A study regarding the anterior cruciate ligament remnant: Differences in balance and postural control between remnant-preserving and remnant-non-preserving patients

Introduction: The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. However, quantitative studies on evaluate the postural control influence resulted from the ACL remnant preservation or not are scarce. The aim of this study is to evaluate the postural control of patients submitted to ACL reconstruction with and without preservation of the injured remnant in pre and postoperative periods.MethodsEighteen patients underwent ACL reconstruction and separated into 2 groups according to the preservation or not of the remnant: (I) submitted to ACL reconstruction with preservation of the remnant (10 patients); (II) submitted to ACL reconstruction without preservation of the remnant (8 patients). They were assessed using the Lysholm score and force plate, which evaluated the patient's postural stability for remnant and non-remnant preservation in ACL reconstruction surgery.ResultsGroup I showed statistically significant subjective and objective improvements, both at 3 and 6 months. Additionally, improvement of the Lysholm test at 6 months in Group II was also statistically significant. Furthermore, the results of the Friedman test for the VCOP and VY variables of Group I, with support of the injured side in the force plate, showed a statistically significant difference both for pre and postoperative period at 3 months, compared to the 6-month postoperative period. The variables EAC and VX were statistically different for Group II, considering the preoperative period, 3 and 6 months postoperatively.ConclusionPreserving the ACL remnant in patients with ACL injuries has a positive impact on postural stability during recovery.(AU)

Introducción: El ligamento cruzado anterior (LCA) es el ligamento de la rodilla que se lesiona con mayor frecuencia. Sin embargo, escasean los estudios cuantitativos sobre la evaluación de la influencia del control postural derivada de la preservación, o no, del remanente del LCA. El objetivo de este estudio es evaluar el control postural de los pacientes sometidos a la reconstrucción del LCA, con y sin preservación del remanente lesionado, en los periodos previo y posterior a la cirugía.MétodosDieciocho pacientes sometidos a reconstrucción del LCA separados en 2 grupos, de acuerdo con la preservación o no preservación del remanente: I) sometidos a reconstrucción del LCA con preservación del remanente (10 pacientes), y II) sometidos a reconstrucción del LCA sin preservación del remanente (8 pacientes). Los pacientes fueron evaluados utilizando la puntuación de Lysholm y una placa de aplicación de fuerza, que evaluó la estabilidad postural del paciente para la preservación y no preservación del remanente en la cirugía de reconstrucción del LCA.ResultadosEl grupo I mostró mejoras subjetivas y objetivas estadísticamente significativas, transcurridos 3 y 6 meses. Además, la mejora de la prueba de Lysholm transcurridos 6 meses en el grupo II fue también estadísticamente significativa. Asimismo, los resultados de la prueba de Friedman para las variables VCOP y VY en el grupo I, con apoyo del lado lesionado en la placa de aplicación de fuerza, reflejaron una diferencia estadísticamente significativa en ambos períodos pre y postoperatorio transcurridos 3 meses, en comparación con el período postoperatorio transcurridos 6 meses. Las variables EAC y VX fueron estadísticamente diferentes para el grupo II, considerando el periodo preoperatorio, y los 3 y 6 meses postoperatorios.ConclusiónPreservar el remanente del LCA en los pacientes con lesiones en dicho ligamento tiene un impacto positivo en la estabilidad postural durante la recuperación.(AU)

EVALUATION OF VOLUME AND STRENGTH OF THE QUADRICEPS MUSCLE BEFORE AND AFTER ANTERIOR CRUCIATED LIGAMENT RECONSTRUCTION SURGERY / AVALIAÇÃO DO VOLUME E FORÇA DO MÚSCULO QUADRÍCEPS ANTES E APÓS OPERAÇÃO DE RECONSTRUÇÃO DO LIGAMENTO CRUZADO ANTERIOR

