DOPING CONTROL IN MALE SOCCER PLAYERS IN BRAZIL: 10 YEARS OF FOLLOW-UP.

Objective: To understand the Adverse Analytical Finding (AAF) that have occurred in Brazilian soccer in a recent 10-year period, comparing them to international data, to know the Brazilian profile. Methods: A review of the AAR in the Doping Control Commission database of the Brazilian Football Association from 2008 to 2017. The AAR in professional male soccer players between 2008 and 2017 were considered. Results: The sample selected in this research was composed of 40,092 doping tests, with 113 AAR, identified in 18 different competitions (0.28%) in the professional category, in Brazilian national and state competitions between 2008 and 2017, flagged in doping control exams through urine samples. Stimulants were detected most frequently (31.0%), followed by glucocorticoids (21.2%), diuretics, and masking agents (19.5%). The Brazilian Championship series did not show a relationship with any of the World Anti-Doping Agency (WADA) groups of substances. Series A showed 0.07% of AAR, Series B 0.21%, Series C 0.75% and Series D 1.49. Conclusion: The rate of AAR in Brazilian soccer was 0.28%, lower than the average for all soccer worldwide, and shows similar percentages among field positions. Stimulants were the most prevalent drugs. The national elite soccer competitions showed significantly fewer cases than the lower divisions. Level of Evidence II; Retrospective Study.

Objetivo: Compreender os Resultados Analíticos Adversos (RAA) ocorridos no futebol brasileiro nos últimos 10 anos, comparando-os aos dados internacionais, para conhecer o perfil do futebol brasileiro. Métodos: Revisão dos RAA no banco de dados da Comissão de Controle de Doping da Confederação Brasileira de Futebol de 2008 a 2017. Foram consideradas os RAA entre 2008 e 2017. Resultados: A amostra selecionada nesta pesquisa foi composta por 40.092 exames antidoping com 113 RAA, os quais foram identificados em 18 competições diferentes (0,28%) em atletas da categoria professional, entre 2008 e 2017, sinalizadas em exames de controle de doping através de amostras de urina. Estimulantes foram detectados com maior frequencia (31%), seguidos de glicocorticoides (21,2%), diuréticos e agentes mascarantes (19,5%). A série do Campeonato Brasileiro não apresentou relação com nenhum dos grupos de substâncias da World Anti-Doping Agency (WADA). A série A apresentou 0,07% da AAR, Série B 0,21%, Série C 0,75% e Série D 1,49%. Conclusão: A taxa de RAA no futebol brasileiro foi de 0,28%, inferior à media do futebol mundial e apresenta percentuais semelhantes entre as posições do campo. Os estimulantes foram as drogas mais prevalentes. As competições nacionais de futebol das Séries superiores apresentaram significativamente menos casos do que as inferiores. Nível de Evidência II; Estudo Retrospectivo.

Shoulder injuries in Brazilian professional football players: epidemiological analysis of 3828 games.

OBJECTIVES: Football is a globally played sport that poses potential risks for musculoskeletal injuries. Upper-limb injuries have a lower incidence rate than lower-limb injuries but can still cause absenteeism and performance impairment in football players. This descriptive epidemiological study aimed to evaluate and compare the epidemiological data on shoulder injuries among professional football players in two major Brazilian football championships. METHODS: Data were collected throughout the championships, and club physicians medically evaluated each player during official games using two online forms. The collected information included the player's age and position, injury diagnosis, laterality, location on the field where the injury occurred, playing time, imaging examinations performed, need for surgical treatment, time to return to play (TRP), and recurrence of the injury. The incidence of injuries was evaluated using the Federation Internationale de Football Association (FIFA) incidence formula. RESULTS: A total of 107 shoulder injuries were recorded (4.3% of all injuries), with a FIFA incidence of 0.847. Glenohumeral dislocations (GHDs) and acromioclavicular dislocations (ACDs) accounted for 37.38% and 35.51% of all shoulder injuries, respectively. Goalkeepers and defenders presented, respectively, a 2.15 and 1.57 times increased risk of suffering shoulder injuries, while attackers presented a 0.63 times decreased risk. Injury recurrence was observed in 14.95% of cases, with GHDs and ACDs showing recurrence rates of 35.00% and 5.26%, respectively. Surgery was performed in 9.35% of cases, with GHDs representing 50% of all surgeries. The average TRP was 22.37 days, with severe and major injuries accounting for 11.21% and 10.28% of all injuries, respectively. Goalkeepers had the highest average TRP of 36.15 days. Recurring injuries had a higher average TRP of 33.44 days compared to nonrecurring injuries, which had an average TRP of 20.43 days. Surgically treated injuries had the highest average TRP of 112.5 days. CONCLUSION: Shoulder injuries in the professional football scenario are of great concern due to the high recurrence rate and need for surgical treatment, which will lead to a long TRP. These findings emphasize the need to implement prevention protocols and effective treatments to reduce the consequences of such injuries, which are usually underestimated in this sport. LEVEL OF EVIDENCE: III.

Doping control in male soccer players in brazil: 10 years of follow-up / Controle de doping no futebol masculino no brasil: 10 anos de acompanhamento

ABSTRACT Objective: To understand the Adverse Analytical Finding (AAF) that have occurred in Brazilian soccer in a recent 10-year period, comparing them to international data, to know the Brazilian profile. Methods: A review of the AAR in the Doping Control Commission database of the Brazilian Football Association from 2008 to 2017. The AAR in professional male soccer players between 2008 and 2017 were considered. Results: The sample selected in this research was composed of 40,092 doping tests, with 113 AAR, identified in 18 different competitions (0.28%) in the professional category, in Brazilian national and state competitions between 2008 and 2017, flagged in doping control exams through urine samples. Stimulants were detected most frequently (31.0%), followed by glucocorticoids (21.2%), diuretics, and masking agents (19.5%). The Brazilian Championship series did not show a relationship with any of the World Anti-Doping Agency (WADA) groups of substances. Series A showed 0.07% of AAR, Series B 0.21%, Series C 0.75% and Series D 1.49. Conclusion: The rate of AAR in Brazilian soccer was 0.28%, lower than the average for all soccer worldwide, and shows similar percentages among field positions. Stimulants were the most prevalent drugs. The national elite soccer competitions showed significantly fewer cases than the lower divisions. Level of Evidence II; Retrospective Study.

