MMP-8 polymorphism is genetic marker to tendinopathy primary posterior tibial tendon.

Posterior tibial tendon is particularly vulnerable and is responsible for much morbidity in sportspersons. Some patients have a predisposition without a clinically recognized cause, suggesting that individual characteristics, inclusive genetic inheritance, play an important role in tendinopathy. Matrix metalloproteinase (MMP)-8 is a proteinase capable of degrading a large amount of extracellular proteins, and influence degradation and remodeling of collagen. To determine whether the -799 polymorphism in the promoter of MMP-8 gene is associated with tendinopathy in posterior tibial tendon, 50 patients undergoing surgical procedures and anatomopathological diagnosis of degenerative lesions of the posterior tibial tendon and 100 control patients with posterior tibial tendon integrity and without signs of degeneration in magnetic resonance imaging were evaluated for the -799 MMP-8 polymorphism. There was a significant difference in the presence of the different alleles (P = 0.001) and genotype (P = 0.003) between the control group and the test group for the MMP-8 gene. The polymorphism at position -799 of the gene for MMP-8 is associated with tendinopathy primary posterior tibial tendon in the population studied. The results suggest that individuals with the T allele are at greater risk of developing tendinopathy.

Effect of neurotrophic factor, MDP, on rats’ nerve regeneration

Our objective was to determine the immune-modulating effects of the neurotrophic factor N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP) on median nerve regeneration in rats. We used male Wistar rats (120-140 days of age, weighing 250-332 g) and compared the results of three different techniques of nerve repair: 1) epineural neurorrhaphy using sutures alone (group S - 10 rats), 2) epineural neurorrhaphy using sutures plus fibrin tissue adhesive (FTA; group SF - 20 rats), and 3) sutures plus FTA, with MDP added to the FTA (group SFM - 20 rats). Functional assessments using the grasp test were performed weekly for 12 weeks to identify recovery of flexor muscle function in the fingers secondary to median nerve regeneration. Histological analysis was also utilized. The total number and diameter of myelinated fibers were determined in each proximal and distal nerve segment. Two indices, reported as percentage, were calculated from these parameters, namely, the regeneration index and the diameter change index. By the 8th week, superiority of group SFM over group S became apparent in the grasping test (P = 0.005). By the 12th week, rats that had received MDP were superior in the grasping test compared to both group S (P < 0.001) and group SF (P = 0.001). Moreover, group SF was better in the grasping test than group S (P = 0.014). However, no significant differences between groups were identified by histological analysis. In the present study, rats that had received MDP obtained better function, in the absence of any significant histological differences.

[Contribution to the anatomical study of medial arm flap]. / Contribuição ao estudo anatômico do retalho medial do braço.

The reports of transfer of the medial arm flap have been inconsistent, and confusion remains about its anatomy and use. The advantages of this donor site, however, justify new researches about the vascular anatomy of the flap. In this study, the vascular supply to the medial side of the arm was analysed in fifteen fresh cadaver dissections. The methods, the anatomical bases, and the technique of elevation of the flap were detailed. Methylene blue injection studies showed the extent of the medial arm flap. The authors found that, in most cases, the superior ulnar collateral artery was the main vessel of this flap, giving cutaneous branches to medial arm skin. The diameter of the superior ulnar collateral artery was measured and considered adequate for microsurgical transfer. If no major cutaneous branches are noted from superior ulnar collateral artery, then a significant direct cutaneous branch from the brachial artery will be always present. With this in mind, the dissection must initially proceed carefully, preserving all vessels that may contribute to cutaneous perfusion. The authors conclude that with knowledge of its anatomical variations, the medial arm flap is a plausible reconstructive option.

[Surgical approach to giant cell tumors of the distal radius]. / Abordagem cirúrgica do tumor de células gigantes da extremidade distal do rádio.

The authors review 15 patients with giant cell tumor of the distal part of the radius in the period from 1980 to 1993. Pain was always present. The treatment of stage 2 with marginal resection and methylmethacrylate yielded excellent result. In the treatment of stage 3 the authors emphasize the need of wide resection. In these patients the best functional results were obtained with the use of vascularized proximal epiphyseal fibular graft, preserving some painless mobility of the wrist and forearm.

[Wrist arthroscopy]. / Artroscopia do punho.

Wrist arthroscopy was performed in 12 patients that complained of wrist pain for four months and in whom the diagnosis not established. The instruments and the technique of the procedure is described. In two patients the wrist pain diminished and in eight it disappeared. In other two patients the pain was not relieved. There were no complications.