The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis.

PURPOSE: To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years. METHODS: A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division. RESULTS: Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001). CONCLUSION: A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions. LEVEL OF EVIDENCE: IV.

Higher Meniscal Slope Is a Risk Factor for Anterior Cruciate Ligament Injury in Skeletally Immature Patients.

PURPOSE: To evaluate the relation between the femoral intercondylar index, tibial slope, and meniscal slope between 3 different groups of skeletally immature patients: primary anterior cruciate ligament (ACL) injury (group 1), ACL reconstruction failure (group 2), and control group, without an ACL injury history (group 3). METHODS: This retrospective study evaluated magnetic resonance imaging scans of the knees of 605 skeletally immature patients obtained between 2015 and 2020. The inclusion criteria were as follows: patients younger than 16 years who were skeletally immature and underwent knee magnetic resonance imaging for any reason. RESULTS: A total of 605 skeletally immature patients were included in the study. The ratio of patients with ACL injury (cases) to those without ACL injury (controls) was 1:2.5. Patients with ACL injury had significantly greater medial meniscal slope and lateral meniscal slope values than the control group without ACL injury (P < .001). There was no statistically significant difference between patients with primary ACL injury and those with ACL reconstruction failure for all measured variables. CONCLUSIONS: The medial and lateral meniscal slope values were significantly higher in skeletally immature patients with ACL injury than in the control group of patients without ACL injury. There was no statistically significant difference in measurements of the femoral intercondylar index, lateral meniscal slope, medial meniscal slope, lateral tibial slope, or medial tibial slope between patients with primary injury and those with ACL reconstruction failure. LEVEL OF EVIDENCE: Level III, retrospective comparative trial.

Pediatric Anterior Cruciate Ligament Reruptures Are Related to Lower Functional Scores at the Time of Return to Activity: A Prospective, Midterm Follow-up Study.

BACKGROUND: Skeletally immature patients show a higher rate of anterior cruciate ligament (ACL) reruptures. A better understanding of the risk factors for an ACL rerupture in this population is critical. PURPOSE/HYPOTHESIS: The objective of this study was to analyze preoperative, intraoperative, and postoperative characteristics of pediatric patients undergoing ACL reconstruction and determine the relationship of these factors with an ACL rerupture. It was hypothesized that patients with worse activity scores and knee function at the time of return to activity would have a higher rate of ACL reruptures at midterm follow-up. Additionally, it was hypothesized that most ACL reruptures would occur before age 20 years in the study population. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 65 skeletally immature patients (age <16 years) with ACL ruptures underwent reconstruction with a quadruple hamstring tendon graft between 2002 and 2016. Of these patients, 52 were available for the study. Patient characteristics, surgical details, Tegner and Lysholm scores, and ACL reconstruction outcomes were recorded. Patients were analyzed and compared according to ACL rerupture occurrence. RESULTS: Of the 52 patients, 18 (34.6%) experienced an ACL rerupture after reconstruction. The majority of reruptures (77.8%) occurred before age 20 years. There were 2 patients who sustained ACL reruptures during the rehabilitation period before they returned to activity. The majority of reruptures occurred after 12 months (83.2%), with 66.6% occurring after 24 months. Upon returning to activity between 6 and 9 months postoperatively, patients who ended up with intact ACL grafts reported 69% higher mean Tegner scores (P = .006) and 64% higher mean Lysholm scores than patients who sustained ACL reruptures (P < .001). Within the limits of this study, we could identify no statistical relationship between the rate of ACL reruptures and different sport types, surgical techniques, or associated injuries (P > .05). CONCLUSION: Skeletally immature patients who underwent ACL reconstruction and sustained ACL reruptures had lower Tegner and Lysholm scores upon returning to activity than patients without ACL reruptures. In addition, most ACL reruptures occurred in patients younger than 20 years (77.8%) and after 24 months postoperatively (66.6%).

Closing-Wedge Distal Femoral Osteotomies-Retrospective Study.

