A Novel Ligamentous Complex in the Anteromedial Region of the Knee: A Cadaveric Study.

Background: The medial knee structures have a primary role in stabilizing valgus and rotational stress, which makes them important in assessing the ligament-injured knee globally and choosing the most adequate treatment. Purpose: To conduct a layer-by-layer dissection of the knee's anteromedial side and provide a qualitative and quantitative description of the anatomy and histology of a ligament in the anteromedial region of the knee, which we have termed the anterior oblique ligament (AOL). Also, to describe the AOL relationship with what we have termed the medial cross-a ligament complex that stabilizes the medial pivot. Study Design: Descriptive laboratory study. Methods: A total of 35 fresh-frozen knees from transfemoral amputations that were exclusively performed for vascular reasons were dissected. Structures were identified after meticulous dissection, respecting the same protocol, measured with a digital caliper rule, and histologically studied for data. Results: The AOL was found in all dissected knees, with a mean length of 31.47 ± 5.06 mm. This structure presented a ligament histology with densely organized collagen fibrils. The medial cross was represented by the superficial medial collateral ligament, AOL (anterior region), and posterior oblique ligament. Conclusion: This study demonstrated the presence of a ligament in the anteromedial region of the knee, termed the AOL. This structure was in the anterior part of a ligament complex-the medial cross. Clinical Relevance: Studying and revisiting the medial compartment can provide important information for understanding joint instability and promoting better results in ligament reconstructions.

Reproductive evaluation of Luisa, the last jaguar of the Caatinga.

The in situ population of jaguars in the Caatinga is less than 250 individuals, subdivided into five subpopulations, and is classified as endangered regarding its risk of extinction. Luisa, a 15-year-old female weighing 36 kg, was the last known ex situ jaguar from this biome. Her reproductive evaluation is detailed in this manuscript. Luisa was subjected to both a clinical and laparoscopic evaluation of her reproductive system. After 45 days of reproductive investigation, she died unexpectedly, and skin fragments were taken to establish the postmortem fibroblast lineage. At the clinical evaluation, Luisa had small, undeveloped mammary gland and a small vulva, characteristic of a nulliparous female, with no mammary gland nodules, edema, or abnormal masses. By laparoscopy, normal-appearing bladder and bowel loops were observed, as were uterine horns with standard color, shape, and length with no striae. Ovaries and uterine horns seem free of fibrinous adhesions. Both ovaries showed a yellowish color, a fibrous consistency, a decreased size (atrophied), and no follicles, hemorrhagic corpus, corpus luteum, luteal scars, or other abnormal structures. We may assume that this jaguar female was infertile based on Luisa's mature age and the absence of birthing or ovarian activity signs. The harsh conditions of the Caatinga biome, which included low food availability and frequent conflicts with humans, may have impacted both the pregnancy and lactation of Luisa's mother and her development after birth.

Peroneus Longus Tendon Graft to Reconstruct the Posterolateral Corner of the Knee.

The posterolateral corner is critical to knee stability. Neglected injuries have a direct impact on the prognosis due to residual instability, chronic pain, deformities, and failure to repair other structures. Several techniques are used to reconstruct the posterolateral corner, often with autologous ischiotibial grafts or homologous grafts. An option little used for knee ligament reconstructions is the peroneus longus tendon graft. Although reported as a good alternative for anterior cruciate ligament reconstruction, we found no case using a peroneus longus tendon graft for posterolateral corner reconstruction. Here, we describe the case of a patient who underwent a non-anatomical reconstruction of the posterolateral corner using a peroneus longus tendon graft. The patient underwent surgical procedures for ligament reconstruction and correction of the deformity caused by a failed graft, but his knee remained unstable. During the preoperative planning, it was decided to reconstruct the posterolateral corner with an ipsilateral peroneus longus tendon graft. Studies have shown that the peroneus longus tendon graft does not increase ankle morbidity, and that its length and diameter favor ligament reconstruction. Thus, the present article highlights the importance of the proper diagnosis of ligament injuries in the acute phase, and describes a new technique for posterolateral corner reconstruction that must be included in the surgeon's body of knowledge, increasing the amount of technical options.

Magnetic resonance imaging of the knee anteromedial quadrant.

OBJECTIVE: This study aims to evaluate the possibility of characterizing an extra-articular thickening in the knee anteromedial quadrant in routine MRI scans. MATERIALS AND METHODS: Firstly, in a pilot study, for a better understanding of this extra-articular thickening trajectory in MRI, polytetrafluoroethylene (PTFE) tubes were attached to the ligament structure topography in two dissected pieces. Afterward, 100 knee MRI studies were randomly selected from our database, and 97 met the inclusion criteria. Two musculoskeletal radiologists interpreted the exams separately. Both had previously studied the ligament in the cadaveric knee MRI with the PTFE tube. RESULTS: The intraobserver and interobserver agreement for the ligament identification was calculated using Cohen's Kappa coefficient. The first radiologist identified the structure in 41 of the 97 scans (42.2%), and the second radiologist in 38 scans (39.2%). The interobserver agreement was substantial, with a Kappa of 0.68 and an agreement of 84.5%. The results suggest that this extra-articular thickening, recently called Anterior Oblique Ligament (AOL) in the literature, is a structure that can be frequently visualized on MRI scans with a high level of interobserver agreement in a relatively large number of exams. CONCLUSION: Therefore, this study indicates that MRI is a promising method for evaluating this anteromedial thickening, and it may be used for future studies of the Anterior Oblique Ligament.

