Regenerative effect of platelet-rich plasma in the murine ischemic limbs.

AIMS: The purpose of this study was to investigate the effect of PPRP (pure PRP) and LPRP (PRP with leukocytes) on recovery from limb ischemia and on expression of growth factors involved in angiogenesis, myogenesis and fibrogenesis. MATERIAL AND METHODS: PPRP and LPRP prepared by centrifugation were added to cultures of C2C12 and NIH3T3 cells (1 or 10% PRPs) to evaluate alterations in cell metabolism and expression of growth factors by MTT, ELISA and RT-qPCR, respectively. To evaluate in vivo regenerative effects, PRPs were injected into the ischemic limbs of BALB/c mice and muscle mass/strength and histomorphometry were evaluated after 30 days. KEY FINDINGS: Mice treated with PRPs after limb ischemia showed an increase in the size of myofibers and muscle strength, reduced fibrosis and adipocytes, and decreased capillary density and necrosis scores compared to untreated mice. In cell culture, serum deprivation reduced the viability of C2C12 and NIH3T3 cells to about 50%, but the addition of 1% PRPs completely recovered this loss. Both PRPs, downregulated most of the tested genes; however, angiogenic gene Vegfa in C2C12 and the fibrogenic genes Col1a1 and Col3a1 in NIH3T3 cells were upregulated by LPRP. SIGNIFICANCE: PPRP and LPRP had similar effects in regulation of genes involved in angiogenesis, myogenesis and fibrogenesis. However, the presence of leucocytes did not significantly affect regenerative activities of PRP in the ischemic limb.

Return to Sports After High Tibial Osteotomy Using the Opening Wedge Technique.

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.

Return to Sports After High Tibial Osteotomy Using the Opening Wedge Technique / Retorno ao esporte após osteotomia tibial alta com método de cunha de abertura

Abstract 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.

Resumo Objetivo Avaliar o retorno ao esporte em pacientes jovens e ativos praticantes de alguma modalidade esportiva submetidos a osteotomia tibial alta (OTA) com o método de cunha de abertura. Métodos Foram analisados prospectivamente 12 pacientes submetidos ao procedimento de OTA utilizando-se método de cunha de abertura. Todos os pacientes estavam afastados do esporte. Foram utilizados os escores Lysholm, questionário International Knee Documentation Committee (IKDC, na sigla em inglês), escala analógica de dor e nível de retorno em comparação ao período pré-operatório. O tempo médio de seguimento foi de 12 meses. Resultados Um paciente retornou ao esporte em nível muito abaixo do pré-operatório, oito pacientes retornaram em nível pouco abaixo, dois pacientes retornaram no mesmo nível e um paciente retornou em nível acima. Conclusão A OTA com uso do método de cunha de adição como forma de tratamento para osteoartrose medial isolada demonstra resultados clínicos e funcionais favoráveis e permite o retorno ao esporte.

Intramedullary reaming modality for management of postoperative long bone infection: a prospective randomized controlled trial in 44 patients.

BACKGROUND: Studies addressing the management of intramedullary infection are mainly retrospective and with a limited number of cases. Reaming can be performed using either conventional reaming or using the reamer/irrigator/aspirator (RIA) system. Until now there have been no comparative prospective studies between these two methods. We aimed to compare the efficacy of RIA with conventional reaming followed by insertion of antibiotic-loaded cement, for the treatment of intramedullary nail infection of long bones. We assessed the rate of remission between groups after two-year follow-up and identified microorganisms using tissue cultures and sonication of explanted intramedullary nail (IMN). METHODS: A noninferiority, randomized clinical trial was carried out between August 2013 and August 2015 involving 44 patients of whom a locked IMN implant of the femur and/or tibia was retrieved and who all met the clinical and radiological criteria for IMN-associated osteomyelitis. Patients were randomized into two groups: RIA alone versus conventional reaming followed by antibiotic-loaded cement insertion. Both groups also underwent six-weeks of antibiotic treatment according to the results of the antibiogram. Patients were evaluated after 1, 3, 6, 12 and 24 months for radiological and clinical follow-up. RESULTS: After 24 months, the rate of infection remission was similar between the two groups, 87% in the RIA group and 95.5% in the conventional reaming group (p = 0.60). Among four patients who had recurrence of infection, the time to reappearance of symptoms varied from 20 days to twenty-two months. Staphylococcus aureus and coagulase-negative Staphylococci were isolated in 23 (40.4%) and 13 (22.9%) patients, respectively. Interestingly, we identified 20% (9/45) of polymicrobial infection. CONCLUSION: This study concludes that the RIA system alone, is noninferior to conventional reaming followed by antibiotic cement spacer in the treatment of IMN infection. However, RIA shows greater efficacy in the collection of infected medullary bone tissue, mainly in cases of infected retrograde nail of the femur. TRIAL REGISTRATION: ISRCTN82233198. Retroactively registered on July 29, 2019.