Objective To describe the surgical technique of distal closing-wedge femoral osteotomy and a cases series submitted to this technique. Methods A total of 26 patients submitted to medial closing-wedge distal femoral osteotomy from 2002 to 2013 were evaluated. All of the patients had their medical files and imaging exams reviewed to evaluate the degree of correction and their current state. Results Out of the 26 patients, 12 were male and 14 were female. Their mean age was 47.15 years old. In all of the cases, a neutral alignment related to the anatomical axis was achieved. Most of the patients presented bone healing at 6 weeks. There were no cases of bleeding during the surgery. One patient presented with delayed bone healing. One patient complained of plaque-related discomfort, requiring the removal of the device. One patient had a superficial infection, but no osteotomy revision was needed. There were no cases of deep venous thrombosis or of pulmonary thromboembolism. To date, there has been no conversion to total knee replacement. Conclusion Treatment with medial closing-wedge distal femoral osteotomy sustained the proposed correction in patients with up to 15 years of follow-up.

Closing-Wedge Distal Femoral Osteotomies- Retrospective Study / Osteotomias femorais distais com cunha de fechamento medial-estudo retrospectivo

Abstract Objective To describe the surgical technique of distal closing-wedge femoral osteotomy and a cases series submitted to this technique. Methods A total of 26 patients submitted to medial closing-wedge distal femoral osteotomy from 2002 to 2013 were evaluated. All of the patients had their medical files and imaging exams reviewed to evaluate the degree of correction and their current state. Results Out of the 26 patients, 12 weremale and 14 were female. Their mean age was 47.15 years old. In all of the cases, a neutral alignment related to the anatomical axis was achieved. Most of the patients presented bone healing at 6 weeks. There were no cases of bleeding during the surgery. One patient presented with delayed bone healing. One patient complained of plaque-related discomfort, requiring the removal of the device. One patient had a superficial infection, but no osteotomy revision was needed. Therewere no cases of deep venous thrombosis or of pulmonary thromboembolism. To date, there has been no conversion to total knee replacement. Conclusion Treatment with medial closing-wedge distal femoral osteotomy sustained the proposed correction in patients with up to 15 years of follow-up.

Resumo Objetivo Descrever a técnica cirúrgica da osteotomia femoral com cunha de fechamento medial e uma série de casos submetidos a essa técnica. Métodos Foram avaliados 26 pacientes submetidos a osteotomia femoral distal com cunha de fechamento medial de 2002 a 2013. Os prontuários e exames de imagem de todos os pacientes foram revisados para avaliação do grau de correção e estado atual. Resultados Dos 26 pacientes operados, 12 eramdo sexomasculino e 14 do feminino. A idade média foi de 47,15 anos. Em todos os casos, obteve-se alinhamento neutro em relação ao eixo anatômico. A maioria dos pacientes alcançou a consolidação óssea da osteotomia com seis semanas. Não foram observados casos de sangramentos durante a cirurgia. Um paciente apresentou retardo da consolidação óssea. Um paciente apresentou desconforto sobre a placa, foi necessária sua retirada. Um paciente apresentou infecção superficial sem necessidade de revisão da osteotomia. Não foram observados casos de trombose venosa profunda e tromboembolismo pulmonar. Até o momento não houve conversão para artroplastia total de joelho. Conclusão O tratamento com osteotomia femoral distal com cunha de fechamento medial manteve a correção proposta em pacientes com seguimento de até 15 anos.

Evaluation and Management of Subchondral Calcium Phosphate Injection Technique to Treat Bone Marrow Lesion.

PURPOSE: This study aimed to compile available data in medical literature about subchondral calcium phosphate injection, comparing results obtained with this technique, as well as indications, complications, and other important factors in treatment of bone marrow lesions. DESIGNS: A literature review using PubMed and Medline database in order to identify works with terms "subchondral calcium phosphate injection," " subchondroplasty®," "bone marrow lesion," and "knee." Eight relevant articles were found. RESULTS: A total of 164 patients with bone marrow lesion mainly on femoral condyle and tibial plateau recovered with significant functional improvement of knee after subchondral calcium phosphate treatment. Although 25% of them still had some type of pain complaint, they also showed improvement. There were few complications reported and return to activities occurred after 3 months on average. CONCLUSIONS: Few studies evaluate the result of using subchondral calcium phosphate injection technique. However, all presented favorable results regarding pain and improvement of knee function. In addition, within 2 years, there was a 70% reduction in conversion to total knee arthroplasty in patients with previous surgical indication who choose calcium phosphate treatment.