Anterior Cruciate and Anterior Oblique Ligament Reconstruction Using Hamstrings and Peroneus Longus' Anterior Half Grafts.

Anterior cruciate ligament injuries are common in high school and college with an estimated 120,000 cases per year in the United States. Most sports injuries occur without direct contact, and knee valgus with external rotation of the foot is the most common movement. This movement may be related to the injury of the anterior oblique ligament located in the anteromedial quadrant of the knee. This technical note presents anterior cruciate ligament reconstruction with extraarticular anteromedial reinforcement using hamstring and the anterior half of the peroneus longus grafts.

Peroneus Longus Tendon Graft to Reconstruct the Posterolateral Corner of the Knee / Enxerto do tendão fibular longo na reconstrução do canto posterolateral do joelho

Abstract The posterolateral corner is critical to knee stability. Neglected injuries have a direct impact on the prognosis due to residual instability, chronic pain, deformities, and failure to repair other structures. Several techniques are used to reconstruct the posterolateral corner, often with autologous ischiotibial grafts or homologous grafts. An option little used for knee ligament reconstructions is the peroneus longus tendon graft. Although reported as a good alternative for anterior cruciate ligament reconstruction, we found no case using a peroneus longus tendon graft for posterolateral corner reconstruction. Here, we describe the case of a patient who underwent a non-anatomical reconstruction of the posterolateral corner using a peroneus longus tendon graft. The patient underwent surgical procedures for ligament reconstruction and correction of the deformity caused by a failed graft, but his knee remained unstable. During the preoperative planning, it was decided to reconstruct the posterolateral corner with an ipsilateral peroneus longus tendon graft. Studies have shown that the peroneus longus tendon graft does not increase ankle morbidity, and that its length and diameter favor ligament reconstruction. Thus, the present article highlights the importance of the proper diagnosis of ligament injuries in the acute phase, and describes a new technique for posterolateral corner reconstruction that must be included in the surgeon's body of knowledge, increasing the amount of technical options.

Resumo O canto posterolateral tem grande importância na estabilidade do joelho. Sua lesão pode ser negligenciada, o que tem um impacto direto no prognóstico e resulta em instabilidade residual, dor crônica, deformidades e falha do reparo de outras estruturas. Existem diversas técnicas de reconstrução do canto posterolateral e o uso de enxertos autólogos dos isquiotibiais ou homólogos são as mais comuns. Uma opção pouco utilizada para reconstruções ligamentares no joelho é o enxerto do tendão fibular longo. Apesar de descrito como boa opção na reconstrução do ligamento cruzado anterior, não foi encontrado nenhum caso de uso do enxerto do tendão fibular longo na reconstrução do canto posterolateral. Neste artigo, descrevemos o caso de um paciente submetido a reconstrução não anatômica do canto posterolateral com uso do enxerto do tendão fibular longo. O paciente foi submetido a procedimentos cirúrgicos para reconstrução ligamentar e correção de deformidade ocasionada pela falha do enxerto, mas manteve instabilidade ligamentar. No planejamento pré-operatório, optou-se pela reconstrução do canto posterolateral com enxerto do tendão fibular longo ipsilateral. Estudos evidenciaram que o enxerto do tendão fibular longo não provoca aumento de morbidadeem relação aotornozelo abordado, bem comoseapresenta com comprimento e diâmetro favoráveis à reconstrução ligamentar. Dessa forma, este artigo aponta para a importânciadodiagnóstico correto das lesões ligamentaresnafase aguda,e para uma nova técnica na reconstrução do canto posterolateral, que deve fazer parte do arsenal de conhecimentos do cirurgião, pois aumenta as opções de técnicas.

Epidemiological profile of amateur athletes at a medical school in the city of são paulo / Perfil epidemiológico de deportistas amateurs de una facultad de medicina de la ciudad de são paulo / Perfil epidemiológico de atletas amadores em faculdade de medicina da cidade de são paulo

ABSTRACT Introduction: Epidemiologic data about sports injuries among college athletes in Brazil is scarce. The aim of this study was to analyze the epidemiology of sports injuries in a single center. Methods: We interviewed 262 athletes from 10 different sports retrospectively about injuries sustained in their university careers and whose injuries sustained during one season were monitored prospectively. The characterization of the injuries included data on the location of the injury, type of injury, time of year, injury mechanism, and the moment of the injury during training or a game. Results: In the university history, the incidence of injuries was higher in men (81.5%) than in women (67.8%). Lower limb injuries were the most frequent both in the university history and the season. The sports with the highest injury rate for the season was handball (34.2%) and for the university history was basketball (80.8%). The main injury mechanism was non-contact. The months with the highest incidence of injuries were those at the beginning of the season (53.3%). The most frequent diagnoses were ligament injuries, followed by fractures. Both the presence of a previous injury in the same region and the practice of weight training were predictive factors for injury. Conclusion: College athletes at this center are more likely to suffer injuries during the first months of the season, especially in contact sports involving lower limbs. Level of Evidence III; Study of non-consecutive patients, without uniformly applied "gold" reference standard .