RESUMO Objetivo: Compreender os Resultados Analíticos Adversos (RAA) ocorridos no futebol brasileiro nos últimos 10 anos, comparando-os aos dados internacionais, para conhecer o perfil do futebol brasileiro. Métodos: Revisão dos RAA no banco de dados da Comissão de Controle de Doping da Confederação Brasileira de Futebol de 2008 a 2017. Foram consideradas os RAA entre 2008 e 2017. Resultados: A amostra selecionada nesta pesquisa foi composta por 40.092 exames antidoping com 113 RAA, os quais foram identificados em 18 competições diferentes (0,28%) em atletas da categoria professional, entre 2008 e 2017, sinalizadas em exames de controle de doping através de amostras de urina. Estimulantes foram detectados com maior frequencia (31%), seguidos de glicocorticoides (21,2%), diuréticos e agentes mascarantes (19,5%). A série do Campeonato Brasileiro não apresentou relação com nenhum dos grupos de substâncias da World Anti-Doping Agency (WADA). A série A apresentou 0,07% da AAR, Série B 0,21%, Série C 0,75% e Série D 1,49%. Conclusão: A taxa de RAA no futebol brasileiro foi de 0,28%, inferior à media do futebol mundial e apresenta percentuais semelhantes entre as posições do campo. Os estimulantes foram as drogas mais prevalentes. As competições nacionais de futebol das Séries superiores apresentaram significativamente menos casos do que as inferiores. Nível de Evidência II; Estudo Retrospectivo.

Medical planning for mass gathering sports events in brazil / Planificación médica para eventos deportivos masivos en brasil / Planejamento médico para eventos esportivos de massa no brasil

ABSTRACT Introduction: Medical planning for mass gathering events is founded on the structuring of assistance to the population involved and the preservation of the response capacities of the local healthcare system. Large sporting events attended by crowds are increasingly common in society. These events have been shown to be dangerous, generating higher incidences of injuries and illnesses than usual. Thus, planning and the interaction among various public and private sectors are required for the prevention of and response to emergencies and incidents involving multiple victims. Methods: Recently published studies on medical planning for large sports events and current federal agency legislation were selected to conduct an updated review on the subject. Results: After reading titles and abstracts, 159 papers were chosen for a full reading, 50 of which met the eligibility criteria and were included as the basis for this review. The size of the audience, the weather, and the behavior of the crowd seem to contribute significantly to the estimated need for resources in sporting events. Conclusion: Mass events require planning for prevention and to strengthen the resilience of host communities. There is a still a lack of evidence that these events increase the risk of the mass spreading of disease. Level of Evidence: V; Expert opinion .

RESUMEN Introducción: La planificación médica de eventos masivos tiene como pilares la estructuración de la atención a la población involucrada y la preservación de las capacidades de respuesta del sistema local de salud. Los grandes eventos deportivos a los que asisten multitudes son cada vez más comunes en la sociedad. Estos eventos han demostrado ser peligrosos, generando una mayor incidencia de lesiones y enfermedades de lo habitual. Por lo tanto, es necesaria la planificación y la interacción de diversos sectores, públicos y privados, para la prevención y respuesta a emergencias o incidentes con múltiples víctimas. Métodos: Se seleccionaron estudios recientes publicados sobre la planificación médica de grandes eventos deportivos y la legislación vigente en organismos federales con el objetivo de realizar una revisión actualizada sobre el tema. Resultados: Después de leer los títulos y resúmenes, se eligieron 159 artículos para lectura completa y 50 cumplieron los criterios de elegibilidad y se utilizaron como base para esta revisión. El tamaño del público, las condiciones climáticas y el comportamiento de la multitud parecen contribuir significativamente a la estimación de los requisitos de recursos en los eventos deportivos. Conclusión: Los eventos masivos requieren una planificación para la prevención y el fortalecimiento de la resiliencia de las comunidades anfitrionas. Todavía no hay pruebas de que estos eventos aumenten el riesgo de propagación masiva de enfermedades. Nivel de Evidencia: V; Opinión experta .

RESUMO Introdução: O planejamento médico para eventos de massa tem como pilares a estruturação dos atendimentos à população envolvida e a preservação da capacidade de resposta do sistema de saúde local. Grandes eventos esportivos frequentados por multidões são cada vez mais comuns na sociedade. Esses eventos têm se mostrado perigosos, gerando maiores incidências de lesões e doenças do que o habitual. Dessa forma, é necessário planejamento e interação de diversos setores, públicos e privados, para prevenção e resposta à ocorrência de emergências ou incidentes com múltiplas vítimas. Métodos: Foram selecionados trabalhos recentes publicados sobre o planejamento médico para grandes eventos esportivos e a legislação vigente em órgãos federais com o objetivo de realizar uma revisão atualizada sobre o assunto. Resultados: Após a leitura de títulos e resumos, 159 trabalhos foram escolhidos para leitura integral e 50 preencheram os critérios de elegibilidade e foram usados como base para esta revisão. O tamanho do público, as condições climáticas e o comportamento da multidão parecem contribuir significativamente para a estimativa da necessidade de recursos em eventos esportivos. Conclusão: Eventos de massa exigem planejamento para prevenção e fortalecimento da resiliência das comunidades anfitriãs. Ainda faltam evidências de que esses eventos aumentem o risco de propagação maciça de doenças. Nível de evidência: V; Opinião do especialista .

