its middle third on magnetic resonance imaging (MRI) scans and to assess whether there is any association between variations in ligament thickness and patients' heights and ages, along with variations in the anatomical measurements on the knee. METHODS: MRI scans on 48 knees were evaluated. The anteroposterior size of the femoral condyles, interepicondylar distance, intercondylar distance and anteroposterior and mediolateral thicknesses of the ACL were measured. It was assessed whether there was any statistical relationship between ACL thickness and the patients' age, height or other measurements evaluated. RESULTS: The mean thickness of the middle third of the ACL was 4.5 mm in the sagittal plane and 4.3 mm in the frontal plane. The anteroposterior thickness of the ACL in its middle third had a positive relationship with the size of the lateral condyle. The mediolateral thickness of the ACL in its middle third had a positive relationship with the size of the lateral condyle and with the intercondylar distance in the axial plane. There was no relationship between the thickness of the ACL and the patients' age or height. CONCLUSION: The thickness of the ACL presented positive associations with the size of the lateral femoral condyle and the intercondylar distance.

OBJETIVO: Obter as medidas da espessura do ligamento cruzado anterior (LCA) em seu terço médio em exames de ressonância magnética e avaliar se existe associação entre a variação da espessura do ligamento com a altura e a idade dos pacientes, bem como com as variações das medidas anatômicas do joelho. MÉTODOS: Foram avaliados os exames de ressonância magnética de 48 joelhos, aferidas as medidas do tamanho anteroposterior dos côndilos femorais, distância interepicondilar, distância intercondilar e as espessuras anteroposterior e mediolateral do LCA e avaliamos se existe relação estatística entre a espessura do LCA e a idade ou a altura dos pacientes e as demais medidas avaliadas. RESULTADOS: A média da espessura no terço médio do LCA foi de 4,5 mm no plano sagital e 4,3 mm no plano frontal. A espessura anteroposterior do LCA no seu terço médio tem relação positiva com o tamanho do côndilo lateral. A espessura mediolateral do LCA no seu terço médio tem relação positiva com o tamanho do côndilo lateral e com a distância intercondilar no plano axial. Não encontramos relação entre a espessura do LCA e a idade ou a altura dos pacientes. CONCLUSÃO: A espessura do LCA apresenta uma associação positiva com o tamanho do côndilo femoral lateral e a distância intercondilar.

Comparative investigation of the fetus and adult joint ligament in the knee and elbow with structural levels / Investigación comparativa del ligamento conjunto de rodilla y codo con niveles estructurales en fetos y adultos

The aim of this study was to examine and compare fetal and adult knee and elbow joint ligaments and determine histologically how these ligaments change over time. In addition, the images of fetal and adult joint ligaments were examined with magnetic resonance imaging (MRI). This study was conducted on 10 male fetus ranging from ages 14 to 17.5 weeks, two adult male cadavers obtained from Gazi University Faculty of Medicine Department of Anatomy and MR images of the knee and elbow regions of 10 male adults obtained from Atatürk Educational and Research Hospital between 2009 and 2011. In the present study, the sections taken from knee and elbow of ten 14­17.5 week old fetuses and the ligaments of tissue taken from the knee and elbow of two male cadavers using the same method of dissection were monitored. After monitoring tissue, microtome sections taken from paraffin-embedded structures were stained using the Masson-Trichrom and Orcein-Picroindigocarmine staining method. These sections were examined under a microscope and photographed. The images of 17 week old fetuses and the knee and elbow of the adults were obtained with MRI. The differences detected between adult and fetus ligaments consisted of fibroblast density and collagen thickness, density and waves. Although the fetus ligaments were not seen sufficiently with 1.5 Tesla (T) MR, they were seen very clearly with 3 T MR. Structural differences between adult and fetal ligaments revealed in histological and MRI images.