RESUMEN Introducción: Hay muy pocos datos en Brasil sobre la epidemiologia de las lesiones deportivas en atletas universitarios. El objetivo de este estudio es analizar la epidemiologia de las lesiones en deportes en un único centro. Métodos: Fueron entrevistados 262 atletas de 10 deportes distintos retrospectivamente con respecto a las lesiones sufridas en su historial universitario y fueron acompañados prospectivamente con respecto a las lesiones sufridas durante una temporada. La caracterización de las lesiones se basó en los datos del lugar de la lesión, el tipo de lesión, la época del año, el mecanismo de la lesión y el momento en que se produjo la lesión durante el entrenamiento o el partido. Resultados: En el historial universitario, la incidencia de las lesiones fue mayor en los hombres (81,5%) que en las mujeres (67,8%). Las lesiones en los miembros inferiores fueron más frecuentes tanto en el historial universitario como en la temporada. El deporte con mayor índice de lesiones en la temporada fue el balonmano (34,2%) y en el historial universitario fue el baloncesto (80,8%). El principal mecanismo de lesión fue sin contacto. Los meses con mayor incidencia de lesiones son el inicio de la temporada (53,3%). Los diagnósticos más frecuentes son las lesiones de ligamentos seguida de las fracturas. Tanto la presencia de una lesión previa en la misma topografía como la práctica de musculación fueron factores predictivos de lesión. Conclusiones: Los atletas universitarios de esta institución son más susceptibles de sufrir lesiones durante los primeros meses de la temporada, especialmente en los deportes de contacto y con mayor incidencia en los miembros inferiores. Nivel de evidencia III; Estudio de pacientes no consecutivos, sin patrón "oro" de referencia aplicado uniformemente .

RESUMO Introdução: Há escassez de dados no Brasil sobre a epidemiologia de lesões esportivas em atletas universitários. O objetivo deste estudo é fazer uma análise sobre a epidemiologia das lesões esportivas em um único centro. Métodos: Foram entrevistados 262 atletas de 10 esportes diferentes, de forma retrospectiva, com relação às lesões sofridas em seu histórico universitário e foram acompanhados de forma prospectiva quanto às lesões sofridas ao longo de uma temporada. A caracterização das lesões contava com dados de local da lesão, tipo de lesão, época do ano, mecanismo de lesão, momento de ocorrência da lesão durante treino ou jogo. Resultados: No histórico universitário, a incidência de lesões foi maior em homens (81,5%) do que em mulheres (67,8%). As lesões de membros inferiores foram as mais frequentes tanto no histórico universitário, quanto na temporada. O esporte com maior índice de lesão na temporada foi o handebol (34,2%) e no histórico universitário foi o basquete (80,8%). O principal mecanismo de lesão foi sem contato. Os meses de maior incidência de lesão são os do começo da temporada (53,3%). Os diagnósticos mais frequentes são as lesões ligamentares, seguidas por fraturas. Tanto a presença de lesão prévia na mesma topografia, quanto a prática de musculação foram fatores preditivos de lesão. Conclusões: Os atletas universitários deste centro estão mais susceptíveis a sofrer lesões durante os primeiros meses da temporada, especialmente em esportes de contato e maior incidência nos membros inferiores. Nível de Evidência III; Estudo de pacientes não consecutivos, sem padrão de referência "ouro" aplicado uniformemente .

Anatomical Study of the Medial Region of the Knee: Qualitative, Quantitative Analysis and Description of the Anterior Oblique Ligament.

Objective To describe all ligamentous, capsular, tendinous and bone landmarks structures of the medial region of the knee, as well as a new ligamentous structure identified in a series of anatomical dissections of cadaveric specimens. Methods Twenty cadaver knees were dissected to study the medial compartment. The main structures of this region were identified during dissection. The morphology of the structures and their relationship with known anatomical parameters were determined both qualitatively and quantitatively. The collected data were analyzed and interpreted using descriptive statistics. Results In the dissection of all specimens, all ligamentous structures previously described in the anatomical study of the medial part of the knee were identified, and objective measures that can help as parameters for surgical ligament reconstruction were identified. When dissecting the medial collateral ligament, a bony prominence immediately distal to its proximal tibial insertion was observed and described, as well as a bursa below the ligament, in which it was not inserted. We also described a ligamentous structure with extracapsular location, originated anteriorly to the medial epicondyle and following obliquely towards the tibia. These structures were named, respectively, interinsertional tubercle, interinsertional bursa and anterior oblique ligament. Conclusion In addition to the description and measurement of the structures and parameters already existing in the anatomical study of the medial part of the knee, it was possible to describe three new structures not yet described in the literature: the interinsertional tubercle, the interinsertional bursa, and the anterior oblique ligament. These structures were found in all dissections performed.

