ABSTRACT
With the COVID-19 pandemic, elective orthopedic surgeries were interrupted in most healthcare services. This leads to impacts on the quality of life, as well as on the emotional, professional, and financial situation of patient athletes who had their surgical treatment postponed. OBJECTIVE: To evaluate clinical, emotional, and professional impacts on athletes who had their knee surgery postponed. METHODS: This study included 21 patients who were diagnosed with knee injuries and were on a surgical waiting list. Participants answered a questionnaire with socioeconomic questions, activity level (amateur/professional), diagnosis, proposed surgery, and questions about anxiety regarding the postponement and uncertainty of performing the surgery, worsening symptoms, and psychological status in general. RESULTS: The most prevalent diagnosis was anterior cruciate ligament injury (81%). Moreover, 42.9% of patients reported being highly anxious about the date of surgery, with 23.8% being highly anxious about the uncertainty of surgery. There was a direct positive correlation (r = 0.418), indicating a higher level of anxiety in patients who faced greater financial impact. CONCLUSION: The indefinite postponement of surgeries had a great impact on anxiety levels and surgery uncertainty of patients awaiting surgery. Level of Evidence III, Transversal Study.
Com a pandemia de COVID-19, as cirurgias ortopédicas eletivas foram interrompidas na maioria dos serviços de saúde. Isso acarretou impacto emocional, profissional, financeiro e na qualidade de vida de atletas que tiveram seu tratamento cirúrgico adiado. Objetivo: Avaliar esse impacto clínico, emocional e profissional em atletas que tiveram suas cirurgias de joelho postergadas. Métodos: Foram selecionados 21 pacientes com diagnóstico de lesão do joelho que estavam aguardando intervenção cirúrgica. Eles responderam um questionário sobre sua situação socioeconômica, nível de atividade (amador/profissional), diagnóstico, cirurgia proposta, ansiedade em relação ao adiamento e incerteza da realização da cirurgia, piora dos sintomas e quadro psicológico de modo geral. Resultados: O diagnóstico mais prevalente foi a lesão do ligamento cruzado anterior (81%). Dos pacientes, 42,9% relataram estar muito ansiosos sobre a data da cirurgia, e 23,8% muito ansiosos quanto à incerteza da cirurgia. Houve correlação positiva direta (r = 0,418) que indicou maior nível de ansiedade nos pacientes conforme o aumento do impacto financeiro. Conclusão: A suspensão indeterminada das cirurgias gerou um grande impacto, com ansiedade e incerteza dos pacientes que estavam aguardando suas cirurgias. Nível de Evidência III, Estudo Transversal.
ABSTRACT
ABSTRACT With the COVID-19 pandemic, elective orthopedic surgeries were interrupted in most healthcare services. This leads to impacts on the quality of life, as well as on the emotional, professional, and financial situation of patient athletes who had their surgical treatment postponed. Objective: To evaluate clinical, emotional, and professional impacts on athletes who had their knee surgery postponed. Methods: This study included 21 patients who were diagnosed with knee injuries and were on a surgical waiting list. Participants answered a questionnaire with socioeconomic questions, activity level (amateur/professional), diagnosis, proposed surgery, and questions about anxiety regarding the postponement and uncertainty of performing the surgery, worsening symptoms, and psychological status in general. Results: The most prevalent diagnosis was anterior cruciate ligament injury (81%). Moreover, 42.9% of patients reported being highly anxious about the date of surgery, with 23.8% being highly anxious about the uncertainty of surgery. There was a direct positive correlation (r = 0.418), indicating a higher level of anxiety in patients who faced greater financial impact. Conclusion: The indefinite postponement of surgeries had a great impact on anxiety levels and surgery uncertainty of patients awaiting surgery. Level of Evidence III, Transversal Study.