Introduction: The anterior cruciate ligament is one of the main ligaments of the knee, often more susceptible to injuries due to its central position and its vital role in stabilizing this joint. The strength of the quadriceps plays a crucial role, with impact absorption function, helping to reduce load. Objective: To evaluate the volume and strength of the quadriceps muscle before and after reconstruction of the anterior cruciate ligament of the knee, their correlation and which variables predict pre- and postoperative muscle strength. Method: Prospective cohort of 37 patients evaluated preoperatively and 4 months after the operation, using magnetic resonance imaging and isokinetic dynamometry. The measurements of the limb undergoing the operation were compared to the contralateral limb as a control. Result: The volume of the quadriceps muscle was 65.2+13.4cm3 before and 63.4+15.9 cm3 after, significantly lower in the control at both moments, with a reduction of 3.0cm3 (4.1%) in the pre and 7.8 cm3 post (12.0%). Muscle strength was 105.5+29.9N/m before and 100.9+28.6N/m after, significantly lower in the operated limb (126.4+28.2N/m and 129.6+27.6N /m, p<0.001). This reduction was similar in the 2 evaluation moments, on average of 17.5N/m (16.3%) in the pre and 22.8N/m (22.5%) in the post. The loss of strength was greater than the loss of muscle volume, with muscle volume and time of anterior cruciate ligament injury being the main determinants of muscle strength in the pre-op. The strength in the post was mainly determined by that in the pre. Conclusion: The loss of muscle strength was 4 times greater than the loss of volume pre-operatively and 2 times greater post-operatively, indicating the beginning of recovery 4 months post-operatively.

Introdução: O ligamento cruzado anterior é um dos principais ligamentos do joelho, frequentemente mais suscetível às lesões devido à sua posição central e seu papel vital na estabilização desta articulação. A força do quadríceps desempenha papel crucial, com função de absorção de impacto, auxiliando na redução de carga. Objetivo: Avaliar o volume e a força do músculo quadríceps antes e após a reconstrução do ligamento cruzado anterior do joelho, sua correlação e quais as variáveis preditivas da força muscular pré e pós-operatória. Método: Coorte prospectiva de 37 pacientes avaliados no pré-operatório e com 4 meses após a operação, por meio de ressonância magnética e dinamometria isocinética. As medidas do membro submetido à operação foram comparadas ao membro contralateral como controle. Resultado: O volume do músculo quadríceps foi de 65,2+13,4cm3 antes e de 63,4+15,9 cm3 após, significativamente menor no controle nos 2 momentos, com redução de 3,0cm3 (4,1%) no pré e 7,8 cm3 no pós (12,0%). A força muscular foi de 105,5+29,9N/m antes e de 100,9+28,6N/m após, significativamente menor no membro operado (126,4+28,2N/m e 129,6+27,6N/m, p<0,001). Esta redução foi semelhante nos 2 momentos de avaliação, em média de 17,5N/m (16,3%) no pré e de 22,8N/m (22,5%) no pós. A perda de força foi maior que a perda de volume muscular, sendo que o volume muscular e o tempo da lesão do ligamento cruzado anterior foram os principais determinantes da força muscular no pré. A força no pós foi determinada principalmente pela do pré. Conclusão: A perda de força muscular foi 4 vezes maior que a perda de volume no pré e 2 vezes maior no pós, indicando início da recuperação com 4 meses no pós-operatório.

HOW MUCH VOLUMETRIC AND STRENGTH LOSS OF THE QUADRICEPS FEMORAL MUSCLE IS EXPECTED IN THE POST-OPERATIVE RECONSTRUCTION OF THE ANTERIOR CRUCIATED LIGAMENT? / QUANTO DE PERDA VOLUMÉTRICA E DE FORÇA DO MÚSCULO QUADRÍCEPS FEMORAL É ESPERADA NO PÓS-OPERATÓRIO DA RECONSTRUÇÃO DO LIGAMENTO CRUZADO ANTERIOR?

