Lesión complejo ligamentario interno del codo por valgo forzado sin luxación previa / Internal ligament complex elbow injury without previous dislocation

Se presenta el reporte de un caso de un paciente que consulta por dolor e inestabilidad de codo izquierdo tras un traumatismo directo realizando práctica deportiva. En el examen físico se constata bostezo medial de más de 4 mm tras maniobras de stress. Los estudios por imágenes informan avulsión del complejo ligamentario interno y desprendimiento de la masa muscular flexopronadora. Se realizó la reparación directa de las estructuras dañadas, se utilizó el DASH score (00.0), el score de la Clínica Mayo (100.0) para la evaluación y seguimiento del paciente

We present the case report of a patient who consulted for pain and instability of the left elbow after a direct trauma doing sports practice. In the physical examination, a medial opening of more than 4mm was observed after stress maneuvers. Imaging studies report avulsion of the internal ligament complex and detachment of flexopronator muscle mass. Direct repair of the damagedstructures was performed, the DASH score (00.0), the Mayo Clinic score(100.0) was used for the evaluation and follow-up of the patient

Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso / Isolated irreducible anterior radial head dislocation in a child: a rare case report

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

Lesiones meniscales ramp, y lesiones del ligamento meniscotibial posteromedial / Meniscal ramp lesions, and posteromedial meniscotibial ligament lesions

Las lesiones meniscales son las lesiones más frecuentemente asociadas a lesiones del Ligamento Cruzado anterior (LCA), encontrándose 9,3 a 16,9% en el segmento posteromedial y comprometiendo el ligamento meniscotibial. Descritas por Strobel por su apariencia artroscópica de rampa, se ha presentado su importancia dado el subdiagnóstico y el efecto biomecánico de una lesión posteromedial del menisco sobre el LCA y que su reparación restaura la traslación nativa de la tibia en conjunto con la reconstrucción del pivote central. Se ha demostrado que la mejor forma para diagnosticar lesiones ramp, es por visiones artroscópicas accesorias, una a través del surco intercondíleo y la otra por un portal posteromedial, logrando diagnosticar y manejar aquellas lesiones que sean inestables, a través de suturas dentro tanto por el portal anterior como por el posterior. Los resultados quirúrgicos son buenos, con mayor riesgo de falla en casos que la lesión se extiende al cuerpo meniscal. Es una lesión que debe buscarse bajo lupa, ya que pasarla por alto puede llevar a progresión de la lesión y a un mayor riesgo de rerotura del ligamento cruzado reconstruido.

Meniscal tears are the most frequently associated lesions in Anterior Cruciate Ligament (ACL) rupture, 9.3 to 16.9% on them in the posteromedial segment compromising the meniscotibial ligament. Described by Strobel for its arthroscopic ramp appearance, has gained importance given the underdiagnosis and biomechanical effect of a posteromedial meniscal lesion on the ACL, and that its repair restores the native anterior tibial translation when the central pivot is also reconstructed. It has been shown that the best way to diagnose ramp lesions is by accessory portals, one through the intercondylar notch and the other through a posteromedial portal, useful to diagnose and repair those lesions that are unstable, through all-inside sutures within both Anterior and posterior portals. Surgical results are good, with increased risk of failure in cases where the lesion extends to the meniscal body. It is a lesion that must be looked for in a direct way, since misdiagnosing it can lead to ramp lesion progression and increased risk of re rupture of the reconstructed ACL.

Fractura de miembro inferior de alta energía asociada a lesión multiligamentaria de rodilla / Multiligament knee injuries with high energy limb fractures