A Hamstring-Based Anatomic Posterolateral Knee Reconstruction With Autografts Improves Both Radiographic Instability and Functional Outcomes.

PURPOSE: To report the subjective outcomes and objective stability in a series of chronically grade III posterolateral injured knees treated with a hamstring-based anatomic posterolateral corner (PLC) reconstruction technique using autografts. METHODS: An outcome study of patients with a chronic complete tear of all ligamentous structures of the PLC (>5 mm of varus gapping at 30o, ≥10° of external tibial rotation during the dial test, ≥4 mm of increased lateral compartment opening during varus stress radiographs) was performed. The patients were evaluated subjectively with Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores and objectively with varus stress radiographs at 20° of knee flexion, IKDC objective scores, and recurvatum evaluation. Institutional review board approval: CEP/UNIFESP n: 1251/2016. RESULTS: Twenty-nine of 33 patients were available for follow up at an average of 31.9 ± 12.3 months (range, 24-59 months) postoperatively. Twenty-five patients underwent multiple-ligament reconstruction without prior osteotomy. No patient had an isolated PLC knee reconstruction. The average comparative preoperative and postoperative outcomes were, respectively: Lysholm: 49.7 ± 10.3, 81.2 ± 12.8, P < .001, 89.7% met minimal detectable change; IKDC: 36.7 ± 8.3, 70.4 ± 19.8, P < .001, 82.8% met minimal clinically important difference; Tegner, 6.6 ± 1.3, 5.5 ± 1.6, P < .001; and varus stress radiograph: 7.1 ± 3.1 mm, 1.8 ± 1.8 mm, P < .001. A significant improvement, P < .001, was found between preoperative and postoperative IKDC objective scores for varus opening at 0° and 30° and external rotation measured by the dial test at 30°. Recurvatum was also improved: preoperatively, 52% had a low-grade and 48% had a high-grade recurvatum, whereas postoperatively, 100% were classified as low grade, P < .001. CONCLUSIONS: The presented anatomic PLC reconstruction, concomitant to other surgical procedures and ligament reconstructions, is a valid technique in a multiligamentous knee injury involving the PLC, improving subjective outcomes and objective stability in patients with a chronic PLC knee injury, similar to historical controls. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Anteromedial Tibial Tubercle Osteotomy Improves Results of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Patients With Tibial Tuberosity-Trochlear Groove Distance of 17 to 20 mm.

PURPOSE: To compare the midterm clinical outcomes of anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction (TTO+MPFLR) with MPFLR alone (MPFLRa) for the treatment of recurrent patellar instability (RPI) in patients with a tibial tuberosity-trochlear groove (TT-TG) of 17 to 20 mm. METHODS: From January 2008 to August 2013, patients with RPI and a TT-TG of 17 to 20 mm were divided into 2 groups: TTO+MPFLR or MPFLRa. Subjects were evaluated for J sign classification (1-4+); patellar glide (1-4+); the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT-TG; and Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores. Kujala improvement was the primary outcome. RESULTS: Forty-two subjects were evaluated, 18 in the TTO+MPFLR group and 24 in the MPFLRa group. Mean follow-up time was 40.86 months (range, 24-60 months). Demographics between the groups were not different. Preoperatively, there was no statistically significant difference between groups regarding J sign classification; patellar glide; the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT-TG; and Kujala, Lysholm, IKDC, and Tegner scores. Postoperative J sign classification mean results comparing TTO+MPFLR and MPFLRa, respectively, were 1 and 1.33 (P = .006). Improvement was significantly higher in the TTO+MPFLR group in all scores except for Tegner. Kujala improvement, 30.27 and 23.95, respectively (P = .003), was also clinically significant, favoring TTO+MPFLR. Lysholm improvement was 40.5 and 36.2, respectively (P = .02), and IKDC improvement was 38.59 and 31.6, respectively (P = .002). There were no reported recurrent subluxations or dislocations in either group. CONCLUSIONS: TTO+MPFLR resulted in better functional outcome scores and patellar kinematics compared with MPFLRa in the surgical treatment of RPI in patients with a TT-TG distance of 17 to 20 mm. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Bicruciate lesion biomechanics, Part 2-treatment using a simultaneous tensioning protocol: ACL fixation first is better than PCL fixation first to restore tibiofemoral orientation.

