Clinical pathway improves medical practice in total knee arthroplasty.

PURPOSE: Clinical pathways in total knee arthroplasty (TKA) consist of general guidelines, including several topics as early rehabilitation and antibiotic systematization, which are used to improve patient's management, decrease complication rates and enhance clinical outcomes. The primary purpose of this study was to assess whether the use of a clinical pathway for TKA can contribute to reduce LOS and healthcare costs in a private hospital, without an increase in the hospital readmission rate. We also aimed to assess whether care providers adhered to the recommendations mainly antibiotic use and physical therapy. METHODS: Retrospective cohort study of 485 patients who underwent TKA at private hospital. Patients were analyzed in two groups: Group I (GI), composed by 220 TKA patients, prior to the clinical pathway implementation, and Group 2 (GII), with 265 TKA patients post-clinical pathway. Several outcomes were analyzed: length of hospital stay, time from use of prophylactic antibiotic therapy, readmission within 30 days, physical therapy and costs associated to procedures and hospitalization rates. RESULTS: The implementation of the clinical pathway was related with the reduction of the length of hospital stay from 6.3 days to 4.9 days (p = 0.021) without increase in readmissions. The physical therapy on the first postoperative day was most frequent in GII than GI (96.2% vs 78.1%, p < 0.001). Prophylactic ATB 60 minutes prior the surgery was significantly more used in GII than GI (99.2% vs 87.4%, p < 0.001). In addition, ATB suspension within 48 hours was significantly more frequent in GII than GI (84.7% vs. 51.6%, p < 0.001). The cost procedure of TKA showed a reduction of US$1,252.00 in GII when compared with GI (p<0,001). CONCLUSION: The implementation of a clinical pathway, with focus on early rehabilitation, for patients underwent TKA, contributed to a reduction of LOS and costs during hospital stay, with no increase in the readmission rate. We also concluded that there was adherence to the clinical pathway by care providers in our institution.

Influence of body mass index on patellofemoral pain / Influência do índice de massa corpórea na dor patelofemoral / Influencia del índice de masa corporal en el dolor patelofemoral

Abstract Introduction: Patellofemoral Pain Syndrome is characterized by retro-patellar and peripatellar pain during squatting, kneeling and running whose intensity can be related to Body Mass Index (BMI). Objective: To evaluate the relationship between overweight, pain and function in women with Patellofemoral Pain Syndrome (PFPS). Method: Cross-sectional observational study of fifty-four women with PFPS assessed in the period between January and December 2015, in the physiotherapy outpatient clinic of a tertiary hospital in the city of São Paulo. To verify the variables of pain at rest, at effort and function, the Numerical Pain Rating Scale (NPRS) and the Kujala Anterior Knee Pain Scale (AKPS) were used. The participants were divided into two groups, according to the BMI categories defined by the World Health Organization (WHO): Group 1, composed of women with normal BMI (18-24.9 kg/m²), with 36 patients, and group 2 composed of overweight women (25-29.9 k/m²), with 18 patients. Comparison between groups of pain at rest and effort and AKPS were performed using Student's t-test and Mann-Witney with statistical significance p < 0,05. Results: There was no statistically significant difference between groups for the pain at rest and effort and for AKPS. Conclusion: BMI does not impact pain intensity and function in women with PFPS.

Resumo Introdução: A síndrome da dor patelofemoral (SDPF) é por dor retropatelar e peripatelar ao subir e descer escadas, ajoelhar, agachar ou correr, cuja intensidade pode estar relacionada com o Índice de Massa Corpórea (IMC). Objetivo: Avaliar a relação entre o IMC, a dor e a função em mulheres com SDPF. Método: Estudo observacional transversal de 54 mulheres com SDPF avaliadas no período entre janeiro e dezembro de 2015, no ambulatório de fisioterapia de um hospital terciário da cidade de São Paulo. Para verificação das variáveis de dor ao repouso e ao esforço, foi utilizada a Escala Numérica de Dor e para a variável função, foi utilizada a escala Kujala de dor anterior no joelho. As participantes foram divididas em dois grupos, de acordo com o IMC, seguindo os critérios da Organização Mundial de Saúde (OMS): Grupo 1, composto por mulheres com IMC normal (18-24,9 kg/m²), com 36 pacientes, e o grupo 2 composto por mulheres com sobrepeso (25-29,9 kg/m²), com 18 pacientes. Foi realizada a comparação das médias de dor ao repouso e ao esforço e da escala Kujala de dor anterior no joelho entre os dois grupos, por meio dos testes t.-Student para amostras independentes e Mann-Witney, considerando significância estatística p < 0,05. Resultados: Não houve diferença estatisticamente significante entre os grupos para as variáveis de dor ao repouso, ao esforço e para a escala Kujala de dor anterior no joelho. Conclusão: O IMC não impacta na intensidade da dor e na função em mulheres com SDPF.