Assessment of Predictors of Infection in Primary Knee and Hip Arthroplasty: A Case-control Study.

Objective This study assesses risk factors for periprosthetic joint infection after elective primary total knee or hip arthroplasty. Methods The study included 706 medical records of patients undergoing elective primary total hip or knee arthroplasty from January to December 2018. We used a multivariate analysis of infection predictors through a logistic regression model. The R software performed all statistical analysis. Results The prevalence of infection in the sample was 2.0% (14 cases). Most patients were women (79.6%), with an afflicted right side (50.6%), and underwent a total knee arthroplasty (61.3%). Significant risk factors ( p < 0.05) for infection included surgical time greater than 120 minutes ( p = 0.009) and a history of diabetes ( p = 0.025). Conclusion The risk of infection after elective primary total knee or hip arthroplasty is higher when the surgical procedure is lengthy (over 120 minutes), or the patient has a history of diabetes mellitus. Level of Evidence IIIB, retrospective, case-control study.

Epidemiology of Upper Limb Injuries in two major Brazilian Soccer Championships from 2016 to 2019.

PURPOSE: To evaluate epidemiological data of upper limb injuries in professional athletes who participated in two major Brazilian soccer championships between 2016 and 2019. METHODS: A prospective cohort study was conducted to evaluate the teams of two divisions over four seasons within the Brazilian Soccer Championship and the Paulista Soccer Championship. Clubs and their doctors were contacted to participate in the study and guided on the correct way to enter data via online platforms: Transfermarkt (Transfermarkt GmbH & Co. KG) and Survey Monkey (Momentive.AI). Demographic data, injury characteristics, and FIFA Incidence Formula were analyzed. RESULTS: Overall, the study analyzed 3,828 matches and 126,357 hours of play. Upper limb injuries were registered 169 times, representing 6.8% of total injuries, with a FIFA incidence of 1.34. Most lesions occurred in forward players (21.3%), the shoulder exhibited the highest number of injuries (63.3%). The player's position was related to the location on the field where the injury occurred (p < 0.001); however, there was no relationship between the type of injury and the location on the body (p > 0.001). The average time to return to play was 19.1 days (range 0-200 days) and it was longer for goalkeepers. The necessity of surgical treatment was statistically associated with additional time to return to play (p < 0.001). CONCLUSIONS: Shoulder injuries were the most frequent upper limb injury sustained during the two major Brazilian soccer championships. Forward players suffered the most upper limb injuries and goalkeepers experienced the longest time to return to play.

Assessment of Predictors of Infection in Primary Knee and Hip Arthroplasty: A Case-control Study / Avaliação de fatores preditores de infecção na artroplastia primária de joelho e quadril: Um estudo caso-controle

Abstract Objective This study assesses risk factors for periprosthetic joint infection after elective primary total knee or hip arthroplasty. Methods The study included 706 medical records of patients undergoing elective primary total hip or knee arthroplasty from January to December 2018. We used a multivariate analysis of infection predictors through a logistic regression model. The R software performed all statistical analysis. Results The prevalence of infection in the sample was 2.0% (14 cases). Most patients were women (79.6%), with an afflicted right side (50.6%), and underwent a total knee arthroplasty (61.3%). Significant risk factors (p< 0.05) for infection included surgical time greater than 120 minutes (p= 0.009) and a history of diabetes (p= 0.025). Conclusion The risk of infection after elective primary total knee or hip arthroplasty is higher when the surgical procedure is lengthy (over 120 minutes), or the patient has a history of diabetes mellitus. Level of EvidenceIIIB, retrospective, case-control study.

Resumo Objetivo Avaliar os fatores de risco para infecção articular periprotética após procedimento cirúrgico eletivo de artroplastia primária total de joelho ou quadril. Métodos Incluem-se no estudo 706 prontuários de pacientes que foram submetidos a artroplastia total primária eletiva de quadril ou joelho entre os meses de janeiro e dezembro de 2018. Utilizou-se a análise multivariada dos fatores preditores de infecção por meio de um modelo de regressão logística. Toda a análise estatística foi realizada no software R. Resultados A prevalência de infecção de toda a amostra foi de 2,0% (14 casos). A amostra contou com a maioria do gênero feminino (79,6%), com o lado direito afetado (50,6%) e predomínio da artroplastia total de joelho (61,3%). Os fatores de risco significativos (p< 0,05) para a infecção foram: tempo cirúrgico maior do que 120 minutos (p= 0,009) e diagnóstico prévio de diabetes (p= 0,025). Conclusão Artroplastias totais primárias eletivas de joelho ou quadril possuem maior risco de infecção quando ocorre um tempo prolongado do procedimento cirúrgico (acima de 120 minutos) e quando o paciente possui diagnóstico prévio de diabetes mellitus. Nível de EvidênciaIIIB, estudo retrospectivo caso-controle.

Atypical femur fractures associated with chronic bisphosphonates use: A case series with 66 patients.

Objective The present study aims to describe outcomes from a series of surgically treated patients with atypical femoral fracture due to bisphosphonates use, in addition to correlate the time of previous medication use with fracture consolidation time, and to compare the consolidation time of complete and incomplete fractures. Methods This is an observational, retrospective study with 66 patients diagnosed with atypical femur fractures associated with chronic bisphosphonates use. The patients underwent orthopedic surgical treatment at a referral hospital from January 2018 to March 2020. Results All patients were females, with two bilateral cases. Fracture consolidation occurred in all cases, with an average time of 2.3 months and a follow-up time of 5.8 months. The average time of bisphosphonates use was 7.8 years. There was no correlation between the time of previous bisphosphonates use and the time for fracture consolidation. Consolidation time differed in complete and incomplete fractures. Conclusion Surgical treatment with a long cephalomedullary nail resulted in consolidation in all patients. The consolidation time was longer in complete fractures when compared with incomplete lesions, and there was no correlation between the time of previous bisphosphonates use and the consolidation time . Level of evidence Level IV, case series.