PURPOSE: An uncommon technique for bicruciate ligament reconstruction involving simultaneous tensioning of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) grafts with ACL graft fixation first has been pointed out as superior to the "gold-standard" PCL graft fixation first. The purpose of this study was to compare tibiofemoral biomechanics between ACL fixation first and PCL fixation first in a simultaneous tensioning protocol for bicruciate ligament reconstruction. METHODS: 12 fresh-frozen cadaveric knees (six matched pairs) were tested using a custom testing system. Neutral tibial position representing tibiofemoral orientation, anterior-posterior (AP) tibial translation, varus-valgus laxity, and internal-external rotation were measured using a Microscribe 3DLX at 0°, 30°, 60°, and 90° of knee flexion. The following knee conditions were evaluated: intact, bicruciate deficient and following bicruciate reconstruction. A simultaneous tensioning protocol was used for bicruciate reconstruction and PCL fixation first was compared to ACL fixation first. PCL graft fixation was always performed at 90° of flexion and ACL graft fixation was always performed at full extension. RESULTS: ACL fixation first achieved a tibiofemoral orientation closer to the intact knee than PCL fixation first at 90° flexion (1.8 ± 1.6 mm versus 6.1 ± 3.2 mm, p = 0.016). PCL fixation first had a larger decrease in AP translation than ACL fixation first at 30° flexion (64.6 ± 3.5% vs. 58.3 ± 2.4%, p = 0.01). No significant differences were found for varus/valgus, external-internal rotation decrements after bicruciate reconstruction nor for AP translation, varus/valgus and internal/external rotation increase after bicruciate lesion comparing ACL fixation first to PCL fixation first. CONCLUSION: Bicruciate ligament reconstruction using a simultaneous tensioning protocol with ACL fixation first resulted in a closer to normal tibiofemoral orientation. This study will help guide surgeons in decision making for the graft tensioning protocol and fixation sequence in a bicruciate ligament reconstruction. LEVEL OF EVIDENCE: V therapeutic study.

Bicruciate lesion biomechanics, Part 1-Diagnosis: translations over 15 mm at 90° of knee flexion are indicative of a complete tear.

PURPOSE: Understanding the pathomechanics of a bicruciate injury (BI) is critical for its correct diagnosis and treatment. The purpose of this biomechanical study aims to quantify the effects of sequential sectioning of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) bundles on knee laxity. METHODS: Twelve cadaveric knees (six matched pairs) were used. Knee laxity measurements consisted of neutral tibial position, anterior-posterior translation, internal-external rotation, and varus-valgus angulation in different conditions: intact, ACL cut, incomplete BI (divided into two groups: anterolateral (AL) bundle intact or posteromedial (PM) bundle intact) and complete bicruciate tear. Data were collected using a Microscribe system at 0°, 30°, 60°, and 90° of knee flexion. RESULTS: In comparison to the intact knees, incomplete BI and complete BI showed a significant increase of total antero-posterior tibial translation. The largest significant increase was observed at 90° of flexion after a complete bicruciate resection (p < 0.001). A threshold difference greater than 15 mm from the intact could be used to identify a complete BI from an incomplete BI evaluating the total antero-posterior translation at 90°. All sectioned states had significant increases compared with the intact condition in internal-external rotation and varus-valgus stability at all tested flexion angles. CONCLUSION: Both incomplete and complete BI led to an important AP translation instability at all angles; however, full extension was the most stable position at all injured models. Total antero-posterior translation at 90° of knee flexion over 15 mm, in comparison to the intact condition, was indicative of a complete BI. Since the appropriate assessment of a combined ACL and PCL lesion remains a challenge, this study intends to assist its diagnosis. As BI's main antero-posterior instability occurred at 90°, a total antero-posterior drawer test is proposed to evaluate BI in the clinical setting. Total antero-posterior translation at 90° > 15 mm, in comparison to the intact condition or the contra-lateral non-injured knee, can be used to identify a complete from an incomplete BI.