Anatomical Study of the Medial Region of the Knee: Qualitative, Quantitative Analysis and Description of the Anterior Oblique Ligament / Estudo anatômico da região medial do joelho: Análise qualitativa, quantitativa e descrição do ligamento oblíquo anterior

Abstract Objective To describe all ligamentous, capsular, tendinous and bone landmarks structures of the medial region of the knee, as well as a new ligamentous structure identified in a series of anatomical dissections of cadaveric specimens. Methods Twenty cadaver knees were dissected to study the medial compartment. The main structures of this region were identified during dissection. The morphology of the structures and their relationship with known anatomical parameters were determined both qualitatively and quantitatively. The collected data were analyzed and interpreted using descriptive statistics. Results In the dissection of all specimens, all ligamentous structures previously described in the anatomical study of the medial part of the knee were identified, and objective measures that can help as parameters for surgical ligament reconstruction were identified. When dissecting the medial collateral ligament, a bony prominence immediately distal to its proximal tibial insertion was observed and described, as well as a bursa below the ligament, in which it was not inserted. We also described a ligamentous structure with extracapsular location, originated anteriorly to the medial epicondyle and following obliquely towards the tibia. These structures were named, respectively, interinsertional tubercle, interinsertional bursa and anterior oblique ligament. Conclusion In addition to the description and measurement of the structures and parameters already existing in the anatomical study of the medial part of the knee, it was possible to describe three new structures not yet described in the literature: the interinsertional tubercle, the interinsertional bursa, and the anterior oblique ligament. These structures were found in all dissections performed.

Resumo Objetivo Descrever todas as estruturas ligamentares, capsulares, tendinosas e marcos ósseos da região medial do joelho, assim como uma nova estrutura ligamentar identificada em uma série de dissecções anatômicas de espécimes cadavéricos. Métodos Vinte joelhos de cadáveres foram dissecados para estudar o compartimento medial. As principais estruturas dessa região foram identificadas durante a dissecção. A morfologia das estruturas e sua relação com parâmetros anatômicos conhecidos foram determinados tanto de forma qualitativa quanto de forma quantitativa. Os dados coletados foram analisados e interpretados por meio de estatística descritiva. Resultados Na dissecção de todos os espécimes, foram identificadas todas as estruturas ligamentares já descritas anteriormente no estudo anatômico da porção medial do joelho, e foram realizadas medidas objetivas que podem auxiliar como parâmetros para a reconstrução ligamentar cirúrgica. Foram observados e descritos, ainda, ao se desprender o ligamento colateral medial superficial, uma proeminência óssea imediatamente distal à sua inserção tibial proximal, uma bursa abaixo do ligamento, na qual o mesmo não se mostrava inserido, assim como uma estrutura ligamentar localizada extracapsularmente e com origem na face anterior do epicôndilo medial, seguindo obliquamente em direção à tíbia, aos quais foram dados os nomes, respectivamente, de tubérculo interinsercional, bursa interinsercional e ligamento oblíquo anterior. Conclusão Além da descrição e medida das estruturas e parâmetros já existentes no estudo anatômico da porção medial do joelho, foi possível a descrição de três novas estruturas: o tubérculo interinsercional a bursa interinsercional e o ligamento oblíquo anterior, ainda não descritos na literatura. Essas estruturas foram encontradas em todas as dissecções realizadas.

Knee anteromedial compartment dissection: Final results and anterior oblique ligament description.

The anteromedial region of the knee is little explored in the literature and may play an important role in anteromedial rotatory instability. The purpose of this study is to describe a ligamentous structure in the anteromedial region of the knee identified in a series of anatomical dissections of cadaveric specimens. Twenty-one cadaveric knees were dissected to study the medial compartment. Exclusion criteria were signs of trauma, previous surgery, signs of osteoarthritis, and poor preservation state. The main structures of this region were identified during medial dissection. After releasing the superficial medial collateral ligament of the tibia, the anterior oblique ligament (AOL) was isolated. The morphology of the structure and its relationship with known anatomical parameters were determined. For the statistical analysis, the means and standard deviations were calculated for continuous variables. A 95% confidence interval was defined as significant. Student's t-tests were used for continuous variables. After dissection, a distinct ligamentous structure (AOL) was found in the medial region of the knee. This structure was found in 100% of the cases, was located extracapsularly and originated in the anterior aspect of the medial epicondyle, running obliquely toward the tibia. When crossing the joint, the ligament presented a fan-shaped opening, exhibiting a larger area at the tibial insertion. The AOL had a mean thickness of 6.83 ± 1.51 mm at its femoral origin and 13.39 ± 2.64 at its tibial insertion. It had a significantly (p = 0.0001) longer mean length with the knee at 90° of flexion (35.27 ± 6.59 mm) than with the knee in total extension (27.89 ± 5.46 mm), indicating that the ligament is tensioned in flexion. A new structure was identified in the anteromedial compartment of the knee with a ligamentous appearance. Further studies are necessary to identify its importance on knee stability. This study demonstrates the anatomy of a new medial structure of the knee. As a result, there will be a better understanding of the stability of the knee.

Prospective and Randomized Clinical Evaluation of Hamstring Versus Patellar Tendon Autograft for Anterior Cruciate Ligament Reconstruction in Soccer Players.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is usually performed with autologous bone-patellar tendon-bone (PT) or hamstring tendon (HT) graft. There has been only 1 randomized clinical trial examining ACL reconstruction with these grafts specifically in soccer players, and more studies comparing these graft types within a homogenous cohort such as soccer athletes may better highlight differences in outcomes. PURPOSE: To compare the results of ACL reconstruction with PT versus HT autograft in soccer players and to evaluate objective and subjective outcomes. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 62 professional or semiprofessional soccer players (mean age, 25.1 years) with ACL injury were randomized to undergo reconstruction with PT or HT autograft by a single orthopaedic surgeon (n = 31 in each group). Outcome measures were recorded preoperatively and at 2 years postoperatively. The primary outcome was the modified Cincinnati Knee Rating System, and secondary outcomes were the objective and subjective International Knee Documentation Committee scores, Lachman test, pivot-shift test, anterior drawer test, and Lysholm score. The following variables were also evaluated postoperatively: return to soccer, level at return, graft rerupture, postoperative complications, anterior knee pain, patellar tendinitis, difficulty sprinting, and loss of kicking power. RESULTS: The PT and HT groups were homogenous in terms of age, sex distribution, injured side, and time from injury to surgery, and there was no difference between them on any preoperative outcome score. At 2 years postoperatively, there were no differences between the groups on any outcome score; however, there were significantly fewer patients with anterior knee pain in the HT group compared with the PT group (7 [22.6%] vs 15 [48.4%], respectively; P = .03). Two patients from each group (2/31; 6.5%) sustained rerupture. CONCLUSION: There were no differences between soccer players who underwent different types of ACL reconstruction with the exception of anterior knee pain, which was more frequent in players who underwent reconstruction with PT graft.Registration: NCT02642692 (ClinicalTrials.gov).