Introduction: When injured and/or reconstructed the anterior cruciate ligament, not only occurs decrease in strength, but also less contraction of the quadriceps, in addition to muscle atrophy. Magnetic resonance imaging and isokinetic dynamometry have offered better evaluation of the pre- and post-surgical periods and can better monitor and predict postoperative rehabilitation. Objectives: To review the role of volume and strength of the quadriceps femoris muscle before and after reconstruction of the anterior cruciate ligament and how these measurements correlate with the predictive variables of pre- and postoperative muscle strength. Method: Integrative review collecting information on virtual platforms. The texts were selected from SciELO, Google Scholar, Pubmed and Scopus. The descriptors related to the topic were the following: anterior cruciate ligament reconstruction; magnetic resonance imaging; quadriceps muscle in Portuguese and English with AND or OR search, considering the title and/or abstract. Results: The entire selected texts were read and 61 articles were included. Conclusion: A loss of volume and strength of the quadriceps muscle was observed after reconstruction. The loss of strength was 4 times greater than the preoperative volume and 2 times greater postoperatively, with improvement 4 months after the operation.

Introdução: Observa-se, quando da lesão e/ou reconstrução do ligamento cruzado anterior, não somente que há diminuição da força, mas também da qualidade e da contração do quadríceps, além de atrofia muscular. A ressonância magnética e dinamometria isocinética têm oferecido melhor avaliação dos períodos pré e pós-cirúrgicos, podendo melhor monitorizar e prever a reabilitação pós-operatória. Objetivos: Revisar o papel do volume e da força do músculo quadríceps femoral antes e após reconstrução do ligamento cruzado anterior e como estas medidas se correlacionam com as variáveis preditivas da força muscular pré e pós-operatória. Método: Revisão integrativa colhendo informações em plataformas virtuais. Os textos foram selecionados do SciELO, Google Scholar, Pubmed e Scopus. Os descritores relacionados ao tema foram os seguintes: reconstrução do ligamento cruzado anterior; ressonância magnética; músculo quadríceps em português e inglês com busca AND ou OR, considerando o título e/ou resumo. Resultados: Foi realizada a leitura da íntegra dos textos selecionados e incluídos 61 artigos. Conclusão: Observou-se perda de volume e força do músculo quadríceps após a reconstrução. A perda da força muscular foi 4 vezes maior que a do volume pré- operatório e 2 vezes maior no pós-operatório com melhora após 4 meses da operação.

4 Domain Sports PROM in Spanish: Cross-cultural adaptation in the Chilean population and reliability analysis. / 4 Domain Sports PROM en español: adaptación transcultural en la población chilena y análisis de confiabilidad.

BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.

Retorno a la actividad completa tras cirugía de reconstrucción de ligamento cruzado anterior en personal militar: metaanálisis / Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis

Objetivo: Se realizó un metaanálisis para evaluar los resultados clínico-funcionales de la cirugía de ligamento cruzado anterior en militares, así como las complicaciones asociadas a la misma. Material y métodos: Se realizó una búsqueda en las 3 principales fuentes de bases de datos hasta diciembre de 2022 (PubMed, Google Scholar y ScienceDirect) en cuanto a los resultados tras la cirugía de ligamento cruzado anterior en personal militar. La revisión sistemática se realizó siguiendo las normas Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA–, y los criterios de inclusión siguieron la estrategia PICO. Los datos de los estudios incluidos se analizaron mediante el software Review Manager 5.4. Resultados: Se seleccionaron un total de 7 estudios retrospectivos. La tasa general de retorno a la actividad completa en el personal militar fue del 62,3% (61,5% para el grupo de no oficiales frente a 68,3% para el grupo de oficiales), sin ser esta diferencia significativa (p=0,92). La tasa general de lesión meniscal en los militares fue del 58,8%, sin ser esta diferencia significativa (p=0,88). La homogeneidad en ambos casos fue buena (I2=0%, p=0,99). Conclusión: El regreso a la actividad militar completa puede usarse en la población militar como un marcador de éxito después de una reconstrucción de ligamento cruzado anterior. Hay que destacar que una gran cantidad de militares experimentan limitaciones permanentes en la actividad que impiden el regreso completo al servicio.(AU)