Total knee and hip arthroplasty: the reality of assistance in Brazilian public health care / Artroplastia total de joelho e quadril: a preocupante realidade assistencial do Sistema Único de Saúde brasileiro

ABSTRACT Objective: To analyze the number of hospital permits for total knee arthroplasty (TKA) and total hip arthroplasty (THA) in Brazil between 2008 and 2015, and correlate them with regional, national, and international demographic and epidemiological aspects. Methods: Data on demographics, economic level, and TKA and THA were obtained from the website of the Ministry of Health/DATASUS, Brazilian Institute of Geography and Statistics, and the National Health Agency to assess the assistance provided by the Public Health Care System in arthroplasties for elderly Brazilian population without private health care. Results: The South and Southeast had the best care, with 8.07 and 6.07 TKAs/100,000 inhabitants, one TKA per 1811 and 2624 seniors, 17.3 and 10.99 THAs/100,000 inhabitants, and one THA per 923 and 1427 seniors, respectively. The worst rates were found in the North and Northeast, with 0.88 and 0.98 TKAs/100,000, one TKA per 6930 and 10,411 seniors, 0.96 and 3.25 THAs/100,000, and one THA per 6849 and 2634 seniors, respectively. The national average was 4.00 TKAs/100,000, one TKA per 3249 seniors, 8.01 THAs/100,000, and one THA per 1586 seniors. The international average was 142.8 TKAs/100,000 and 191.8 THAs/100,000. Conclusion: The results expressed unsatisfactory results for TKA and THA in Brazil, with greater relevance in the North and Northeast.

RESUMO Objetivo: Analisar o número de autorizações de internação hospitalar para cirurgias de artroplastia total de joelho (ATJ) e quadril (ATQ) no Brasil entre 2008 e 2015 e correlacioná-lo com aspectos demográficos e epidemiológicos regionais, nacionais e internacionais. Métodos: Os dados sobre informativos demográficos, econômicos e sobre ATJ e ATQ foram obtidos no website do Instituto Brasileiro de Geografia e Estatística (IBGE), Agência Nacional de Saúde (ANS) e Ministério da Saúde/Datasus para avaliar o assistencialismo do Sistema Único de Saúde (SUS) em artroplastias para a população idosa brasileira sem planos de saúde privados. Resultados: As Regiões Sul e Sudeste apresentaram a melhor relação assistencial, com 8,07 e 6,07ATJ/100.000 habitantes e uma ATJ para 1.811 e 2.624 idosos e 17,3 e 10,99ATQ/100.000 habitantes e uma ATQ para 923 e 1.427 idosos, respectivamente. Os piores índices foram do Norte e Nordeste, com 0,88 e 0,98 ATJ/100.000 e uma ATJ para 6.930 e 10.411 idosos e 0,96 e 3,25 ATQ/100.000 e uma ATQ para 6.849 e 2.634 idosos, respectivamente. A média nacional foi de 4,00 ATJ/100.000 e uma ATJ para 3.249 idosos e 8,01 ATQ/100.000 e uma ATQ para 1.586 idosos. A média internacional foi de 142,8 ATJ/100.000 e 191,8 ATQ/100.000. Conclusão: Os resultados indicaram resultados assistenciais insatisfatórios para ATJ e ATQ no Brasil, principalmente nas regiões Norte e Nordeste.

Total knee and hip arthroplasty: the reality of assistance in Brazilian public health care.

OBJECTIVE: To analyze the number of hospital permits for total knee arthroplasty (TKA) and total hip arthroplasty (THA) in Brazil between 2008 and 2015, and correlate them with regional, national, and international demographic and epidemiological aspects. METHODS: Data on demographics, economic level, and TKA and THA were obtained from the website of the Ministry of Health/DATASUS, Brazilian Institute of Geography and Statistics, and the National Health Agency to assess the assistance provided by the Public Health Care System in arthroplasties for elderly Brazilian population without private health care. RESULTS: The South and Southeast had the best care, with 8.07 and 6.07 TKAs/100,000 inhabitants, one TKA per 1811 and 2624 seniors, 17.3 and 10.99 THAs/100,000 inhabitants, and one THA per 923 and 1427 seniors, respectively. The worst rates were found in the North and Northeast, with 0.88 and 0.98 TKAs/100,000, one TKA per 6930 and 10,411 seniors, 0.96 and 3.25 THAs/100,000, and one THA per 6849 and 2634 seniors, respectively. The national average was 4.00 TKAs/100,000, one TKA per 3249 seniors, 8.01 THAs/100,000, and one THA per 1586 seniors. The international average was 142.8 TKAs/100,000 and 191.8 THAs/100,000. CONCLUSION: The results expressed unsatisfactory results for TKA and THA in Brazil, with greater relevance in the North and Northeast.