RESUMO Com a pandemia de COVID-19, as cirurgias ortopédicas eletivas foram interrompidas na maioria dos serviços de saúde. Isso acarretou impacto emocional, profissional, financeiro e na qualidade de vida de atletas que tiveram seu tratamento cirúrgico adiado. Objetivo: Avaliar esse impacto clínico, emocional e profissional em atletas que tiveram suas cirurgias de joelho postergadas. Métodos: Foram selecionados 21 pacientes com diagnóstico de lesão do joelho que estavam aguardando intervenção cirúrgica. Eles responderam um questionário sobre sua situação socioeconômica, nível de atividade (amador/profissional), diagnóstico, cirurgia proposta, ansiedade em relação ao adiamento e incerteza da realização da cirurgia, piora dos sintomas e quadro psicológico de modo geral. Resultados: O diagnóstico mais prevalente foi a lesão do ligamento cruzado anterior (81%). Dos pacientes, 42,9% relataram estar muito ansiosos sobre a data da cirurgia, e 23,8% muito ansiosos quanto à incerteza da cirurgia. Houve correlação positiva direta (r = 0,418) que indicou maior nível de ansiedade nos pacientes conforme o aumento do impacto financeiro. Conclusão: A suspensão indeterminada das cirurgias gerou um grande impacto, com ansiedade e incerteza dos pacientes que estavam aguardando suas cirurgias. Nível de Evidência III, Estudo Transversal.
ABSTRACT
Epiphysiolysis is a relatively common disease in the adolescent population (9-16 years); however, it is rare in the adult population. It is characterized by non-traumatic proximal femur slipping. When it occurs in this population it is associated with some disease that slows sexual development and physis closure, such as endocrine diseases or brain tumors. The aim of the present study is to report a case of epiphysiolysis in a 22-year-old patient with hypogonadotropic hypogonadism. There are only 63 cases reported in the world literature on epiphysiolysis in the adult population.
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OBJECTIVE: To evaluate the perceptions of students and teachers regarding remote teaching modality in comparison with the traditional face-to-face method. METHODS: In this observational, retrospective, comparative, single-center study, questionnaires containing three major assessment domains were sent to two groups: university professors and undergraduate and graduate students. The first domain collected demographic and general data on the platforms used. The second and third domains contained questions that compared the perception of the quality of information offered by the two systems. RESULTS: Between May and September 2020, 162 students and 71 teachers participated in the study. A greater proportion of students demonstrated previous contact with the online method, while professors had presented a greater number of courses. Most participants reported that their expectations regarding the remote teaching method were met (students, 80.3%; teachers, 94.4%). A significant number of students (83.3%) and teachers (88.7%) rated the classes as easier to attend and manage. Despite difficulties, such as concentration retention, most of the participants agree (at least partially) that the format should be maintained. CONCLUSION: The remote teaching methodology, although still incipient in Brazil, has become a reality in light of current health restrictions. Our study demonstrated a high level of overall satisfaction and a high sense of learning from both students and faculty. However, new challenges associated with this system have been identified, such as retention of attention and interference from the external environment. Longitudinal comparative studies that incorporate various aspects of medical education in all cycles are necessary to corroborate the findings of this study. DESIGN: Retrospective comparative study, level III evidence.
Subject(s)
COVID-19 , Education, Medical , Humans , Pandemics , Retrospective Studies , StudentsABSTRACT
Abstract Epiphysiolysis is a relatively common disease in the adolescent population (9-16 years); however, it is rare in the adult population. It is characterized by non-traumatic proximal femur slipping. When it occurs in this population it is associated with some disease that slows sexual development and physis closure, such as endocrine diseases or brain tumors. The aim of the present study is to report a case of epiphysiolysis in a 22-year-old patient with hypogonadotropic hypogonadism. There are only 63 cases reported in the world literature on epiphysiolysis in the adult population.
Resumo A epifisiólise é uma doença relativamente comum na população adolescente (de 9-16 anos), entretanto rara na população adulta. Se caracteriza pelo escorregamento metáfiso-epifisário do fêmur proximal não-traumático. Quando ocorre nessa população, está associada a alguma doença que retarda o desenvolvimento sexual e fechamento fisário, como doenças endocrinológicas ou tumores cerebrais. O objetivo do presente estudo é relatar um caso de epifisiólise numa paciente com 22 anos de idade e hipogonadismo hipogonadotrófico. Existem apenas 63 casos relatados na literatura mundial sobre epifisiólise na população adulta.
