RESUMEN
The presence of abnormalities in knee alignment (genu varum and genu valgum) is extremely common in soccer. It can occur in the junior league / youth academy and perpetuate itself throughout the professional career. The consequences of years of high-level sports practice in players with genu varum / genu valgum can be harmful to the knees. By observing football matches of the present and the past, the authors of the article noted that great Brazilian soccer players were, or are, affected by the malalignment of the knees: Garrincha (the most famous), Leandro, Dunga, Romário, Rivaldo and Neymar. This study aims to discuss the relationship between high-performance sport and the development of these orthopedic deformities, serving as a tool for updating the trauma-orthopedic knee subspecialty. Level of Evidence III, Retrospective comparative study.
A presença de anormalidades no alinhamento dos joelhos (geno varo e geno valgo) é extremamente comum no futebol. Seu aparecimento pode ocorrer quando os jogadores estão nas categorias de base e se perpetuar durante a carreira profissional. As consequências de anos de prática esportiva em alto nível em jogadores com geno varo/geno valgo podem ser deletérias aos joelhos. A partir da observação de jogos de futebol do presente e do passado, os autores do artigo notaram que grandes nomes brasileiros deste esporte foram ou são acometidos pelo desalinhamento dos joelhos: Garrincha - o mais famoso -, Leandro, Dunga, Romário, Rivaldo e Neymar. O presente estudo tem como objetivo discutir a relação entre o esporte de alto rendimento e o desenvolvimento dessas deformidades ortopédicas, servindo como ferramenta de atualização da subespecialidade traumato-ortopédica do joelho. Nível III de Evidência, Estudo Retrospectivo Comparativo.
RESUMEN
Stem cells in platelet-rich plasma (PRP) scaffolds may be a promising treatment for cartilage repair. Human dental pulp stem cell (hDPSC) subpopulations have been identified to have substantial angiogenic, neurogenic and regenerative potential when compared with other stem cell sources. The present study evaluated the potential of hDPSCs in a PRP scaffold to regenerate full-thickness cartilage defects in rabbits. Full-thickness articular cartilage defects were created in the patellar groove of the femur of 30 rabbits allocated into three experimental groups: Those with an untreated critical defect (CTL), those treated with PRP (PRP) and those treated with stem cells in a PRP scaffold (PRP+SC). The patellar grooves of the femurs from the experimental groups were evaluated macroscopically and histologically at 6 and 12 weeks post-surgery. The synovial membranes were also collected and evaluated for histopathological analysis. The synovial lining cell layer was enlarged in the CTL group compared with the PRP group at 6 weeks (P=0.037) but not with the PRP+SC group. All groups exhibited low-grade synovitis at 6 weeks and no synovitis at 12 weeks. Notably, macroscopic grades for the area of articular cartilage repair for the PRP+SC group were significantly improved compared with those in the CTL (P=0.001) and PRP (P=0.049) groups at 12 weeks. Furthermore, histological scores (modified O'Driscoll scoring system) of the patellar groove articular cartilage in the PRP+SC and PRP groups, in which the articular cartilage was primarily hyaline-like, were significantly higher compared with those in the CTL group at 12 weeks (P=0.002 and P=0.007, respectively). The present results support the therapeutic use of hDPSCs for the treatment of full-thickness articular cartilage defects.
RESUMEN
The medial patellofemoral ligament (MPFL) and the MPFL/vastus medialis obliquus complex are essential for patellar stability. Insufficiency of the MPFL can lead to altered biomechanics and patellofemoral joint contact pressure, high recurrence rate, osteochondral lesions, compromised knee function, and patellofemoral osteoarthritis. Most frequently surgical reconstruction of the MPFL is performed to address patellar instability; however, open physis and donor site morbidity can be a concern. This Technical Note presents a surgical technique to identify the insufficient MPFL and describes in detail an anatomical retensioning repair of the MPFL to restore patellar stability.
RESUMEN
OBJECTIVE: To compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL) reconstruction using a single band. METHODS: A prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients) or two incisions (group 2: 20 patients). The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm) were evaluated. RESULTS: The positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p < 0.05). The positioning of the femoral tunnel on the lateral radiograph, expressed as a mean percentage relative to the anterior border of Blumensaat's line, was 68.4% in group 1 and 58% in group 2 (p < 0.05). The mean inclination of the graft was 19° in group 1 and 27.2° in group 2 (p < 0.05). The mean graft isometricity was 0.96 mm in group 1 and 1.33 mm in group 2 (p > 0.05). Group 2 had better results from the pivot-shift maneuver (p < 0.05). CONCLUSION: The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.