OBJETIVO: Analisar o número de autorizações de internação hospitalar para cirurgias de artroplastia total de joelho (ATJ) e quadril (ATQ) no Brasil entre 2008 e 2015 e correlacioná-lo com aspectos demográficos e epidemiológicos regionais, nacionais e internacionais. MÉTODOS: Os dados sobre informativos demográficos, econômicos e sobre ATJ e ATQ foram obtidos no website do Instituto Brasileiro de Geografia e Estatística (IBGE), Agência Nacional de Saúde (ANS) e Ministério da Saúde/Datasus para avaliar o assistencialismo do Sistema Único de Saúde (SUS) em artroplastias para a população idosa brasileira sem planos de saúde privados. RESULTADOS: As Regiões Sul e Sudeste apresentaram a melhor relação assistencial, com 8,07 e 6,07ATJ/100.000 habitantes e uma ATJ para 1.811 e 2.624 idosos e 17,3 e 10,99ATQ/100.000 habitantes e uma ATQ para 923 e 1.427 idosos, respectivamente. Os piores índices foram do Norte e Nordeste, com 0,88 e 0,98 ATJ/100.000 e uma ATJ para 6.930 e 10.411 idosos e 0,96 e 3,25 ATQ/100.000 e uma ATQ para 6.849 e 2.634 idosos, respectivamente. A média nacional foi de 4,00 ATJ/100.000 e uma ATJ para 3.249 idosos e 8,01 ATQ/100.000 e uma ATQ para 1.586 idosos. A média internacional foi de 142,8 ATJ/100.000 e 191,8 ATQ/100.000. CONCLUSÃO: Os resultados indicaram resultados assistenciais insatisfatórios para ATJ e ATQ no Brasil, principalmente nas regiões Norte e Nordeste.

Forgotten Joint Score - Portuguese translation and cultural adaptation of the instrument of evaluation for hip and knee arthroplasties.

OBJECTIVE: To translate and adapt culturally to Brazilian Portuguese the Forgotten Joint Score (FJS) patient-reported outcome questionnaire. METHODS: Forty-five patients in the postoperative period (3-12 months) of total knee and hip arthroplasty were asked to answer the Br FJS questionnaire, translated into Portuguese based on the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). RESULTS: Twenty-three patients completed the questionnaire correctly, suggesting changes when pertinent. In the first round of answers, it was observed that 20% had difficulty in understanding the expression "joint awareness." In further harmonization of the questionnaire, it was decided to change the term "awareness" for "remember." After this change no difficulty was observed in understanding for more than 85% of patients. CONCLUSION: The FJS questionnaire was translated and culturally adapted to Brazilian Portuguese. Additional studies are underway to compare the reproducibility and validity of the Brazilian translation to other questionnaires already established for the same outcome.

OBJETIVO: Traduzir para a língua portuguesa e adaptar culturalmente para o Brasil o questionário autoavaliativo Forgotten Joint Score (FJS) para mensuração de desfecho clínico em artroplastia total de joelho e quadril. MÉTODOS: O processo de tradução seguiu as diretrizes da International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Quarenta e cinco pacientes em pós-operatório (3-12 meses) de artroplastia total de joelho e quadril foram selecionados para responder ao Forgotten Joint Score traduzido para o português (Br-FJS) para a validação cultural do questionário. RESULTADOS: Responderam o questionário de maneira correta e sugeriram mudanças quando acharam pertinentes 23 pacientes. No primeiro ciclo de respostas, observou-se que 20% dos pacientes apresentaram dificuldade de compreensão da expressão "consciência articular". Em nova harmonização do questionário, optou-se pela mudança da expressão "consciência" para a expressão "lembrar". Após a mudança, mais de 85% dos pacientes não apresentaram dificuldades de compreensão. CONCLUSÃO: O questionário FJS foi traduzido e adaptado culturalmente para o português do Brasil. Estudos adicionais estão em andamento para comparar a reprodutibilidade e validade da tradução brasileira a outros questionários já estabelecidos para o mesmo desfecho.