Resumen Introducción: El síndrome de dolor patelofemoral (SDPF) se caracteriza por dolor retropatelar y peripatelar al subir y bajar escaleras, arrodillarse o correr, cuya intensidad puede estar relacionada con el Índice de Masa Corporal (IMC). Objetivo: Evaluar la relación entre el IMC, el dolor y la función en mujeres con SDPF. Método: Estudio observacional transversal con 54 mujeres con SDPF evaluadas en el período entre enero y diciembre de 2015, en el ambulatorio de fisioterapia de un hospital terciario de la ciudad de São Paulo. Para verificación de las variables de dolor al reposo y al esfuerzo, se utilizó la Escala Numérica de Dolor, y para la variable función, se utilizó la escala Kujala de dolor existente en la rodilla. Las participantes se dividieron en dos grupos, de acuerdo con el IMC, siguiendo los criterios de la Organización Mundial de la Salud (OMS): grupo 1 compuesto por mujeres con IMC normal (18-24,9 kg/m²) con 36 pacientes, y el grupo 2 compuesto por mujeres con sobrepeso (25-29,9 kg/m²) con 18 pacientes. Se realizó la comparación de los promedios de dolor al reposo y al esfuerzo y de la escala entre los grupos, por medio de la prueba t de Student para las muestras independientes y de la prueba de Mann-Whitney, considerando significancia estadística p < 0,05. Resultados: No hubo diferencia estadísticamente significativa entre los grupos para las variables dolor al reposo, al esfuerzo y a la escala Kujala de dolor existente en la rodilla. Conclusión: El IMC no impacta en la intensidad del dolor y en la función de mujeres con SDPF.

Evolution and projection of knee arthroplasties from 2003 to 2030 in the state of São Paulo.

OBJECTIVE: Analyze data regarding total knee arthroplasty (TKA) carried out by the Public Health System (SUS) in the state of São Paulo from 2003 to 2010 and determine the projections expected for 2030. METHODS: A cross-sectional study (observational). We analyzed 10,952 patients who underwent primary total knee arthroplasty (PTKA) and revision total knee arthroplasty (RTKA) in the state of São Paulo between 2003 and 2010. The collection of data based on ICD-10 and HAA (Hospital Admission Authorization) were provided by the Tabnet and Sigtap software (Management System for the Table of Procedures, Medications, and OPM by SUS). The following variables were analyzed: gender, number of PTKAs and RTKAs, and their projections. The information collected formed a database developed in Excel® for Windows, and the statistical analysis was performed by the Stata® 11 SE and Minitab 16 software. RESULTS: There was a significant difference in the prevalence of TKA between genders (p<0.0001); most of the patients were females (7,891; 72%). The projection for 2030 when compared with the first year of the series, 2003, indicates a growth of 428% for PTKA and 1,380% for RTKA, with a greater increase percentage of RTKA in males than in females (1,558% and 1,318%, respectively). CONCLUSION: The proportions of the RTKA projection are much greater than those of PTKA by 2030, with a greater percentage of increase of RTKA in males than in females.

Functional Evaluation after Medial Patellofemoral Ligament Reconstruction in Athletes.

Objective The aim of the present study was to evaluate the clinical results, functional outcomes, and risk factors after anatomic reconstructions using knee flexor grafts in athletes. Methods The authors followed-up 32 patients and 34 knees for 1 year in a prospective design case series evaluating pre- and postoperative functional scores (Kujala and Lysholm) and associated risk factors. Results All of the 32 patients had a significant increase of the Lysholm and Kujala scores. Patients with < 5 preoperative dislocations had a better score on the Lysholm and Kujala scales. The mean preoperative Lysholm score was 62.8, and the mean postoperative score was 94.3. The mean preoperative Kujala score was 63.0, and the mean postoperative score was 94.0. Conclusion Medial patellofemoral ligament reconstruction with hamstring graft in athletes with patellar instability improved clinical and functional scores. The bone drilling through the patella and the positioning of the femoral tunnel should be judiciously performed.