Objective: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. Material and method: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA– standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. Results: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). Conclusion: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.(AU)

[Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis / Retorno a la actividad completa tras cirugía de reconstrucción del ligamento cruzado anterior en personal militar: metaanálisis

Objetivo: Se realizó un metaanálisis para evaluar los resultados clínico-funcionales de la cirugía de ligamento cruzado anterior en militares, así como las complicaciones asociadas a la misma. Material y métodos: Se realizó una búsqueda en las 3 principales fuentes de bases de datos hasta diciembre de 2022 (PubMed, Google Scholar y ScienceDirect) en cuanto a los resultados tras la cirugía de ligamento cruzado anterior en personal militar. La revisión sistemática se realizó siguiendo las normas Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA–, y los criterios de inclusión siguieron la estrategia PICO. Los datos de los estudios incluidos se analizaron mediante el software Review Manager 5.4. Resultados: Se seleccionaron un total de 7 estudios retrospectivos. La tasa general de retorno a la actividad completa en el personal militar fue del 62,3% (61,5% para el grupo de no oficiales frente a 68,3% para el grupo de oficiales), sin ser esta diferencia significativa (p=0,92). La tasa general de lesión meniscal en los militares fue del 58,8%, sin ser esta diferencia significativa (p=0,88). La homogeneidad en ambos casos fue buena (I2=0%, p=0,99). Conclusión: El regreso a la actividad militar completa puede usarse en la población militar como un marcador de éxito después de una reconstrucción de ligamento cruzado anterior. Hay que destacar que una gran cantidad de militares experimentan limitaciones permanentes en la actividad que impiden el regreso completo al servicio.(AU)

Objective: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. Material and method: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA– standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. Results: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). Conclusion: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.(AU)

[Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis.

OBJECTIVE: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analysed using Review Manager 5.4 software. RESULTS: A total of seven retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group versus 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.

Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. / Retorno a la actividad completa tras cirugía de reconstrucción de ligamento cruzado anterior en personal militar: metaanálisis.

OBJECTIVE: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. RESULTS: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.

A study regarding the anterior cruciate ligament remnant: Differences in balance and postural control between remnant-preserving and remnant-non-preserving patients.

INTRODUCTION: The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. However, quantitative studies on evaluate the postural control influence resulted from the ACL remnant preservation or not are scarce. The aim of this study is to evaluate the postural control of patients submitted to ACL reconstruction with and without preservation of the injured remnant in pre and postoperative periods. METHODS: Eighteen patients underwent ACL reconstruction and separated into 2 groups according to the preservation or not of the remnant: (I) submitted to ACL reconstruction with preservation of the remnant (10 patients); (II) submitted to ACL reconstruction without preservation of the remnant (8 patients). They were assessed using the Lysholm score and force plate, which evaluated the patient's postural stability for remnant and non-remnant preservation in ACL reconstruction surgery. RESULTS: Group I showed statistically significant subjective and objective improvements, both at 3 and 6 months. Additionally, improvement of the Lysholm test at 6 months in Group II was also statistically significant. Furthermore, the results of the Friedman test for the VCOP and VY variables of Group I, with support of the injured side in the force plate, showed a statistically significant difference both for pre and postoperative period at 3 months, compared to the 6-month postoperative period. The variables EAC and VX were statistically different for Group II, considering the preoperative period, 3 and 6 months postoperatively. CONCLUSION: Preserving the ACL remnant in patients with ACL injuries has a positive impact on postural stability during recovery.