Introducción: La lesión multiligamentaria de la rodilla en pacientes con fracturas del miembro inferior ipsilateral es una entidad poco frecuente y que suele pasar desapercibida en la etapa aguda. El objetivo de este trabajo es analizar una serie de pacientes con fractura de miembro inferior asociado a lesión multiligamentaria de rodilla. Materiales y método: Se realizó una búsqueda retrospectiva de enero 2010 a diciembre 2016, de aquellos pacientes atendidos en nuestro centro con fractura de miembro inferior asociada a inestabilidad multidireccional de la rodilla ipsilateral. Se evaluó el patrón de fractura, la lesión ligamentaria asociada, si presentaba Resonancia Magnética (RM) inicial que pesquisara el diagnóstico de dicha lesión, y la decisión del momento del tratamiento quirúrgico. Se realizó una valoración del dolor con la Escala Visual Analógica (EVA) y funcional con escala de Lysholm y Tegner a todos aquellos pacientes con más de 12 meses de evolución postoperatoria. Resultado: Se encontraron 6 pacientes con un promedio de edad de 26 años. Cinco pacientes presentaban resonancia magnética al momento del trauma. El intervalo de tiempo promedio entre la resolución de la fractura y la reparación ligamentaria fue de 4 días. El promedio de las escalas evaluadas fue: EVA 0.2, Tegner 4 y Lysholm 87. Conclusión: En pacientes con fractura de miembro inferior de alta energía el compromiso ligamentario no debe subestimarse. Consideramos que la realización de una RM durante la atención inicial del paciente optimiza los tiempos en el diagnóstico y tratamiento de dichas lesiones y conlleva a mejores resultados funcionales al final del tratamiento. Tipo de studio: Serie de casos. Estudio retrospectivo. Nivel de evidencia: IV.

Introduction: Multiligament knee injuries in patients with ipsiletaral inferior limb fractures is a rare entity that can be easily missed. The objective of this work was to analyze a series of patients with multiligament lesion associated with inferior limb fracture. Material and method: A retrospective search was carried out from January 2010 to December 2016 of patients admitted in our hospital with diagnosis of inferior limb fracture associated to multidirectional knee instability. We evaluated the fracture pattern, ligament knee injury, if an initial Magnetic Resonance Imaging (MRI) was performed and the surgical timing. We evaluated pain with Visual Analogue Scale (VAS) and functional outcomes using Tegner and IKDC scores. We included patients with more than one-year postoperative. Results: Six patients were evaluated with an average age of 26 years-old. Five patients presented initial MRI, before the first surgery was performed. The average time between fracture osteosynthesis and ligament reconstruction was 4 days. VAS, Tegner and IKDC mean results were 0.2, 4 and 87 respectively. Conclusion: In patients with high-energy lower limb fractures, ligament compromise must be suspected. We consider that MRI should be performed during the first examination to optimize the diagnosis and treatment of possible associated ligament injuries and to obtain better functional outcomes. Type of study: Retrospective cases serie. Level of evidence: IV.

Reconstrucción del ligamento patelofemoral medial. descripción de técnica quirúrgica. estudio retrospectivo / Medial patellofemoral ligament reconstruction. surgical technique

Introducción: la luxación de la patela es una patología relativamente frecuente sin embargo, su manejo es controversial. En los últimos años la tendencia a realizar reconstrucciones que asemejen más la anatomía nativa, ha generado un renovado interés por las reconstrucciones del ligamento patelofemoral medial (LPFM). De las estructuras que permiten mantener la patela en adecuada posición, el LPFM es la estructura más importante y su lesión es reconocida como esencial para que se origine una luxación de patela. Objetivo: La reconstrucción del LPFM con la técnica de doble haz fijada anatómicamente y verificada por artroscopia pretende acercarse a los parámetros actuales de reconstrucción. Este estudio busca describir los resultados del tratamiento quirúrgico con esta técnica en pacientes con luxación de patela tratados entre mayo de 2010 y mayo de 2016 mediante la aplicación de escalas funcionales establecidas en la literatura, para identificar la mejoría de los síntomas y la no recidiva un año posterior a finalizar el período de rehabilitación. Resultados: Se intervinieron 16 rodillas en 15 pacientes (una de las pacientes con compromiso bilateral), de las cuales el 81,2% fueron de sexo femenino. El tiempo entre la primera luxación y la intervención quirúrgica fue en promedio 11,81 meses. Al año se encontraron diferencias estadísticamente significativas para las escalas funcionales Lisholm, Tegner, y Kujala y no se realizaron reintervenciones durante el seguimiento. Conclusión: La reconstrucción del LPFM, con doble fijación en patela y fijación asistida por artroscopia, es una variación a la técnica abierta tradicional que, teniendo en cuenta parámetros anatómicos, se puede realizar de forma segura. La evolución clínica de los pacientes es satisfactoria teniendo en cuenta que las escalas funcionales medidas en estos pacientes mejoraron estadísticamente significativo con respecto a los puntajes iniciales.