Atypical femur fractures associated with chronic bisphosphonates use: A case series with 66 patients / Fraturas atípicas do fêmur associadas ao uso crônico de bisfosfonatos: Uma série de casos de 66 pacientes

Abstract Objective The present study aims to describe outcomes from a series of surgically treated patients with atypical femoral fracture due to bisphosphonates use, in addition to correlate the time of previous medication use with fracture consolidation time, and to compare the consolidation time of complete and incomplete fractures. Methods This is an observational, retrospective study with 66 patients diagnosed with atypical femur fractures associated with chronic bisphosphonates use. The patients underwent orthopedic surgical treatment at a referral hospital from January 2018 to March 2020. Results All patients were females, with two bilateral cases. Fracture consolidation occurred in all cases, with an average time of 2.3 months and a follow-up time of 5.8 months. The average time of bisphosphonates use was 7.8 years. There was no correlation between the time of previous bisphosphonates use and the time for fracture consolidation. Consolidation time differed in complete and incomplete fractures. Conclusion Surgical treatment with a long cephalomedullary nail resulted in consolidation in all patients. The consolidation time was longer in complete fractures when compared with incomplete lesions, and there was no correlation between the time of previous bisphosphonates use and the consolidation time . Level of evidenceLevel IV, case series

Resumo Objetivo Descrever os resultados de uma série de pacientes tratados cirurgicamente com diagnóstico de fratura femoral atípica associada ao uso de bisfosfonatos, assim como correlacionar o tempo de uso prévio da medicação com o tempo de consolidação da fratura e comparar o tempo de consolidação das fraturas completas e incompletas. Métodos Trata-se de um estudo observacional e retrospectivo de 66 pacientes com diagnóstico de fratura atípica do fêmur associada ao uso crônico de bisfosfonatos. Os pacientes foram submetidos ao tratamento cirúrgico ortopédico em hospital de referência no período de janeiro de 2018 a março de 2020. Resultados Os pacientes incluídos no estudo eram todos do sexo feminino, com dois casos bilaterais. A consolidação da fratura ocorreu em todos os casos com tempo médio de 2,3 meses e seguimento de 5,8 meses. O tempo médio de uso de bisfosfonatos foi de 7,8 anos. Não houve correlação do tempo de uso prévio de bisfosfonatos com o tempo de consolidação das fraturas. Houve uma diferença do tempo de consolidação entre as fraturas completas e incompletas. Conclusão Houve consolidação após tratamento cirúrgico com haste cefalomedular longa em todos os pacientes do presente estudo, sendo o tempo de consolidação maior nas fraturas completas em relação às incompletas, e não houve correlação entre o tempo de uso prévio de bisfosfonatos e o tempo de consolidação. Nível de evidênciaNível IV, série de casos

MORTALITY IN PATIENTS > 90 YEARS OLD WITH PROXIMAL FEMORAL FRACTURES SUBJECTED TO SURGERY.

Introduction: Proximal femoral fractures have a high mortality rate among older adults, especially those aged > 80 years. Objective: To analyze predictive factors for hospital or late mortality of patients > 90 years old who showed proximal femoral fracture and subjected to surgery. Methods: The study included data from 230 patients aged > 90 years diagnosed with proximal femoral fracture and who underwent surgery between January and December 2017. The statistical evaluation was performed by multivariate analysis by a logistic regression. The associations were estimated by the odds ratio (OD) and confidence interval (95%). Statistical significance was determined with p < 0.05. Results: Late death occurred in 51.3% (118 patients) of the sample and hospital death in 3.5% (8 patients). Most patients were women (83.5%) and the most common fracture was transtrochanteric (57.0%). There was association between late death and the surgery duration (p < 0.05), and between hospital death and the presence of heart diseases (p < 0.05) or endocrinopathies (p < 0.05). Conclusion: Most patients aged > 90 years with proximal femoral fracture subjected to surgery died in less than one year. Late death was associated with the surgery duration and hospital death was associated with the presence of previous endocrinopathies or heart diseases, and the female gender was a protective factor from this outcome. Level of Evidence III, Retrospective Case-Control Study.

Introdução: As fraturas do fêmur proximal têm alta taxa de mortalidade entre os idosos, especialmente entre os considerados superidosos (> 80 anos). Objetivo: Analisar fatores preditivos para mortalidade hospitalar ou tardia de pacientes com idade superior a 90 anos que apresentaram fratura do fêmur proximal e foram submetidos ao tratamento cirúrgico. Métodos: O estudo incluiu dados de 230 pacientes com idade superior a 90 anos que apresentaram diagnóstico de fratura do fêmur proximal e foram submetidos ao tratamento cirúrgico entre janeiro e dezembro de 2017. A avaliação estatística foi realizada pela análise multivariada por meio da regressão logística. As associações foram estimadas pelo valor de odds ratio (OD) e intervalo de confiança (95%). A significância estatística foi determinada com p < 0,05. Resultados: O óbito tardio ocorreu em 51,3% (118 pacientes) da amostra e o hospitalar em 3,5% (8 pacientes). A maioria dos pacientes foram do sexo feminino (83,5%) e a fratura mais comum foi a transtrocanteriana (57,0%). Houve associação do óbito tardio com a duração do procedimento cirúrgico (p < 0,05), e do óbito hospitalar com a presença de cardiopatias (p < 0,05) ou endocrinopatias (p < 0,05). Conclusão: A maioria dos pacientes com idade superior a 90 anos com fratura do fêmur proximal submetida ao tratamento cirúrgico evoluiu para óbito em menos de um ano. O óbito tardio foi associado à duração do procedimento cirúrgico e o óbito hospitalar à presença de endocrinopatias ou cardiopatias prévias, sendo o sexo feminino fator de proteção para tal desfecho. Nível de Evidência III, Estudo Caso-Controle Retrospectivo.