Subject(s)
Humans , Female , Adult , Kallmann Syndrome , Epiphyses, Slipped , Femur HeadABSTRACT
ABSTRACT Objective To evaluate the perceptions of students and teachers regarding remote teaching modality in comparison with the traditional face-to-face method. Methods In this observational, retrospective, comparative, single-center study, questionnaires containing three major assessment domains were sent to two groups: university professors and undergraduate and graduate students. The first domain collected demographic and general data on the platforms used. The second and third domains contained questions that compared the perception of the quality of information offered by the two systems. Results Between May and September 2020, 162 students and 71 teachers participated in the study. A greater proportion of students demonstrated previous contact with the online method, while professors had presented a greater number of courses. Most participants reported that their expectations regarding the remote teaching method were met (students, 80.3%; teachers, 94.4%). A significant number of students (83.3%) and teachers (88.7%) rated the classes as easier to attend and manage. Despite difficulties, such as concentration retention, most of the participants agree (at least partially) that the format should be maintained. Conclusion The remote teaching methodology, although still incipient in Brazil, has become a reality in light of current health restrictions. Our study demonstrated a high level of overall satisfaction and a high sense of learning from both students and faculty. However, new challenges associated with this system have been identified, such as retention of attention and interference from the external environment. Longitudinal comparative studies that incorporate various aspects of medical education in all cycles are necessary to corroborate the findings of this study. Design Retrospective comparative study, level III evidence.
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Objective The present paper evaluates the resuming of physical activities by young, active patients who practiced some sport modality and underwent a high tibial osteotomy (HTO) using the opening wedge technique. Methods A total of 12 patients submitted to HTO using the opening wedge technique were prospectively analyzed. All patients were not playing sports at that time. Pre- and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores, visual analog scale for pain and performance level were compared. The average follow-up time was of 12 months. Results One patient resumed sporting activities at a performance level significantly lower compared to the preoperative level, while eight patients returned at a slightly below level, two returned at the same level and one patient returned at a higher level in comparison with the preoperative period. Conclusion For isolated medial osteoarthrosis treatment, HTO using the opening wedge technique has favorable clinical and functional results, allowing patients to resume their sporting activities.
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Objective The aim of the present study was to quantify the urinary concentration of the C-terminal cross-linked telopeptide of type-II collagen (CTX-II) biomarker in patients who suffered an isolated ACL injury, and to compare the concentrations found in this population with a control group of patients with no metabolic changes in the knee that could lead to cartilage degeneration. Methods A cross-sectional pilot study was performed in two groups: patients with ACL tears and a control group (each group with 10 male subjects, with an age range between 18 and 35 years, and body mass index below 30 kg/m 2 ). In both groups, urine concentrations of a biomarker related to the degradation of type-II collagen (CTX-II) was measured. For the group with ACL tears, a temporal relationship between the time after the injury and the amount of the biomarker was also examined. Results There were significant differences in the concentrations of urinary CTX-II between the ACL group and the control group ( p = 0.009). No significant relationship was observed between the time after the injury and the quantity of the biomarker. Conclusions Patients with ACL injury had higher concentrations of urinary CTX-II biomarker than those with no ACL injury ( p = 0.009). However, there was no correlation between the concentration of this biomarker and the elapsed time after the injury ( p > 0.05).
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OBJECTIVE: This study aims to identify the epidemiology of orthopedic injuries in jiu-jitsu practitioners. METHODS: Ninety-six jiu-jitsu practitioners aged between 18 and 45 years, male and female, answered a questionnaire addressing personal data and history of injuries related to the sport during the last 24 months. RESULTS: In the period cover, 85% of the sample presented injuries related to the practice of jiu-jitsu, with an average of 60 days of absenteeism from sports practice. Fingers, shoulders, and knees were the joints most affected by orthopedic injuries. CONCLUSION: Orthopedic injuries are quite prevalent among jiu-jitsu practitioners, often distancing athletes from the sport. Level of Evidence IV, case series / cross sectional study.
OBJETIVO: Este estudo tem como objetivo identificar um perfil epidemiológico das lesões ortopédicas presentes em praticantes da modalidade jiu-jitsu. MÉTODOS: 96 praticantes de jiu-jitsu, entre 18 e 45 anos, de ambos os sexos, responderam a um questionário que abordou dados pessoais e histórico de lesões relacionadas à prática do esporte nos últimos 24 meses. RESULTADOS: 85% da amostra apresentou lesão relacionada à prática do jiu-jitsu no período abordado, com média de 60 dias de absenteísmo da prática esportiva. Os locais mais acometidos por lesões ortopédicas foram: dedos, ombros e joelhos. CONCLUSÃO: As lesões ortopédicas são bastante prevalentes na prática do jiu-jitsu, muitas vezes afastando os atletas de sua prática. Nível de evidência IV - série de casos / estudo transversal.
