Anabolic steroids and the evaluation of patients with acute PM tendon rupture using microscopy and MRI.

This study presented a pioneering investigation of the changes in the magnetic resonance imaging images of pectoralis major muscle (PMM) tendon rupture. In all, 26 men were evaluated with acute total PMM rupture (<3 months since injury) with a mean age of 37.3 years (SD = 9.7 years) and 10 control patients with a mean age of 32.6 years (SD = 4.2 years). The evaluation of the tendon PMM injuries was based on the magnetic resonance imaging exam and the histological analysis. The magnetic resonance imaging of the surgically showed two (7.1%) contralateral sides were normal, 16 (57.1%) showed superior tendinopathy, and 10 (35.7%) had total tendinopathy. Inferior tendinopathy was not observed. The tendon histology revealed degenerative changes in 16 (66.7%) fragments, with 12 (50.0%) considered as mild (<25%), and four considered as (16.7%) high (>50.0%) tendinopathy. Total acute rupture of the PMM tendon among weightlifters might be associated with tendinous degeneration prior to injury.

Surgical treatment of patients with chronic rupture of the pectoralis major muscle tendon. Prospective comparative study with 2 years of follow-up.

To compare outcomes between autologous fascia lata and autologous hamstring grafts for chronic pectoralis major muscle (PMM) rupture repair, and perform histological, and imaging analyses. Forty male patients with chronic PMM ruptures (time since injury ranging from >3 months to 5 years) and a mean age of 37.3 years (SD = 9.7 years) were evaluated. One group (20 patients) received an autologous semitendinosus graft, and another group (20 patients) received an autologous fascia lata graft for PMM reconstruction. These patients with fascia lata grafts by Bak 2criterium 60% of the patients presented excellent results, 20% presented good results, 15% presented fair results, and 5% presented poor results. In the hamstring group 65% of the patients presented excellent results, 30% presented good results, and 5% presented fair results. In this comparative study, no difference was observed regarding the functional result, image, and histology between groups.

Distal rupture of the biceps brachii tendon in a female mixed martial arts athlete: a case report.

The distal rupture of the biceps brachii muscle tendon (DBT) accounts for 3% of biceps ruptures. Diagnosis typically relies on high clinical suspicion and complementary imaging studies, with >90% of cases documented in males between the fourth and sixth decades of life. Reports of DBT ruptures in females are scarce, mostly involving partial and degenerative injuries. Here, we present an unprecedented case of a 28-year-old female professional mixed martial arts athlete with a total traumatic DBT rupture. The athlete underwent surgical repair using anchor reattachment technique. No complications were observed, and the athlete showed satisfactory outcomes, being cleared for physiotherapy after 2 weeks and returning to sports after a 3-month postoperative period.

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.

Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications?

Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.

Glenoid Bone Loss - A Retrospective Evaluation of Functional Outcomes after Bone Block Surgery for Anterior Shoulder Instability in High-demand Athletes.

Objective This study assesses the relationship between the glenoid bone loss size and range of motion, functional outcomes, and complications in high-performance athletes undergoing bone block surgery for anterior shoulder instability. Methods This retrospective study evaluated postoperative outcomes in athletes submitted to bone block surgery for anterior shoulder instability. In 5 years, 41 shoulders underwent the procedure; 20 had bone losses up to 15%, and 21 shoulders presented bone losses ranging from 15% and 25%. Results There was no statistically significant difference regarding postoperative complications, new dislocations, and the rate of return to sports. In addition, the quantitative criteria evaluated, i.e., ranges of motion and functional scores, showed no statistically significant difference between groups. Conclusion The size of the bone loss per se does not seem to affect functional outcomes and complications from these procedures, which are safe techniques for small and large bone losses.

Can three-dimensional models enhance understanding and knowledge of rotator cuff tears?