OBJETIVO: Comparar as técnicas transtibial e de duas incisões na reconstrução do ligamento cruzado anterior (LCA) com banda única. MÉTODOS: Foi feito um estudo prospectivo e randomizado em bloco. Os pacientes foram submetidos a reconstrução do LCA por meio de duas técnicas: transtibial (grupo 1: 20 pacientes) ou de duas incisões (grupo 2: 20 pacientes). Foram avaliados o posicionamento radiográfico dos túneis, a inclinação do enxerto, a isometricidade do enxerto e os resultados funcionais (IKDC e Lysholm). RESULTADOS: O posicionamento do túnel femoral na radiografia em AP expresso em porcentagem em relação à borda medial do planalto tibial no grupo 1 foi em média de 54,6% e no grupo 2 foi de 60,8% (p < 0,05). O posicionamento do túnel femoral na radiografia em P expresso em porcentagem em relação à borda anterior da linha de Blumensaat no grupo 1 foi em média de 68,4% e no grupo 2 foi de 58% (p < 0,05). A inclinação do enxerto no grupo 1 foi em média de 19 graus e no grupo 2 foi de 27,2 graus (p < 0,05). A isometricidade do enxerto no grupo 1 foi em média de 0,96 mm e no grupo 2 foi de 1,33 mm (p > 0,05). O grupo 2 apresentou melhores resultados pela manobra de Pivot-Shift (p < 0,05). CONCLUSÃO: A técnica de duas incisões permitiu um posicionamento do túnel femoral mais lateralizado e anteriorizado e que o enxerto ficasse mais inclinado e demonstrou clinicamente um melhor resultado pela manobra de Pivot-Shift. Não houve diferença na isometricidade e no resultado funcional final no curto tempo de seguimento avaliado.
RESUMEN
ABSTRACT The presence of abnormalities in knee alignment (genu varum and genu valgum) is extremely common in soccer. It can occur in the junior league / youth academy and perpetuate itself throughout the professional career. The consequences of years of high-level sports practice in players with genu varum / genu valgum can be harmful to the knees. By observing football matches of the present and the past, the authors of the article noted that great Brazilian soccer players were, or are, affected by the malalignment of the knees: Garrincha (the most famous), Leandro, Dunga, Romário, Rivaldo and Neymar. This study aims to discuss the relationship between high-performance sport and the development of these orthopedic deformities, serving as a tool for updating the trauma-orthopedic knee subspecialty. Level of Evidence III, Retrospective comparative study.
RESUMO A presença de anormalidades no alinhamento dos joelhos (geno varo e geno valgo) é extremamente comum no futebol. Seu aparecimento pode ocorrer quando os jogadores estão nas categorias de base e se perpetuar durante a carreira profissional. As consequências de anos de prática esportiva em alto nível em jogadores com geno varo/geno valgo podem ser deletérias aos joelhos. A partir da observação de jogos de futebol do presente e do passado, os autores do artigo notaram que grandes nomes brasileiros deste esporte foram ou são acometidos pelo desalinhamento dos joelhos: Garrincha - o mais famoso -, Leandro, Dunga, Romário, Rivaldo e Neymar. O presente estudo tem como objetivo discutir a relação entre o esporte de alto rendimento e o desenvolvimento dessas deformidades ortopédicas, servindo como ferramenta de atualização da subespecialidade traumato-ortopédica do joelho. Nível III de Evidência, Estudo Retrospectivo Comparativo.
RESUMEN
OBJECTIVE: To compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL) reconstruction using a single band. METHODS: A prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients) or two incisions (group 2: 20 patients). The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm) were evaluated. RESULTS: The positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p < 0.05). The positioning of the femoral tunnel on the lateral radiograph, expressed as a mean percentage relative to the anterior border of Blumensaat's line, was 68.4% in group 1 and 58% in group 2 (p < 0.05). The mean inclination of the graft was 19° in group 1 and 27.2° in group 2 (p < 0.05). The mean graft isometricity was 0.96 mm in group 1 and 1.33 mm in group 2 (p > 0.05). Group 2 had better results from the pivot-shift maneuver (p < 0.05). CONCLUSION: The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.