Evolution and projection of knee arthroplasties from 2003 to 2030 in the state of São Paulo

SUMMARY OBJECTIVE Analyze data regarding total knee arthroplasty (TKA) carried out by the Public Health System (SUS) in the state of São Paulo from 2003 to 2010 and determine the projections expected for 2030. METHODS A cross-sectional study (observational). We analyzed 10,952 patients who underwent primary total knee arthroplasty (PTKA) and revision total knee arthroplasty (RTKA) in the state of São Paulo between 2003 and 2010. The collection of data based on ICD-10 and HAA (Hospital Admission Authorization) were provided by the Tabnet and Sigtap software (Management System for the Table of Procedures, Medications, and OPM by SUS). The following variables were analyzed: gender, number of PTKAs and RTKAs, and their projections. The information collected formed a database developed in Excel® for Windows, and the statistical analysis was performed by the Stata® 11 SE and Minitab 16 software. RESULTS There was a significant difference in the prevalence of TKA between genders (p<0.0001); most of the patients were females (7,891; 72%). The projection for 2030 when compared with the first year of the series, 2003, indicates a growth of 428% for PTKA and 1,380% for RTKA, with a greater increase percentage of RTKA in males than in females (1,558% and 1,318%, respectively). CONCLUSION The proportions of the RTKA projection are much greater than those of PTKA by 2030, with a greater percentage of increase of RTKA in males than in females.

RESUMO OBJETIVO Analisar os dados referentes às artroplastias totais de joelho (ATJ) realizadas pelo Sistema Público de Saúde (SUS) no estado de São Paulo de 2003 a 2010 e determinar as projeções esperadas para 2030. MÉTODOS Estudo transversal (observacional). Foram analisados 10.952 pacientes que realizaram artroplastia total de joelho primária (ATJP) e revisão (ATJR) no estado de São Paulo entre 2003 e 2010. A coleta de dados baseados no CID-10 e AIH (Autorização de Internação Hospitalar) foram fornecidos pelo programa Tabnet e Sigtap (Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e OPM do SUS). Foram analisadas as seguintes variáveis: gênero, número de ATJP e número de ATJR, além de suas projeções. As informações coletadas formaram um banco de dados desenvolvido no programa Excel® for Windows e a análise estatística foi realizada pelos softwares Stata® 11 SE e Minitab 16. RESULTADOS Houve diferença significativa na prevalência da ATJ entre os gêneros (p<0,0001), sendo a maioria do gênero feminino (7.891; 72%). A projeção para 2030 quando comparado com o primeiro ano da série, 2003, indica um crescimento de 428% para as ATJP e 1.380% nas ATJR, com uma porcentagem de aumento maior nas ATJR no gênero masculino do que no feminino (1.558% e 1.318%, respectivamente). CONCLUSÃO As proporções de projeção da ATJR se mostram muito maiores do que nas ATJP até o ano de 2030, percebendo-se uma porcentagem de aumento maior de ATJR no gênero masculino comparado ao feminino.

Functional Evaluation after Medial Patellofemoral Ligament Reconstruction in Athletes / Avaliação funcional da reconstrução do ligamento patelofemoral medial em atletas

Abstract Objective The aim of the present study was to evaluate the clinical results, functional outcomes, and risk factors after anatomic reconstructions using knee flexor grafts in athletes. Methods The authors followed-up 32 patients and 34 knees for 1 year in a prospective design case series evaluating pre- and postoperative functional scores (Kujala and Lysholm) and associated risk factors. Results All of the 32 patients had a significant increase of the Lysholm and Kujala scores. Patients with < 5 preoperative dislocations had a better score on the Lysholm and Kujala scales. The mean preoperative Lysholm score was 62.8, and the mean postoperative score was 94.3. The mean preoperative Kujala score was 63.0, and the mean postoperative score was 94.0. Conclusion Medial patellofemoral ligament reconstruction with hamstring graft in athletes with patellar instability improved clinical and functional scores. The bone drilling through the patella and the positioning of the femoral tunnel should be judiciously performed.