Intra-articular Infiltration of Platelet-Rich Plasma versus Hyaluronic Acid in Patients with Primary Knee Osteoarthritis: Preliminary Results from a Randomized Clinical Trial.

Objective The present study aimed to compare the effects of intraarticular infiltration of platelet-rich plasma with those of hyaluronic acid infiltration in the treatment of patients with primary knee osteoarthritis. Methods A randomized clinical trial was conducted with 29 patients who received an intraarticular infiltration with hyaluronic acid (control group) or platelet-rich plasma. Clinical outcomes were assessed using the visual analog scale for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire before and after the intervention. In addition, the posttreatment adverse effects were recorded. Categorical variables were analyzed using the chi-square and Fisher exact tests, whereas continuous variables were analyzed using the Student t test, analysis of variance, and the Wilcoxon test; all calculations were performed with the Stats package of the R software. Results An independent analysis of each group revealed a statistical difference within the first months, with improvement in the pain and function scores, but worsening on the 6 th month after the procedure. There was no difference in the outcomes between the groups receiving hyaluronic acid or platelet-rich plasma. There was no serious adverse effect or allergic reaction during the entire follow-up period. Conclusion Intraarticular infiltration with hyaluronic acid or platelet-rich plasma in patients with primary knee gonarthrosis resulted in temporary improvement of functional symptoms and pain. There was no difference between interventions.

Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis.

Objective To develop an evidence-based protocol to guide magnetic resonance imaging (MRI) requests in elderly patients with suspected knee osteoarthrosis and to evaluate its effectiveness after implementation. Methods The institutional protocol was developed after reviewing the literature during the first semester of 2018. The control group was defined as patients cared for in the first semester of 2018, before the implementation/dissemination of the institutional protocol, and the study group was composed by patients cared for during the second semester of 2018 after the standardization of MRI requests for suspected knee osteoarthrosis. Results Our sample included 826 patients undergoing knee MRI, with a mean age of 69.3 years. Protocol implementation decreased MRI requests and increased radiograph requests ( p < 0.001). After the implementation of the protocol, the MRI changed the diagnosis or treatment in only 11.2% of the cases. Conclusion Protocol implementation resulted in a 47.5% reduction in the number of requests for knee MRI, with most (89%) patients with alteration in diagnosis or treatment. Level of evidence: case-control study (IIIB).

Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis / Protocolo de solicitação de ressonância magnética do joelho em pacientes idosos com suspeita de osteoartrose: Redução da solicitação de exames e o impacto na conduta e no diagnóstico

Abstract Objective To develop an evidence-based protocol to guide magnetic resonance imaging (MRI) requests in elderly patients with suspected knee osteoarthrosis and to evaluate its effectiveness after implementation. Methods The institutional protocol was developed after reviewing the literature during the first semester of 2018. The control group was defined as patients cared for in the first semester of 2018, before the implementation/dissemination of the institutional protocol, and the study group was composed by patients cared for during the second semester of 2018 after the standardization of MRI requests for suspected knee osteoarthrosis. Results Our sample included 826 patients undergoing knee MRI, with a mean age of 69.3 years. Protocol implementation decreased MRI requests and increased radiograph requests (p < 0.001). After the implementation of the protocol, the MRI changed the diagnosis or treatment in only 11.2% of the cases. Conclusion Protocol implementation resulted in a 47.5% reduction in the number of requests for knee MRI, with most (89%) patients with alteration in diagnosis or treatment. Level of evidence: case-control study (IIIB).

Resumo Objetivo Desenvolver um protocolo, baseado em evidências, para guiar a solicitação de exames de ressonância magnética (RM) em pacientes idosos com suspeita de osteoartrose do joelho e avaliar a sua eficácia após implementação. Métodos O protocolo institucional foi desenvolvido após revisão da literatura durante o primeiro semestre do ano de 2018. Definiu-se como grupo de controle os pacientes do primeiro semestre de 2018, antes da aplicação/divulgação do protocolo institucional, e o grupo de estudo foi composto por pacientes atendidos no segundo semestre do mesmo ano após a padronização dos pedidos de RM para a suspeita de osteoartrose do joelho. Resultados Nossa amostra contou com 826 pacientes submetidos a RM do joelho, com média de idade de 69,3 anos. Após a implementação do protocolo, houve um decréscimo das solicitações de RM e um aumento no número de solicitações de radiografias (p < 0,001). Após a implementação do protocolo, a RM alterou o diagnóstico ou a conduta do médico em apenas 11,2% dos casos. Conclusão Após a introdução do protocolo, encontrou-se uma redução de 47,5% no número de pedidos de RM do joelho, sendo que a maioria (89%) dos pacientes não tiveram suas condutas ou diagnóstico alterados. Nível de evidência: estudo caso-controle (IIIB).

Intra-articular Infiltration of Platelet-Rich Plasma versus Hyaluronic Acid in Patients with Primary Knee Osteoarthritis: Preliminary Results from a Randomized Clinical Trial / Infiltração intraarticular de plasma rico em plaquetas versus ácido hialurônico em pacientes com osteoartrose primária do joelho: Ensaio clínico randomizado com resultados preliminares

Abstract Objective The present study aimed to compare the effects of intraarticular infiltration of platelet-rich plasma with those of hyaluronic acid infiltration in the treatment of patients with primary knee osteoarthritis. Methods A randomized clinical trial was conducted with 29 patients who received an intraarticular infiltration with hyaluronic acid (control group) or platelet-rich plasma. Clinical outcomes were assessed using the visual analog scale for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire before and after the intervention. In addition, the posttreatment adverse effects were recorded. Categorical variables were analyzed using the chi-square and Fisher exact tests, whereas continuous variables were analyzed using the Student t test, analysis of variance, and the Wilcoxon test; all calculations were performed with the Stats package of the R software. Results An independent analysis of each group revealed a statistical difference within the first months, with improvement in the pain and function scores, but worsening on the 6th month after the procedure. There was no difference in the outcomes between the groups receiving hyaluronic acid or platelet-rich plasma. There was no serious adverse effect or allergic reaction during the entire follow-up period. Conclusion Intraarticular infiltration with hyaluronic acid or platelet-rich plasma in patients with primary knee gonarthrosis resulted in temporary improvement of functional symptoms and pain. There was no difference between interventions.