Introduction: dislocation of the patella is a relatively frequent pathology, however, its handling is controversial. In the recent years the tendency to perform reconstructions that more closely resemble native anatomy has generated a renewed interest in reconstructions of the medial patellofemoral ligament (LPFM).1,2 Of the structures that maintain the patella in a suitable position, LPFM is the most important one and its lesion is recognized as essential for the origin of a patella dislocation.3 Objective: The reconstruction of the LPFM with the anatomically fixed and double-beam technique, which was verified by arthroscopy, aims to approach the current reconstruction parameters. This study looks at the results of the surgical treatment with this technique in patients with patellar dislocation treated between May 2010 and May 2016, through the application of functional scales established in the literature to identify the improvement of symptoms and non-recurrence, one year after the end of the rehabilitation period. Results: 16 knees were involved in 15 patients (one of the patients with bilateral involvement), of whom 81.2% were female. The time between the first dislocation and the surgery had an average of 11.81 months. There were found statistically significant differences for the Lisholm, Tegner, and Kujala functional scales and there were no interventions performed during the year of follow-up. Conclusion: The reconstruction of LPFM, with double fixation in patella and fixation assisted by arthroscopy is a variation to the traditional open technique, taking into account anatomical parameters can be performed safely. The clinical evolution of the patients is satisfactory considering that the functional scales measured in these patients improved compared to their initial scores.

Ligamento teres de la cadera. Revisión bibliográfica / Ligamentun teres of the hip. Bibliographic revision

Resumen: La función del ligamento teres de la cadera ha llamado la atención en los últimos años debido al incremento y a la realización de la artroscopía de cadera, la información en la literatura es escasa, por ello nos propusimos realizar una revisión bibliográfica sobre los conceptos actuales, su anatomía, función, biomecánica, diagnóstico y rupturas del ligamento de teres de la cadera.

Abstract: The role and function of the ligamentum teres has drawn our attention in the last years due to the increasing and performance in hip arthroscopy, few is written in the literature, this is why we proposed to perform and assessed a review on the current literature of the anatomy, function, diagnose and rupture of the ligamentum teres of the hip.

Luxación irreductible posterolateral de rodilla. Presentación de un caso / Irreductible posterolateral knee dislocation. Case report

La luxación irreductible de rodilla es una patología poco frecuente. Normalmente se trata de luxaciones posterolaterales, constituyendo una urgencia ortopédica con indicación formal de reducción abierta mediante artrotomía de rodilla y en algunos casos con un debridamiento asistido por artroscopía. Por su condición irreductible, no se recomienda la reducción manual cerrada. Presentamos un caso de luxación irreductible posterolateral de rodilla en una paciente de 21 años como consecuencia de un traumatismo de alta velocidad, su tratamiento mediante reducción abierta, desbridamiento artroscópico y reconstrucción del ligamento colateral medial en un solo tiempo. Tipo de estudio: Reporte de caso. Nivel de evidencia: V.

An irreducible knee dislocation is a rare condition. It is usually a posterolateral dislocation, (orthopedic urgency) constituting a formal indication of open reduction through knee arthrotomy and in some cases assisted with arthroscopic debridement. For its irreducible condition, closed manual reduction is not recommended. We present a case of an irreducible posterolateral knee dislocation in a patient of 21 years due to high-energy trauma, treatment by open reduction, arthroscopic debridement and sMCL reconstruction in an unstaged procedure. Type of study: Case presentation. Evidence level: V.