Estrategias para la prevención de lesiones de ligamento cruzado anterior en mujeres deportistas con valgo dinámico de rodilla. Revisión sistemática / Strategies for the prevention of anterior cruciate ligament injuries in female athletes with dynamic knee valgus: Systematic review

Antecedentes y objetivo El aumento de la participación deportiva de las mujeres en la última década produce un aumento del riesgo, la frecuencia y la prevalencia de lesiones de ligamento cruzado anterior (LCA). Su incidencia de lesión es entre 2-8 veces mayor que en hombres debido a factores de riesgo como el valgo dinámico de rodilla (DKV). El objetivo de este trabajo consiste en evidenciar los programas de prevención actuales disponibles en la literatura científica, dirigidos a reducir las lesiones de LCA en mujeres deportistas con DKV y sus características en cuanto a variables y herramientas de medición, dosificación y aplicación. Material y métodos Se efectuó una revisión sistemática siguiendo la declaración PRISMA. Se buscó en las bases de datos PubMed, Cochrane, Embase, Science Direct, Web of Science y Scopus. Los artículos seleccionados tenían que mostrar las estrategias preventivas que pueden contribuir a reducir las lesiones del LCA en mujeres deportistas con DKV. Para valorar la calidad metodológica se utilizaron las escalas PEDro y STROBE. La última búsqueda fue realizada en febrero de 2022. Resultados Diecisiete estudios con un total de 1.634 participantes (79,5% mujeres; 20,5% hombres) cumplieron los criterios de inclusión de esta revisión. Todos los estudios mostraron mejoras significativas del DKV y del gesto deportivo. La fuerza y la activación muscular de miembros inferiores (59,3%) tras completar protocolos de control motor, fuerza o equilibrio también muestran mejoras significativas. Conclusiones Aunque sea necesaria una mayor investigación sobre la inclusión de estos programas en deportistas femeninas con DKV, los estudios revisados han comprobado que existen programas de prevención variados (pliometría, equilibrio, fuerza, entre otros) que aportan una mejora significativa del DKV y, por tanto, de la prevención de lesiones de LCA en mujeres deportistas a corto plazo (AU)

Background and objective The increase in female sports participation in the last decade has led to an increase in the risk, frequency and prevalence of anterior cruciate ligament (ACL) injuries. Their incidence of injury is 2–8 times higher than in men due to risk factors such as dynamic knee valgus (DKV). The aim of this study is to demonstrate the current prevention programmes available in the scientific literature aimed at reducing ACL injuries in female athletes with DKV and their characteristics in terms of variables and measurement tools, dosage and application. Material and methods A systematic review was conducted following the PRISMA statement. The databases PubMed, Cochrane, Embase, Science Direct, Web of Science and Scopus were searched. The articles selected had to show preventive strategies that can contribute to reducing ACL injuries in female athletes with DKV. The PEDro and STROBE scales were used to assess methodological quality. The last search was conducted in February 2022. Results Seventeen studies with a total of 1634 participants (79.5% women; 20.5% men) met the inclusion criteria for this review. All studies showed significant improvements in DKV and sport gesture. Lower limb muscle strength and activation (59.3%) after completing motor control, strength or balance protocols also showed significant improvements. Conclusions Although more research is needed on the inclusion of these programmes in female athletes with DKV, the studies reviewed have shown that there are varied prevention programmes (plyometrics, balance, strength, among others) that provide a significant improvement in DKV and, therefore, in the prevention of ACL injuries in female athletes in the short term (AU)

An Unusual Cause of Posterior Knee Pain: Mucoid Degeneration of the Anterior Cruciate Ligament - Case Report / Uma causa incomum de dor posterior no joelho: degeneração mucóide do ligamento cruzado anterior - Relato de caso

Abstract Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon cause of pain in the posterior region of the knee, of unknown pathophysiology and underdiagnosed. The best treatment modality is still under discussion. Resection of the lesion with partial ACL debridement has shown good results without the occurrence of instability. The authors present a case of mucoid degeneration of the ACL treated with resection of the mucoid degeneration and partial debridement of the ACL by arthroscopy.