Anterior Half of the Peroneus Longus Tendon Combined with Semitendinosus and Gracilis Tendons for Anterior Cruciate Ligament Reconstruction: An Athlete Case Report.

In clinical practice, it is observed that the hamstring tendon graft, despite being first choice in knee ligament reconstruction, may not present adequate size. Therefore, it becomes necessary to search for other graft alternatives. In this context, the peroneus longus tendon arises as an option to replace or complement other grafts. The surgeon can opt to use the tendon in its totality or only its anterior half, presenting adequate length, diameter, and biomechanics, without major repercussions for the donor site. In this study, we report a case of an athlete in which the autologous hamstring tendon graft did not present the adequate diameter for anterior cruciate ligament reconstruction. It was, then, necessary to use the anterior half of the peroneus longus tendon.

Anterior Cruciate and Anterolateral Ligament Reconstruction Using Hamstring and Peroneus Longus Tendons: Surgical Technique Description.

The main objective of this study is to describe a surgical technique that combines intra- and extra-articular techniques using the semitendinosus, gracilis, and peroneus longus to perform reconstruction of the anterior cruciate ligament and anterolateral ligament. This technique offers a more stable, fast, low-cost, and widely accessible procedure and consists of drilling 3 tunnels-1 femoral and 2 tibial tunnels-in which the grafts are fixed with interference screws. The fact that the peroneus longus graft is long and thick allows for robust reconstruction of the aforementioned ligaments.

Bifosfonatos en Odontopediatría: Revisión de la literatura, protocolo de manejo y reporte de un caso clínico / Bisfosfonatos em Odontopediatria: Revisão da literatura, protocolo de gestão e relato de caso clínico / Bisphosphonates in pediatric dentistry: literature review, management protocol and report of a clinical case

En la actualidad, los bifosfonatos son utilizados en la población pediátrica con diagnóstico de osteogénesis imperfecta, desórdenes neuromusculares, displasia ósea, displasia fibrosa, osteoporosis idiopática juvenil, enfermedad de Crohn y trastornos reumatológicos. La osteonecrosis de los maxilares secundaria al tratamiento con bifosfonatos, se ha convertido en una complicación cada vez más común debido al incremento de su uso en la población adulta. En cuanto a la atención pediátrica la información es escasa. Este estudio presenta el caso clínico de una paciente de sexo femenino con diagnóstico de osteogénesis imperfecta tipo III quien fue tratada con múltiples extracciones dentales bajo anestesia general, previa Bifosfonatos en Odontopediatría: Revisión de la literatura, protocolo de manejo y reporte de un caso clínico Ingrid Báez Madrigal,1..... Rubí López Fernández,2..... Jorge Pedro Téllez Rodríguez,2..... Revista de Odontopediatría Latinoamericana¹ Estomatóloga Pediatra Egresada del Instituto Nacional de Pediatría.2Cirujano Maxilofacial, adscrito al Servicio de Estomatología del Instituto Nacional de Pediatría.Casos ClínicosDOI: 10.47990/alop.v11i2.278administración de amoxicilina 50 mg/kg 1 hora antes; debido a erupción anómala de caninos y primeros premolares superiores, así como persistencia de caninos y molares primarios superiores. Se realizaron citas control postoperatorias, en donde mostró adecuado proceso de cicatrización sin datos de necrosis maxilar. El objetivo es informar al estomatólogo sobre cómo actúan los bifosfonatos, los diagnósticos en la población pediátrica tratados con dicho fármaco y dar a conocer el protocolo de manejo de estos pacientes. Se realizó una revisión integradora en las bases de datos PubMed y Cochrane Library, los artículos fueron seleccionados de acuerdo a los criterios establecidos

Atualmente, os bisfosfonatos são utilizados na população pediátrica diagnosticada com osteogênese imperfeita, distúrbios neuromusculares, displasia óssea, displasia fibrosa, osteoporose idiopática juvenil, doença de Crohn e distúrbios reumatológicos. A osteonecrose dos maxilares secundárias ao tratamento com bifosfonatos tornou-se uma complicação cada vez mais comum devido ao aumento do uso na população adulta. Quanto ao atendimento pediátrico, as informações são escassas. Este estudo apresenta o caso clínico de uma paciente do sexo feminino com diagnóstico de osteogênese imperfeita tipo III, tratada com múltiplas exodontias sob anestesia geral, após administração de amoxicilina 50 mg / kg 1 hora antes; devido à erupção anômala de caninos superiores e primeiros pré-molares, bem como persistência de caninos decíduos superiores e molares. Foram marcadas consultas de controle pós-operatório, onde apresentava processo de cicatrização adequado, sem dados de necrose maxilar. O objetivo é informar ao estomatologista como os bisfosfonatos atuam, os diagnósticos na população pediátrica tratada com esse medicamento e apresentar o protocolo de manejo desses pacientes. Realizou-se revisão integrativa nas bases de dados PubMed e Cochrane Library, os artigos foram selecionados de acordo com os critérios estabelecidos

