Rotura do tendão semimembranoso ­ Relato de caso de uma rara rotura tendínea / Semimembranous tendon rupture ­ Case report of a rare tendon rupture

Contexto: A rotura da inserção distal do tendão semimembranoso é uma lesão ocasionada no tendão de um dos músculos do grupo isquiotibiais, acarretando dor no joelho. Para o diagnóstico da lesão do tendão semimembranoso, a ressonância magnética é a principal modalidade de imagem. Descrição do caso: Homem de 63 anos acusa dor no joelho esquerdo há 1 semana. Apresenta melhora da dor com repouso e medicação. Ao exame físico, apresenta teste de Waldron positivo e testes de McMurray e Appley negativos, com edema articular, sem hematomas, apresentando limitação à movimentação devido à dor. A ressonância magnética apresenta a rotura do semimembranoso, e o tratamento foi realizado com medicação analgésica e anti-inflamatória. Discussão: Essa rotura é rara, e surge de uma força em valgo em uma perna hiperextendida externamente. O uso de esteroides anabolizantes pode aumentar o risco de rotura do tendão. Contudo, a ultrassonografia é um método de fácil acesso e é cada vez mais utilizada. O diagnóstico é realizado por meio de ressonância magnética. Seu tratamento pode ser realizado com anti-inflamatórios ou reparo cirúrgico. Conclusão: Relatamos um caso de rotura do tendão semimembranoso, composta por uma sintomatologia como dor no joelho, que pode ser tratada com anti-inflamatório ou reparo cirúrgico.

Alternativa quirúrgica usando autoinjertos de tendón de gracilis y tendón de semitendinoso en re-rotura de tendón rotuliano. Reporte de caso / Surgical alternative using gracilis and semitendinosus tendon autografts in patellar tendon re-rupture. Case report

La rotura del tendón rotuliano es infrecuente y aún más lo es su re-rotura. La integridad de este tendón es fundamental para una adecuada movilidad de la rodilla y una marcha apropiada. El tratamiento se basa en diferentes técnicas quirúrgicas: reparación y aumentación tendinosa usando autoinjertos o aloinjertos. En el presente artículo se describe una alternativa en el posicionamiento de los autoinjertos del tendón de gracilis y tendón de semitendinoso, preservando su inserción en el caso de tener mala calidad de tejidos blandos. A los seis meses postoperatorios se logra un adecuado mecanismo extensor íntegro, con arcos de movilidad en el plano sagital de 0 a 90°, con un buen patrón de marcha sin dolor.

Rupture of the patellar tendon is infrequent and even more infrequent re-rupture; the integrity of this tendon is necessary for an adequate knee mobility and a proper gait. The treatment is based on different surgical techniques performing a tendon repair and augmentation using autografts or allografts. The present article describes an alternative in the positioning of autografts of gracilis tendon and semitendinosus tendon, achieving a complete extensor mechanism after a 6-month follow-up, with ranges of mobility in the sagittal plane from 0 to 90°, with an adequate gait pattern without pain

Rotura traumática simultánea y bilateral del tendón del cuádriceps en un paciente fisicoculturista: informe de caso y revisión de la literatura / Simultaneous bilateral traumatic quadriceps tendon rupture in a bodybuilding patient: case report and literature review

La rotura traumática, simultánea y bilateral del tendón cuadricipital es una lesión infrecuente, generalmente asociada a otras enfermedades sistémicas tales como insuficiencia renal o trastornos endocrinos. Presentamos el caso de un varón sano y atleta de 38 años que sufrió esta lesión mientras realizaba una sentadilla en el gimnasio. (AU)

The traumatic bilateral and simultaneous quadriceps tendon rupture is a rare injury, usually associated with other systemic diseases such as renal insufficiency or endocrine disorders. We present the case of a 38-year-old healthy male athlete who sustained this injury while performing a squat at the gym. (AU)

Effectiveness analysis of "tail compression fixation+suture bridge" technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of "tail compression fixation+suture bridge" technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff.@*METHODS@#The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with "tail compression fixation+suture bridge" technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system.@*RESULTS@#All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation ( P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation ( P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).@*CONCLUSION@#For the patients with primary tear in medial enthesis of rotator cuff, the "tail compression fixation+suture bridge" technology under shoulder arthroscopy is simple and effective.

Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT).@*METHODS@#The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared.@*RESULTS@#All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation ( P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation ( P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group ( P<0.05). There was no significant difference in other baseline data between the two groups ( P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group ( P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups ( P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B ( P>0.05).@*CONCLUSION@#Tendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.

Un caso de neumonía organizada tras la ruptura intracapsular de implantes mamarios de silicona / A case of organized pneumonia after intracapsular rupture of silicone breast implants

La neumonía organizada es una entidad poco frecuente, caracterizada por la formación de conglomerados fibroblásticos intraalveolares conocidos como cuerpos de Masson, que puede ser criptogénica o secundaria a una respuesta inmunitaria a diversos estímulos, tales como enfermedades hematológicas, autoinmunitarias, exposición a sustancias químicas, fármacos, tóxicos, etc. Detectada y tratada de forma precoz, suele tener una buena respuesta a la corticoterapia, aunque si se diagnostica de forma tardía, la afectación pulmonar puede ser extensa, y, además, si el estímulo antigénico persiste, la respuesta al tratamiento será incompleta. Presentamos el caso clínico de una paciente de 65 años de edad quien hace 18 meses aproximadamente presentó la rotura intracapsular de sus implantes mamarios, 27 años después de su colocación. Con el mismo tiempo de evolución ha desarrollado progresivamente disnea, tos seca y dolor inframamario, habiendo llegado al diagnóstico de neumonía organizada bilateral difusa, asociada a dicha rotura de implantes.

Organizing pneumonia is a rare entity, characterized by the formation of intraalveolar fibroblastic conglomerates known as Masson bodies, which may be cryptogenic or secondary to an immune response to various stimuli, such as hematological, autoimmune diseases, exposure to chemical substances, drugs, toxics, etc. If it is detected and treated early, it usually has a good response to corticosteroid therapy, although if it is diagnosed late, the lung involvement can be extensive, and furthermore, if the antigenic stimulus persists, the response to treatment will be incomplete. We present the clinical case of a 65-year-old patient who had intracapsular rupture of her breast implants approximately 18 months ago, 27 years after their placement. With the same evolution time, she progressively developed dyspnea, dry cough and under mammary pain, having reached the diagnosis of diffuse bilateral organizing pneumonia, associated with implant rupture.

Reconstrucción de ligamento cruzado anterior con isquiotibiales manteniendo su inserción tibial / ACL reconstruction with hamstring autograft maintaining tibial insertion

Introducción: La no desinserción tibial de semitendinoso-recto interno (ST-RI) parece constituir una opción para evitar la necrosis avascular en el proceso de ligamentización. El objetivo de nuestro trabajo es hacer una comparación entre ST-RI desinsertado versus ST-RI no desinsertado. Materiales y métodos: estudio comparativo, prospectivo, randomizado, doble ciego, para el que se formaron dos grupos. El grupo de estudio, conformado por treinta y ocho pacientes con plástica de LCA sin desinserción tibial de ST-RI; el grupo de control, de treinta y nueve pacientes con desinserción tibial. Se realizaron evaluaciones de RM a los seis meses del postoperatorio, se evaluaron el Coeficiente Señal ruido (CS) y la orientación del neoligamento en planos sagital, coronal y axial. La valoración clínica, a través de IKDC, Tegner Lysholm y KT-1000, fue efectuada por médicos en forma ciega.Resultados: el CS valorado por RM a los seis meses mostró diferencias significativas entre el grupo de estudio (14.4) y el de control (24.9) con un valor p <0.001. No existieron diferencias en cuanto a la orientación del injerto entre ambos grupos, ni en el plano sagital, coronal, ni axial. En cuanto al IKDC y Tegner Lysholm, sin diferencias entre grupos a los nueve meses. En el KT-1000 tampoco se encontraron diferencias entre grupos (p = 0.518).Discusión: la no desinserción tibial de ST-RI es una opción válida que podría evitar la fase de necrosis avascular de la ligamentización. Nuestros resultados, sustentados en RM, nos estimulan a utilizarla como una opción con cierta ventaja biológica.