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INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction is the most performed orthopedic surgical procedure. The result of ACL reconstructions depends on multiple technical variables, including tension to be applied to the graft for fixation, knee-flexion angle during fixation and the type of fixation to the bone. OBJECTIVE: To carry out a survey of the literature with the best evidence on these themes. METHODS: Literature review about methods of tibial-graft fixation in ACL reconstructions - tension applied at the time of fixation, type of graft fixation, and knee-flexion degree during tibial fixation. RESULTS: Thirty studies on the selected topics were found. Most studies point to graft-tension levels close to 90 N to obtain the best results. Regarding the knee-flexion angle, multiple studies suggest that fixation at a 30° angle would bring superior biomechanical advantages. Regarding the type of implant for fixation, it is not possible to affirm the superiority of one method over another in clinical outcomes. CONCLUSIONS: There is no consensus on the best method for tibial fixation of the grafts in ACL reconstructions regarding tension, type of implant and knee-flexion angle. However, the analysis of the studies pointed to certain trends and allowed the drawing of specific conclusions.
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Introduction: Complications in the recent postoperative period of anterior cruciate ligament reconstruction are common. Among them, pain, hemarthrosis, and difficulty of complete range of motion. The purpose of this study is to evaluate the use of the intra-articular carboxymethylcellulose polysaccharide B bicomponent shortly after anterior cruciate ligament reconstruction, and to compare the results obtained for pain control, hemarthrosis, and knee range of motion with a control group. Materials and methods: randomized, and prospective clinical trial of thirty-two patients divided into two groups: reconstruction of the anterior cruciate ligament with an intra-articular injection of a bicomponent carboxymethylcellulose-polysaccharide B (n = 16) and without the bicomponent (n = 16). Pain, hemarthrosis and knee range of motion were evaluated in the first postoperative week. Results: the group with bicomponent presented less pain on the third (p = 0.017) and fifth (p = 0.029) postoperative day when compared to the control group. Hemarthrosis was significantly lower on the first postoperative day (p = 0.001), and there was a significant improvement in the range of motion on the seventh day of surgery (p = 0.008) in this same group. Conclusions: the use of intra-articular carboxymethylcellulose-polysaccharide B showed superior results for pain control, hemarthrosis, and gain in the knee range of motion in the recent postoperative period (up to seven days) after anterior cruciate ligament reconstruction, when compared to patients from the control group
Subject(s)
Adult , Hemostatic Techniques , Anterior Cruciate Ligament Reconstruction , Hemarthrosis , Knee JointABSTRACT
OBJECTIVE: To evaluate the fellow in knee surgery and the training offered by accredited programs in Brazil. METHODS: This cross-sectional study administered a questionnaire to fellows in knee surgery. RESULTS: Most fellows reported being assisted by the preceptor in theoretical, practical, and scientific activities. CONCLUSION: The training offered by accredited programs to fellows in knee surgery presented good results for their education. This study may propose educational measures for the Brazilian Society for Surgery of the Knee (SBCJ). Level of Evidence IIC, Cross-sectional study.
OBJETIVO: Avaliar o especializando em cirurgia de joelho e o treinamento oferecido pelos serviços credenciados no Brasil. MÉTODOS: Estudo transversal por meio de um questionário enviado para os especializados em cirurgia de joelho responderem. RESULTADOS: A maioria dos especializandos relataram assistência por parte da preceptoria nas atividades teórica, prática e científica. CONCLUSÃO: O treinamento dos serviços credenciados oferecido para os especializandos em cirurgia de joelho apresentou bons resultados para a formação deles. O estudo pode promover medidas educacionais para a Sociedade Brasileira de Cirurgia de Joelho (SBCJ). Nível de Evidência IIC, Estudo transversal.
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Introduction: Jiu-jitsu is an ancient martial art originally from Japan and very common in Brazil, usually known as Brazilian jiu-jitsu. Jiu-jitsu aims to "finish" the opponent through projections, strangulations and immobilizations, which can lead to certain orthopedic injuries with certain particularities such as: type, location and frequency, information that is crucial for prevention and treatment. Objective: This study aims to identify an epidemiological aspect of orthopedic injuries present in jiu-jitsu practitioners. Material and Method: 96 jiu-jitsu practitioners, between 18 and 45 years old, male and female, answered a questionnaire that addressed personal data and history of injuries related to the sport in the last 24 months. Results: 85% of the sample presented injuries related to the practice of jiu-jitsu in the period covered, with an average of 60 days of absenteeism from sports practice. The joints most affected by orthopedic injuries were: fingers, shoulders and knees. Conclusion: orthopedic injuries are quite prevalent in the practice of jiu-jitsu, often distancing athletes from their practice.