Achalasia and thyroid disease: possible autoimmune connection? / Acalasia e doença tireoidiana: uma conexão autoimune possível?

Many cases have been published showing a co-existence of autoimmune thyroid diseases (AITDs) and other autoimmune diseases. About a quarter of patients with achalasia have a concurrent thyroid disease, most commonly associated with hypothyroidism. Although relatively rare, the association of achalasia and hyperthyroidism requires attention. The physiopathology of Grave's Disease (GD) involves B- and T-mediator lymphocytes, which have an affinity for known thyroid antigens: thyroglobulin, thyroid-peroxidase, and thyrotrophin receptor. Currently, however, the real physiopathogenesis of achalasia continues to be unknown. Some important findings are suggestive of an autoimmune mechanism: significant infiltration of the myoenteric plexus by monocytes, presence of the class II-Human Histocompatibility Complex DQwl antigen and antibodies to myoenteric neurons. The present case reports a patient who, despite testing negative for Chagas' disease, had achalasia, progressed to developing significant wasting and worsening of his quality of life, was later diagnosed with hyperthyroidism. After endoscopic esophageal dilatation and radioiodine ablation of the thyroid gland, there was great improvement in the patient clinical condition. Arq Bras Endocrinol Metab. 2012;56(9):677-82.

Muitos casos têm sido publicados mostrando uma coexistência entre as doenças autoimunes da tireoide (DAIT) e outras doenças autoimunes. Cerca de um quarto dos pacientes com acalasia têm doenças da tireoide concomitantemente, sendo a mais comum a associação com hipotireoidismo. Apesar de ser relativamente rara, a associação da acalasia e hipertireoidismo requer atenção. A fisiopatologia da doença de Graves (DG) envolve os linfócitos B e T-mediados, os quais têm afinidade pelos antígenos da tireoide: tireoglobulina, tireoperoxidase e receptor de tireotrofina. Atualmente, a real fisiopatogenia da acalasia continua desconhecida. No entanto, alguns importantes achados em análise são sugestivos de mecanismo autoimune: infiltração significativa do plexo mioentérico pelos monócitos, presença do antígeno-DQwl do Complexo Humano de Histocompatibilidade classe II e presença de anticorpos contra neurônios mioentéricos. Este presente caso aborda um paciente que, apesar de testes negativos para doença de Chagas, tem acalasia que progrediu para o desenvolvimento de significativa perda ponderal e piora da sua qualidade de vida, posteriormente, diagnosticado com hipertireoidismo. Após dilatação endoscópica esofágica e ablação da glândula tireoide com radioiodo, houve grande melhora na condição clínica do paciente. Arq Bras Endocrinol Metab. 2012;56(9):677-82.

Achalasia and thyroid disease: possible autoimmune connection?

Many cases have been published showing a co-existence of autoimmune thyroid diseases (AITDs) and other autoimmune diseases. About a quarter of patients with achalasia have a concurrent thyroid disease, most commonly associated with hypothyroidism. Although relatively rare, the association of achalasia and hyperthyroidism requires attention. The physiopathology of Grave's Disease (GD) involves B- and T-mediator lymphocytes, which have an affinity for known thyroid antigens: thyroglobulin, thyroid-peroxidase, and thyrotrophin receptor. Currently, however, the real physiopathogenesis of achalasia continues to be unknown. Some important findings are suggestive of an autoimmune mechanism: significant infiltration of the myoenteric plexus by monocytes, presence of the class II-Human Histocompatibility Complex DQwl antigen and antibodies to myoenteric neurons. The present case reports a patient who, despite testing negative for Chagas' disease, had achalasia, progressed to developing significant wasting and worsening of his quality of life, was later diagnosed with hyperthyroidism. After endoscopic esophageal dilatation and radioiodine ablation of the thyroid gland, there was great improvement in the patient clinical condition.