OBJETIVO: Comparar as técnicas transtibial e de duas incisões na reconstrução do ligamento cruzado anterior (LCA) com banda única. MÉTODOS: Foi feito um estudo prospectivo e randomizado em bloco. Os pacientes foram submetidos a reconstrução do LCA por meio de duas técnicas: transtibial (grupo 1: 20 pacientes) ou de duas incisões (grupo 2: 20 pacientes). Foram avaliados o posicionamento radiográfico dos túneis, a inclinação do enxerto, a isometricidade do enxerto e os resultados funcionais (IKDC e Lysholm). RESULTADOS: O posicionamento do túnel femoral na radiografia em AP expresso em porcentagem em relação à borda medial do planalto tibial no grupo 1 foi em média de 54,6% e no grupo 2 foi de 60,8% (p < 0,05). O posicionamento do túnel femoral na radiografia em P expresso em porcentagem em relação à borda anterior da linha de Blumensaat no grupo 1 foi em média de 68,4% e no grupo 2 foi de 58% (p < 0,05). A inclinação do enxerto no grupo 1 foi em média de 19 graus e no grupo 2 foi de 27,2 graus (p < 0,05). A isometricidade do enxerto no grupo 1 foi em média de 0,96 mm e no grupo 2 foi de 1,33 mm (p > 0,05). O grupo 2 apresentou melhores resultados pela manobra de Pivot-Shift (p < 0,05). CONCLUSÃO: A técnica de duas incisões permitiu um posicionamento do túnel femoral mais lateralizado e anteriorizado e que o enxerto ficasse mais inclinado e demonstrou clinicamente um melhor resultado pela manobra de Pivot-Shift. Não houve diferença na isometricidade e no resultado funcional final no curto tempo de seguimento avaliado.
Asunto(s)
Humanos , Masculino , Femenino , Reconstrucción del Ligamento Cruzado Anterior , Rodilla/cirugíaRESUMEN
OBJECTIVE: To compare the results from treating tropical pyomyositis through percutaneous drainage of abscesses versus open surgical drainage of abscesses, by means of a randomized prospective study. METHODS: Twenty-five patients with tropical pyomyositis (Chiedozi grade II) were included in this study. They were randomized into two groups: group A (n = 13), treated with antibiotics and open drainage of the abscesses; and group B (n = 12), treated with antibiotics and percutaneous drainage of the abscesses. RESULTS: The mean age was 35.3 years (± 19.2) in group A and 30.1 years (± 9) in group B (p = 0.41). There were eight female patients (61.5%) and five male patients (38.5%) in group A; in group B, three were female (25%) and nine were male (75%) (p = 0.11). Staphylococcus aureus was the microorganism most frequently found (72%). The mean hospital stay in group A was 12.7 days (± 2.3), and in group B, 10.6 days (± 1.6) (p = 0.01). The mean duration of antibiotic use in group A was 12.2 days (± 2.3), and in group B, 10.1 days (± 1.5) (p = 0.02). CONCLUSION: Percutaneous drainage of the abscesses, in association with antibiotic therapy, is an efficient treatment method for tropical pyomyositis grade II, with shorter antibiotic use and hospital stay for patients.
RESUMEN
CONTEXT AND OBJECTIVE: In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. DESIGN AND SETTING: Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, Brazil. METHODS: Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. RESULTS: There was an average increase in tibial slope angle after surgery of 2.38 degrees (95% confidence interval: +/- 0.73 degrees ). There was no correlation (r = -0.28) between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13). CONCLUSION: Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis.
Asunto(s)
Osteoartritis de la Rodilla/cirugía , Tibia/anatomía & histología , Adulto , Anciano , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Persona de Mediana Edad , Osteotomía/efectos adversos , Osteotomía/métodos , Cuidados Posoperatorios , Cuidados Preoperatorios , Radiografía , Estudios Retrospectivos , Estadísticas no Paramétricas , Tibia/cirugía , Resultado del TratamientoRESUMEN
OBJETIVO: Comparar, através de estudo prospectivo e randomizado, os resultados do tratamento da piomiosite tropical (PT) através da drenagem percutânea dos abscessos aos da drenagem cirúrgica aberta dos mesmos. MÉTODOS: Foram incluídos neste estudo 25 pacientes com PT, grau II de Chiedozi. Os pacientes foram randomizados em dois grupos: grupo A (n = 13), tratados com antibioticoterapia e drenagem aberta dos abscessos e grupo B (n = 12), tratados com antibioticoterapia e drenagem percutânea dos mesmos. RESULTADOS: A idade média no grupo A foi de 35,3 ± 19,2 anos e, no grupo B, de 30,1 ± 9 anos (p = 0,41). No grupo A, oito pacientes (61,5 por cento) eram do sexo feminino e cinco do masculino (38,5 por cento); no grupo B, três eram do sexo feminino (25 por cento) e nove do masculino (75 por cento) (p = 0,11). O Staphylococcus aureus foi o microorganismo mais frequentemente encontrado (72 por cento). O tempo médio de internação no grupo A foi de 12,7 ± 2,1 dias e, no grupo B, de 10,6 ± 1,6 dias (p = 0,01). O tempo médio de antibiótico no grupo A foi de 12,2 ± 2,3 dias e, no grupo B, de 10,1 ± 1,5 dias (p = 0,02). CONCLUSÃO: A drenagem percutânea dos abscessos associada à antibioticoterapia constituiu-se em método eficaz para o tratamento da piomiosite tropical grau II, diminuindo o tempo de antibioticoterapia e de internação hospitalar dos pacientes.
