Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis.

BACKGROUND: There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. PURPOSE: To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score for randomized controlled trials. RESULTS: Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference, -0.14; 95% confidence interval, -0.27 to -0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test. CONCLUSION: Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.

Anatomic and functional outcome of eyes with massive submacular hemorrhage secondary to retinal macroaneurysm submitted to vitrectomy

Purpose: To report the anatomic and functional outcome in patients with severe visual loss after acute massive submacular hemorrhage secondary to retinal arterial macroaneurysm submitted to vitrectomy and subretinal recombinant tissue plasminogen activator injection. Methods: Retrospective, observational, case-series of 4 eyes of 4 patients submitted to pars plana posterior vitrectomy (ppV) combined with internal limiting membrane (ILM) removal and subretinal recombinant tissue plasminogen activator (rtPA-12.5 mg/0.1 ml) injection with dilute (20%) sulfur hexafluoride (SF6) gas in the vitreous cavity of eyes with recent onset (≤7 days) massive macular hemorrhage due to retinal arterial macroaneurysm (RAMA). Optical coherence tomography (OCT) was obtained both at presentation and during follow up. Results: Patients ranged in age from 63 to 78 years and all had systemic arterial hypertension. Visual acuity at presentation ranged from hand motions to count fingers at 50 cm. All eyes showed extensive retinal hemorrhage involving more than two-thirds of macular area. The time between the onset of symptoms and the surgery ranged from 3 to 7 days. After a mean postoperative follow-up of 15.5 ± 5.19 months (range, 10-22 months), all eyes showed visual acuity improvement and final visual acuity ranged from 20/30 to 20/80. All had complete displacement of the subretinal hemorrhage from the fovea after the surgery. OCT images showed neurosensory retina thinning and disruption of the reflective line that represents the junction between inner and outer photoreceptors segments (IS/OS line) beneath the macular area and absence of the external limiting membrane (ELM). Conclusions: ppV associated with subretinal rtPA injection with intravitreal gas seems to be a safe and effective technique to promote visual improvement in patients with multilevel macular hemorrhage secondary to RAMA. Despite functional improvement, OCT images demonstrate that...

Objetivo: Relatar os resultados anatômicos e funcionais em uma série de pacientes com perda visual grave por hemorragia submacular maciça aguda secundária a macroaneurisma arterial de retina (MAR) e descrever a técnica cirúrgica utilizada. Métodos: Este é um estudo retrospectivo, observacional, série de casos, incluindo 4 olhos de 4 pacientes que foram submetidos à cirurgia de vitrectomia posterior (VP), associada a peeling da membrane limitante interna (MLI) e injeção sub-retiniana de ativador do plasminogênio tecidual recombinante (rtPA-12,5 mg/0.1 ml) por hemorragia submacular maciça recente (≤7 dias) secundária MAR. Em todos os casos, o exame de tomografia de coerência óptica (OCT) foi obtido na consulta inicial e nas subsequentes para avaliação das alterações estruturais da retina. Resultados: A idade dos pacientes variou entre 63 a 78 anos e todos apresentavam hipertensão arterial sistêmica. A acuidade visual inicial nos olhos afetados variou de movimento de mãos a conta dedos a 50 cm. Todos os olhos apresentaram hemorragia retiniana extensa ocupando mais do que dois terços da região macular. O tempo decorrido entre a perda visual e a cirurgia variou entre 3 a 7 dias. Após um seguimento médio de 15.5 ± 5.19 meses (variando entre 10 a 22 meses), a acuidade visual pós-operatória variou entre 20/30 e 20/80. Todos os olhos apresentaram um deslocamento completo da hemorragia subretiniana da região macular central no pós operatório. As imagens seccionais da retina obtidas pela OCT revelaram um afilamento da retina neurossensorial e interrupções na linha refletiva que representa a junção entre os segmentos internos e externos dos fotorreceptores na região macular, além de falhas na membrane limitante externa em todos os casos. Conclusão: De acordo com os resultados do presente estudo, a VP associada à injeção sub-retiniana de rtPA parece ser uma técnica segura e eficaz em promover melhora visual em pacientes com hemorragia submacular...

Similaridade da fauna de Chiroptera (Mammalia), da Serra Negra, municípios de Rio Preto e Santa Bárbara do Monte Verde, Minas Gerais, com outras localidades da Mata Atlântica / Similarity of the bat fauna (Mammalia) in Serra Negra, Rio Preto and Santa Bárbara do Monte Verde municipalities, Minas Gerais, with other localities of Atlantic Forest

A face sul da região da Serra Negra está localizada entre os municípios de Rio Preto e Santa Bárbara do Monte Verde no estado de Minas Gerais. A região é marcada por um relevo montanhoso e vegetação formada por Floresta Ombrófila Densa. Os estudos foram conduzidos em altitudes entre 800 a 1.200 m onde os morcegos foram capturados em redes de neblina instaladas principalmente no interior e borda de mata. Durante um período de 14 meses e um esforço de captura de 22.140 m²r.h, foram capturados 246 morcegos pertencentes a 15 espécies, 13 gêneros e 2 famílias: Phyllostomidae (12 espécies) e Vespertilionidae (3 espécies). A espécie Sturnira lilium foi a mais freqüente com 33,7 por cento das capturas, seguida por Carollia perspicillata com 21,1 por cento, Desmodus rotundus com 19,1 por cento e Artibeus lituratus com 16,3 por cento. Em análise de agrupamento realizada entre a fauna de Chiroptera da face sul da Serra Negra com outros levantamentos, a área de estudo se mostrou similar a fauna de morcegos do Parque Nacional da Serra dos Órgãos.

The southern slope of the Serra Negra region is located between the Rio Preto and Santa Bárbara do Monte Verde municipalities, state of Minas Gerais. The region is a mountain chain inserted in the Atlantic rainforest domain. The studies were conducted in a rainforest at elevations of 800-1,200 m, where bats were captured in mist-nets installed at the ground level in the interior and edges of the forest. After 14 monthly samplings and total capture effort of 22,140 m²r.h, 246 bats belonging to Phyllostomidae (12 species) and Vespertilionidae (3 species) were captured. Sturnira lilium was the most frequently captured species, followed by Carollia perspicillata, Desmodus rotundus and Artibeus lituratus (33.7, 21.1, 19.1 and 16,3 percent of the captures, respectively). Cluster Analysis including Serra Negra and bat checklists of other patches of Atlantic forest revealed that Serra Negra is more similar to the Serra dos Órgãos, State of Rio de Janeiro, southeastern Brazil, than the other areas.