Técnica de Larson modificada para la reconstrucción del complejo postero-lateral de la rodilla / Modified Larson´s technique for knee posterolateral corner reconstruction

Presentamos la modificación de la técnica descripta por Larson, para la reconstrucción de las lesiones del complejo postero-lateral (CPL) de la rodilla. La misma se basa en el concepto de la reconstrucción del ligamento colateral lateral (LCL), y de la reconstrucción del ligamento peroneo poplíteo (LPP), que es considerado como el componente estático del tendón del poplíteo (TP) y su inserción en la cabeza del peroné. A diferencia de la técnica original, en esta modificación se realizan las inserciones proximales a nivel femoral del LCL y el TP, logrando y reproduciendo la isometría de estas estructuras. Las técnicas similares, pero que suman la reconstrucción tibial del TP además de la peronea, no parecerían tener ninguna ventaja clínica ni funcional con respecto a la que describimos. Ambas son sumamente útiles para recuperar la estabilidad postero-lateral, mediante el control de la rotación externa y la restricción del varo. Sin embargo, la técnica presentada se caracteriza por la menor morbilidad, menor tiempo quirúrgico y menos demandante técnicamente. Las técnicas de reconstrucción del CPL parecerían ser más efectivas por el menor número de fallas y mejores resultados clínicos y funcionales, que las técnicas de reparación o aumentación, aunque es una buena opción en especial en lesiones agudas, utilizar este procedimiento junto con reparaciones. La técnica de Larson modificada es de gran utilidad para el tratamiento de las inestabilidades postero-laterales aisladas o combinadas, mediante un procedimiento relativamente sencillo y mediante una técnica anatómica e isométrica.

We present a modification of the technique described by Larson for reconstruction of injuries of the posterolateral corner of the knee (PLC). This technique is based on the concept of reconstruction of lateral collateral ligament (LCL) and reconstruction of popliteofibular ligament (PFL), which is considered the static component of the popliteal tendon (PT) and its insertion in the fibular head. Unlike the original technique, this modification performs proximal insertions at the femoral level of the LCL and the PT, obtaining and reproducing the isometry of these structures. Similar techniques that use tibial reconstruction of PT in addition to fibular reconstruction do not show any clinical or functional advantage compared to this modified technique. Both are very useful to recover posterolateral stability through the control of external rotation and restriction of varus. However, this technique has lower morbility, less time of surgery, and is less technically demanding. PLC reconstruction techniques appear to be more effective due to a lower number of failures and better clinical and functional results than repair or augmentation techniques, although it is a good decision to use this procedure together with repairs, in particular, with acute injuries. This modified Larson’s technique is very useful for treatment of isolated or combined posterolateral instabilities, by means of a relatively simple and anatomic and isometric technique.

Exploração operatória e redução de sindesmose em lesão de tornozelo de Weber tipo C / Operative exploration and reduction of syndesmosis in Weber type C ankle injury

Objetivo: Investigar os métodos cirúrgicos no tratamento de fratura de tornozelo de Weber tipo C e estimar a necessidade de exploração cirúrgica da sindesmose. Métodos: quarenta e três pacientes que apresentavam fratura de tornozelo de Weber tipo C foram tratados com redução aberta e fixação interna de outubro de 2004 a dezembro de 2009. Vinte e nove pacientes foram tratados com o procedimento de rotina, que envolve redução aberta e fixação interna, exploração de sindesmose. Nos outros pacientes, foram realizados reparos adicionais. Trinta e quatro pacientes foram acompanhados durante um período médio de 31,2 meses (faixa, 18 a 50 meses), 22 pacientes desse total foram tratados com procedimentos de rotina e 12 foram tratados com exploração cirúrgica adicional da sindesmose. Resultados: todas as fraturas estavam unidas no período médio de 13,1 semanas (faixa, 10 a 18 semanas), tendo início o apoio de peso total. A escala média de tornozelo e retropé do escore da American Orthopaedics Foot and Ankle Society foi 79,86 (faixa, 65 a 98) no grupo procedimentos de rotina e 86,67 (faixa, 78 a 100) no grupo exploração da sindesmose. Os valores do escore de Olerud-Molander foram 77,27 (faixa, 55 a 100) e 86,67 (faixa, 75 a 100), respectivamente. Constatou-se diferença estatisticamente significante entre os dois grupos (P < 0,05). Conclusão: A exploração cirúrgica da sindesmose é essencial em certas fraturas de tornozelo de Weber tipo C, que torna possível o desbridamento e a redução direta da sindesmose, permitindo maior estabilização da articulação do tornozelo. Nível de evidência III, Estudo retrospectivo comparativo .