OBJECTIVES: Magnetic resonance imaging (MRI) is currently the standard diagnostic tool for rotator cuff tears. However, its two-dimensional (2D) output, displayed on a monitor, can complicate the interpretation of anatomy. Three-dimensional (3D) imaging may offer a solution to this issue. This study aimed to demonstrate the diagnostic and interpretive value of a 3D model in assessing lesion anatomy. The hypothesis was that 3D models, compared to 2D MRI, can enhance the comprehension and knowledge of rotator cuff injuries, improve the application of classifications for total tears, and provide a more precise definition of the size and type of tear. METHODS: A prospective single-centre study was conducted. 3D models for rotator cuff tears were created and analysed in conjunction with preoperative MRI for each patient up to 2 months before surgery. The 3D models were based on the preoperative MRI. Collected data included 2D plane measurements by MRI in coronal and sagittal planes, descriptions of 3D lesion geometry (new shapes), 3D measurements in coronal and sagittal planes, arthroscopic classifications of rotator cuff injuries, and arthroscopic measurements in coronal and sagittal planes. RESULTS: After examining 25 cases, 3D imaging demonstrated similar arthroscopic values post-bursectomy in the sagittal plane (16.70 â€‹mm for 3D and 18.28 â€‹mm for post-bursectomy, p-value â€‹= â€‹0.189), although these measurements did not align with those of MRI (which underestimated measurements, p-value â€‹= â€‹0.010). Both MRI measurement and 3D imaging showed similar measurement accuracy in the coronal plane when compared to arthroscopic measurements taken before and after bursectomy. The creation of 3D objects enabled the analysis of new geometries, including the length, width, and depth of each lesion. These geometries included the rectangle, rectangular trapezoid, scalene trapezoid, irregular pentagon, and irregular hexagon. CONCLUSIONS: 3D models can enhance the understanding and knowledge of rotator cuff injuries. They can be a promising tool for diagnosing and interpreting the anatomy of the injury, particularly in the sagittal plane. The new 3D understanding of the pathological process has led to the description of new geometric features not visible in conventional 2D MRI. LEVEL OF EVIDENCE: II - Development of diagnostic criteria on consecutive patients (all compared to "gold" standard).

Bristow-Latarjet Surgery: A Current Overview in Brazil.

Objective To provide a current overview of the Bristow-Latarjet surgery in Brazil. Materials and Methods This cross-sectional study was based on an electronic questionnaire with 26 items, which was sent to active members of the Brazilian Society of Shoulder and Elbow Surgery (Sociedade Brasileira de Cirurgia do Ombro e Cotovelo, SBCOC, in Portuguese). The questionnaire addressed training, surgical technique, complications, and postoperative management. Results We sent the questionnaire to 845 specialists from April 20 to May 12, 2021, and 310 of them answered i in full. During their specialization, most specialists participated in up to ten Bristow-Latarjet procedures. The most frequent complication was graft fracture, while the most common technical difficulty was screw positioning. In total, 50.6% and 73.9% reported having experienced intraoperative and postoperative complications respectively; 57.1% declared performing subscapularis suture; 99.7% indicated postoperative immobilization; and 61.9% considered graft consolidation fundamental. Conclusion Most specialists participated in up to ten Bristow-Latarjet procedures during the specialization, but 13.5% of them graduated without participating in the surgery. The most frequent complication was graft fracture. The most common technical difficulty was screw positioning. Most participants prefer postoperative immobilization since they believe graft consolidation is essential to resume the practiced of sports. The highest complication rate occurred with specialists who have obtained their titles 11 to 15 years ago. In Brazil, the Southeast region is the largest producer of specialists and has the highest concentration of these professionals.

ASSESSMENT OF THE LEVEL OF SATISFACTION OF PATIENTS SUBMITTED TO LATARJET SURGERY UNDER OUTFIT SYSTEM COMPARED TO HOSPITAL SYSTEM.

Anterior shoulder instability causes functional changes that affect patients' quality of life. The Latarjet procedure is one of the most frequently performed surgeries for cases of recurrent shoulder instability. Objective: To assess the level of satisfaction of patients who underwent the Latarjet procedure in outpatient settings (day hospital) compared with inpatient settings. Methods: A questionnaire was administered to both groups and a descriptive analysis of the results was performed. Results: 51 patients were included, with a mean age of 29.9 years, 82.3% men and 17.6% women. Of the patients who underwent surgery in the day hospital, 46.1% were operated within 100 days of their first outpatient visit; among those in the inpatient group, 76.3% underwent surgery more than 200 days later. Delays occurred in 15.3% of cases in the day hospital compared with 68.4% in the inpatient group. Of the patients in the day hospital, 92.3% felt comfortable contacting the medical team in case of complications and would perform the procedure again in the same setting. Moreover, 63.2% of inpatients would have preferred to have been discharged on the same day. The final satisfaction rate for both groups was 100%. Conclusion: Outpatient surgery guarantees more patient comfort, safety, and can be performed in a timely manner and with fewer delays, which has influenced patients' decision to have surgery during the COVID-19 pandemic. Level of Evidence V, Cross-sectional Study.

A instabilidade anterior do ombro acarreta alterações funcionais que impactam a qualidade de vida do paciente. A cirurgia de Latarjet é um dos procedimentos mais executados para casos de instabilidade recorrente de ombro. Objetivo: Comparar o grau de satisfação dos pacientes submetidos ao procedimento de Latarjet no regime ambulatorial (hospital dia) com o dos operados no regime hospitalar. Métodos: Um questionário foi aplicado em ambos os grupos e uma análise descritiva dos resultados foi realizada. Resultados: Foram incluídos 51 pacientes, com idade média de 29,9 anos, sendo 82,3% homens e 17,6% mulheres. Dos submetidos à cirurgia no hospital dia, 46,1% operaram em até 100 dias depois do primeiro atendimento ambulatorial; já entre os do grupo hospitalar, 76,3% operaram mais de 200 dias depois. O atraso na cirurgia ocorreu com 15,3% dos pacientes do hospital dia contra 68,4% do grupo hospitalar. Do hospital dia, 92,3% pacientes sentiram-se confortáveis em contatar a equipe médica em caso de intercorrências e fariam novamente o procedimento de forma ambulatorial. Além disso, 63,2% dos internados gostariam de ter recebido alta no mesmo dia. O grau de satisfação final em ambos os grupos foi de 100%. Conclusão: A cirurgia ambulatorial garante mais conforto para o paciente, mostrando-se segura e podendo ser performada em tempo hábil e com menos atrasos, o que influenciou a decisão dos pacientes em operar durante a pandemia de COVID-19. Nível de Evidência V, Estudo Transversal.

FUNCTIONAL ASSESSMENT OF THE SHOULDER IN JIU-JITSU BLACK BELT ATHLETES.

OBJECTIVE: To assess the epidemiological profile of Jiu-Jitsu black belt athletes, including the prevalence of pain and shoulder function. METHODS: Cross-sectional study carried out with Jiu-Jitsu athletes from 2014 to 2016. The studied variables were: sex, age, dominant limb, weight, height, profession, time of Jiu-Jitsu practice, weekly training hours, other practiced sports, comorbidities, injuries and previous surgeries, medications and habits. For the functional assessment of the shoulder, the ASES Score was used. RESULTS: 53 male athletes were evaluated. There was a prevalence of alcohol consumption (60.4%) and supplement use (32.1%). The practice of other sports included weight training (49.1%) and other martial arts (17%). There was a prevalence of knee (66.0%) and shoulder (52.8%) injuries and, in some cases, the need for surgical procedures. There was a prevalence of shoulder pain (73.6%) and more than half of the athletes (52.9%) had minimal or moderate limitation of shoulder function. CONCLUSION: Jiu-jitsu black belt athletes often have a history of injuries, with the shoulder being the second most affected body part. In more than half of the athletes, there was a prevalence of shoulder pain and functional limitation, according to the ASES Score. Level of evidence III, Retrospective comparative study.

OBJETIVO: Avaliar o perfil epidemiológico de atletas faixas-pretas de jiu-jitsu, incluindo a prevalência de dor e a função do ombro. Métodos: Estudo transversal realizado com atletas de jiu-jitsu entre 2014 e 2016. As variáveis estudadas foram: sexo, idade, membro dominante, peso, altura, profissão, tempo de prática do esporte, horas semanais de treino, outros esportes praticados, comorbidades, lesões e cirurgias prévias, medicamentos e hábitos. Para a avaliação funcional do ombro, foi utilizado o escore American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES). RESULTADOS: Foram avaliados 53 atletas, todos do sexo masculino. Houve alta prevalência de consumo de bebida alcoólica (60,4%) e uso de suplementos (32,1%). A prática de outros esportes incluiu musculação (49,1%) e outras artes marciais (17%). Houve alta prevalência de lesões no joelho (66,0%) e no ombro (52,8%), e em alguns casos houve a necessidade de procedimentos cirúrgicos. Verificou-se alta prevalência de dor no ombro (73,6%), sendo que mais da metade dos atletas (52,9%) apresentaram limitação mínima ou moderada da função do ombro. Conclusão: Atletas faixas-pretas de jiu-jitsu frequentemente apresentam histórico de lesões, sendo o ombro o segundo local mais acometido. Houve alta prevalência de dor nos ombros e limitação funcional conforme o escore ASES em mais da metade dos atletas. Nível de evidência III, Estudo comparativo retrospectivo.

Bristow-Latarjet Surgery: A Current Overview in Brazil / Cirurgia de Bristow-Latarjet: Um panorama atual do Brasil

Abstract Objective To provide a current overview of the Bristow-Latarjet surgery in Brazil. Materials and MethodsThis cross-sectional study was based on an electronic questionnaire with 26 items, which was sent to active members of the Brazilian Society of Shoulder and Elbow Surgery (Sociedade Brasileira de Cirurgia do Ombro e Cotovelo, SBCOC, in Portuguese). The questionnaire addressed training, surgical technique, complications, and postoperative management. Results We sent the questionnaire to 845 specialists from April 20 to May 12, 2021, and 310 of them answered i in full. During their specialization, most specialists participated in up to ten Bristow-Latarjet procedures. The most frequent complication was graft fracture, while the most common technical difficulty was screw positioning. In total, 50.6% and 73.9% reported having experienced intraoperative and postoperative complications respectively; 57.1% declared performing subscapularis suture; 99.7% indicated postoperative immobilization; and 61.9% considered graft consolidation fundamental. Conclusion Most specialists participated in up to ten Bristow-Latarjet procedures during the specialization, but 13.5% of them graduated without participating in the surgery. The most frequent complication was graft fracture. The most common technical difficulty was screw positioning. Most participants prefer postoperative immobilization since they believe graft consolidation is essential to resume the practiced of sports. The highest complication rate occurred with specialists who have obtained their titles 11 to 15 years ago. In Brazil, the Southeast region is the largest producer of specialists and has the highest concentration of these professionals.

Resumo Objetivo Traçar um panorama atual da cirurgia de Bristow-Latarjet no Brasil. Materiais e Métodos Estudo transversal no qual um questionário eletrônico com 26 perguntas sobre aspectos de formação, técnica cirúrgica, complicações e manejo pós-cirúrgico foi enviado a membros ativos da Sociedade Brasileira de Cirurgia do Ombro e Cotovelo (SBCOC). Resultados Entre 20 de abril e 12 de maio de 2021, o questionário foi enviado a 845 especialistas, e obteve-se 310 respostas completas. Durante a especialização, a maior parte dos especialistas participou de até dez procedimentos de Bristow-Latarjet. A complicação mais frequente foi a fratura do enxerto, e a dificuldade técnica, o posicionamento dos parafusos. Ao todo, 50,6% já tiveram complicações no intraoperatório; 73,9% já tiveram complicações no pós-operatório; 57,1% fazem a sutura do subescapular; 99,7% indicam a imobilização no pós-operatório; e 61,9% consideram a consolidação do enxerto fundamental. Conclusão A maior parte dos especialistas participou de até dez procedimentos de Bristow-Latarjet durante a especialização, mas 13,5% se formaram sem ter participado de nenhuma cirurgia. A complicação mais frequente foi a fratura do enxerto. A dificuldade técnica mais frequente foi o posicionamento dos parafusos. Imobilização no pós-operatório é a preferência da maioria dos participantes, que consideram fundamental a consolidação do enxerto para o retorno ao esporte. O maior número de complicações ocorreu com especialistas que obtiveram o título de 11 a 15 anos atrás. A região Sudeste é a maior formadora de especialistas e onde está concentrada a maior parte deles.

Non-operative management of shoulder osteoarthritis: Current concepts.

Glenohumeral osteoarthritis (OA) is one of the most common causes of shoulder pain. Conservative treatment options include physical therapy, pharmacological therapy, and biological therapy. Patients with glenohumeral OA present shoulder pain and decreased shoulder range of motion (ROM). Abnormal scapular motion is also seen in patients as adaptation to the restricted glenohumeral motion. Physical therapy is performed to (1) decrease pain, (2) increase shoulder ROM, and (3) protect the glenohumeral joint. To decrease pain, it should be assessed whether the pain appears at rest or during shoulder motion. Physical therapy may be effective for motion pain rather than rest pain. To increase shoulder ROM, the soft tissues responsible for the ROM loss need to be identified and targeted for intervention. To protect the glenohumeral joint, rotator cuff strengthening exercises are recommended. Administration of pharmacological agents is the major part next to physical therapy in the conservative treatment. The main aim of pharmacological treatment is the reduction of pain and diminution of inflammation in the joint. To achieve this aim, non-steroidal anti-inflammatory drugs are recommended as first-line therapy. Additionally, the supplementation of oral vitamin C and vitamin D can help to slow down cartilage degeneration. Depending on the individual comorbidities and contraindications, sufficient medication with good pain reduction is thus possible for each patient. This interrupts the chronic inflammatory state in the joint and, in turn, enables pain-free physical therapy. Biologics such as platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells have gathered increased attention. Good clinical outcomes have been reported, but we need to be aware that these options are helpful in decreasing shoulder pain but neither stopping the progression nor improving OA. Further evidence of biologics needs to be obtained to determine their effectiveness. In athletes, a combined approach of activity modification and physical therapy can be effective. Oral medications can provide patients with transient pain relief. Intra-articular corticosteroid injection, which provides longer-term effects, must be used cautiously in athletes. There is mixed evidence for the efficacy of hyaluronic acid injections. There is still limited evidence regarding the use of biologics.

Rupture of the bilateral and simultaneous tendon of the pectoralis major muscle. Description of three cases.

Pectoralis major muscle tendon ruptures associated with physical activity or effort are no longer uncommon in the medical literature. Treatment has also evolved significantly in the last 20 years. However, simultaneous bilateral rupture has only been described in a few cases. This article reports three cases with simultaneous bilateral rupture and describes the examinations and treatment performed. Bilateral lesions, although infrequent, also require early diagnosis and treatment in the acute phase. The chronic phase requires tendon grafting for full correction and a slow rehabilitation process.

Primer caso, en un estado brasileño, de tratamiento quirúrgico de una fractura distal de clavícula con placa bloqueada con un botón pegado asociado a otro botón subcoracoideo asistido por artroscopía / First case, in a Brazilian state, of surgical treatment of a distal clavicle fracture with a plate locked with a glued button associated with another subcoracoid button assisted by arthroscopy

El tratamiento de las fracturas de clavícula distal se puede lograr a través de varias opciones. Las placas de bloqueo asociadas con los botones coracoclaviculares son una alternativa para estabilizar las lesiones de ligamentos asociadas con las fracturas de tipo IIB de Craig. La artroscopía puede ayudar a colocar el botón subcoracoideo. Presentamos el caso de una mujer de treinta y cinco años quien, al caer de una bicicleta, resultó con traumatismo directo en el hombro izquierdo. Las radiografías mostraron fractura conminuta de la clavícula distal asociada con lesiones de ligamentos (tipo IIB de Craig). Se optó por tratamiento quirúrgico con placa bloqueada con un botón pegado asociado a otro botón subcoracoideo asistido por artroscopía. A través de una vía de acceso directo sobre la clavícula mediolateral, se redujeron anatómicamente los fragmentos de fractura y se fijaron con una placa bloqueada para la clavícula distal y siete tornillos. Se realizó portal artroscópico posterior para visualizar la articulación. Mediante portal anterior se expusieron el espacio rotador y la región subcoracoidea. Con la ayuda de guías especiales se instalaron dos botones (uno subcoracoideo y otro pegado a la placa) conectados por cables especiales. Tres meses después de la cirugía, la paciente estaba sin dolor y volvió a practicar deportes al nivel previo a la lesión. Se logró un ROM normal y radiografías con la fractura anatómicamente consolidada y distancia coracoclavicular normal. Nivel de Evidencia: IV

The treatment of distal clavicle fractures can be accomplished through several options. Locking plates associated with coracoclavicular buttons are an alternative to stabilize ligament injuries associated with Craig's type IIB fractures. Arthroscopy can assist in positioning the subcoracoid dog button.We present the case of a thirty-five-year-old female fell from a bicycle with direct trauma to her left shoulder. Radiographs showed comminuted fracture of the distal clavicle associated with ligament injuries (Craig's type IIB). We opted for surgical treatment with a locked plate with a coupled button associated with a subcoracoid dog bone, assisted by arthroscopy. Through a direct region route over the mediolateral clavicle, the fracture fragments were anatomically reduced and fixed with a locked plate for the distal clavicle and seven screws. Posterior arthroscopic portal was performed to visualize the joint. Anterior portal was performed and the rotator space and subcoracoid region was exposed. With the aid of special guides, two buttons were installed (one sub-coracoid button and other attached to the plate) connected by special wires ("tapes"). Three months after the surgery, the patient was pain-free and returned to sports at the level prior to the injury. Normal ROM was achieved and radiographs with the anatomically consolidated fracture and normal coracoclavicular distance. Level of Evidence: IV

Functional assessment of the shoulder in jiu-jitsu black belt athletes / Avaliação funcional do ombro em atletas faixas-pretas de jiu-jitsu

ABSTRACT Objective: To assess the epidemiological profile of Jiu-Jitsu black belt athletes, including the prevalence of pain and shoulder function. Methods: Cross-sectional study carried out with Jiu-Jitsu athletes from 2014 to 2016. The studied variables were: sex, age, dominant limb, weight, height, profession, time of Jiu-Jitsu practice, weekly training hours, other practiced sports, comorbidities, injuries and previous surgeries, medications and habits. For the functional assessment of the shoulder, the ASES Score was used. Results: 53 male athletes were evaluated. There was a prevalence of alcohol consumption (60.4%) and supplement use (32.1%). The practice of other sports included weight training (49.1%) and other martial arts (17%). There was a prevalence of knee (66.0%) and shoulder (52.8%) injuries and, in some cases, the need for surgical procedures. There was a prevalence of shoulder pain (73.6%) and more than half of the athletes (52.9%) had minimal or moderate limitation of shoulder function. Conclusion: Jiu-jitsu black belt athletes often have a history of injuries, with the shoulder being the second most affected body part. In more than half of the athletes, there was a prevalence of shoulder pain and functional limitation, according to the ASES Score. Level of evidence III, Retrospective comparative study.