El objetivo del estudio fue examinar y comparar los ligamentos de la articulación de la rodilla y del codo en fetos y adultos y determinar histológicamente como estos ligamentos cambian con el tiempo. Además, las imágenes de los ligamentos de las articulaciones fetales y adultas se examinaron con imágenes de resonancia magnética (IRM). Fueron utilizados 10 fetos masculinos entre 14 y 17,5 semanas, y dos cadáveres adultos masculinos obtenidos del Departamento de Anatomía, Facultad de Medicina de la Universidad Gazi junto con las IRM de las regiones de la rodilla y del codo de 10 hombres adultos obtenidos de Atatürk Educativa y del Hospital de Investigación entre los años 2009 y 2011. Para las secciones de rodilla y codo de los diez fetos y de los cadáveres masculinos se utilizó el mismo método de disección. Después de procesar los tejidos e incluirlos en parafina, se obtuvieron cortes en micrótomo los cuales fueron posteriormente teñidos con Tricrómico de Masson y Orceína-picro-índigo Carmín. Las secciones fueron fotografiadas y examinadas bajo microscopio. Se obtuvieron IRM del codo y de la rodilla de los fetos y adultos. Las diferencias encontradas entre los ligamentos de adultos y fetos estaban en relación a la densidad de fibroblastos y espesor de colágeno. Aunque no fue posible observar los ligamentos fetales con 1,5 Tesla (T) MR, se observaron claramente con 3 T MR. Las diferencias estructurales entre los ligamentos fetales y adultos se observan tanto a nivel histológico y de resonancia magnética.

Software to browse the pictures of two knees in diverse states of dissection, flexion and rotation / Programa para navegar las imágenes de dos rodillas en diversos estados de disección, flexión y rotación

The aim of this study was to produce pictures of the knees from an embalmed cadaver and another fresh cadaver with various levels of dissection, flexion, and rotation, consequently to aid medical students and doctors in studying knee anatomy. In this study, we intended to improve the accessibility of the numerous knee photographs, by entering them into our own made browsing software. This software could be downloaded for free from the website (anatomy.co.kr). In the software, a displayed array consisted of four pictures: a knee at three different depths of dissection and the same knee in flexed state. The knee could be rotated interactively at every 5° angle. Annotation of important knee structures could be seen at 90° angle intervals. With the browsing software, users were able to observe detailed and realistic features of the dissected and flexed knees. Furthermore, the comparison of embalmed and fresh knees enhanced understanding of the genuine appearance of the knee. The software and extractable image data can be used as anatomy education materials for various purposes.

El objetivo de este estudio fue producir imágenes de las rodillas de un cadáver embalsamado y otro de cadáver fresco, con diversos niveles de disección, flexión y rotación, con el fin de ayudar a los estudiantes de medicina y a los médicos, en el estudio de la anatomía de la rodilla. En este estudio, la intención fue mejorar la accesibilidad de las numerosas fotografías de la rodilla, mediante la introducción de éstas, producidas en nuestro propio programa de navegación. El programa se puede descargar de forma gratuita desde la página web (anatomy.co.kr). En el programa, una matriz que constaba de cuatro fotografías: una rodilla a tres profundidades diferentes de disección y la misma rodilla en el estado flexionado. La rodilla podía girar de forma interactiva en cada ángulo de 5°. Anotación de las estructuras importantes de la rodilla podían ser vistas a intervalos de 90° de ángulo. Con el software de navegación, los usuarios pudieron observar características detalladas y realistas de las rodillas flexionadas y disecadas. Además, la comparación de las rodillas embalsamadas y frescas mejora la comprensión de la apariencia real de la rodilla. Los datos del programa y de imagen extraíble se pueden utilizar como materiales de educación en anatomía para diversos fines.

Lesões do canto posterolateral do joelho: uma revisão completa da anatomia ao tratamento cirúrgico / Injuries to posterolateral corner of the knee: a comprehensive review from anatomy to surgical treatment

Embora as lesões do canto posterolateral do joelho tenham sido previamente consideradas como uma condição rara, elas estão presentes em quase 16% de todas as lesões de joelho e são responsáveis pela instabilidade sustentada e falha das reconstruções concomitantes caso não tenham sido adequadamente reconhecidas. Embora tenha sido considerado como o "lado negro do joelho", o maior conhecimento da anatomia e da biomecânica do canto posterolateral levou à melhoria da capacidade diagnóstica e à melhor compreensão do exame físico e de imagem. O manejo das lesões do canto posterolateral evoluiu e bons desfechos têm sido relatados após o tratamento cirúrgico que segue princípios da reconstrução anatômica.