Objective: To investigate the surgical methods in treating weber type c ankle injury and estimate the necessity of syndesmosis operative exploration. Methods: forty three patients presenting weber type c ankle injury were treated with open reduction and internal fixation from October 2004 to December 2009. Twenty nine patients were treated with routine procedure involving open reduction and internal fixation, syndesmosis exploration. Additional repair was performed in the others. Thirty four patients were followed during an average time of 31.2 months (range, 18 to 50 months), 22 patients of those were treated with routine procedures and 12 were treated with additional syndesmosis surgical exploration. Results: all the fractures were united within the average time of 13.1 weeks (range, 10 to 18 weeks) and full weight bearing began. The mean ankle and hindfoot scale of the American Orthopaedics Foot and Ankle Society score was 79.86 (range, 65 to 98) in the routine procedures group and 86.67 (range, 78 to 100) in the syndesmosis exploration group. The values of olerud-molander score were 77.27 (range, 55 to 100) and 86.67 (range, 75 to 100), respectively. Statistcally significant difference was found between the two groups (p<0.05). Conclusion: syndesmosis surgical exploration is essential in some weber type c ankle injuries, which make debridement and direct reduction of the syndesmosis possible, allowing higher stabilization of the ankle joint. Level of Evidence III, Retrospective Comparative Study.

Posterior Ligamentous Complex Injuries Are Related to Fracture Severity and Neurological Damage in Patients with Acute Thoracic and Lumbar Burst Fractures

PURPOSE: The proposed the thoracolumbar injury classification system (TLICS) for thoracolumbar injury cites the integrity of the posterior ligamentous complex (PLC). However, no report has elucidated the severity of damage in thoracic and lumbar injury with classification schemes by presence of the PLC injury. The purpose of this study was to accurately assess the severity of damage in thoracic and lumbar burst fractures with the PLC injuries. MATERIALS AND METHODS: One hundred consecutive patients treated surgically for thoracic and lumbar burst fractures were enrolled in this study. There were 71 men and 29 women whose mean age was 36 years. Clinical and radiologic data were investigated, and the thoracolumbar injury classification schemes were also evaluated. All patients were divided into two groups (the P group with PLC injuries and the C group without PLC injuries) for comparative examination. RESULTS: Fourth-one of 100 cases showed PLC injuries in MRI study. The load sharing classification score was significantly higher in the P group [7.8+/-0.2 points for the P group and 6.9+/-1.1 points for the C group (p<0.001)]. The TLICS (excluded PLC score) score was also significantly higher in the P group [6.2+/-1.1 points for the P group and 4.0+/-1.4 points for the C group (p<0.001)]. CONCLUSION: The presence of PLC injury significantly influenced the severity of damage. In management of thoracic lumbar burst fractures, evaluation of PLC injury is important to accurately assess the severity of damage.

Hallazgos por resonancia magnética en pacientes esqueléticamente inmaduros con primer episodio de luxación aguda de rótula / Findings on magnetic resonance imaging following first-time acute lateral patellar dislocation in skeletally immature patients