Resumo Objetivo Avaliar os resultados clínicos e funcionais da reconstrução anatômica do ligamento patelofemoral medial com tendões flexores em atletas. Métodos Estudo tipo série de casos, prospectivo, que analisou a reconstrução do ligamento patelofemoralmedial em32 pacientes (34 joelhos). A avaliação funcional foi feita pelos escores Lysholm e Kujala nos períodos pré e pós-operatórios e os fatores de risco envolvidos foram avaliados. Resultados Dos 32 pacientes analisados, todos obtiveram melhoria dos escores funcionais comparativamente ao período pré-operatório. Pacientes com menos de cinco episódios de luxação prévios obtiveram melhores resultados funcionais. O valor médio de Lysholm no pré-operatório foi de 62,8 e no pós-operatório de 94,3, quanto ao escore de Kujala a média pré-operatório foi de 63,0 e pós-operatória de 94,0. Conclusão A reconstrução do ligamento patelofemoral medial com enxerto de tendão flexor do joelho em atletas propiciou melhoria dos escores clínicos e funcionais nos pacientes com instabilidade patelofemoral. A perfuração óssea da patela e o posicionamento do túnel femoral devem ocorrer de forma judiciosa.

Prevalence of knee arthroplasty in the state of São Paulo between 2003 and 2010.

CONTEXT AND OBJECTIVE:: The volume of knee arthroplasty procedures has increased over the last decade. The aim of this study was to estimate the frequency of these procedures performed within the public healthcare system of the state of São Paulo between 2003 and 2010. DESIGN AND SETTING:: Cross-sectional study conducted in the state of São Paulo by researchers at Hospital do Servidor Público do Estado de São Paulo. METHODS:: A sample of 10,952 patients (7,891 females and 3,061 males) who underwent primary total knee arthroplasty (TKA) and revision of total knee arthroplasty (RTKA) in the state of São Paulo between 2003 and 2010 was evaluated. The patients were cataloged using the public healthcare service's TABNET software. All of the patients presented primary osteoarthritis of the knee. The variables of gender, number of primary TKA procedures and number of RTKA procedures were evaluated. RESULTS:: A total of 10,952 TKA procedures were performed (annual average of 1369), of which 9,271 (85%) were TKA and 1,681 (15%), RTKA. Of the TKA procedures, 72% were carried out on females (P < 0.0001), while 70% of the RTKA procedures were on females (P < 0.0001). The average ratio of TKA to RTKA was 5.5:1 (P < 0.0001); the ratios in 2003 and 2010 were 9.0:1 and 4.4:1 (P < 0.0001), respectively. CONCLUSION:: The number and frequency of TKA and RTKA procedures increased in the state of São Paulo between 2003 and 2010. This increase was relatively greater in RTKA than in TKA and was predominantly in female patients.

Prevalence of knee arthroplasty in the state of São Paulo between 2003 and 2010 / Prevalência de artroplastia de joelho no estado de São Paulo entre 2003 e 2010

ABSTRACT CONTEXT AND OBJECTIVE: The volume of knee arthroplasty procedures has increased over the last decade. The aim of this study was to estimate the frequency of these procedures performed within the public healthcare system of the state of São Paulo between 2003 and 2010. DESIGN AND SETTING: Cross-sectional study conducted in the state of São Paulo by researchers at Hospital do Servidor Público do Estado de São Paulo. METHODS: A sample of 10,952 patients (7,891 females and 3,061 males) who underwent primary total knee arthroplasty (TKA) and revision of total knee arthroplasty (RTKA) in the state of São Paulo between 2003 and 2010 was evaluated. The patients were cataloged using the public healthcare service's TABNET software. All of the patients presented primary osteoarthritis of the knee. The variables of gender, number of primary TKA procedures and number of RTKA procedures were evaluated. RESULTS: A total of 10,952 TKA procedures were performed (annual average of 1369), of which 9,271 (85%) were TKA and 1,681 (15%), RTKA. Of the TKA procedures, 72% were carried out on females (P < 0.0001), while 70% of the RTKA procedures were on females (P < 0.0001). The average ratio of TKA to RTKA was 5.5:1 (P < 0.0001); the ratios in 2003 and 2010 were 9.0:1 and 4.4:1 (P < 0.0001), respectively. CONCLUSION: The number and frequency of TKA and RTKA procedures increased in the state of São Paulo between 2003 and 2010. This increase was relatively greater in RTKA than in TKA and was predominantly in female patients.