Bisphosphonates are currently used in the pediatric population diagnosed with osteogenesis imperfecta, neuromuscular disorders, skeletal dysplasia, fibrous dysplasia, juvenile idiopathic osteoporosis, Crohn's disease, and rheumatologic disorders.Bisphosphonate-related osteonecrosis of the jaw has become an increasingly common complication due to its increased use in the adult population. Regarding pediatric care, information is scarce. This study presents the clinical case of a female patient diagnosed with type III osteogenesis imperfecta who was treated with multiple dental extractions under general anesthesia, after administration of amoxicillin 50 mg/kg 1 hour before; due to anomalous eruption of upper canines and first premolars, as well as persistence of upper primary canines and molars. Postoperative control appointments were made, where she showed an adequate healing process without evidence of maxillary necrosis. The aim is to inform the stomatologist about how bisphosphonates act, the diagnoses in the pediatric population treated with

Correction to: Anteromedial positioning of the femoral tunnel in Anterior Cruciate Ligament reconstruction is the best option to avoid revision: a single surgeon registry.

An amendment to this paper has been published and can be accessed via the original article.

Anteromedial positioning of the femoral tunnel in anterior cruciate ligament reconstruction is the best option to avoid revision: a single surgeon registry.

PURPOSE: The aim of the study is to compare the risk of revision of single-bundle hamstring anterior cruciate ligament (ACL) reconstruction between the anteromedial, transtibial and outside-in techniques. METHODS: This cohort study was based on data from a single surgeon's registry. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon using the anteromedial portal, transtibial and outside-in technique, operated between 1 November 2003 to 31 December 2016, were eligible for inclusion. A minimum follow-up of 2 years was used, and the end-point of the study was revision surgery. RESULTS: The total number of registered surgeries identified was 665; 109 were excluded, and 556 was the final sample. The overall revision rate was 8.7%. The transtibial technique presented 14/154 [9.9%] of revisions, the transportal 11/96 [11.4%] and the outside-in 22/306 [7.2%]. Separating the outside-in group into central outside-in and anteromedial (AM) outside-in, 18/219 [8.2%] was found for the central outside-in and 4/87 [4.5%] for the AM outside-in technique. Statistical evaluation of the first comparison (transtibial vs. transportal vs. outside-in) obtained p = (n.s.) The second comparison (transtibial vs. central transportal vs. central outside-in vs. AM outside-in, p = (n.s). Placement was also evaluated: high anteromedial placement (transtibial) vs. central (transportal and central outside-in technique) vs. AM placement (AM outside-in). The high AM placement presented 14/154 [9.9%] of revision, the central placement 29/315 [9.2%] and the AM placement 4/87 [4.5%], p = (n.s.) The AM placement was also compared with the other placements (high and central AM), p = (n.s.) CONCLUSION: Based on the registry of a single surgeon during 14 years of ACL reconstruction, the placement of the femoral tunnel in the high anteromedial region was associated with a rupture rate of 9.9%, central placement with 9.2% and anteromedial placement with 4.5%.

Difference in Articular Degeneration Depending on the Type of Sport.

Objective To determine whether type-II collagen degradation is determined by the type of sport. Carboxy-terminal telepoptide of type-II collagen (CTX-II), a serum biomarker of collagen degradation, was measured in athletes who play different sports, and was compared with matched controls. Methods The sample size consisted of 70 female participants aged between 18 and 25 years, 15 of whom were members of a soccer team, 10 of a futsal (a variant of association football played on a hard court) team, 10 of a handball team, 18 of a volleyball team, and 7 of a swimming team. A total of 9 age- and sex-matched individuals with sedentary lifestyles were included in the control group. 3-mL blood samples were collected from each participant, and they were analyzed using an enzyme-linked immunosorbent assay (ELISA). Results A comparison of the CTX-II concentrations of the players of different sports with those of the control group resulted in the following p -values: volleyball ( p = 0.21); soccer ( p = 0.91); handball ( p = 0.13); futsal ( p = 0.02); and swimming ( p = 0.0015). Therefore, in the investigated population, futsal represented the highest risk for type-II collagen degradation and, consequently, for articular cartilage degradation, whereas swimming was a protective factor for the articular cartilage. No statistically significant difference was found in the body mass index among the groups. Conclusion Futsal players are exposed to greater articular degradation, while swimmers exhibited less cartilage degradation compared with the control group in the study population, suggesting that strengthening the periarticular muscles and aerobic exercise in low-load environments has a positive effect on the articular cartilage.

Difference in Articular Degeneration Depending on the Type of Sport / Diferença na degeneração articular de acordo com o tipo de esporte

Abstract Objective To determine whether type-II collagen degradation is determined by the type of sport. Carboxy-terminal telepoptide of type-II collagen (CTX-II), a serum biomarker of collagen degradation, was measured in athletes who play different sports, and was compared with matched controls. Methods The sample size consisted of 70 female participants aged between 18 and 25 years, 15 of whom were members of a soccer team, 10 of a futsal (a variant of association football played on a hard court) team, 10 of a handball team, 18 of a volleyball team, and 7 of a swimming team. A total of 9 age- and sex-matched individuals with sedentary lifestyles were included in the control group. 3-mL blood samples were collected from each participant, and they were analyzed using an enzyme-linked immunosorbent assay (ELISA). Results A comparison of the CTX-II concentrations of the players of different sports with those of the control group resulted in the following p-values: volleyball (p = 0.21); soccer (p = 0.91); handball (p = 0.13); futsal (p = 0.02); and swimming (p = 0.0015). Therefore, in the investigated population, futsal represented the highest risk for type-II collagen degradation and, consequently, for articular cartilage degradation, whereas swimming was a protective factor for the articular cartilage. No statistically significant difference was found in the body mass index among the groups. Conclusion Futsal players are exposed to greater articular degradation, while swimmers exhibited less cartilage degradation compared with the control group in the study population, suggesting that strengthening the periarticular muscles and aerobic exercise in low-load environments has a positive effect on the articular cartilage.

Resumo Objetivo Determinar se a degradação de colágeno tipo II é determinada pelo tipo de esporte. O telopeptídeo carboxiterminal do colágeno tipo II (CTX-II), biomarcador de soro de degradação de colágeno, foi medido em atletas de esportes diferentes e comparado aos controles correspondentes. Métodos A amostra consistiu em 70 participantes do sexo feminino com idade entre 18 a 25 anos, das quais 15 eram membros de uma equipe de futebol, 10 de uma equipe de futebol de salão, 10 de uma equipe de handebol, 18 de uma equipe de voleibol, e 7 de uma equipe de natação. Foram incluídos no grupo de controle 9 indivíduos sedentários, pareados por idade e sexo. Uma amostra de sangue de 3 ml foi coletada de cada participante e analisada usando um ensaio imunossorvente ligado a enzima (ELISA, do inglês enzyme-linked immunosorbent assay). Resultados Uma comparação das concentrações de CTX-II das praticantes de diferentes esportes em comparação com o grupo de controle apresentou os seguintes valores de p: voleibol (p = 0,21); futebol (p = 0,91); handebol (p = 0,13); futebol de salão (p = 0,02) e natação (p = 0,0015). Portanto, na população investigada, o futebol de salão apresentou o maior risco de degradação do colágeno tipo II, e, consequentemente, de degradação da cartilagem articular, enquanto a prática de natação foi um fator protetor para a cartilagem articular. Não foi observada diferença estatisticamente significativa no índice de massa corporal entre os grupos. Conclusão As jogadoras de futebol de salão estão expostas a uma maior degradação articular, enquanto as nadadoras apresentam menor degradação da cartilagem em comparação com o grupo de controle na população estudada, o que sugere que o fortalecimento dos músculos periarticulares e o exercício aeróbico em ambientes de baixa carga têm um efeito positivo na cartilagem articular.

Effect of protein source and probiotic on the intestinal tract of pacific white shrimp Litopenaeus vannamei / Efeito da fonte de proteína e probiotico sobre trato intestinal do camarão branco pacífico Litopenaeus vannamei

This study aimed to evaluate the viability of supplementing two diets for the shrimp Litopenaeus vannamei with Lactobacillus plantarum. One using fish meal as a protein source and another using soy protein concentrate, as well as the effect of these formulations on shrimp intestinal microbiota. To assay probiotic viability in the formulated diets, the number of CFU g-1 was observed weekly over the course of four weeks. The viability of Lactobacillus plantarum in relation to the physical parameters of the diets, including stability, buoyancy, and expansion, was quantified. The effect of the diets on microbiota and intestinal tract morphology was determined by performing a 2x2 factorial experiment (two diets, with or without supplementation) in triplicate, totaling 12 experimental units, with five animals per unit, fed with 3.5% of biomass for 17 days. The concentration of lactic acid bacteria decreased over time, irrespective of protein source. The diet with fishmeal as a protein source, independent of probiotic supplementation, presented good stability and did not disintegrate after four hours. In contrast, the diet with soy protein concentrate, supplemented or not, disintegrated between 2.5 and 3 hours, presenting low stability. All diets presented 0% buoyancy. The expansion rate was higher in diets with soy protein concentrate, but without the influence probiotic supplementation or interaction between the factors. In the in vivo assay, both supplemented diets showed greater total heterotrophic bacteria count than without probiotic; however, no difference in count was noted in diets with different protein source. Lactic acid bacteria were only observed in the shrimp fed diets supplemented with probiotic. Histology of the intestinal tract showed that all intestines had intact, well-developed and well-organized cells, irrespective of diet. Thus, L. plantarum, when combined with different protein sources, produced similar effects on...(AU)