Objetivo: Evaluar los hallazgos encontrados en la resonancia magnética (RMN) luego del primer episodio de luxación aguda de la rótula (LAR) en pacientes esqueléticamente inmaduros. Comparar la morfología de la articulación patelofemoral (APF) con un grupo control. Material y Método: Se analizaron 15 RMN obtenidas dentro de las 4 semanas después del primer episodio de LAR. Se evaluó la lesión del ligamento patelofemoral medial (LPFM), derrame articular, lesiones osteocondrales, fragmentos libres, contusiones óseas, edema del vasto medial (VMO) y otras lesiones asociadas. Se analizó además la altura de la rótula, la distancia TT-TG y la displasia troclear. 30 pacientes sin evidencia de LAR fueron utilizados como controles. Resultados: La edad promedio fue de 13,8 ± 2,57 años. En el 93 por ciento se objetivó lesión del LPFM (33 por ciento en la inserción patelar, 20 por ciento femoral, 6,7 por ciento intrasustancia y 33 por ciento combinada). Los estudios mostraron derrame intra-articular en el 73 por ciento, lesión osteocondral 33,3 por ciento y cuerpos libres en el 20 por ciento. El 87 por ciento mostró contusiones óseas, edema del VMO (13,4 por ciento), lesión del ligamento colateral medial (6,7 por ciento) y lesión meniscal (6,7 por ciento). Al ser comparados con el grupo control presentaron mayor altura de la rótula (p 0,008), aunque no se observaron diferencias significativas en la distancia TT-TG (p 0,96) y displasia troclear (p 0,16). Conclusión: La RMN en el primer episodio de LAR permite detectar lesiones de los estabilizadores mediales y de la superficie articular. La APF de estos pacientes suele presentar algunas diferencias morfológicas. Esta información es de vital importancia para evaluar el pronóstico y decidir el tratamiento. Nivel de evidencia: III.

HAGL: avulsión humeral de los ligamentos glenohumerales: diagnóstico y reparación artroscópica / Humeral avulsion of the glenohumeral ligament (HAGL): diagnosis and arthroscopic repair

La patología relacionada con la inestabilidad anterior traumática del hombro corresponde a un espectro tanto de lesiones óseas, como de lesiones de partes blandas. La avulsión humeral de los ligamentos glenohumeral (por sus singlas en ingles: HAGL) es una causa poco frecuente de inestabilidad anterior de hombro. Se debe sospechar esta lesión en pacientes con recidivas luego de una reparación o en pacientes con inestabilidad anterior en ausencia de lesión de Bankart. La evaluación artroscópica de la articulación glenohumeral puede identificar la mayoría de las lesiones de HAGL. La reparación artroscópica sigue siendo un procedimiento complejo debido a la difícil angulación para abordar la parte inferior del cuello humeral. A pesar de ello, los resultados iniciales son alentadores.

Semilunar flotante: tratamiento artroscopico: reporte de un caso y revision de la bibliografia / Floating lunate: arthroscopic treatment: case report and bibliography review

La asistencia artroscópica ha beneficiado de manera significativa el diagnóstico y tratamiento de la inestabilidad carpiana. Presentamos un caso clínico en donde se combinan dos lesiones ligamentarias carpianas, la lesión del ligamento escafo-lunar y la del luno-piramidal. Ambas corresponden a lesiones pre-dinámicas y de grado III según la clasificación de Geissler. Describimos el tratamiento quirúrgico en donde se realizó en forma artroscópica termo contracción y fijación temporaria con clavijas. Pasados dos años de seguimiento no se han observado nuevos signos de inestabilidad ni dolor residual.

Componentes ricos em plaquetas na reparação de afecções tendo-ligamentosas e osteo-articulares em animais: [revisão] / Components rich in platelets used in wound healing tendon, ligaments and osteo-articular diseases of animals: [revision]

O plasma rico em plaquetas e o concentrado de plaquetas são fontes de diversos fatores de crescimento, com grande potencial terapêutico. Uma vez liberados dos grânulos alfa das plaquetas ativadas, esses fatores atuarão no sítio da lesão, estimulando a quimiotaxia, fibroplasia e angiogênese, melhorando assim a reparação tecidual. Embora esses componentes ricos em plaquetas sejam de fácil obtenção e de eficácia comprovada na medicina humana e odontologia, a utilização desses componentes na medicina veterinária é relativamente recente, necessitando ainda de estudos controlados. Neste artigo, os aspectos morfológicos das plaquetas, a ação dos fatores de crescimento e a utilização de componentes ricos em plaquetas na reparação tecidual de estruturas tendo-ligamentosas e osteo-articulares são revisados.