RESUMO CONTEXTO E OBJETIVO: O volume das artroplastias de joelho tem crescido na última década. O objetivo deste estudo foi estimar a frequência desses procedimentos realizados no Sistema Público de Saúde (SUS) do Estado de São Paulo no período de 2003 a 2010. TIPO DE ESTUDO E LOCAL: Estudo transversal conduzido por pesquisadores do Hospital do Servidor Público Estadual. MÉTODOS: Foi avaliada uma amostra de 10.952 pacientes (7.891 mulheres e 3.061 homens) submetidos a artroplastia primária total de joelho (ATJ) e a revisão de artroplastia total de joelho (RATJ) no estado de São Paulo entre 2003 e 2010. Os pacientes foram catalogados por meio do programa TABNET do SUS. Todos os pacientes eram portadores de osteoartrite primária do joelho. As variáveis analisadas foram: gênero, número de ATJs e número de RATJs. RESULTADOS: No total, 10.592 ATJs foram realizadas (média anual de 1.369 procedimentos), com 9.271 (85%) ATJs e 1.691 (15%) RATJ. Das ATJ, 72% ocorreram em mulheres (P < 0.0001), enquanto 70% das RATJs foram em mulheres (P < 0.0001). A relação média de ATJ para RATJ foi de 5.5:1 (P < 0.0001), com proporção em 2003 e 2010 de 9.0:1 e 4.4:1 (P < 0.0001), respectivamente. CONCLUSÃO: O número e a prevalência das ATJs e RATJs aumentaram no estado de São Paulo no período de 2003 a 2010. Essa elevação foi relativamente maior nas RATJs quando comparadas com as ATJs e ocorreu predominantemente nos pacientes do sexo feminino.

Influence of body mass index in revision total knee arthroplasty

ABSTRACTOBJECTIVE: To evaluate the influence of the body mass index (BMI) on the functional assessment of patients who underwent revision total knee arthroplasty (RTKA).METHODS: Thirty patients who un-derwent RTKA between January 2008 and January 2012 were retrospectively assessed using the WOMAC questionnaire. The patients were divided into three groups according to the BMI ca-tegories defined by the World Health Organization (WHO): Group I with normal BMI (18-24.9 Kg/m2), with eight patients; Group II, overweight (BMI 25-29.9 Kg/m2), with 15 patients, and Group III obesity with BMI ≥ 30 Kg/m2, with seven patients. The post-ope-rative function scores obtained through the WOMAC questionnaire were compared with the BMI of each group. The statistical analysis between BMI and WOMAC scores was performed with the Spe-arman correlation test.RESULTS: The average functional WOMAC score for individuals in Group I was 16.7; in Group II it was 47.7; and in Group III it was 69.9, with a statistically significant differen-ce between groups I, II and III (p< 0.0001).CONCLUSION: Patients with BMI > 25 Kg/m2 had a worse functional evaluation through WOMAC scores when compared to patients with normal BMI after RTKA. Level of Evidence III, Tranversal Retrospective Study.

Return to sport after surgical treatment for pubalgia among professional soccer players / Retorno ao esporte após tratamento cirúrgico de pubeíte em jogadores de futebol profissional

OBJECTIVE: to evaluate the return to sport after surgical treatment for pubalgia among 30 professional soccer players and describe the surgical technique used. METHOD: this case series was evaluated by means of a questionnaire and physical examination on 30 male professional soccer players of mean age 24.4 years (range: 18-30). The mean duration of the symptoms was 18.6 months (range: 13-28). The diagnosis was made through clinical investigation, special maneuvers and complementary examinations, by the same examiner. All the patients underwent surgical treatment after conservative treatment failed; all procedures were performed by the same surgeon using the same technique. Nonparametric comparisons were made to investigate the time taken to recover after the surgery, for the patients to return to their sport. RESULTS: five patients evolved with hematoma, with the need to remove the stitches three weeks after the operation because of a small dehiscence at the site of the operative wound. The wound healed completely in all these cases by five weeks after the surgery. Four patients presented dysuria in the first week, but improved in the second postoperative week. The mean time taken to return to training was around eight weeks (range: seven-nine). All the players returned to competitive soccer practice within 16 weeks. When asked about their degree of satisfaction after the operation (satisfied or dissatisfied), taking into consideration their return to the sport, there was 100% satisfaction, and they returned to professional practice at the same competitive level as before the injury. This degree of satisfaction continued to the last assessment, which was made after 36 months of postoperative follow-up. CONCLUSION: the surgical technique presented in this case series, with trapezoidal resection of the pubic symphysis in association with bilateral partial tenotomy of the long adductor, was a fast and effective procedure with...