Introduction: Non disinsertion of hamstring autograft tendons may result in avoiding cellular necrosis at the early stage of ligamentization process. The aim of this study was to compare between disinserted vs non disinserted hamstring autograft. Materials and methods: in this prospective, double-blind, randomised controlled trial, two groups were created. In the study group, hamstring tendon retraction (n=39) was performed. In the control group, maintaining tibial insertion (n=38) harvesting technique was used. Patients were evaluated with MRI after six months of follow-up. Graft maturity was evaluated with the signal-to-noise quotient (SNQ) and graft direction and orientation with sagittal, coronal, and axial views. Clinical outcomes were assessment of IKDC, Tegner-Lisholm activity level score and KT-1000 evaluation from a blind ortopaedic surgeon.Results: signal-to-noise quotient (SNQ) was significantly lower in non disinserted hamstring group (study group 14.4 vs control group 24.9-p = 0.001). There were no differences in graft direction between both groups. KT-1000 measurements showed no difference, the same as clinical outcomes assessment of IKDC and Tegner-Lisholm scores.Discussion: non disinserting hamstring tendons autograft is a valid option and may avoid the necrosis phase in ligamentization process. Our results, sustained on MRI imaging encourage us to use it with some biological advantage.

Complications in repairing acute closed Achilles tendon rupture with micro-incision percutaneous Achilles tendon suture system / 中国骨伤

OBJECTIVE@#To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture.@*METHODS@#A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed.@*RESULTS@#No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores.@*CONCLUSION@#Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.

Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study / 中华创伤杂志(英文版)

PURPOSE@#Previous studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function.@*METHODS@#In this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference.@*RESULTS@#AOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = -17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = -8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period.@*CONCLUSION@#Achilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.

Value of contrast-enhanced percutaneous ultrasound in the diagnosis of rotator cuff tear subtype / 中国骨伤

OBJECTIVE@#To explore characteristics of contrast-enhanced ultrasound (CEUS) images features and diagnostic value of rotator cuff tear subtypes.@*METHODS@#From January 2019 to March 2022, percutaneous ultrasound-guided subacromial bursography (PUSB) with persutaneous ultrasound-guide tendon lesionography (PUTL) was performed on 114 patients with suspected rotator cuff injury were evaluated, including 54 males and 60 females ranged in age from 35 to 75 years old with an average of (58.8±8.7 ) years old;76 patients on the right side and 38 patients on the left side;the course of disease ranged from 0.13 to 111 months with an average of (10.2±9.8) months. GE LOGIQ E9 color doppler ultrasound diagnostic high frequency(6 to 12 MHz) was used to CEUS Using arthroscopy as gold standard, receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficacy of US, MRI and CEUS for rotator cuff injury, also sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated.@*RESULTS@#The sensitivity of US in diagnosing full-thickness tears was 72.1%, specificity was 93.0%, and accuracy was 85.1%. The sensitivity, specificity and accuracy of MRI diagnosis of full-thickness tear were 90.9%, 92.6% and 92.1% respectively. The sensitivity, specificity and accuracy of CEUS in diagnosis of full-thickness tear were 100%. The sensitivity, specificity and accuracy of US in the diagnosis of partial tear were 85.7%, 77.2% and 79.8% respectively. The sensitivity, specificity and accuracy of MRI diagnosis of partial tear were 83.7%, 81.7% and 82.5% respectively. The sensitivity, specificity and accuracy of CEUS in diagnosis of partial tear were 95.7%, 92.6% and 93.9% respectively. There were significant differences in diagnosis results of US, MRI and CEUS for rotator cuff bursa tear (P<0.001). Kapp test showed good consistency between CEUS and arthroscopy in diagnosing rotator cuff tear subtypes (full-thickness and partial tears).@*CONCLUSION@#Using PUSB/PUTL to observe distribution of contrast media in bursa, tendon and joint cavity to evaluate the type of rotator cuff tear, its diagnostic performance is significantly better than US and MRI. Therefore, percutaneous contrast-enhanced ultrasound can be a reliable method for diagnosing subtypes of rotator cuff tears.