Platelet-rich plasma and platelet concentrates are involved in growing factors. Both have great therapeutic potential. When the alpha-granules are released by the active platelet, they act in the lesion site stimulating the chemotaxis, the fiberplasia and the angiogenesis. They improve the regeneration of the tissue. Although these rich platelet components are easy to obtain and efficiently to prove by medicine and dentistry, their use on vet medicine is recent. So, much more control studies need to be done. This article reviews morphological aspects of platelets, action of growing factors and use of components rich in platelet in wound healing tendons, ligaments and osteo-articular structures.

Vídeo-artroscopia da articulação fêmoro-tíbio-patelar em cães após secção do ligamento cruzado cranial guiada por artroscopia / Videoarthroscopy of the stifle joint in dogs after cranial cruciate ligament rupture guided by arthroscopy

Avaliaram-se e classificaram-se por meio da vídeo-artroscopia as alterações da articulação fêmoro-tíbio-patelar (FTP), 21 dias após secção experimental do ligamento cruzado cranial (LCCr) em cães, tendo como referência os parâmetros encontrados no exame artroscópico imediatamente anterior à secção. Ao exame artroscópico, foi possível visibilizar os cotos remanescentes do LCCr e as alterações articulares, como aumento da vascularização, aumento das vilosidades na membrana sinovial, bem como fibrilação e osteófitos, principalmente nas bordas trocleares do fêmur. Os resultados sugerem que a artroscopia é um método preciso de avaliação macroscópica dos tecidos articulares moles e duros.

By the use of videoarthroscopy, the changes of the stifle joint after experimental rupture of cranial cruciate ligament (CCL) in dogs were evaluated and classified, based on the parameters found at the arthroscopic examination right before the rupture. By the arthroscopic examination, it was possible to visualize the remainings of the CCL and joint changes such as increase of the vascularity and synovial proliferation increase in the synovial membranes, as well as fibrillation and irregularities on the joint surfaces and osteophyte formation, mainly on the trochlear ridges. The results suggest that arthroscopy is a precise method for macroscopic evaluation of the smooth and bone joint tissues.

Estabilidade articular do joelho no quadro do "joelho-flutuante" / Knee joint stability in a \"floating knee\" condition

Neste trabalho, 22 pacientes com fraturas ipslaterais do fêmur e da tíbia ("joelho flutuante") tratados cirurgicamente foram convocados para reavaliação. Com seguimento mínimo de 4 meses, 17 pacientes compareceram e foram reavaliados através de exame físico, radiológico, escala de Lysholm e o escore de Kãrlstron. As fraturas foram classificadas quanto ao grau de exposição (Gustillo e Andersen), cominuição (AO) e o "joelho-flutuante" (Fraser). Doze pacientes (70,6 por cento) apresentaram alterações objetivas no exame físico do joelho. A instabilidade articular foi a alteração mais encontrada, presente em oito casos (47 por cento), seguida da restrição de movimento em sete pacientes (41,2 por cento). A instabilidade anterior foi diagnosticada em cinco casos (29,4 por cento), sendo três associados à instabilidade em varo. A instabilidade posterior estava presente em dois pacientes (11,8 por cento), ambos associados com instabilidade em varo. Um paciente apresentou instabilidade periférica em varo e valgo, associada à restrição importante da flexão do joelho. As presença de fraturas intra-articulares, fraturas expostas do fêmur cursaram com maior incidência de restrição do arco de movimento. Nesta casuística os resultados obtidos reforçam a necessidade da avaliação sistemática da estabilidade articular do joelho, visto que o quadro de "joelho flutuante" está freqüentemente associado à lesão cápsulo-ligamentar desta articulação.