Resumo A degeneração mucoide do ligamento cruzado anterior (LCA) é uma causa pouco frequente de dor na região posterior do joelho, de patofisiologia desconhecida e subdiagnosticada. A melhor modalidade de tratamento ainda está em discussão. A ressecção da lesão com desbridamento parcial do LCA tem apresentado bons resultados, sem a ocorrência de instabilidade. Os autores apresentam um caso de degeneração mucoide do LCA tratado com ressecção da degeneração mucoide e desbridamento parcial do LCA por artroscopia.

Risk Factors for Symptomatic Cyclops Lesion Formation after Anterior Cruciate Ligament Reconstruction / Fatores de risco para formação de lesão cyclops sintomática após a reconstrução do ligamento cruzado anterior

Abstract Objective To evaluate the incidence of symptomatic cyclops lesions requiring surgical treatment after anterior cruciate ligament (ACL) reconstruction and to establish possible intraoperative risk factors related to it. Methods Three hundred and eighty-nine patients aged between 18 and 50 years who underwent primary ACL reconstruction were retrospectively evaluated. Patients were divided into groups according to the presence or absence of symptomatic cyclops lesions, and their characteristics were compared. Patients with associated lesions that required additional surgical procedures (except anterolateral extra-articular procedures) were not included. The rate of symptomatic cyclops lesions was recorded and the following parameters were evaluated: age, gender, time from injury to surgery, graft type and diameter, femoral tunnel perforation technique, fixation type, presence of knee hyperextension, preservation of the ACL remnant, associated anterolateral extra-articular procedure, associated meniscal injury and participation in sports. Results 389 patients were evaluated and 26 (6.7%) patients developed cyclops. The patients with and without cyclops lesions did not differ in age, time from injury to surgery, graft type or diameter, surgical technique, femoral fixation method, presence of knee hyperextension, remnant preservation and associated meniscal injury. The group with cyclops lesion had a higher proportion of females (10 (38.4%) vs 68 (18.7%); OR = 2.7; p= 0.015), higher proportion of extra-articular reconstruction (18 (11.8%) vs 8 (3.4%); OR = 3.8; p= 0.001) and higher proportion of sports practice (23 (8.6%) vs 3 (2.5%); OR = 3.6; p= 0.026). Conclusion In our series, 6.7% of the patients required arthroscopic removal of cyclops lesions. Female gender, associated extra-articular reconstruction and sports practice were factors related to this lesion. Remnant preservation had no relationship with cyclops lesion formation.

Resumo Objetivo Avaliar a incidência de lesões cyclops sintomáticas que precisam de tratamento cirúrgico após a reconstrução do ligamento cruzado anterior (LCA) e estabelecer os possíveis fatores de risco intraoperatórios relacionados a elas. Métodos Trezentos e oitenta e nove pacientes com idades entre 18 e 50 anos submetidos à reconstrução primária do LCA foram avaliados de forma retrospectiva. Os pacientes foram divididos em grupos de acordo com a presença ou ausência de lesões cyclops sintomáticas e suas características foram comparadas. Não foram incluídos pacientes com lesões associadas que necessitassem de outros procedimentos cirúrgicos (à exceção de procedimentos extra-articulares ântero-laterais). A taxa de lesões cyclops sintomáticas foi registrada e os seguintes parâmetros foram avaliados: idade, sexo, tempo da lesão à cirurgia, tipo e diâmetro do enxerto, técnica de perfuração do túnel femoral, tipo de fixação, presença de hiperextensão do joelho, preservação do LCA remanescente, associação a procedimento extra-articular ântero-lateral, lesão de menisco associada e participação em esportes. Resultados Dos 389 pacientes avaliados, 26 (6,7%) desenvolveram lesão cyclops. Os pacientes com e sem lesão cyclops não diferiram quanto à idade, tempo da lesão à cirurgia, tipo ou diâmetro do enxerto, técnica cirúrgica, método de fixação femoral, presença de hiperextensão do joelho, preservação do LCA remanescente e lesão de menisco associada. O grupo com lesão cyclops apresentou mais mulheres (10 [38,4%] vs. 68 [18,7%]; razão de probabilidades [OR] = 2,7; p= 0,015), maior proporção de reconstrução extra-articular (18 [11,8%] vs. 8 [3,4 %]; OR = 3,8; p= 0,001) e maior proporção de prática esportiva (23 [8,6%] vs. 3 [2,5%]; OR = 3,6; p= 0,026). Conclusão Em nossa série, 6,7% dos pacientes necessitaram de remoção artroscópica das lesões cyclops. O sexo feminino, a reconstrução extra-articular associada e a prática esportiva foram fatores relacionados a essa lesão. A preservação do menisco remanescente não foi associada à formação de lesões cyclops.