Study on clinical characteristics and surgical methods of bucket-handle meniscal tears / 中国修复重建外科杂志

OBJECTIVE@#To summarize the clinical features, surgical methods, and prognosis of bucket-handle meniscal tears (BHMTs), and provide guidance for clinical treatment.@*METHODS@#The clinical data of 91 BHMTs patients (91 knees), who met the selection criteria and were admitted between January 2015 and January 2021, was retrospectively analyzed. There were 68 males and 23 females. Age ranged from 16 to 58 years with an average of 34.4 years. The injury was caused by sports in 68 cases, traffic accident in 15 cases, and falls or sprains in 8 cases. There were 49 cases of left knee injury and 42 cases of right knee injury. The time from the onset of symptoms to the admission ranged from 1 day to 13 months (median, 18 days), including >1 month in 35 cases and ≤1 month in 56 cases. Medial BHMTs occurred in 52 cases and lateral BHMTs in 39 cases. There were 36 cases with ACL rupture and 12 cases with discoid meniscus. The knee extension was limited more than 10° in 55 cases. According to the condition of meniscus injury, the meniscus suture with Inside-out combined with All-inside techniques (54 cases) or meniscoplasty (37 cases) under arthroscopy were selected. ACL reconstruction was performed in all patients with ACL rupture with autogenous hamstring tendon. Postoperative complications were observed. International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were used to evaluate knee function, and clinical failure was recorded.@*RESULTS@#Two patients developed intermuscular venous thrombosis, which improved after oral anticoagulant therapy. No vascular injury, postoperative infection, joint stiffness, or other complications occurred in all patients. All patients were followed up 24-95 months, with a median of 64 months. A total of 12 cases (13.19%) failed the operation and were re-operated or given oral anti-inflammatory analgesics and rehabilitation therapy. At last follow-up, IKDC score and Lysholm score of 91 patients significantly increased when compared with those before operation ( P<0.05), while Tegner score significantly decreased ( P<0.05). The above indexes of patients treated with meniscus suture and meniscoplasty were also significantly different from those before operation ( P<0.05).@*CONCLUSION@#BHMTs occurs mostly in young men and is one of the important reasons for the limitation of knee extension after trauma. Arthroscopic meniscus suture and meniscoplasty can obtain good effectiveness according to individual conditions of patients. But the latter can better preserve the shape and function of meniscus, and theoretically can obtain better long-term outcomes, which needs to be confirmed by further research with larger sample size.

Correlation of Physical Examination with Arthroscopic Findings in the Treatment of Rotator Cuff Tear / Correlação do exame físico com achados artroscópicos no tratamento da ruptura do manguito rotador

Abstract Objective To compare clinical data from the physical examination with arthroscopic findings in rotator cuff rupture. Methods A total of 177 patients submitted to arthroscopic treatment of rotator cuff rupture were selected, and arthroscopic findings were compared with physical examination. Results The impingement tests showed high sensitivity for rotator cuff rupture. Among the strength tests, the most sensitive was the Patte test (85.7%), and the one with the highest positive predictive value (PPV) was the Jobe test (95%). The Drop Sign test showed higher specificity and negative predictive value (NPV) (98.7 and 95.9%, respectively). Patients with a history of trauma were 3.5 times more likely to have a positive Lift Off test. Conclusion The impingement tests had high sensitivity for rotator cuff ruptures. The Jobe test showed similar sensitivity among patients who had partial or total supraspinal injury. For complete lesions of the subscapularis, The Lift Off and Belly Press tests showed high sensitivity and specificity.

Resumo Objetivo Comparar dados clínicos do exame físico com os achados artroscópicos na ruptura do manguito rotador. Métodos Foram selecionados 177 pacientes submetidos ao tratamento artroscópico de ruptura do manguito rotador e foram comparados os achados artroscópicos com o exame físico. Resultados Os testes irritativos de impacto apresentaram alta sensibilidade para ruptura do manguito rotador. Dentre os testes de força, o de maior sensibilidade foi o teste de Patte (85,7%) e o de maior valor preditivo positivo (VPP) foi o teste de Jobe (95%). O teste Drop Sign apresentou maior especificidade e valor preditivo negativo (VPN) (98,7 e 95,9%, respectivamente). Pacientes com história de trauma possuíam 3,5 vezes mais chances de apresentarem o teste Lift Off positivo. Conclusão Os testes irritativos tiveram alta sensibilidade para rupturas do manguito rotador. O teste de Jobe apresentou sensibilidade semelhante entre os pacientes que tinham lesão parcial ou total do supraespinhal. Para as lesões completas do subescapular, as testes Lift Off e Belly Press apresentaram alta sensibilidade e especificidade.