Resumo Objetivo Comparar o efeito da infiltração intraarticular do plasma rico em plaqueta com a do ácido hialurônico no tratamento de pacientes com osteoartrose primária de joelho. Métodos Realizou-se um ensaio clínico randomizado com 29 pacientes, sendo um grupo submetido à infiltração com ácido hialurônico (controle) e o outro com plasma rico em plaquetas. Os desfechos clínicos avaliados foram a escala visual analógica da dor; o questionário Western Ontario and McMaster Universities Arthritis Index (WOMAC), antes e depois da intervenção; e os efeitos adversos após as aplicações. Utilizou-se os testes do qui-quadrado e exato de Fisher para as variáveis categóricas, e o teste t de Student, análise de variância, e Wilcoxon para as variáveis contínuas, através do software R. Resultados A análise independente de cada grupo revelou uma diferença estatística nos meses iniciais, com melhora dos escores de dor e função; porém, com piora no 6° mês após o procedimento. Não houve diferença dos desfechos avaliados entre os grupos que foram submetidos à infiltração com ácido hialurônico ou com plasma rico em plaquetas. Não houve efeito adverso grave ou reação alérgica durante todo o seguimento. Conclusão A infiltração intraarticular com ácido hialurônico ou plasma rico em plaquetas nos joelhos dos pacientes com gonartrose primária apresentou melhora temporária dos sintomas de função e dor. Não houve diferença entre as duas intervenções.

ORTHOPAEDIC TELEMEDICINE SERVICES DURING THE CURRENT NOVEL CORONAVIRUS PANDEMIC.

Introduction: To evaluate the use of telemedicine by physicians specializing in orthopaedics and traumatology at the authors' institution, and to assess the rates of satisfaction and resolution for this type of care. The current global coronavirus disease 2019 (COVID-19) pandemic has resulted in the expansion of telemedicine services. However, quality measures and barriers for physicians dealing with the rapid increase in patients have not been well described. Materials and Methods: This study included 255 patients with orthopaedic complaints. Between 24 and 48 hours after the appointment, independent physicians, who did not participate in the initial appointment, contacted one another to assess the degree of satisfaction with the appointment, and whether there was a solution to the orthopaedic complaint. Results: There was a need for referral for face-to-face consultation in only 13.8% of cases. When asked about the probability of recommending telemedicine to a friend/family member, the answer was 90.3%. The satisfaction rate with the service was 91.1% and 93.69% of patients would return for a telemedicine consultation. Telemedicine consultations solved the problem in 82.74% of cases. Conclusions: Telemedicine care in orthopaedics proved to be a service modality with a high rate of satisfaction among the patients evaluated. Level of evidence III, Retrospective cohort study.

Introdução: O estudo avaliou o uso da telemedicina por especialistas em ortopedia e traumatologia da instituição dos autores e avaliou os índices de satisfação e resolução desse tipo de atendimento. A atual pandemia causada pelo coronavírus 2019 (COVID-19) resultou na expansão dos serviços de telemedicina. Contudo, as medidas de qualidade e barreiras para médicos que lidam com o rápido aumento não foram bem descritas. Material e Método: Este estudo incluiu 255 pacientes com queixas ortopédicas. Entre 24 e 48 horas depois da consulta, médicos independentes, que não participaram da primeira consulta, entraram em contato para avaliar o grau de satisfação com o atendimento e se houve solução da queixa ortopédica. Resultados: Houve necessidade de encaminhamento para consultas presenciais em apenas 13,8% dos casos. Quando questionados sobre a probabilidade de recomendar a telemedicina para um amigo/familiar, a resposta dos participantes foi 90,3%. A taxa de satisfação com o serviço foi de 91,1% e 93,6% de pacientes que retornariam para consulta por telemedicina. As consultas de telemedicina resolveram o problema em 82,74% dos casos. Conclusões: O atendimento por telemedicina em ortopedia mostrou ser uma modalidade de serviço com alto índice de satisfação entre os pacientes avaliados. Nível de evidência III, Estudo de coorte retrospectivo.

Ultrasound-guided hyaluronic acid injection for the treatment of insertional Achilles tendinopathy: A prospective case series.

BACKGROUND: Heel pain is a common condition and often involves the Achilles tendon and is classified as insertional or non-insertional. Several operative and non-operative treatments have been described, but there is no consensus on the most effective therapy. The aim of this study is to evaluate a case series of patients with insertional Achilles tendinopathy refractory to conservative treatment submitted to a single-dose ultrasound-guided injection of hyaluronic acid (40 mg/2.0 mL). METHODS: We prospectively included 25 patients (29 feet) who underwent a single ultrasound-guided injection of hyaluronic acid after conservative treatment failure. Clinical outcomes such as pain (using the Visual Analog Scale - VAS), function (using the American Orthopedic Foot & Ankle Society - AOFAS score), personal satisfaction, and complications were evaluated. Statistical analysis was performed using the R software. RESULTS: Most patients were female (80%) and there was a right-side predominance (55%). The median VAS was 8 points [range 4-10] at baseline, decreasing to 3 points [range 0-8] at the six-month follow-up, with statistical significance (p < .001). The median AOFAS score was 71 points [range 38-87] at baseline, increasing to 90 points [range 48-100] at the six-month follow-up (p < .001). The personal satisfaction level was 69%, and 48% of patients considered the result excellent. There were no Achilles tendon ruptures, infections, or allergic reactions post injection. CONCLUSION: Single-dose injection of hyaluronic acid is a safe treatment option, improving function and reducing pain for six months in patients with insertional Achilles tendinopathy after conservative treatment failure. LEVEL OF EVIDENCE: IV, case series.

Orthopaedic telemedicine services during the current novel coronavirus pandemic / Serviço de telemedicina em ortopedia durante a atual pandemia do coronavírus

ABSTRACT Introduction To evaluate the use of telemedicine by physicians specializing in orthopaedics and traumatology at the authors' institution, and to assess the rates of satisfaction and resolution for this type of care. The current global coronavirus disease 2019 (COVID-19) pandemic has resulted in the expansion of telemedicine services. However, quality measures and barriers for physicians dealing with the rapid increase in patients have not been well described. Materials and Methods This study included 255 patients with orthopaedic complaints. Between 24 and 48 hours after the appointment, independent physicians, who did not participate in the initial appointment, contacted one another to assess the degree of satisfaction with the appointment, and whether there was a solution to the orthopaedic complaint. Results There was a need for referral for face-to-face consultation in only 13.8% of cases. When asked about the probability of recommending telemedicine to a friend/family member, the answer was 90.3%. The satisfaction rate with the service was 91.1% and 93.69% of patients would return for a telemedicine consultation. Telemedicine consultations solved the problem in 82.74% of cases. Conclusions Telemedicine care in orthopaedics proved to be a service modality with a high rate of satisfaction among the patients evaluated. Level of evidence III, Retrospective cohort study.

RESUMO Introdução O estudo avaliou o uso da telemedicina por especialistas em ortopedia e traumatologia da instituição dos autores e avaliou os índices de satisfação e resolução desse tipo de atendimento. A atual pandemia causada pelo coronavírus 2019 (COVID-19) resultou na expansão dos serviços de telemedicina. Contudo, as medidas de qualidade e barreiras para médicos que lidam com o rápido aumento não foram bem descritas. Material e Método Este estudo incluiu 255 pacientes com queixas ortopédicas. Entre 24 e 48 horas depois da consulta, médicos independentes, que não participaram da primeira consulta, entraram em contato para avaliar o grau de satisfação com o atendimento e se houve solução da queixa ortopédica. Resultados Houve necessidade de encaminhamento para consultas presenciais em apenas 13,8% dos casos. Quando questionados sobre a probabilidade de recomendar a telemedicina para um amigo/familiar, a resposta dos participantes foi 90,3%. A taxa de satisfação com o serviço foi de 91,1% e 93,6% de pacientes que retornariam para consulta por telemedicina. As consultas de telemedicina resolveram o problema em 82,74% dos casos. Conclusões O atendimento por telemedicina em ortopedia mostrou ser uma modalidade de serviço com alto índice de satisfação entre os pacientes avaliados. Nível de evidência III, Estudo de coorte retrospectivo.

MORTALITY IN PATIENTS > 90 YEARS OLD WITH PROXIMAL FEMORAL FRACTURES SUBJECTED TO SURGERY / Mortalidade em pacientes acima de 90 anos com fraturas do fêmur proximal submetidos a cirurgia

ABSTRACT Introduction: Proximal femoral fractures have a high mortality rate among older adults, especially those aged > 80 years. Objective: To analyze predictive factors for hospital or late mortality of patients > 90 years old who showed proximal femoral fracture and subjected to surgery. Methods: The study included data from 230 patients aged > 90 years diagnosed with proximal femoral fracture and who underwent surgery between January and December 2017. The statistical evaluation was performed by multivariate analysis by a logistic regression. The associations were estimated by the odds ratio (OD) and confidence interval (95%). Statistical significance was determined with p < 0.05. Results: Late death occurred in 51.3% (118 patients) of the sample and hospital death in 3.5% (8 patients). Most patients were women (83.5%) and the most common fracture was transtrochanteric (57.0%). There was association between late death and the surgery duration (p < 0.05), and between hospital death and the presence of heart diseases (p < 0.05) or endocrinopathies (p < 0.05). Conclusion: Most patients aged > 90 years with proximal femoral fracture subjected to surgery died in less than one year. Late death was associated with the surgery duration and hospital death was associated with the presence of previous endocrinopathies or heart diseases, and the female gender was a protective factor from this outcome. Level of Evidence III, Retrospective Case-Control Study.

RESUMO Introdução: As fraturas do fêmur proximal têm alta taxa de mortalidade entre os idosos, especialmente entre os considerados superidosos (> 80 anos). Objetivo: Analisar fatores preditivos para mortalidade hospitalar ou tardia de pacientes com idade superior a 90 anos que apresentaram fratura do fêmur proximal e foram submetidos ao tratamento cirúrgico. Métodos: O estudo incluiu dados de 230 pacientes com idade superior a 90 anos que apresentaram diagnóstico de fratura do fêmur proximal e foram submetidos ao tratamento cirúrgico entre janeiro e dezembro de 2017. A avaliação estatística foi realizada pela análise multivariada por meio da regressão logística. As associações foram estimadas pelo valor de odds ratio (OD) e intervalo de confiança (95%). A significância estatística foi determinada com p < 0,05. Resultados: O óbito tardio ocorreu em 51,3% (118 pacientes) da amostra e o hospitalar em 3,5% (8 pacientes). A maioria dos pacientes foram do sexo feminino (83,5%) e a fratura mais comum foi a transtrocanteriana (57,0%). Houve associação do óbito tardio com a duração do procedimento cirúrgico (p < 0,05), e do óbito hospitalar com a presença de cardiopatias (p < 0,05) ou endocrinopatias (p < 0,05). Conclusão: A maioria dos pacientes com idade superior a 90 anos com fratura do fêmur proximal submetida ao tratamento cirúrgico evoluiu para óbito em menos de um ano. O óbito tardio foi associado à duração do procedimento cirúrgico e o óbito hospitalar à presença de endocrinopatias ou cardiopatias prévias, sendo o sexo feminino fator de proteção para tal desfecho. Nível de Evidência III, Estudo Caso-Controle Retrospectivo.