Although injuries to the posterolateral corner of the knee were previously considered to be a rare condition, they have been shown to be present in almost 16% of all knee injuries and are responsible for sustained instability and failure of concomitant reconstructions if not properly recognized. Although also once considered to be the "dark side of the knee", increased knowledge of the posterolateral corner anatomy and biomechanics has led to improved diagnostic ability with better understanding of physical and imaging examinations. The management of posterolateral corner injuries has also evolved and good outcomes have been reported after operative treatment following anatomical reconstruction principles.

Anatomical basis for sciatic nerve block at the knee level / Bases anatômicas para o bloqueio anestésico do nervo isquiático no nível do joelho / Bases anatómicas para el bloqueo anestésico del nervio isquiático al nivel de la rodilla

BACKGROUND AND OBJECTIVES: Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the popliteal fossa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve. METHOD: The study was conducted by dissection of human cadavers' popliteal fossa, fixed in 10% formalin, from the Laboratory of Human Anatomy and Morphology Departments of the Universidade Federal de Alagoas and Universidade de Ciências da Saúde de Alagoas. Access to the sciatic nerve was obtained. RESULTS: 44 popliteal fossa were analyzed. The bifurcation of the sciatic nerve in relation to the apex of the fossa was observed. There was bifurcation in: 67.96% below the apex, 15.90% above the apex, 11.36% near the apex, and 4.78% in the gluteal region. CONCLUSIONS: The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%. .

JUSTIFICATIVA E OBJETIVOS: Recentemente a feitura de bloqueio do nervo isquiático tem sido revista devido ao potencial benéfico para analgesia pós-operatória e satisfação dos pacientes após o advento da ultrassonografia. O objetivo deste estudo foi descrever as relações anatômicas do nervo isquiático na fossa poplítea para determinar a distância ideal em que a agulha deve ser posicionada para a feitura do bloqueio anestésico do nervo isquiático anterior a sua bifurcação em nervo tibial e fibular comum. MÉTODO: O trabalho foi feito por meio de dissecção de fossa poplítea de cadáveres humanos, fixados em formol a 10%, provenientes do Laboratório de Anatomia Humana dos departamentos de Morfologia da Universidade Federal de Alagoas e da Universidade de Ciências da Saúde de Alagoas. Obteve-se acesso ao nervo isquiático. RESULTADOS: Foram analisadas 44 fossas poplíteas. Observou-se a bifurcação do nervo isquiático em relação ao ápice da fossa. Houve bifurcação em 67,96% abaixo do ápice, 15,90% acima do ápice, 11,36% próxima ao ápice e 4,78% na região glútea. CONCLUSÕES: A bifurcação do nervo isquiático em seus ramos ocorre em vários níveis e a chance de se obter sucesso quando a agulha é usada entre 5 e 7 cm acima da fossa poplítea é de 95,22%. .

JUSTIFICACIÓN Y OBJETIVOS: Recientemente la realización de bloqueo del nervio isquiático ha sido nuevamente analizada debido al potencial beneficioso para la analgesia postoperatoria y por la satisfacción de los pacientes después del advenimiento de la ecografía. El objetivo de este estudio fue describir las relaciones anatómicas del nervio isquiático en la fosa poplítea para determinar la distancia ideal en que la aguja debe ser posicionada para la realización del bloqueo anestésico del nervio isquiático anterior a su bifurcación en el nervio tibial y fibular común. MÉTODO: El trabajo se hizo por medio de la disección de la fosa poplítea de cadáveres humanos, empapados en formol al 10%, provenientes del Laboratorio de Anatomía Humana de los departamentos de Morfología de la Universidad Federal de Alagoas y de la Universidad de Ciencias de la Salud de Alagoas. Se obtuvo el acceso al nervio isquiático. RESULTADOS: Fueron analizadas 44 fosas poplíteas. Se observó la bifurcación del nervio isquiático con relación al ápice de la fosa. Hubo una bifurcación en un 67,96% por debajo del ápice, un 15,90% por encima del ápice, un 11,36% cercana al ápice y un 4,78% en la región glútea. CONCLUSIONES: La bifurcación del nervio isquiático en sus ramas se da en varios niveles y la probabilidad de que se obtenga éxito cuando la aguja se usa entre 5 y 7 cm por encima de la fosa poplítea es de un 95,22%. .

Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination / Avaliação do ligamento anterolateral do joelho por meio de exame de ressonância magnética

OBJECTIVE: To evaluate the presence of the anterolateral ligament (ALL) of the knee in magnetic resonance imaging (MRI) examinations. METHODS: Thirty-three MRI examinations on patients' knees that were done because of indications unrelated to ligament instability or trauma were evaluated. T1-weighted images in the sagittal plane and T2-weighted images with fat saturation in the axial, sagittal and coronal planes were obtained. The images were evaluated by two radiologists with experience of musculoskeletal pathological conditions. In assessing ligament visibility, we divided the analysis into three portions of the ligament: from its origin in the femur to its point of bifurcation; from the bifurcation to the meniscal insertion; and from the bifurcation to the tibial insertion. The capacity to view the ligament in each of its portions and overall was taken to be a dichotomous categorical variable (yes or no). RESULTS: The ALL was viewed with signal characteristics similar to those of the other ligament structures of the knee, with T2 hyposignal with fat saturation. The main plane in which the ligament was viewed was the coronal plane. Some portion of the ligament was viewed clearly in 27 knees (81.8%). The meniscal portion was evident in 25 knees (75.7%), the femoral portion in 23 (69.6%) and the tibial portion in 13 (39.3%). The three portions were viewed together in 11 knees (33.3%). CONCLUSION: The anterolateral ligament of the knee is best viewed in sequences in the coronal plane. The ligament was completely characterized in 33.3% of the cases. The meniscal portion was the part most easily identified and the tibial portion was the part least encountered. .

OBJETIVO: Avaliar a presença do ligamento anterolateral (LAL) do joelho em exames de ressonância magnética (RM). MÉTODOS: Foram avaliadas 33 RM de joelho de pacientes feitas por indicações não relacionadas a instabilidade ligamentar ou trauma. Foram obtidas imagens no plano sagital ponderadas em T1 e imagens nos planos axial, sagital e coronal ponderadas em T2 com saturação de gordura. As imagens foram avaliadas por dois radiologistas experientes em patologias musculoesqueléticas. Na avaliação da visualização, dividimos a análise do ligamento em três porções: origem femoral até o seu ponto de bifurcação, da bifurcação até a inserção meniscal e da bifurcação até a inserção tibial. Considerou-se com variável categórica dicotômica (sim ou não) a capacidade de visualizar o ligamento em cada uma das porções e no seu todo. RESULTADOS: O LAL foi visualizado com característica de sinal semelhante às demais estruturas ligamentares do joelho, com hipossinal em T2 com saturação de gordura. O principal plano em que o ligamento foi identificado foi o coronal. Alguma porção do ligamento foi visualizada com clareza em 27 (81,8%) joelhos. A porção meniscal ficou evidente em 25 (75,7%) dos joelhos, a porção femoral em 23 (69,6%) e a tibial em 13 (39,3%). As três porções foram visualizadas em conjunto em 11 (33,3%) joelhos. CONCLUSÃO: O ligamento anterolateral do joelho é mais bem visualizado em sequências no plano coronal. O ligamento foi caracterizado por completo em 33,3% dos casos. A porção meniscal foi a mais facilmente identificada e a tibial a menos encontrada. .

Effect of hyaluronic acid on chondrocyte apoptosis

OBJECTIVE: To determine the percentage of apoptotic cells in a contusion model of osteoarthritis (OA) and to assess whether intra-articular injection of high doses of hyaluronic acid (HA) immediately after trauma reduces chondrocyte apoptosis. METHODS: Forty knees from adult rabbits were impacted thrice with a 1 kg block released through a 1 meter tall cylinder (29.4 Joules). Subsequently, 2 mL of HA was injected in one knee and 2 mL saline in the contra-lateral knee. Medication were administered twice a week for 30 days, when animals were sacrificed. Specimens were prepared for optical microscopy exam and terminal deoxynucleotidyl transferase end labeling assay (TUNEL). RESULTS: The apoptosis rate in the contusion model was 68.01% (± 19.73%), a higher rate than previously described. HA significantly reduced the rate of apoptosis to 53.52% (± 18.09) (p <0.001). CONCLUSION: Intra-articular HA administration started immediately after trauma reduces impact-induced chondrocyte apoptosis rates in rabbits. Level of Evidence I, Experimental Study.

Estimación de la talla en la evaluación nutricional de niños con parálisis cerebral / Alternatives to estimate stature during nutritional assessment of children with cerebral palsy

Introduction: The assessment of nutritional status plays a critical role in comprehensive child care, however, in children with cerebral palsy (CP) is difficult to meet some reliable anthropometric measures, particularly height. Objective: To determine if the equations to estimate stature, developed and validated in CP populations of other countries, apply to our reality. Patients and Method: An anthropometric assessment in 60 children with cerebral palsy that included measurement of weight, height and body segments like tibia length (TL) and knee height (KH) was performed. The height was estimated using the above described segments and the Stevenson et al.¹ equations. The correlation and agreement between the measured and the estimated stature were evaluated. Results: Height could be reliably measured in 36 individuals and in all cases height was estimated. The correlation between the measured and the estimated lengths for TL and KH was 0.975 and 0.981 respectively (p < 0.001). The analysis of agreement between the estimated and measured lengths showed on average a significant level of agreement, with an error of -2.96 cm for TL and 0.21 cm for KH. Conclusions: The equations to estimate stature from the body segments, tibia length and knee height, are valid and useful to assess the linear growth in children with CP in our population.

Introducción: La evaluación del estado nutricional es fundamental en el cuidado integral del niño, sin embargo, en los niños con parálisis cerebral (PC) existe dificultad para obtener medidas antropométricas confiables, particularmente de la estatura. Objetivo: Determinar si las ecuaciones para estimar la talla, desarrolladas y validadas en población con PC de otras nacionalidades, tienen aplicabilidad en nuestro medio. Pacientes y Método: Se realizó una evaluación antropométrica en 60 niños con parálisis cerebral que incluyó la medición del peso, la talla y los segmentos corporales: Longitud de la tibia (LT) y altura de rodilla (AR). La talla se estimó usando los segmentos antes descritos y las ecuaciones de Stevenson et al¹. Se evaluó la correlación y concordancia entre la talla medida y la estimada. Resultados: En 36 individuos la talla pudo ser medida de manera confiable y en todos los casos la talla también se estimó. La correlación entre la longitud medida y la estimada con LT y fue de 0,975 y de 0,981 respectivamente (p < 0,001). El análisis de la concordancia entre longitud estimada y longitud medida, en promedio, mostró un importante nivel de acuerdo, evidenciando un error sistemático de -2,96 cm en la talla estimada con el segmento LT y de 0,21 cm con AR. Conclusiones: Las ecuaciones para estimar la talla a partir de los segmentos corporales, longitud de tibia y altura de rodilla, son válidas y útiles, para evaluar el crecimiento lineal de los niños con PC en nuestro medio, ante la dificultad de obtener medidas lineales convencionales.

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. .

Morphophysiopathology of synovial plica from knee joint: a literature review

Synovial plicae around the knees are a relatively common occurrence. They have been the object of many clinical and anatomical researches, not only because of their intra-articular existence, but also for their painful symptomatology caused on knee joint. These plicae are excessive folds of synovial membrane and are remnants from embryonic septum, which were not properly absorbed during fetal development. These synovial plicae are divided anatomically, as location and existence, and are classified into suprapatellar, infrapatellar, medial patellar and lateral patellar plicae; being still each of these subdivided according to their appearance and juxtaposition. Material and methods: A retrospective literature review selected articles in PubMed and MEDLINE databases; papers were searched using the keywords: synovial plicae, knee, embryology, anatomy, histology and treatment. Results: In this literature review was verified the incidence about the types, shape, location, symptoms, pathophysiology, and the main methods of study for the verification of synovial plica and treatments. Conclusion: In summary, asymptomatic plica can become symptomatic due to a bucket‑handle tear following a twisting injury and lateral traction to the knee, when carefully diagnosed; a synovial plica represents a potential cause of pain in patients. After careful examination, arthroscopic resection of the bucket‑handle portion of the plica is sufficient for the improvement of the symptoms if conservative treatment of pathological plica fail.