OBJETIVO: avaliar o retorno ao esporte após tratamento cirúrgico da pubeíte em 30 jogadores de futebol profissional e descrever a técnica cirúrgica empregada. MÉTODO: série de casos por meio de questionário e exame físico em 30 jogadores de futebol profissional. Atletas masculinos, com idade média de 24,4 anos (18 a 30). A duração média dos sintomas foi de 18,6 meses (13 a 28). O diagnóstico foi feito por meio de investigação clínica, manobras especiais e exames complementares por um mesmo examinador. Todos os pacientes foram submetidos ao tratamento cirúrgico após falha do tratamento conservador, pelo mesmo cirurgião e com a mesma técnica. A comparação não paramétrica foi efetuada para investigar o tempo de recuperação após a cirurgia para retorno ao esporte. RESULTADOS: cinco pacientes evoluíram com hematoma e foi necessária a retirada dos pontos com três semanas por causa de pequena deiscência no local da ferida operatória. Houve cicatrização completa da ferida em todos esses casos após cinco semanas. Quatro pacientes apresentaram disúria na primeira semana, porém melhoraram na segunda semana pós-operatória. O tempo médio para retorno aos treinos ocorreu em torno de oito semanas (sete a nove). Todos os atletas retornaram à prática de futebol competitivo em até 16 semanas. Quando interrogados sobre o grau de satisfação no pós-operatório (satisfeito ou insatisfeito), levando em consideração o retorno ao esporte, houve 100% de satisfação e retorno à prática profissional no mesmo nível competitivo prévio à lesão. Esse grau de satisfação persistiu até a última avaliação após 36 meses de seguimento...

Common injuries in athletes' knee: experience of a specialized center

OBJECTIVE: The present cross-sectional study aims to identify the most common knee injuries in athletes cared at a Specialized Outpatient Clinics. METHOD: Analysis of patients cared at the Knee Outpatient Clinics of a Sports Trauma Center, divided by gender, age and diagnosed injury. RESULTS: Initially 440 patients were divided into 33 types of sports; after excluding the less statistically significant practices, nine sports remained. The most frequently performed sports were football with almost 50% of total patients presenting anterior cruciate ligament (ACL) injury, and road runs with great frequency of meniscal injury. There was no correlation of the disorder with the type of sports performed but a correlation was found with patient's age/gender. CONCLUSION: The complete ACL rupture was the most common injury found in football, basketball and volleyball players, followed by meniscal injury in street runners. Level of Evidence IV, Study Transversal. .

Osteocondrite dissecante bilateral de joelho em jogador de basquetebol: relato de caso / Bilateral osteochondritis dissecans of the knee in a basketball player: case report

Os autores relatam um caso de osteocondrite dissecante em joelho bilateral de um jogador de basquetebol de 17 anos que foi diagnosticado e tratado conforme a literatura.

The authors report a case of bilateral osteochondritis dissecans in a 17-year-old basketball player who was diagnosed and treated as shown in the literature.

Lipossarcoma de joelho em um atleta de tênis: relato de caso / Lipossarcoma of the knee in a tennis player: case report

O lipossarcoma é uma neoplasia rara, originária de células mesenquimais primitivas e, entre os sarcomas, é o tipo histológico mais frequente. Os autores relatam o caso de um lipossarcoma localizado em região de joelho e coxa posterior distal direita de um paciente de 40 anos, jogador de tênis.

Lipossarcoma is an uncommon malignant tumor. It originates in the mesenchymal cells, and is the most common of the soft tissue sarcomas. The authors report a case of a 40 year-old male tennis player with lipossarcoma in the posterior right knee and distal thigh region.

An anatomic study of the posterior septum of the knee.

PURPOSE: To evaluate the posterior septum of the knee and determine the presence of a safe zone that could be removed, without significant damage to blood vessels and nerves. METHODS: Nineteen fresh unpaired adult human cadaveric knees, with no macroscopic degenerative or traumatic changes, were used in this study. Microscopic evaluation was performed by analysis of H&E, CD-34, and S-100 staining. RESULTS: The posterior septum of the knee is rich in type II and type IV mechanoreceptors and blood vessels. The superior half has a greater number of blood vessels (21.52 ± 6.36 v 12.05 ± 4.1, P < .001), higher-caliber vessels (2.2 ± 0.89 µm v 1.41 ± 0.45 µm, P < .006), and a greater number of mechanoreceptors per field (type II, 1.8 ± 1.8 v 0.42 ± 1, P = .04; type IV, 22.6 ± 14 v 14.5 ± 9.4, P = .04) than the inferior half of the septum. CONCLUSIONS: This study has shown that the posterior septum of the knee is highly vascularized and has a great number of type II and IV mechanoreceptors. The presence of these structures is significantly higher in the superior half of the septum. CLINICAL RELEVANCE: If debridement of the posterior septum is necessary, it should be done at the inferior aspect so that a greater number of blood vessels and mechanoreceptors can be preserved.