Los Músculos Isquiosurales y su Capacidad Profiláctica sobre la Translación Tibial Anterior en Lesión de Ligamento Cruzado Anterior: Una Revisión Sistemática / The Hamstrings Muscles and their Prophylactic Capacity on Anterior Tibial Translation in Anterior Cruciate Ligament Injury: A Systematic Review

La ruptura de ligamento cruzado anterior (LCA) es la lesión de rodilla más común que se trata de una reconstruc- ción quirúrgica. El objetivo principal de esta revisión fue analizar la importancia de la función de los músculos isquiosurales como factor de riesgo de posibles lesiones de LCA. Se llevó a cabo siguiendo las normas Preferred Reported Item for Systematic Reviews and Meta- analyses (PRISMA). La fuente de la recopilación de datos fue la consulta directa de las bases de datos Pubmed, Sportdiscus, Web of Science y Scopus. Para la recuperación documental, se utilizaron varias palabras clave y se evaluó la calidad de los estudios que fueron seleccionados mediante la escala PEDro. Los déficits de la función muscular en los músculos isquiosurales se han relacionado con una mayor translación tibial anterior y, como consecuencia, un incremento del estrés tensional sobre el LCA entre los 10° y 45° de flexión de rodilla. Una co-activación de los músculos isquiosurales con el músculo cuádriceps femoral puede ser de gran ayuda para reducir los factores de riesgo de la lesión LCA.

SUMMARY: Anterior cruciate ligament (ACL) rupture is the most common knee injury to undergo surgery in the sports setting. The main objective of this review was to analyze the importance of hamstring function as a risk factor for potential ACL injury. It was conducted following the Preferred Reported Item for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The source of data collection was direct consultation of the Pubmed, Sportdiscus, Web of Science and Scopus databases. For documentary retrieval, several key words were used and the quality of the studies that were selected was assessed using the PEDro scale. Muscle function deficits in the hamstrings have been related to increased anterior tibial translation and, as a consequence, increased tensional stress on the ACL between 10° and 45° of knee flexion. A co-activation of the hamstrings with the quadriceps may be helpful in reducing the risk factors for ACL injury.

Graft Selection Between Tendon Autograft and Allograft in Anterior Cruciate Ligament Reconstruction Based on the Histological Perspective: A Meta-Analysis / Seleção de enxerto entre autoenxerto e aloenxerto de tendão na reconstrução do ligamento cruzado anterior com base na perspectiva histológica: uma metanálise