In this study, 22 patients who had undergone surgical treatment for ipsilateral fractures of the femur and tibia ("floating knee") were recalled for reassessment. Seventeen patients turned up after a follow-up period of four months and were reassessed by applying the physical and radiological exams, the Lysholm's knee scale and the Karlstron score. The fractures were classified according to degree of exposure, communication and "floating knee" condition. Twelve patients (70.6 percent) presented with definite alterations during the physical examination of the knee. The joint instability was present in eight cases (47 percent) followed by restricted movement in seven patients (41.2 percent). Anterior instability was diagnosed in five cases (29.4 percent), three of them associated with varus instability. Posterior instability was observed in two patients (11.8 percent) and in both cases it was associated with varus instability. One patient presented with peripheral varus-valgus instability and an important knee movement restriction. Intra-articular and exposed fractures of the femur and tibia present a higher incidence of restricted arc movement. The results obtained in this study reinforce the need for the systemic assessment of knee joint stability in view of the fact that the "floating knee" condition is often associated with lesions of the knee joint capsule and ligament.

Estudo retrospectivo do tratamento da ruptura de ligamento cruzado cranial no cão por técnica cirúrgica extra-articular / Retrospective study of extra-articular surgical technique on the repair of cranial cruciate ligament deficency in the dog

As técnicas extra-capsulares têm sido amplamente utilizadas para a reparação da ruptura do ligamento cruzado cranial no cão (RLCC); e, a sutura fabelo tibial tem se tornado uma das mais populares. A presente pesquisa teve por finalidade avaliar a evolução clínica de pelo menos 4 meses de pós-operatório de 19 cães (20 articulações) portadores de RLCC e submetidos a técnica acima descrita. Realizou-se entrevista com o proprietário e exame clínico consistindo de avaliação do escore de claudicação, teste de gaveta e mensuração do diâmetro da coxa, volume e ângulo da articulação do joelho. De acordo com os proprietários 90% dos animais apresentaram recuperação boa ou ótima após o tratamento cirúrgico, variando de ausência de claudicação com claudicação esporádica. A avaliação clínica denotou resultado favorável no que tange ao teste de gaveta e escore de claudicação. As mensurações objetivas, contudo, não corroboraram na mesma proporção com os resultados clínicos.

Extra-articular techniques have been widely used on cranial cruciate ligament rupture repair; among these techniques fabelo-tibial suture is one of the most popular. The purpose of the present study was to evaluate the clinical results following at least 4 months of post-operative of cranial cruciate ligament deficiency in 19 dogs (20 joints) using the fabelo-tibial technique. After interviewing the owners a clinical exam was performed by the veterinary and it included gait evaluation, withdraw test and objective measurements of the thigh circumference, stifle angle and stifle diameter of the affected and the contra lateral limbs. The owners evaluated 90% of the dogs as having an excellent to good recovery, without or with sporadic lameness. The gait and withdraw tests of the clinical evaluation showed satisfactory results. Nevertheless, the objectives measurements don´t showed the same results.

Tratamento das lesões ligamentares intrísecas do punho com videoartroscopia: estudo em 12 casos / Treatment of intrinsic ligament lesions of the wrist with videoartroscopy: study of 12 cases

Objetivo: Analisar os resultados clínicos do tratamento videoartroscópico das lesões ligamentares escafo-semilu-nar e semilunar-piramidal do punho. Métodos: Foram analisados 12 casos, todos tratados com videoartroscopia de punho, acompanhados pós-operatoriamente por 26,5 meses (± 16,3); todos apresentaram remissão total da sintomatologia e recuperação das suas atividades funcionais. Não houve diminuição da mobilidade do punho e da força de preensão manual. Resultados: Lesões ligamentares intrínsecas do carpo devem ser preferencialmente tratadas com videoartroscopia, pois permite o tratamento efetivo sem agressões maiores aos tecidos não lesados. Os resultados foram gratificantes, tanto para o cirurgião como, principalmente, para o paciente, o que encoraja os autores a persistirem com a técnica adotada. Conclusão: A videoartroscopia é um procedimento que permite o efetivo diagnóstico e a quantificação da extensão das lesões ligamentares escafo-semilunar e semilunar-piramidal, permitindo ao mesmo tempo o tratamento sem a necessidade de agressão maior aos tecidos não lesados, como ocorre nas reparações abertas