Release of gastrocnemius aponeurosis and suture of the Achilles tendon end scar tissue managing the chronic Achilles tendon rupture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of scar tissue suture at the broken end of Achilles tendon after gastrocnemius aponeurosis release in the treatment of chronic Achilles tendon rupture.@*METHODS@#The clinical data of 17 patients with old achilles tendon rupture treated from January 2017 to December 2019 were analyzed retrospectively, including 15 males and 2 females, aged 26 to 53 years with an average of (35.2±11.6) years old, and the time from injury to operation was 37 to 92 days with an average of (49.3±13.3) days. Myerson's classification included 6 cases of typeⅡ and 11 cases of typeⅢ. The defect of the broken end of Achilles tendon was 2 to 5 cm with an average of(4.1±1.5) cm after partial scar tissue was removed. All patients were treated with gastrocnemius aponeurosis, appropriate excision of scar tissue at the broken end of Achilles tendon and direct suture. The continuity and healing of Achilles tendon were evaluated by color Doppler ultrasound 3 months after operation. The ankle plantar flexor strength was measured by ankle plantar flexor strength tester before operation and 1 year after operation. American Orthopaedic Foot and Ankle Society ankle hindfoot score (AOFAS) and Achilles tendon rupture score were used before operation and 1 year after operation Achilles tendon total fracture score (ATRS) was used to evaluate the clinical rehabilitation of Achilles tendon rupture.@*RESULTS@#All patients were followed up for 12 to 18 months with an average of(13.6±1.8) months. The surgical incision healed in stageⅠ. Color Doppler ultrasound showed good continuity of Achilles tendon, local Achilles tendon slightly thickened and irregular fiber direction. The ankle plantar flexor force (92.2±3.9) N at 1 year after operation was significantly higher than that before operation (29.5±4.2) N (P<0.05);One year after operation, the AOFAS(91.20±3.30) was significantly higher than that before operation (42.20±4.40)(P<0.05);the ATRS (90.70±3.00) was significantly higher than that before operation(40.00±2.90)(P<0.05).@*CONCLUSION@#The gastrocnemius aponeurosis release combined with scar suture of Achilles tendon end is an effective technique for the treatment of chronic Achilles tendon rupture, avoid injury to hallux flexor longus or flexor digitorum longus, with the plantar flexor muscle strength of the ankle was recovered well, is an effective method to treat chronic Achilles tendon rupture.

Repair of KuwadaⅡand Ⅲ Achilles tendon defects through modified medial J-shaped approach with autologous fascia lata transplantation / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified medial J-shaped incision of Achilles tendon combined with fascia lata transplantation in the treatment of Kuwada typeⅡand Ⅲ Achilles tendon defects.@*METHODS@#From January 2016 to August 2018, the clinical data of 15 patients with KuwadaⅡand Ⅲ Achilles tendon defects treated with modified J-shaped approach with autologous fascia lata transplantation were retrospectively analyzed, including 14 males and 1 female, with an average age of 31.7 years old ranging from 24 to 43. There were 9 cases of KuwadaⅡdefect and 6 cases of KuwadaⅢ defect. Postoperative observations were made for incision complications, and the Arner-Lindholm scoring standard was used to evaluate the function of the affected foot at the last follow-up.@*RESULTS@#All 15 cases were followed up from 3 to 16 months with an average of 9.2 months. No skin necrosis or infection occurred after operation, and no Achilles tendon rupture occurred again. According to the Arner-Lindholm scoring standard, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Modified medial J-shaped incision is a satisfactory approach for repairing Achilles tendon defects. It is helpful to prevent postoperative incision complications, which double-strengthen the Achilles tendon strength, so that patients can perform early rehabilitation and functional exercises with satisfactory clinical results.

Comparative analysis of pathological structure between acute closed and open Achilles tendon rupture / 中国骨伤