EXTRACORPOREAL SHOCKWAVE THERAPY IN SHOULDER INJURIES: PROSPECTIVE STUDY.

OBJECTIVE: To evaluate the functional results after the use of extracorporeal shockwave therapy (ESWT) in four groups of patients: tendinopathy, partial rotator cuff injury, adhesive capsulitis and calcareous tendinopathy of the rotator cuff at one month and three months after the end of treatment. METHODS: Case series in which patients were evaluated according to the VAS of pain, range of motion of the shoulder, and functional questionnaires DASH and modified UCLA. RESULTS: There was a significant increase in the measure of flexion, lateral rotation and shoulder abduction in the evaluations after treatment in relation to the baseline measurement (p < 0.001) and no evidence of significant difference was found between the post-treatment evaluations at one month and three months follow-up (p > 0.05). There was a significant reduction in the VAS score, increase in the UCLA score and a significant reduction in the DASH score in the post-treatment evaluations in relation to the baseline score (p < 0.001) and a significant improvement in the three-month evaluation in relation to one month (p < 0.05). CONCLUSION: Extracorporeal shockwave therapy proved to be efficient and safe in the treatment of shoulder pathologies, improving pain, range of motion and functional scores in all groups of patients evaluated in the study. Level of Evidence IV, Case series.

OBJETIVO: Avaliar os resultados funcionais após uso de terapia de ondas de choque (TOC) em quatro grupos de pacientes: tendinopatia, lesão parcial de manguito rotador, capsulite adesiva e tendinopatia calcária do manguito rotador com 1 mês e 3 meses após término do tratamento. MÉTODOS: Série de casos, na qual os pacientes foram avaliados de acordo com a EVA da dor, amplitude de movimento do ombro, e questionários funcionais DASH e UCLA modificados. RESULTADOS: Houve aumento significativo das medidas de flexão, rotação lateral e abdução do ombro nas avaliações após tratamento, em relação à medida basal (p < 0,001) e não houve evidências de variação significativa entre as avaliações pós-tratamento com 1 mês e 3 meses de acompanhamento (p°> 0,05). Houve redução significativa do escore EVA, aumento do escore UCLA e redução significativa do escore DASH nas avaliações após tratamento em relação ao escore basal (p < 0,001) e melhora significativa na avaliação de três meses em relação a um mês (p < 0,05). CONCLUSÃO: A terapia de ondas de choque mostrou-se uma terapia eficiente e segura no tratamento das patologias do ombro, com melhora da dor, arco de movimento e escores funcionais em todos os grupos de pacientes avaliados no estudo. Nível de Evidência IV, Série de casos.

Extracorporeal shockwave therapy in shoulder injuries: prospective study / Uso de terapia de ondas de choque em doenças ortopédicas do ombro: estudo prospectivo

ABSTRACT Objective: To evaluate the functional results after the use of extracorporeal shockwave therapy (ESWT) in four groups of patients: tendinopathy, partial rotator cuff injury, adhesive capsulitis and calcareous tendinopathy of the rotator cuff at one month and three months after the end of treatment. Methods: Case series in which patients were evaluated according to the VAS of pain, range of motion of the shoulder, and functional questionnaires DASH and modified UCLA. Results: There was a significant increase in the measure of flexion, lateral rotation and shoulder abduction in the evaluations after treatment in relation to the baseline measurement (p < 0.001) and no evidence of significant difference was found between the post-treatment evaluations at one month and three months follow-up (p > 0.05). There was a significant reduction in the VAS score, increase in the UCLA score and a significant reduction in the DASH score in the post-treatment evaluations in relation to the baseline score (p < 0.001) and a significant improvement in the three-month evaluation in relation to one month (p < 0.05). Conclusion: Extracorporeal shockwave therapy proved to be efficient and safe in the treatment of shoulder pathologies, improving pain, range of motion and functional scores in all groups of patients evaluated in the study. Level of Evidence IV, Case series.

RESUMO Objetivo: Avaliar os resultados funcionais após uso de terapia de ondas de choque (TOC) em quatro grupos de pacientes: tendinopatia, lesão parcial de manguito rotador, capsulite adesiva e tendinopatia calcária do manguito rotador com 1 mês e 3 meses após término do tratamento. Métodos: Série de casos, na qual os pacientes foram avaliados de acordo com a EVA da dor, amplitude de movimento do ombro, e questionários funcionais DASH e UCLA modificados. Resultados: Houve aumento significativo das medidas de flexão, rotação lateral e abdução do ombro nas avaliações após tratamento, em relação à medida basal (p < 0,001) e não houve evidências de variação significativa entre as avaliações pós-tratamento com 1 mês e 3 meses de acompanhamento (p°> 0,05). Houve redução significativa do escore EVA, aumento do escore UCLA e redução significativa do escore DASH nas avaliações após tratamento em relação ao escore basal (p < 0,001) e melhora significativa na avaliação de três meses em relação a um mês (p < 0,05). Conclusão: A terapia de ondas de choque mostrou-se uma terapia eficiente e segura no tratamento das patologias do ombro, com melhora da dor, arco de movimento e escores funcionais em todos os grupos de pacientes avaliados no estudo. Nível de Evidência IV, Série de casos.