Forgotten Joint Score - Portuguese translation and cultural adaptation of the instrument of evaluation for hip and knee arthroplasties / Tradução e adaptação cultural para a língua portuguesa do instrumento de avaliação para artroplastias de quadril e joelho Forgotten Joint Score

ABSTRACT Objective: To translate and adapt culturally to Brazilian Portuguese the Forgotten Joint Score (FJS) patient-reported outcome questionnaire. Methods: Forty-five patients in the postoperative period (3-12 months) of total knee and hip arthroplasty were asked to answer the Br FJS questionnaire, translated into Portuguese based on the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Results: Twenty-three patients completed the questionnaire correctly, suggesting changes when pertinent. In the first round of answers, it was observed that 20% had difficulty in understanding the expression "joint awareness." In further harmonization of the questionnaire, it was decided to change the term "awareness" for "remember." After this change no difficulty was observed in understanding for more than 85% of patients. Conclusion: The FJS questionnaire was translated and culturally adapted to Brazilian Portuguese. Additional studies are underway to compare the reproducibility and validity of the Brazilian translation to other questionnaires already established for the same outcome.

RESUMO Objetivo: Traduzir para a língua portuguesa e adaptar culturalmente para o Brasil o questionário autoavaliativo Forgotten Joint Score (FJS) para mensuração de desfecho clínico em artroplastia total de joelho e quadril. Métodos: O processo de tradução seguiu as diretrizes da International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Quarenta e cinco pacientes em pós-operatório (3-12 meses) de artroplastia total de joelho e quadril foram selecionados para responder ao Forgotten Joint Score traduzido para o português (Br-FJS) para a validação cultural do questionário. Resultados: Responderam o questionário de maneira correta e sugeriram mudanças quando acharam pertinentes 23 pacientes. No primeiro ciclo de respostas, observou-se que 20% dos pacientes apresentaram dificuldade de compreensão da expressão "consciência articular". Em nova harmonização do questionário, optou-se pela mudança da expressão "consciência" para a expressão "lembrar". Após a mudança, mais de 85% dos pacientes não apresentaram dificuldades de compreensão. Conclusão: O questionário FJS foi traduzido e adaptado culturalmente para o português do Brasil. Estudos adicionais estão em andamento para comparar a reprodutibilidade e validade da tradução brasileira a outros questionários já estabelecidos para o mesmo desfecho.

Anatomic Posterolateral Corner Reconstruction With Autografts.

Anatomic posterolateral corner reconstruction reproduces 3 main structures: the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon. The LaPrade technique reproduces all 3 main stabilizers. However, it requires a long graft, limiting its indication to clinical settings in which allograft tissue is available. We propose a surgical procedure that is a modification of the LaPrade technique using the same tunnel placement, hamstring autografts, and biceps augmentation when necessary. It relies on artificial graft lengthening provided by the loop of the suspensory fixation device fixed at the anterior tibial cortex. The final reconstruction reproduces the popliteus tendon with the bulkiest end of the semitendinosus; the popliteofibular ligament with a strand of the semitendinosus and a strand of the gracilis; and the lateral collateral ligament with a strand of the semitendinosus and a strand of the gracilis, which can also be augmented with a biceps strip.

Quadriceps Strength Deficit at 6 Months After ACL Reconstruction Does Not Predict Return to Preinjury Sports Level.