Este trabalho objetivou avaliar viabilidade da suplementação de duas dietas ao camarão Litopenaeus vannamei com Lactobacillus plantarum. Uma usando farinha de peixe como fonte proteica e outra usando concentrado de proteico de soja, bem como o efeito destas formulações na microbiota intestinal de camarão. Para testar a viabilidade probiótica nas dietas, o número de UFC g-1 foi observado semanalmente ao longo de quatro semanas. A viabilidade de Lactobacillus plantarum em relação aos parâmetros físicos das dietas, incluindo estabilidade, flutuabilidade e expansão, foram testados. O efeito das dietas na microbiota e na morfologia do trato intestinal foi determinado por meio de um experimento fatorial 2x2 (duas dietas, com ou sem suplementação), em triplicata, totalizando 12 unidades experimentais, com cinco animais por unidade, alimentados com 3,5% de biomassa por 17 dias. A concentração de bactérias do ácido láctico diminuiu ao longo do tempo, independentemente da fonte de proteína. A dieta com farinha de peixe como fonte proteica, independente da suplementação probiótica, apresentou boa estabilidade e não se desintegrou após quatro horas. Em contrapartida, dieta com concentrado proteico de soja, suplementado ou não, desintegrou-se entre 2,5 e 3 horas, apresentando baixa estabilidade. Todas as dietas apresentaram flutuabilidade de 0%. A taxa de expansão foi maior nas dietas com concentrado proteico de soja, mas sem influência da suplementação probiótica ou interação entre os fatores. No ensaio in vivo, ambas as dietas suplementadas apresentaram maior contagem de bactérias heterotróficas totais; no entanto, nenhuma diferença na contagem foi observada em dietas com diferentes fontes de proteína. Bactérias ácido-lácticas só foram observadas em dietas suplementadas com probiótico. A histologia do trato intestinal mostrou que todos intestinos tinham células intactas, bem desenvolvidas e organizadas, independentemente da dieta. Assim, L. plantarum, quando...(AU)

Effect of protein source and probiotic on the intestinal tract of pacific white shrimp Litopenaeus vannamei / Efeito da fonte de proteína e probiotico sobre trato intestinal do camarão branco pacífico Litopenaeus vannamei

This study aimed to evaluate the viability of supplementing two diets for the shrimp Litopenaeus vannamei with Lactobacillus plantarum. One using fish meal as a protein source and another using soy protein concentrate, as well as the effect of these formulations on shrimp intestinal microbiota. To assay probiotic viability in the formulated diets, the number of CFU g-1 was observed weekly over the course of four weeks. The viability of Lactobacillus plantarum in relation to the physical parameters of the diets, including stability, buoyancy, and expansion, was quantified. The effect of the diets on microbiota and intestinal tract morphology was determined by performing a 2x2 factorial experiment (two diets, with or without supplementation) in triplicate, totaling 12 experimental units, with five animals per unit, fed with 3.5% of biomass for 17 days. The concentration of lactic acid bacteria decreased over time, irrespective of protein source. The diet with fishmeal as a protein source, independent of probiotic supplementation, presented good stability and did not disintegrate after four hours. In contrast, the diet with soy protein concentrate, supplemented or not, disintegrated between 2.5 and 3 hours, presenting low stability. All diets presented 0% buoyancy. The expansion rate was higher in diets with soy protein concentrate, but without the influence probiotic supplementation or interaction between the factors. In the in vivo assay, both supplemented diets showed greater total heterotrophic bacteria count than without probiotic; however, no difference in count was noted in diets with different protein source. Lactic acid bacteria were only observed in the shrimp fed diets supplemented with probiotic. Histology of the intestinal tract showed that all intestines had intact, well-developed and well-organized cells, irrespective of diet. Thus, L. plantarum, when combined with different protein sources, produced similar effects on...

Este trabalho objetivou avaliar viabilidade da suplementação de duas dietas ao camarão Litopenaeus vannamei com Lactobacillus plantarum. Uma usando farinha de peixe como fonte proteica e outra usando concentrado de proteico de soja, bem como o efeito destas formulações na microbiota intestinal de camarão. Para testar a viabilidade probiótica nas dietas, o número de UFC g-1 foi observado semanalmente ao longo de quatro semanas. A viabilidade de Lactobacillus plantarum em relação aos parâmetros físicos das dietas, incluindo estabilidade, flutuabilidade e expansão, foram testados. O efeito das dietas na microbiota e na morfologia do trato intestinal foi determinado por meio de um experimento fatorial 2x2 (duas dietas, com ou sem suplementação), em triplicata, totalizando 12 unidades experimentais, com cinco animais por unidade, alimentados com 3,5% de biomassa por 17 dias. A concentração de bactérias do ácido láctico diminuiu ao longo do tempo, independentemente da fonte de proteína. A dieta com farinha de peixe como fonte proteica, independente da suplementação probiótica, apresentou boa estabilidade e não se desintegrou após quatro horas. Em contrapartida, dieta com concentrado proteico de soja, suplementado ou não, desintegrou-se entre 2,5 e 3 horas, apresentando baixa estabilidade. Todas as dietas apresentaram flutuabilidade de 0%. A taxa de expansão foi maior nas dietas com concentrado proteico de soja, mas sem influência da suplementação probiótica ou interação entre os fatores. No ensaio in vivo, ambas as dietas suplementadas apresentaram maior contagem de bactérias heterotróficas totais; no entanto, nenhuma diferença na contagem foi observada em dietas com diferentes fontes de proteína. Bactérias ácido-lácticas só foram observadas em dietas suplementadas com probiótico. A histologia do trato intestinal mostrou que todos intestinos tinham células intactas, bem desenvolvidas e organizadas, independentemente da dieta. Assim, L. plantarum, quando...