OBJECTIVE: To compare, by means of a prospective and randomized study, the treatment outcomes of Tropical Pyomyositis (TP) through open drainage of abscesses versus percutaneous surgical drainage. METHODS: 25 patients with TP (Chiedozi stage II) were randomized into two groups: Group A (n=13), treated with antibiotics and open drainage of the abscesses, and Group B (n=12), treated with antibiotics and percutaneous drainage. RESULTS: The mean age was 35.3 years (±19.2) in Group A and 30.1 years in Group B (±9) (p=0.41).There were eight female (61.5 percent) and five male (38.5 percent) patients in Group A; in Group B three were female (25 percent) and nine (75 percent) male (p=0.11). Staphylococcus aureus was the most frequent agent found (72 percent). The mean hospitalization period in Group A was 12.7 days (±2.3), and in Group B, 10.6 days (±1.6) (p=0.01). The mean antibiotics treatment period in Group A was 12.2 days (±2.3), and 10.1 days (±1.5) in Group B (p=0.02). CONCLUSION: The percutaneous drainage of the abscesses is an efficient treatment method for the Tropical Pyomyositis, with a shorter period of hospitalization and antibiotics usage.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Drenaje , Miositis/diagnóstico , Miositis/terapia , Piomiositis/diagnóstico , Piomiositis/terapia , Infecciones EstafilocócicasRESUMEN
CONTEXT AND OBJECTIVE: In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. DESIGN AND SETTING: Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, Brazil. METHODS: Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. RESULTS: There was an average increase in tibial slope angle after surgery of 2.38° (95 percent confidence interval: ± 0.73°). There was no correlation (r = -0.28) between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13). CONCLUSION: Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis.
CONTEXTO E OBJETIVO: No passado, alterações no ângulo de inclinação ântero-posterior do planalto tibial (AIAPPT), conhecido como "slope", não eram levadas em consideração no planejamento e avaliação das osteotomias, e o sucesso da osteotomia proximal tibial era relacionado ao grau de correção do ângulo femoro-tibial e ao alinhamento obtido. O objetivo foi mensurar a alteração no AIAPPT após a osteotomia proximal de abertura de cunha medial da tíbia e verificar o efeito da variação angular do AIAPPT sobre os resultados clínicos. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo de série de casos, realizado no Departamento de Ortopedia e Traumatologia da Faculdade de Medicina de Marília (Famema), Marília, São Paulo, Brasil. MÉTODOS: Foram incluídos 28 pacientes, e um total de 31 joelhos. Foi mensurado o AIAPPT baseado no eixo anatômico proximal tibial na radiografia lateral da tíbia no pré e no pós-operatório. A avaliação clínica foi realizada através do escore de Lysholm para joelho. RESULTADOS: Houve um aumento do AIAPPT após a cirurgia em média de 2,38° (± 0,73°; intervalo de confiança, IC 95 por cento). Não houve correlação (r = -0,28) entre os resultados obtidos pelo escore de Lysholm pós-operatório e a diferença do AIAPPT pós e pré-operatório (P = 0,13). CONCLUSÃO: A osteotomia valgizante da tíbia proximal com cunha de abertura medial levou a um pequeno aumento no AIAPPT. Não houve correlação entre o aumento do slope tibial e os resultados clínicos a curto prazo após a osteotomia proximal da tíbia. Outros estudos clínicos são necessários para comprovar se uma osteotomia de extensão ou de flexão pode trazer benefício ao paciente com artrose unicompartimental do joelho.