OBJECTIVE@#To investigate the morphological, histological and ultrastructural changes of acute closed rupture of Achilles tendon, in order to clarify the pathological basis of the injury and to explore the significance.@*METHODS@#From January 2015 to January 2019, 35 patients with acute Achilles tendon rupture who underwent the minimally invasive Achilles tendon suture technique were retrospectively analyzed. Among these patients, 12 cases in acute open Achilles tendon rupture group included 10 males and 2 females, with an average age of (35.1±9.7) years old ranging from 19 to 50, and the time from injury to operation was 2 to 8 hours with an average of(5.6±1.8);23 cases in acute closed Achilles tendon rupture group included 21 males and 2 females, with an average age of (35.5±6.6) years old ranging from 18 to 50, and the time from injury to operation was 3 to 15 hours with an average of (7.5±3.1). The gross appearance and imaging findings of the broken end of Achilles tendon tissue in the two groups were compared by naked eye observation and foot and ankle MRI at 4 to 6 hours before operation. HE staining, scanning and fluoroscopic electron microscopy, immunohistochemistry(Sirius red staining) were performed on the intraoperative Achilles tendon tissue specimens at 1 to 2 days after operation, the collagen fiber degeneration and local fat infiltration, collagen fiber shape, cell morphology and function, and the distribution of typeⅠand type Ⅲ collagen fibers in Achilles tendon were compared between the two groups.@*RESULTS@#Compared with the acute open Achilles tendon rupture group, the acute closed Achilles tendon rupture group had poor elasticity, hard texture, moderate edema, irregular shape of Achilles tendon broken end, horsetail shape, and more calcification around the broken end. HE staining results:the collagen fibers in the Achilles tendon of the acute open Achilles tendon rupture group were arranged irregularly, with hyaline degeneration and fat infiltration;The results of electron microscopy showed that collagen arranged disorderly and fibroblasts atrophied in the acute closed Achilles tendon rupture group. Immunohistochemical(Sirius staining) results:the proportion of collagenⅠin the acute open Achilles tendon rupture group and the acute closed Achilles tendon rupture group was(91.12±4.34)% and(54.71±17.78)% respectively, and the proportion of collagen Ⅲ was (8.88±4.34)% and (45.29±17.78)% respectively. The content of collagenⅠin the acute closed Achilles tendon rupture group was lower than that in the acute open Achilles tendon rupture group, and the content of collagen Ⅲ in the acute closed Achilles tendon rupture group was higher than that in the acute open Achilles tendon rupture group(P<0.05).@*CONCLUSION@#The morphology, histology and ultrastructure of the acute closed ruptured Achilles tendon are significantly altered compared with the normal Achilles tendon. The original fine and orderly spatial structure cannot be maintained, part of collagen Ⅰ is replaced by collagen Ⅲ, and the toughness and strength of the tendon tissue decreased, which may be the feature of degeneration of the Achilles tendon and an important pathological basis for closed Achilles tendon rupture.

Reconstrucción secuencial de ruptura bilateral del ligamento cruzado anterior. Reporte de un caso / Sequential reconstruction of bilateral anterior cruciate ligament rupture. Case report

Cuando se presentan pacientes con ruptura bilateral del ligamento cruzado anterior y requieren cirugía reconstructiva, se puede optar por procedimientos de reconstrucción unilateral a la vez. Este tipo de abordaje terapéutico ha sido descripto en la literatura, sin embargo, existe muy poca evidencia acerca de la reconstrucción simultánea o secuencial de ambas rodillas en el mismo acto quirúrgico. En este trabajo se presenta un caso de reconstrucción secuencial en el mismo acto quirúrgico, con un solo tiempo anestésico, realizado por un solo equipo quirúrgico en un paciente con ruptura bilateral de ligamento cruzado anterior. Además, se desarrolla una actualización del tema y se compara este procedimiento con aquellos efectuados en dos actos quirúrgicos, desde el punto de vista económico, clínico y funcional, el plan de fisioterapia adoptado y los resultados a mediano plazo mediante la escala de Lysholm. Tipo de Estudio: Reporte de caso y actualización. Nivel de Evidencia: IV

When we face a patient with bilateral anterior cruciate ligament rupture and requires a ligament reconstruction, we can suggest a unilateral reconstruction procedure. This type of surgical management has been described in the literature; however, very scant evidence is published about simultaneous or sequential ACL reconstruction at one stage procedure.This paper presents a case report of a sequential ACL reconstruction made in a one-stage surgical procedure for the same surgical team in a patient with bilateral ACL rupture. A revision of the literature is made, a comparison with those made in two separate procedures is also reported, from a clinical, functional, and economic view, the rehabilitation program and the medium-term outcome by the score of Lysholm. Type of study: Case report and literature review. Level of Evidence: IV

Roturas "irreparables" del manguito rotador: trucos y consejos para conseguir una reparación artroscópica / Irreparable rotator cuff tears. Tips and tricks to achieve arthroscopic repair