BACKGROUND: There is a lack of literature-based objective criteria for return to sport after anterior cruciate ligament (ACL) injury. Establishing such objective criteria is crucial to improving return to sport after ACL reconstruction (ACLR). HYPOTHESES: Patients who return to their preinjury level of sport will have higher isokinetic, postural stability, and drop vertical jump test scores 6 months after surgery and greater patient satisfaction compared with those who did not. Additionally, quadriceps strength deficit cutoff values of 80% and 90% would differentiate patients who returned to preinjury sports level from those who did not. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A retrospective search was conducted to identify all patients who underwent ACLR and completed isokinetic evaluation, postural stability analysis, and drop vertical jump testing at 6 months postoperatively. Patients were asked to complete 3 questionnaires at a minimum 1 year after surgery. Chi-square and logistic regression analyses were used for categorical dependent variables, while the Student t test, Pearson correlation, or analyses of variance with Bonferroni post hoc testing were used for continuous dependent variables. A post hoc power analysis was completed. Based on the results regarding correlations between return to preinjury level and all other variables, effect sizes from 0.24 to 3.03 were calculated. With these effect sizes, an alpha of 0.05 and sample size of 58, a power ranging from 0.15 to 0.94 was calculated. RESULTS: The rates of return to preinjury level and to any sports activity were 53.4% and 84.4%. Those who were able to return to their preinjury level of sport (n = 33) showed significantly higher Lysholm (91.6 ± 9.7 vs 76.7 ± 15.4) and International Knee Documentation Committee (IKDC) (83.6 ± 10.6 vs 69.8 ± 14.6) values compared with those who were unable to return to their preinjury level of sport (n = 25) ( P < 0.001). No significant differences were found for the clinical evaluations between those who were and those who were not able to return at the same level for the clinical evaluations (isokinetic evaluation, postural stability, drop vertical jump test) ( P > 0.05). No significant differences were found when comparing quadriceps strength deficit with cutoff values of 80% and 90% for return to preinjury activity level (Tegner), Lysholm, and IKDC scores. CONCLUSION: Quadriceps strength deficit, regardless of cutoff value (80% or 90%), at 6 months after ACLR does not predict return to preinjury level of sport. Patients who returned to sport at their preinjury level were more satisfied with their reconstruction compared with those who did not. CLINICAL RELEVANCE: Quadriceps strength deficit is not a reliable predictor of return to sports, and therefore it should not be used as the single criterion in such evaluations.

Hamstring Injuries in Professional Soccer Players: Extent of MRI-Detected Edema and the Time to Return to Play.

BACKGROUND: Discrepancies exist in the literature regarding the association of the extent of injuries assessed on magnetic resonance imaging (MRI) with recovery times. HYPOTHESIS: MRI-detected edema in grade 1 hamstring injuries does not affect the return to play (RTP). STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: Grade 1 hamstring injuries from 22 professional soccer players were retrospectively reviewed. The extent of edema-like changes on fluid-sensitive sequences from 1.5-T MRI were evaluated using craniocaudal length, percentage of cross-sectional area, and volume. The time needed to RTP was the outcome. Negative binomial regression analysis tested the measurements of MRI-detected edema-like changes as prognostic factors. RESULTS: The mean craniocaudal length was 7.6 cm (SD, 4.9 cm; range, 0.9-19.1 cm), the mean percentage of cross-sectional area was 23.6% (SD, 20%; range, 4.4%-89.6%), and the mean volume was 33.1 cm3 (SD, 42.6 cm3; range, 1.1-161.3 cm3). The mean time needed to RTP was 13.6 days (SD, 8.9 days; range, 3-32 days). None of the parameters of extent was associated with RTP. CONCLUSION: The extent of MRI edema in hamstring injuries does not have prognostic value. CLINICAL RELEVANCE: Measuring the extent of edema in hamstring injuries using MRI does not add prognostic value in clinical practice.

Magnetic resonance imaging-based morphological and alignment assessment of the patellofemoral joint and its relationship to proximal patellar tendinopathy.

OBJECTIVE: To assess the differences in morphology and alignment of the knee between patients with proximal patellar tendinopathy (PPT) and a control group, using MRI and focusing on the patellofemoral joint. METHODS: We retrospectively included 35 patients with clinically diagnosed and unequivocal findings of PPT on knee MRI, the case group. For the control group, we included 70 patients who underwent knee MRI for other reasons, with no clinical or MRI evidence of PPT. Patients and controls were matched for age and gender, with all subjects reporting frequent physical activity. MRIs were evaluated by two musculoskeletal radiologists, who assessed parameters of patellar morphology, trochlear morphology, patellofemoral alignment, and tibiofemoral alignment. The differences in parameters between cases and controls were assessed using Student's t test. Logistic regression was applied to assess the associations between the MRI parameters and the presence of PPT. RESULTS: The patellar height Insall-Salvati ratio was different between cases and controls (1.37 ± 0.21 vs. 1.24 ± 0.19; p = 0.003). The subchondral Wiberg angle was higher in cases than controls (136.8 ± 7.4 vs. 131.7 ± 8.8; p = 0.004). After applying logistic regression, significant associations with PPT were found [odds ratios (95% CI)] for patellar morphology [1.1 (1.0, 1.2)] and patellar height [1.3 (1.0, 1.7)]. CONCLUSIONS: Patellar height and the subchondral patellar Wiberg angle were greater in patients with PPT and significantly associated with PPT.