Fratura supra e intracondiliana exposta de femur em atleta de motocross: relato de caso / Supra and intracondylar open fracture of the femur in a motocross athlete: case report

Os autores apresentam o relato de um caso de uma paciente (atleta amador de motocross) que sofreu uma queda durante uma competição e teve fratura supra e intracondiliana exposta de fêmur direito.

The authors report the case of a patient (amateur motocross competitor) who suffered a fall during a motocross competition resulting in a supra and intracondylar open fracture in the right femur.

Condromatose sinovial de joelho: relato de caso / Synovial chondromatosis of the knee: case report

Os autores apresentam o relato de caso de um paciente ex-atleta de futebol com osteocondromatose sinovial em joelho.

The authors report the case of a patient with synovial osteochondromatosis of the knee, who had previously been a soccer player.

Avaliação da altura patelar em atletas com tendinopatia crônica do aparelho extensor do joelho / Evaluation of the patellar height in athletes with diagnosed with chronic tendinopathy of the knee extensor mechanism

OBJETIVO: Avaliar radiograficamente a altura patelar de atletas com diagnóstico de tendinopatia crônica do aparelho extensor do joelho (TCAE). MÉTODOS: Na amostra foram avaliados radiograficamente 65 pacientes (110 joelhos) com idade entre 15 e 40 anos e de diferentes modalidades esportivas com e sem diagnóstico de tendinopatia crônica do aparelho extensor do joelho (jumper's knee). Os atletas foram divididos em dois grupos: aqueles com diagnóstico de TCAE (grupo 1: 38 atletas - 56 joelhos) e um grupo que denominamos de controle (grupo 2: 27 atletas - 54 joelhos). RESULTADOS: No grupo 1 tivemos 18 atletas que apresentavam a doença bilateralmente na ocasião dos exames. Para a medida da altura patelar utilizamos os índices radiográficos de Insall e Salvati e Blackburne e Peel. CONCLUSÃO: A presença de patela alta no grupo de atletas com tendinopatia crônica do aparelho extensor do joelho foi significante maior do que a observada no grupo controle.

OBJECTIVES: To carry out a radiographic evaluation of patellar height in athletes diagnosed with chronic tendinopathy of the knee extensor mechanism; METHODS: Radiographic assessments were carried out on 65 patients (110 knees) aged between 15 and 40 years, who practiced different kinds of sports, some with of chronic tendinopathy of the knee extensor mechanism (jumper's knee) and others without. The athletes were divided into two groups: those with diagnosed "jumper's knee" (group 1:38 athletes - 56 knees) and a control group (group 2:27 athletes - 54 knees). In group 1, 18 of the athletes presented the condition in both knees on examination. The height of the patella was measured using the Insall-Salvati and Blackburne-Peel x-ray methods. CONCLUSION: The presence of a high patella in the group of athletes with chronic tendinopathy of the knee extensor mechanism was significantly higher than in the control group.

Síndrome compartimental em perna após reconstrução de ligamento cruzado anterior: relato de caso / Leg's compartment syndrome after reconstruction of the anterior cruciate ligament: case report

Os autores apresentam o relato de caso de um paciente que foi submetido à cirurgia de reconstrução de ligamento cruzado anterior e reparo de ligamento colateral medial de joelho esquerdo e que evoluiu com síndrome de compartimento de perna.

The authors report a case of a patient that was submitted to a surgery of reconstruction of anterior cruciate ligament and collateral medial ligament repair of the left knee that complicated to a compartment syndrome.

Prevalence of pain on palpation of the inferior pole of the patella among patients with complaints of knee pain.

CONTEXT AND OBJECTIVE: Patellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy. METHODS: Palpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded. RESULTS: Of the total number of individuals evaluated, 124 (39%) felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3%) received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity. CONCLUSIONS: Palpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands.