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.

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.

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.

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.

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.

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.

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.

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).

RESULT OF BONE BLOCKING SURGERY IN COMBAT ATHLETES WITH ANTERIOR SHOULDER INSTABILITY: A PROSPECTIVE STUDY.

Objective: This study aims to understand the way fighting athletes respond to bone block surgery in the treatment for shoulder instability. Methods: Prospective clinical study with competitive fighters with shoulder instability who underwent bone block surgery from 2013 to 2016, followed by a postoperative rehabilitation protocol. For the evaluation, eight combat athletes with anterior shoulder instability were treated, with a total of nine shoulders, since one athlete underwent bilateral surgery. All patients signed the Free and Informed Consent Form. The evaluation protocol included medical consultation, radiography of the operated shoulder, degree of active and passive lateral rotation; degree of active and passive elevation; visual analogue scale (VAS) for pain; Athletic Shoulder Outcome Rating Scale (EROE; acronym in Portuguese) scores; Western Ontario Shoulder Instability Index (WOSI), and American Shoulder and Elbow Surgeons (ASES). Results: We observed a decrease in the range of passive and active movement in the recent postoperative period. In later postoperative, values were close to those in the preoperative period at the end of the follow-up. There was improvement in pain, and in all ASES, WOSI and EROE scores no complications were documented. As for returning to sport, two athletes did not return, one of them due to shoulder pain and the other due to retirement. Conclusion: Bone block surgery has shown good functional results in uncomplicated combat athletes. Level of Evidence IV, Prospective Case Series.

Objetivo: Este estudo objetiva entender como atletas de luta respondem ao tratamento para instabilidade do ombro após cirurgia de bloqueio ósseo. Métodos: Estudo clínico prospectivo com pacientes lutadores competitivos que apresentavam instabilidade do ombro submetidos à cirurgia de bloqueio ósseo de 2013 a 2016, seguido por protocolo pós-operatório de reabilitação. Oito atletas de luta com instabilidade anterior do ombro foram tratados, sendo, no total, 9 ombros. Um atleta foi submetido a cirurgia bilateral. Todos os pacientes assinaram o Termo de Consentimento Livre e Esclarecido. O protocolo de avaliação incluía consulta médica, radiografia do ombro operado, grau de rotação lateral ativa e passiva; grau de elevação ativa e passiva; escala visual analógica da dor (EVA); escores EROE; WOSI e ASES. Resultados: Observamos diminuição do arco de movimento passivo e ativo no pós-operatório recente e valores próximos aos do pré-operatório ao final do acompanhamento. Houve melhora da dor e em todos os escores ASES, WOSI e EROE no período pós-operatório, não havendo complicações. Quanto ao retorno ao esporte, dois atletas não retornaram ao esporte, sendo um deles por dor no ombro e outro por aposentadoria. Conclusão: A cirurgia de bloqueio ósseo apresentou bons resultados funcionais em atletas de luta sem complicações. Nível de Evidência IV, Série de Casos Prospectivo .

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).

HYLAN G-F 20 VERSUS TRIAMCINOLONE IN THE TREATMENT OF PRIMARY SHOULDER OSTEOARTHRITIS. RANDOMIZED TRIAL.

Introduction: The aim of this study was to evaluate the effect of using an intra-articular injection of hylan G-F 20 (HA group) on primary shoulder osteoarthritis compared with an intra-articular triamcinolone injection (T group). Materials and Methods: The patients were randomized into 2 groups: in the HA group a single dose of intra-articular hylan G-F 20 was administered and in the T control group a dose of triamcinolone 20 mg was administered. The participants were evaluated at 1 week, 1, 3, and 6 months after the procedure. The patients were evaluated for pain, range of motion, Constant score, modified UCLA score, and SPADI. Results: Seventy patients met the inclusion criteria and were randomized to the HA (38) and T (32) groups. Improvements in range of motion were significant (p > 0.05). We observed decreases in the general visual analog scale (VAS) for pain in both groups, especially in the cases of mild and moderate arthritis that received hyaluronic acid (mean values from 8.1 initially to 4.9 after 6 months) (p = 0). Conclusions: Both injections led to a decrease in pain and an increase in patient satisfaction. The results tend to be better and longer lasting in patients receiving hyaluronic acid. Level of evidence II b; Cohort study.

Introdução: O objetivo deste estudo foi avaliar o efeito do uso de uma injeção intra-articular de Hilano G-F 20 (Grupo HA) na osteoartrite primária do ombro em comparação com injeção intra-articular de triancinolona (Grupo T). Material e Método: Os pacientes foram randomizados em dois grupos: no Grupo HA foi administrada uma dose única de Hilano G-F 20 intra-articular e no Grupo controle T foi administrada uma dose de 20 mg de triancinolona. Os participantes foram avaliados 1 semana, 1, 3 e 6 meses depois do procedimento. Os pacientes foram avaliados quanto à dor, amplitude de movimento, escore de Constant, escore UCLA modificado e índice SPADI. Resultados: Setenta pacientes satisfizeram os critérios de inclusão e foram randomizados para os Grupos HA (38) e T (32). As melhoras da amplitude de movimento foram significativas (p > 0,05). Observamos diminuições na escala visual analógica (EVA) geral para dor em ambos os grupos, principalmente nos casos de artrite leve e moderada que receberam ácido hialurônico (valores médios de 8,1 inicialmente a 4,9 depois de 6 meses) (p = 0). Conclusões: Ambas as injeções reduziram a dor e aumentaram a satisfação do paciente. Os resultados tendem a ser melhores e mais duradouros em pacientes que recebem ácido hialurônico. Nível de evidência II b; Estudo de Coorte.

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.

Isokinetic Evaluation of the Shoulder After Bristow/Latarjet Surgical Procedure in Athletes.

Objectives To evaluate the muscular strength of the internal (IR) and external (ER) rotators of the shoulder after Bristow/Latarjet surgery. Methods Cross-sectional study with 18 patients (36 shoulders). The isokinetic evaluation was performed using the Biodex 3 System Pro dynamometer (Biodex Medical System, Inc., Shirley, NY, USA). The athletic shoulder outcome rating scale (ASORS) and the visual analogue scale (VAS) were applied. Results The values of peak torque and maximum work in concentric and eccentric mode on the non-operated shoulder were higher than on the operated side for both the IR and ER ( p < 0.01). The conventional and functional balance between the ER and IR showed no differences between the operated and the non-operated side. When comparing patients with postoperative time < 1 year or 1 year, no differences were observed in peak torque values at 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the IR to the operated shoulder. However, the peak torque values of 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the ER were higher in subjects with postoperative time ≥ 1 year in all variables ( p < 0.05). Conclusions There was a decrease in the strength of the IR and ER in the operated shoulder compared with the healthy shoulder. However, the conventional and functional balance was maintained.

Isokinetic Evaluation of the Shoulder After Bristow/Latarjet Surgical Procedure in Athletes / Avaliação isocinética do ombro após procedimento cirúrgico de Bristow/Latarjet em atletas

Abstract Objectives To evaluate the muscular strength of the internal (IR) and external (ER) rotators of the shoulder after Bristow/Latarjet surgery. Methods Cross-sectional study with 18 patients (36 shoulders). The isokinetic evaluation was performed using the Biodex 3 System Pro dynamometer (Biodex Medical System, Inc., Shirley, NY, USA). The athletic shoulder outcome rating scale (ASORS) and the visual analogue scale (VAS) were applied. Results The values of peak torque and maximum work in concentric and eccentric mode on the non-operated shoulder were higher than on the operated side for both the IR and ER (p< 0.01). The conventional and functional balance between the ER and IR showed no differences between the operated and the non-operated side. When comparing patients with postoperative time < 1 year or 1 year, no differences were observed in peak torque values at 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the IR to the operated shoulder. However, the peak torque values of 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the ER were higher in subjects with postoperative time ≥ 1 year in all variables (p< 0.05). Conclusions There was a decrease in the strength of the IR and ER in the operated shoulder compared with the healthy shoulder. However, the conventional and functional balance was maintained.

Resumo Objetivos Avaliar a força muscular dos rotadores medial (RM) e lateral (RL) do ombro após cirurgia de Bristow/Latarjet. Métodos Estudo transversal com 18 pacientes (36 ombros). A avaliação isocinética foi realizada por meio do dinamômetro Biodex 3 System Pro (Biodex Medical System, Inc., Shirley, NY, EUA). A escala de avaliação dos resultados do ombro do esportista (EROE) e a escala visual analógica (EVA) da dor foram aplicadas. Resultados Os valores do pico de torque e o trabalho máximo no modo concêntrico e excêntrico no ombro não-operado foram maiores que no lado operado, tanto para o RM e como para o RL (p< 0,01). O equilíbrio convencional e funcional entre o RL e o RM não apresentou diferenças entre o lado operado e o não operado. Na comparação entre pacientes com o tempo pós-operatório < 1 ano ou ≥ 1 ano, não se observou diferenças nos valores do pico de torque em 60°/s e 240°/s e do trabalho máximo em 60°/s e 240°/s do RM para o ombro operado. No entanto, os valores de do pico de torque em 60°/s e 240°/s e do trabalho máximo em 60°/s e 240°/s do RL foram superiores em indivíduos com tempo pós-cirúrgico ≥ 1 ano em todas as variáveis (p< 0,05). Conclusões Houve diminuição da força do RM e do RL no ombro operado em relação ao ombro saudável; porém, o equilíbrio convencional e funcional foi mantido.

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.

Hylan g-f 20 versus triamcinolone in the treatment of primary shoulder osteoarthritis. randomized trial / Hilano g-f 20 versus triancinolona no tratamento da osteoartrite primária do ombro. estudo randomizado

ABSTRACT Introduction The aim of this study was to evaluate the effect of using an intra-articular injection of hylan G-F 20 (HA group) on primary shoulder osteoarthritis compared with an intra-articular triamcinolone injection (T group). Materials and Methods The patients were randomized into 2 groups: in the HA group a single dose of intra-articular hylan G-F 20 was administered and in the T control group a dose of triamcinolone 20 mg was administered. The participants were evaluated at 1 week, 1, 3, and 6 months after the procedure. The patients were evaluated for pain, range of motion, Constant score, modified UCLA score, and SPADI. Results Seventy patients met the inclusion criteria and were randomized to the HA (38) and T (32) groups. Improvements in range of motion were significant (p > 0.05). We observed decreases in the general visual analog scale (VAS) for pain in both groups, especially in the cases of mild and moderate arthritis that received hyaluronic acid (mean values from 8.1 initially to 4.9 after 6 months) (p = 0). Conclusions Both injections led to a decrease in pain and an increase in patient satisfaction. The results tend to be better and longer lasting in patients receiving hyaluronic acid. Level of evidence II b; Cohort study.

RESUMO Introdução O objetivo deste estudo foi avaliar o efeito do uso de uma injeção intra-articular de Hilano G-F 20 (Grupo HA) na osteoartrite primária do ombro em comparação com injeção intra-articular de triancinolona (Grupo T). Material e Método Os pacientes foram randomizados em dois grupos: no Grupo HA foi administrada uma dose única de Hilano G-F 20 intra-articular e no Grupo controle T foi administrada uma dose de 20 mg de triancinolona. Os participantes foram avaliados 1 semana, 1, 3 e 6 meses depois do procedimento. Os pacientes foram avaliados quanto à dor, amplitude de movimento, escore de Constant, escore UCLA modificado e índice SPADI. Resultados Setenta pacientes satisfizeram os critérios de inclusão e foram randomizados para os Grupos HA (38) e T (32). As melhoras da amplitude de movimento foram significativas (p > 0,05). Observamos diminuições na escala visual analógica (EVA) geral para dor em ambos os grupos, principalmente nos casos de artrite leve e moderada que receberam ácido hialurônico (valores médios de 8,1 inicialmente a 4,9 depois de 6 meses) (p = 0). Conclusões Ambas as injeções reduziram a dor e aumentaram a satisfação do paciente. Os resultados tendem a ser melhores e mais duradouros em pacientes que recebem ácido hialurônico. Nível de evidência II b; Estudo de Coorte.

Result of bone blocking surgery in combat athletes with anterior shoulder instability: a prospective study / Resultado da cirurgia de bloqueio osseo em atletas de luta com instabilidade anterior do ombro: um estudo prospectivo

ABSTRACT Objective: This study aims to understand the way fighting athletes respond to bone block surgery in the treatment for shoulder instability. Methods: Prospective clinical study with competitive fighters with shoulder instability who underwent bone block surgery from 2013 to 2016, followed by a postoperative rehabilitation protocol. For the evaluation, eight combat athletes with anterior shoulder instability were treated, with a total of nine shoulders, since one athlete underwent bilateral surgery. All patients signed the Free and Informed Consent Form. The evaluation protocol included medical consultation, radiography of the operated shoulder, degree of active and passive lateral rotation; degree of active and passive elevation; visual analogue scale (VAS) for pain; Athletic Shoulder Outcome Rating Scale (EROE; acronym in Portuguese) scores; Western Ontario Shoulder Instability Index (WOSI), and American Shoulder and Elbow Surgeons (ASES). Results: We observed a decrease in the range of passive and active movement in the recent postoperative period. In later postoperative, values were close to those in the preoperative period at the end of the follow-up. There was improvement in pain, and in all ASES, WOSI and EROE scores no complications were documented. As for returning to sport, two athletes did not return, one of them due to shoulder pain and the other due to retirement. Conclusion: Bone block surgery has shown good functional results in uncomplicated combat athletes. Level of Evidence IV, Prospective Case Series.

RESUMO Objetivo: Este estudo objetiva entender como atletas de luta respondem ao tratamento para instabilidade do ombro após cirurgia de bloqueio ósseo. Métodos: Estudo clínico prospectivo com pacientes lutadores competitivos que apresentavam instabilidade do ombro submetidos à cirurgia de bloqueio ósseo de 2013 a 2016, seguido por protocolo pós-operatório de reabilitação. Oito atletas de luta com instabilidade anterior do ombro foram tratados, sendo, no total, 9 ombros. Um atleta foi submetido a cirurgia bilateral. Todos os pacientes assinaram o Termo de Consentimento Livre e Esclarecido. O protocolo de avaliação incluía consulta médica, radiografia do ombro operado, grau de rotação lateral ativa e passiva; grau de elevação ativa e passiva; escala visual analógica da dor (EVA); escores EROE; WOSI e ASES. Resultados: Observamos diminuição do arco de movimento passivo e ativo no pós-operatório recente e valores próximos aos do pré-operatório ao final do acompanhamento. Houve melhora da dor e em todos os escores ASES, WOSI e EROE no período pós-operatório, não havendo complicações. Quanto ao retorno ao esporte, dois atletas não retornaram ao esporte, sendo um deles por dor no ombro e outro por aposentadoria. Conclusão: A cirurgia de bloqueio ósseo apresentou bons resultados funcionais em atletas de luta sem complicações. Nível de Evidência IV, Série de Casos Prospectivo .