Parylene scaffold for cartilage lesion.

Evaluate parylene scaffold feasibility in cartilage lesion treatment, introducing a novel paradigm combining a reparative and superficial reconstructive procedure. Fifteen rabbits were used. All animals had both knees operated and the same osteochondral lesion model was created bilaterally. The parylene scaffold was implanted in the right knee, and the left knee of the same animal was used as control. The animals were euthanized at different time points after surgery: four animals at three weeks, three animals at six weeks, four animals at nine weeks, and four animals at 12 weeks. Specimens were analyzed by International Cartilage Repair Society (ICRS) macroscopic evaluation, modified Pineda histologic evaluation of cartilage repair, and collagen II immunostaining. Parylene knees were compared to its matched contra-lateral control knees of the same animal using the Wilcoxon matched-pairs signed rank. ICRS mean ± SD values for parylene versus control, three, six, nine and twelve weeks, respectively: 7.83 ± 1.85 versus 4.42 ± 1.08, p = 0.0005; 10.17 ± 1.17 versus 6.83 ± 1.17, p = 0.03; 10.89 ± 0.60 versus 7.33 ± 2.18, p = 0.007; 10.67 ± 0.78 versus 7.83 ± 3.40, p = 0.03. Modified Pineda mean ± SD values for parylene versus control, six, nine and twelve weeks, respectively: 3.37 ± 0.87 versus 6.94 ± 1.7, p < 0.0001; 5.73 ± 2.05 versus 6.41 ± 1.7, p = 0.007; 3.06 ± 1.61 versus 6.52 ± 1.51, p < 0.0001. No inflammation was seen. Parylene implanted knees demonstrated higher collagen II expression via immunostaining in comparison to the control knees. Parylene scaffolds are a feasible option for cartilage lesion treatment and the combination of a reparative to a superficial reconstructive procedure using parylene scaffolds led to better results than the reparative procedure alone.

Is the Use of Spreaders an Accurate Method for Ligament Balancing?

BACKGROUND: To analyze 2 methods of manual spreader gap assessment accuracy, visual vs blinded, compared with a controlled tensioner in total knee arthroplasty. METHODS: Twenty-two fresh frozen cadaver knees were used to perform total knee arthroplasty by 22 surgeons. Extension and flexion gaps were measured with empirical manual force application with spreaders in 2 different manners: (1) surgeons were blinded to gap geometry formation-blind method group (BM) and (2) surgeons viewed them-viewing method group (VM). A tensioner was used to measure the corresponding ligament tension applied during spreader measurements and to measure the extension and flexion gaps with standard force of 100 and 80 N (tensioner method [TM]) in each femorotibial compartment. RESULTS: All measurements with spreaders (VM and BM) presented extension and flexion gaps oversized and asymmetric (P < .0001), when compared with the same gaps measured with the tensioner. Approximately 63% (P = <0.001) and 77.3% (P = .161) of the VM group and 68.2% (P = .018) and 77.3% (P = .161) of the BM group demonstrated asymmetry for extension and flexion gaps up to 3 mm to the TM. Gaps measured in the VM group presented results with slightly less oversizing and asymmetries than the measurements in the BM group compared with TM, although significantly different (P < .0001). CONCLUSION: The assessment of extension and flexion gaps with empirical manual applied force spreaders produced oversized and asymmetric gaps compared with the use of tensioner. No visual influence was observed during the spreader applied empirical manual force compared with the blinded assessment.

Anterolateral ligament anatomy: a comparative anatomical study.

PURPOSE: Some anatomical studies have indicated that the anterolateral ligament (ALL) of the knee is distinct ligamentous structure in humans. The purpose of this study is to compare the lateral anatomy of the knee among human and various animal specimens. METHODS: Fifty-eight fresh-frozen knee specimens, from 24 different animal species, were used for this anatomical study. The same researchers dissected all the specimens in this study, and dissections were performed in a careful and standardized manner. RESULTS: An ALL was not found in any of the 58 knees dissected. Another interesting finding in this study is that some primate species (the prosimians: the red and black and white lemurs) have two LCLs. CONCLUSION: The clinical relevance of this study is the lack of isolation of the ALL as a unique structure in animal species. Therefore, precaution is recommended before assessing the need for surgery to reconstruct the ALL as a singular ligament.