Introdução: O jiu-jitsu é uma arte marcial milenar originaria do Japão e bastante comum no Brasil, comumente chamado de brazilian jiu-jitsu. O jiu-jitsu tem como objetivo "finalizar" o oponente através de projeções, estrangulamentos, torções e imobilizações, o quê, podem levar a determinadas lesões ortopédicas com certas particularidades como: tipo, local e frequência, informações estas cruciais para prevenção e tratamento. Objetivo: Este estudo tem como objetivo identificar um perfil epidemiológico das lesões ortopédicas presentes em praticantes da modalidade jiu-jitsu. Material e Método: 96 praticantes de jiu-jitsu, entre 18 e 45 anos, de ambos os sexos, responderam a um questionário que abordou dados pessoais e histórico de lesões relacionadas à prática do esporte nos últimos 24 meses. Resultados: 85% da amostra apresentou lesão relacionada à prática do jiu-jitsu no período abordado, com média de 60 dias de absenteísmo da prática esportiva. Os locais mais acometidos por lesões ortopédicas foram: dedos, ombros e joelhos. Conclusão: as lesões ortopédicas são bastante prevalentes na prática do jiu-jitsu, muitas vezes afastando os atletas de sua prática.
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OBJECTIVE: To provide an analysis of the 50 most cited articles on knee surgery in the Brazilian medical literature. METHODS: This is a study of systematic review and meta-analysis, level of evidence 3. It was carried out through search in the SCOPUS database to identify scientific articles published in the Brazilian medical literature. Eighty-six Brazilian journals were analyzed, and articles with ten or more citations and which had the word "joelho" or "knee" in the title, abstract or keywords were selected. RESULTS: All articles were published as of the year 2000 in 14 journals. The Journal Clinics presented the largest number of publications, followed by Acta Ortopédica Brasileira. The main focus of the studies was on anatomy and biomechanics, mainly from Brazilian authors. Most of the authors were Brazilian, from Brazilian and public research institutions. CONCLUSION: Biometric analysis has been gaining ground in recent years, but its interpretation must consider various aspects related to the paramount analytical importance.
OBJETIVO: Fornecer uma análise dos cinquenta artigos mais citados sobre cirurgia do joelho na literatura médica brasileira. MÉTODOS: Foi utilizada a base de dados da SCOPUS para identificar artigos científicos publicados na literatura médica brasileira de 1945 a junho de 2008 com o tema referente ao joelho. Foram analisados 86 periódicos brasileiros e selecionados os artigos com número de citações igual ou superior a dez que possuíam a palavra "joelho" ou knee no título, resumo ou palavras-chave. Foram selecionados aqueles que possuíam a articulação do joelho como foco principal do estudo, chegando ao resultado final de cinquenta artigos mais citados. RESULTADOS: Todos os artigos foram publicados a partir do ano 2000, em quatorze revistas. A Revista Clinics apresentou maior número de publicações, seguida da Acta Ortopédica Brasileira. A maior parte foi sobre estudos sobre anatomia e biomecânica, preponderamente de autores brasileiros. Instituições de pesquisa brasileiras e públicas foram as responsáveis pela maior parte das pesquisas. CONCLUSÃO: Análise biométrica vem ganhando espaço nos últimos anos, contudo sua interpretação deve considerar variados aspectos relacionados a importância analítica.
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ABSTRACT Objective: To provide an analysis of the 50 most cited articles on knee surgery in the Brazilian medical literature. Methods: This is a study of systematic review and meta-analysis, level of evidence 3. It was carried out through search in the SCOPUS database to identify scientific articles published in the Brazilian medical literature. Eighty-six Brazilian journals were analyzed, and articles with ten or more citations and which had the word "joelho" or "knee" in the title, abstract or keywords were selected. Results: All articles were published as of the year 2000 in 14 journals. The Journal Clinics presented the largest number of publications, followed by Acta Ortopédica Brasileira. The main focus of the studies was on anatomy and biomechanics, mainly from Brazilian authors. Most of the authors were Brazilian, from Brazilian and public research institutions. Conclusion: Biometric analysis has been gaining ground in recent years, but its interpretation must consider various aspects related to the paramount analytical importance.
RESUMO Objetivo: Fornecer uma análise dos cinquenta artigos mais citados sobre cirurgia do joelho na literatura médica brasileira. Métodos: Foi utilizada a base de dados da SCOPUS para identificar artigos científicos publicados na literatura médica brasileira de 1945 a junho de 2008 com o tema referente ao joelho. Foram analisados 86 periódicos brasileiros e selecionados os artigos com número de citações igual ou superior a dez que possuíam a palavra "joelho" ou knee no título, resumo ou palavras-chave. Foram selecionados aqueles que possuíam a articulação do joelho como foco principal do estudo, chegando ao resultado final de cinquenta artigos mais citados. Resultados: Todos os artigos foram publicados a partir do ano 2000, em quatorze revistas. A Revista Clinics apresentou maior número de publicações, seguida da Acta Ortopédica Brasileira. A maior parte foi sobre estudos sobre anatomia e biomecânica, preponderamente de autores brasileiros. Instituições de pesquisa brasileiras e públicas foram as responsáveis pela maior parte das pesquisas. Conclusão: Análise biométrica vem ganhando espaço nos últimos anos, contudo sua interpretação deve considerar variados aspectos relacionados a importância analítica.
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BACKGROUND: Injuries to the lateral collateral ligament (LCL) are most commonly associated with anterior cruciate ligament (ACL) injury than with posterior cruciate ligament (PCL) injury. There is currently a paucity in the literature in regards to treatment and outcomes of such lesions. METHODS: 30 patients underwent surgical treatment of concomitant LCL and ACL injury or concomitant LCL and PCL injury with follow-up postoperative period of two years. The Lysholm score and varus stress radiographs was calculated and analysed before and at 6, 12, and 24 months postoperatively. RESULTS: There was a significant increase in scores between two timepoints over the follow-up period for both groups: before surgery and after 6 months, and between 6 and 12 months (pâ¯<â¯0.05). The lateral joint opening measured on the varus stress radiographs was greater in group 2 than in group 1 before surgery (pâ¯=â¯0.04). When assessing each group separately, the lateral joint opening decreased at each timepoint in the first year for both groups (pâ¯<â¯0.05). CONCLUSION: Patients diagnosed with combined LCL and PCL injuries were shown to have a higher degree of lateral opening at the time of injury when compared to patients with combined LCL and ACL injuries. However, there was no difference in lateral joint opening on stress radiography after 12 months postoperatively in either group. Finally Lysholm scores for both groups significantly increased between the preoperative period and 6 months postoperatively, as well as between 6 months and 12 months postoperatively. LEVEL OF EVIDENCE: III.
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Objective The aim of the present study was to evaluate the clinical results, functional outcomes, and risk factors after anatomic reconstructions using knee ï¬exor grafts in athletes. Methods The authors followed-up 32 patients and 34 knees for 1 year in a prospective design case series evaluating pre- and postoperative functional scores (Kujala and Lysholm) and associated risk factors. Results All of the 32 patients had a signiï¬cant increase of the Lysholm and Kujala scores. Patients with < 5 preoperative dislocations had a better score on the Lysholm and Kujala scales. The mean preoperative Lysholm score was 62.8, and the mean postoperative score was 94.3. The mean preoperative Kujala score was 63.0, and the mean postoperative score was 94.0. Conclusion Medial patellofemoral ligament reconstruction with hamstring graft in athletes with patellar instability improved clinical and functional scores. The bone drilling through the patella and the positioning of the femoral tunnel should be judiciously performed.
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Abstract Objective The aim of the present study was to evaluate the clinical results, functional outcomes, and risk factors after anatomic reconstructions using knee flexor grafts in athletes. Methods The authors followed-up 32 patients and 34 knees for 1 year in a prospective design case series evaluating pre- and postoperative functional scores (Kujala and Lysholm) and associated risk factors. Results All of the 32 patients had a significant increase of the Lysholm and Kujala scores. Patients with < 5 preoperative dislocations had a better score on the Lysholm and Kujala scales. The mean preoperative Lysholm score was 62.8, and the mean postoperative score was 94.3. The mean preoperative Kujala score was 63.0, and the mean postoperative score was 94.0. Conclusion Medial patellofemoral ligament reconstruction with hamstring graft in athletes with patellar instability improved clinical and functional scores. The bone drilling through the patella and the positioning of the femoral tunnel should be judiciously performed.
Resumo Objetivo Avaliar os resultados clínicos e funcionais da reconstrução anatômica do ligamento patelofemoral medial com tendões flexores em atletas. Métodos Estudo tipo série de casos, prospectivo, que analisou a reconstrução do ligamento patelofemoralmedial em32 pacientes (34 joelhos). A avaliação funcional foi feita pelos escores Lysholm e Kujala nos períodos pré e pós-operatórios e os fatores de risco envolvidos foram avaliados. Resultados Dos 32 pacientes analisados, todos obtiveram melhoria dos escores funcionais comparativamente ao período pré-operatório. Pacientes com menos de cinco episódios de luxação prévios obtiveram melhores resultados funcionais. O valor médio de Lysholm no pré-operatório foi de 62,8 e no pós-operatório de 94,3, quanto ao escore de Kujala a média pré-operatório foi de 63,0 e pós-operatória de 94,0. Conclusão A reconstrução do ligamento patelofemoral medial com enxerto de tendão flexor do joelho em atletas propiciou melhoria dos escores clínicos e funcionais nos pacientes com instabilidade patelofemoral. A perfuração óssea da patela e o posicionamento do túnel femoral devem ocorrer de forma judiciosa.
Subject(s)
Humans , Male , Female , Patellar Dislocation , Patellofemoral Joint , Athletes , Joint InstabilityABSTRACT
ABSTRACT Objective: Perform the preoperative measurement of the hamstring tendons using ultrasound imaging, validating and correlating the measured value with that found during surgical reconstruction of the ligament. Methods: A cross-sectional study was carried out with 24 patients who underwent ultrasonographic measurement of the semitendinosus and gracilis muscle tendons and were subsequently submitted to surgical reconstruction of the ACL, with ipsilateral semitendinosus and gracilis tendon grafting. Results: The patients' ages ranged from 16 to 43 years, with a mean of 24.8 years (SD = 8.4 years), 79.2% were men, and the distribution by side was 41.7% right knees and 58.3% left knees. A non-significant correlation coefficient was found between the area calculated by ultrasound (2 × semitendinosus area + 2 × gracilis area) and the intraoperative measurement (r = 0.16; p = 0.443). No evidence of a difference between intraoperative measurements <8 mm and ≥8 mm was found for the area calculated by the ultrasound (p = 0.746). The difference observed between the groups was −0.01 (95% CI: −0.09 to 0.07). Conclusion: Preoperative ultrasound imaging of the semitendinosus and gracilis tendons does not present a statistically significant correlation with the intraoperative measurement of the quadruple hamstring graft for ligament reconstruction.
RESUMO Objetivo: Fazer a mensuração pré-operatória dos tendões flexores do joelho com o uso do exame de ultrassonografia, validar e correlacionar o valor medido com aquele encontrado durante a reconstrução cirúrgica do ligamento. Métodos: Estudo transversal com 24 pacientes submetidos a mensuração ultrassonográfica dos tendões dos músculos semitendíneo e grácil e posteriormente submetidos a reconstrução cirúrgica do LCA, com enxerto ipsilateral dos tendões semitendíneo e grácil do próprio paciente. Resultados: A idade dos pacientes variou entre 16 e 43 anos, com média de 24,8 (DP = 8,4), 79,2% eram homens e a distribuição quanto ao lado foi de 41,7% joelhos direitos e 58,3% joelhos esquerdos. Foi encontrado coeficiente de correlação não significante entre a área calculada a partir do ultrassom (2 × área do semitendíneo + 2 × área do grácil) e a medida obtida intraoperatoriamente (r = 0,16, p = 0,443). Não foi encontrada evidência de diferença entre medidas intraoperatórias < 8 mm e ≥ 8 mm quanto à área calculada a partir do ultrassom (p = 0,746). A diferença observada entre os grupos foi de -0,01 (IC 95%: -0,09 a 0,07). Conclusão: A mensuração pré-operatória por método de imagem ultrassonográfico dos tendões dos músculos semitendíneo e grácil não apresenta correlação estatisticamente significante com a mensuração intraoperatória do enxerto quádruplo de flexores para reconstrução ligamentar.