RESUMO Objetivo: Avaliar o perfil epidemiológico de atletas faixas-pretas de jiu-jitsu, incluindo a prevalência de dor e a função do ombro. Métodos: Estudo transversal realizado com atletas de jiu-jitsu entre 2014 e 2016. As variáveis estudadas foram: sexo, idade, membro dominante, peso, altura, profissão, tempo de prática do esporte, horas semanais de treino, outros esportes praticados, comorbidades, lesões e cirurgias prévias, medicamentos e hábitos. Para a avaliação funcional do ombro, foi utilizado o escore American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES). Resultados: Foram avaliados 53 atletas, todos do sexo masculino. Houve alta prevalência de consumo de bebida alcoólica (60,4%) e uso de suplementos (32,1%). A prática de outros esportes incluiu musculação (49,1%) e outras artes marciais (17%). Houve alta prevalência de lesões no joelho (66,0%) e no ombro (52,8%), e em alguns casos houve a necessidade de procedimentos cirúrgicos. Verificou-se alta prevalência de dor no ombro (73,6%), sendo que mais da metade dos atletas (52,9%) apresentaram limitação mínima ou moderada da função do ombro. Conclusão: Atletas faixas-pretas de jiu-jitsu frequentemente apresentam histórico de lesões, sendo o ombro o segundo local mais acometido. Houve alta prevalência de dor nos ombros e limitação funcional conforme o escore ASES em mais da metade dos atletas. Nível de evidência III, Estudo comparativo retrospectivo.

Assessment of the level of satisfaction of patients submitted to latarjet surgery under outfit system compared to hospital system / Avaliação do grau de satisfação do paciente submetido à cirurgia de latarjet em regime ambulatorial em comparação com o regime hospitalar

ABSTRACT Anterior shoulder instability causes functional changes that affect patients' quality of life. The Latarjet procedure is one of the most frequently performed surgeries for cases of recurrent shoulder instability. Objective: To assess the level of satisfaction of patients who underwent the Latarjet procedure in outpatient settings (day hospital) compared with inpatient settings. Methods: A questionnaire was administered to both groups and a descriptive analysis of the results was performed. Results: 51 patients were included, with a mean age of 29.9 years, 82.3% men and 17.6% women. Of the patients who underwent surgery in the day hospital, 46.1% were operated within 100 days of their first outpatient visit; among those in the inpatient group, 76.3% underwent surgery more than 200 days later. Delays occurred in 15.3% of cases in the day hospital compared with 68.4% in the inpatient group. Of the patients in the day hospital, 92.3% felt comfortable contacting the medical team in case of complications and would perform the procedure again in the same setting. Moreover, 63.2% of inpatients would have preferred to have been discharged on the same day. The final satisfaction rate for both groups was 100%. Conclusion: Outpatient surgery guarantees more patient comfort, safety, and can be performed in a timely manner and with fewer delays, which has influenced patients' decision to have surgery during the COVID-19 pandemic. Level of Evidence V, Cross-sectional Study.

RESUMO A instabilidade anterior do ombro acarreta alterações funcionais que impactam a qualidade de vida do paciente. A cirurgia de Latarjet é um dos procedimentos mais executados para casos de instabilidade recorrente de ombro. Objetivo: Comparar o grau de satisfação dos pacientes submetidos ao procedimento de Latarjet no regime ambulatorial (hospital dia) com o dos operados no regime hospitalar. Métodos: Um questionário foi aplicado em ambos os grupos e uma análise descritiva dos resultados foi realizada. Resultados: Foram incluídos 51 pacientes, com idade média de 29,9 anos, sendo 82,3% homens e 17,6% mulheres. Dos submetidos à cirurgia no hospital dia, 46,1% operaram em até 100 dias depois do primeiro atendimento ambulatorial; já entre os do grupo hospitalar, 76,3% operaram mais de 200 dias depois. O atraso na cirurgia ocorreu com 15,3% dos pacientes do hospital dia contra 68,4% do grupo hospitalar. Do hospital dia, 92,3% pacientes sentiram-se confortáveis em contatar a equipe médica em caso de intercorrências e fariam novamente o procedimento de forma ambulatorial. Além disso, 63,2% dos internados gostariam de ter recebido alta no mesmo dia. O grau de satisfação final em ambos os grupos foi de 100%. Conclusão: A cirurgia ambulatorial garante mais conforto para o paciente, mostrando-se segura e podendo ser performada em tempo hábil e com menos atrasos, o que influenciou a decisão dos pacientes em operar durante a pandemia de COVID-19. Nível de Evidência V, Estudo Transversal.

Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications? / Avaliação do posicionamento dos parafusos na cirurgia de Latarjet: Existe correlação entre paralelismo à glenoide e complicações radiográficas?

Abstract Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.

Resumo Objetivo Avaliar se o paralelismo dos parafusos com a glenoide na cirurgia de Latarjet interfere no posicionamento do enxerto e verificar a reprodutibilidade de um método de mensuração da posição dos parafusos. Métodos Estudo retrospectivo, multicêntrico, de pacientes com instabilidade anterior do ombro submetidos à cirurgia de Latarjet modificada e no mínimo 1 ano de seguimento pós-operatório. Dois médicos radiologistas analisaram as imagens tomográficas pós-operatórias, adquiridas em um banco de dados, para avaliação do posicionamento dos parafusos e das complicações radiográficas. Resultados Foram avaliados 34 pacientes, com idades entre 21 e 60 anos, sendo que um deles tinha acometimento bilateral dos ombros, totalizando 35 ombros avaliados. A avaliação tomográfica dos ângulos de inclinação dos parafusos não apresentou diferença entre os observadores. Houve concordância intra e interobservador para avaliação dos seguintes parâmetros cirúrgicos: posição do enxerto, presença ou não de complicações radiográficas. Conclusão A técnica descrita para mensuração do paralelismo dos parafusos na cirurgia de Latarjet apresentou uma concordância intra e inter observador muito boa e excelente, respectivamente. O paralelismo do parafuso com a glenoide é recomendado; no entanto, não é condição obrigatória e única para se evitar as complicações radiográficas.

Glenoid Bone Loss - A Retrospective Evaluation of Functional Outcomes after Bone Block Surgery for Anterior Shoulder Instability in High-demand Athletes / Falha óssea na glenoide - Uma avaliação retrospectiva dos desfechos funcionais após cirurgia de bloqueio ósseo para instabilidade anterior do ombro em atletas de alta demanda

Abstract Objective This study assesses the relationship between the glenoid bone loss size and range of motion, functional outcomes, and complications in high-performance athletes undergoing bone block surgery for anterior shoulder instability. Methods This retrospective study evaluated postoperative outcomes in athletes submitted to bone block surgery for anterior shoulder instability. In 5 years, 41 shoulders underwent the procedure; 20 had bone losses up to 15%, and 21 shoulders presented bone losses ranging from 15% and 25%. Results There was no statistically significant difference regarding postoperative complications, new dislocations, and the rate of return to sports. In addition, the quantitative criteria evaluated, i.e., ranges of motion and functional scores, showed no statistically significant difference between groups. Conclusion The size of the bone loss per se does not seem to affect functional outcomes and complications from these procedures, which are safe techniques for small and large bone losses.

Resumo Objetivo Avaliar a relação do tamanho do defeito ósseo da glenoide no arco de movimento, nos resultados funcionais e nas complicações em pacientes atletas de alta performance submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Método Estudo retrospectivo no qual foram avaliados os resultados pós-operatórios de atletas submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Em 5 anos foram 41 ombros operados, sendo 20 deles com até 15% de defeito ósseo e 21 com defeitos entre 15% e 25%. Resultados Não houve diferença estatisticamente significativa com relação a complicações pós-operatórias, novas luxações, e na taxa de retorno ao esporte. Os critérios quantitativos avaliados - arcos de movimento e escores funcionais - também não apresentaram diferença estatisticamente significativa entre os grupos. Conclusão O tamanho do defeito ósseo por si só não parece afetar os resultados funcionais e as complicações desses procedimentos, sendo uma técnica segura tanto para defeitos pequenos, quanto para os maiores.

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 .

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.