Las roturas irreparables del manguito rotador son lesiones graves que pueden conllevar consecuencias drásticas en la calidad de vida de los pacientes. Pese a que su reparación es compleja y la tasa de re-rotura es alta, el intento de reparación se justifica por la ausencia de alternativas poco agresivas o paliativas. Cuando no se consigue una reparación, la alternativa es la transferencia tendinosa, la reconstrucción capsular superior o incluso la prótesis invertida de hombro. Por tanto, en muchos casos de cirugía primaria, se debe intentar la reparación artroscópica con el fin de "salvar" el manguito rotador gravemente lesionado. El objetivo de este artículo es resumir algunas de las técnicas artroscópicas para conseguir una reparación de roturas "irreparables" del manguito rotador. Nivel de Evidencia: V Opinión de expertos

Irreparable rotator cuff tears are major injuries that can drastically affect the quality of life of the patients. Despite the complexity of the procedure and the high rates of re-tear, surgical repair is justified due to the lack of less aggressive and palliative alternatives. If a repair is not achieved, surgical alternatives are considered including tendon transfer, superior capsular reconstruction, or even reverse shoulder arthroplasty. Accordingly, arthroscopic repair must be performed in order to save the severely injured rotator cuff. The aim of this study is to summarize some of the arthroscopic techniques for repairing the so-called irreparable rotator cuff tears. Level of Evidence: V. Expert opinion

Implicações para homens do afastamento do(a) filho(a) devido medida protetiva de urgência / Impacto en los hombres del distanciamiento del(la) hijo(a) debido a medida protectora de urgencia / Implications for men of separation from their children due to emergency protective measure

Resumo Objetivo Desvelar as implicações para os homens do afastamento pai-filho(a) em decorrência de medida protetiva por violência conjugal. Métodos Estudo descritivo exploratório, abordagem qualitativa, desenvolvido com nove homens que respondiam a processo judicial por violência conjugal junto às 1ª e 2ª Varas de Justiça pela Paz em Casa de Salvador, Bahia, Brasil. A pesquisa ocorreu por meio da entrevista semiestruturada, tendo seu conteúdo gravado, transcrito e, em seguida, submetido à validação pelos homens. Os dados foram sistematizados com base nos passos preconizados pela análise de conteúdo temática categorial. Resultados O estudo revela que o afastamento pai-filho em decorrência da medida protetiva de urgência suscita no rompimento do vínculo paterno, fomentando o desenvolvimento de problemas psicoemocionais, como ansiedade, depressão e ideação suicida, muitas vezes somatizados e expressos desde cefaleia até condições que necessitam de cuidados hospitalares. Conclusão O comprometimento do exercício da paternidade viola também o direito de crianças e adolescentes ao convívio com a figura paterna. Deste modo, há grande necessidade de que a Política Nacional de Atenção Integral à Saúde dos Homens contemple uma gestão que priorize ações preventivas para a violência, assim como desempenhe acompanhamento psicossocial aos homens.

Resumen Objetivo Revelar el impacto en los hombres del distanciamiento padre-hijo(a) como consecuencia de medidas protectoras por violencia conyugal. Métodos Estudio descriptivo exploratorio, enfoque cualitativo, llevado a cabo con nueve hombres que respondían a juicio por violencia conyugal en el 1º y 2º Juzgado de Justicia por la Paz en Casa de Salvador, estado de Bahia, Brasil. La investigación se realizó a través de encuesta semiestructurada, con grabación y transcripción del contenido, y luego sometido a su validación por los hombres. Los datos fueron sistematizados con base en los pasos preconizados por el análisis de contenido temático de la categoría. Resultados El estudio revela que el distanciamiento padre-hijo como consecuencia de medidas protectoras de urgencia provoca la ruptura del vínculo paterno y fomenta el desarrollo de problemas psicoemocionales, como ansiedad, depresión e ideación suicida, muchas veces somatizados y expresados desde una cefalea hasta condiciones que necesitan cuidados hospitalarios. Conclusión El comprometimiento del ejercicio de la paternidad también viola el derecho de niños y adolescentes a convivir con la figura paterna. De este modo, hay una gran necesidad de que la Política Nacional de Atención Integral a la Salud de los Hombres contemple una gestión que establezca prioridades en acciones preventivas contra la violencia, así como también realice un seguimiento psicosocial de los hombres.

Abstract Objective To unveil the implications for men of father-son estrangement as a result of a protective measure for conjugal violence. Methods This is an exploratory descriptive study, with a qualitative approach, developed with nine men who were responding to a lawsuit for conjugal violence at the 1st and 2nd Courts of Justice of the Peace in Casa de Salvador, Bahia, Brazil. The research took place through a semi-structured interview, with its content recorded, transcribed and then submitted for validation by the men. Data were systematized based on the steps recommended by the categorical thematic content analysis. Results The study reveals that the father-son estrangement as a result of an emergency protective measure causes paternal bond rupture, promoting the development of psycho-emotional problems, such as anxiety, depression and suicidal ideation, often somatized and expressed from headache to conditions that require hospital care. Conclusion The commitment to the exercise of paternity also violates the right of children and adolescents to live with their father figure. Thus, there is a great need for the Brazilian National Policy for Comprehensive Care for Men's Health to include a management that prioritizes preventive actions against violence as well as providing psychosocial support to men.

Presentación de técnica quirúrgica para rotura de tendón de Aquiles. Resultados funcionales / Achilles tendon rupture. Surgical technique

Introducción: El tendón de Aquiles es el tendón más grande y fuerte del organismo. Es también de los más frecuentes en sufrir rotura. Tradicionalmente se ha realizado cirugía convencional de sutura de los cabos. En la actualidad crecieron en popularidad las técnicas de mini abordaje y percutáneas. Todas con riesgos y beneficios. El objetivo de la presentación en analizar resultados funcionales en la reparación de Aquiles con técnica mini invasiva de diseño propio. Material y Métodos: Se revisaron retrospectivamente 23 cirugías de reparación del tendón de Aquiles agudas con técnica propio mini invasiva. Resultados: Los resultados funcionales según es Score ATRS fueron de 87 puntos promedio. Discusión: Existe en la literatura médica buenos resultados en la reparación del tendón de Aquiles con distintas técnicas. Conclusión: Los beneficios de la técnica es que la misma es segura, reproducible, reduce complicaciones y permite movilización precoz

Introduction: The Achilles tendon is the largest and strongest tendon in the body. It is also one of the most frequent to suffer rupture. Traditionally, conventional suture surgery has been performed on the ends. At present, the mini-approach and percutaneous techniques have grown in popularity. All with risks and benefits. The objective of the presentation is to analyze functional results in Achilles repair with a mini-invasive technique of our own design. Material and Methods: Twenty-three acute Achilles tendon repair surgeries with their own mini-invasive technique were retrospectively reviewed. Results: The functional results according to the ATRS Score were 87 average points. Discussion: There are good results in the medical literature in the repair of the Achilles tendon with different techniques. Conclusion: The benefits of the technique is that it is safe, reproducible, reduces complications and allows early mobilization.

Pseudoaneurisma e fístula arteriovenosa da artéria femoral profunda após rotura completa do músculo vasto medial: tratamento endovascular / Pseudoaneurysm and arteriovenous fistula of the deep femoral artery after complete rupture of the vastus medialis muscle: endovascular treatment

Resumo A artéria femoral profunda, devido às suas características anatômicas, se encontra protegida da maioria dos traumatismos vasculares. Relatamos um caso de pseudoaneurisma de ramo perfurante da artéria femoral profunda, associado à fístula arteriovenosa, secundário a rotura completa do músculo vasto medial em paciente jogador de futebol. A ressonância magnética demonstrou lesão muscular associada a pseudoaneurisma, e a angiotomografia confirmou a presença de pseudoaneurisma associado a fístula arteriovenosa de ramo da artéria femoral profunda. Foi realizado tratamento endovascular da fístula através da embolização com micromolas fibradas e drenagem cirúrgica do hematoma muscular. O paciente evoluiu bem, sem queixas clínicas no 30º dia de pós-operatório e também após 1 ano.

Abstract Due to its anatomical characteristics, the deep femoral artery is protected from most vascular injuries. We report a case of a soccer player with pseudoaneurysm of a perforating branch of the deep femoral artery, associated with an arteriovenous fistula and secondary to complete rupture of the vastus medialis muscle. Magnetic resonance imaging showed muscle damage associated with a pseudoaneurysm and angiotomography confirmed the presence of a pseudoaneurysm associated with a deep arteriovenous fistula of a branch of the deep femoral artery. Endovascular treatment of the fistula was performed by embolization with fibrous microcoils and surgical drainage of the muscle hematoma. The patient recovered well, was free from clinical complaints on the 30th postoperative day and also after 1 year.