Abstract Objective The purpose of this meta-analysis is to compare ligament healing on autograft and allograft in anterior cruciate ligament (ACL) reconstruction. Methods The selection of appropriate studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We made a statistical analysis using a review manager. Electronic reports were searched using the PubMed, Medline, and Cochrane Library databases. The inclusion criteria were animal studies and cellular histology of both grafts as an outcome. Results The initial search revealed 412 potential articles. After duplicates were removed, 246 articles remained. Then, 14 articles were obtained and screened for relevance and eligibility. The relevant articles were searched manually, checking for eligibility and details in order not to miss included reports. Subsequently, 5 studies were included, with a total of 232 samples, reporting the biopsied results with quantitative histology of ligament healing between allograft and autograft. The biopsy samples in those studies were examined under light or electron microscope, to analyze the cellular distribution area and ligamentization stages in each group. Meta-analyses found significant difference between autograft and allograft (Heterogeneity, I2 = 89%; Mean Difference, 95% confidence interval [CI] =-34.92, -54.90, -14.93; p = 0.0006). There is also a significant difference on both graft in cellular count at over 24 weeks (Heterogeneity, I2 = 26%; Mean Difference, 95% CI = -14.59, -16.24, -12.94; p < 0.00001). Conclusion In the current meta-analysis, autograft shows a significant difference when compared to allograft, with more cellular accumulation and faster remodeling response on the ligamentization process being noticed in the former. However, a larger clinical trial will be needed to emphasize this literature's result.

Resumo Objetivo O objetivo desta metanálise comparar a cicatrização de ligamentos no autoenxerto e aloenxerto na reconstrução do ligamento cruzado anterior (LCA). Métodos A seleção dos estudos adequados foi realizada de acordo com as diretrizes de Relatórios Preferenciais para Revisões Sistemáticas e Metanálises (Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA). Uma análise estatística foi feita usando um gerente de revisão. Os relatórios eletrônicos foram pesquisados usando os bancos de dados PubMed, Medline e Cochrane Library. Os critérios de inclusão foram estudos em animais e a histologia celular de ambos os enxertos como desfecho. Resultado A pesquisa inicial revelou 412 artigos potenciais. Após a retirada das duplicatas, restaram 246 artigos. Então, 14 artigos foram obtidos e selecionados pela relevância e elegibilidade. Os artigos relevantes foram pesquisados manualmente, verificando sua elegibilidade e detalhando os estudos para não perder os relatórios incluídos. Posteriormente, foram incluídos 5 estudos, com um total de 232 amostras, relatando os resultados de biópsia com histologia quantitativa de cicatrização de ligamento entre aloenxerto e autoenxerto. As amostras de biópsia nesses estudos foram examinadas sob microscópio leve ou eletrônico, para análise da área de distribuição celular e estágios de ligamentização em cada grupo. As metanálises encontraram diferença significativa entre autoenxerto e aloenxerto (Heterogeneidade, I2 = 89%; Diferença média, 95% intervalo de confiança [IC] =-34,92, -54,90, -14,93; p = 0,0006). Também há uma diferença significativa nosdoisenxertosnacontagem celular de mais de 24 semanas (Heterogeneidade, I2 = 26%; Diferença média, 95% IC = -14,59 , -16,24, -12,94; p < 0,00001). Conclusão Na presente metanálise, o autoenxerto mostra resultados significativos quando comparado ao aloenxerto, com mais acúmulo celular e resposta de remode-lagem mais rápida no processo de ligamentizaçãosendoobservadonoprimeiro.No entanto, será necessário um estudo clínico maior para enfatizar o resultado desta literatura.

Proprioception Analysis following Anterior Cruciate Ligament Reconstruction using Stabilometry: A Prospective, Longitudinal Study / Análise de propriocepção por estabilometria após a reconstrução do ligamento cruzado anterior: Um estudo prospectivo e longitudinal

Abstract Objective Commonly used methods for measuring proprioception have resulted in conflicting reports regarding knee proprioception with anterior cruciate ligament (ACL) rupture and the influence of ACL reconstruction. Methods One hundred subjects (50 patients with radiologically and arthroscopically confirmed unilateral ACL rupture and 50 normal controls) were assessed with regards to proprioception using dynamic single-leg stance postural stabilometry. Instrumented knee ligament laxity and knee outcome scores were also measured. Of the 50 patients in the ACL group, 34 underwent reconstruction and were reassessed postoperatively. Results There was a significant proprioceptive deficiency in the ACL group compared with their contralateral knee ( p < 0.001) and to the control group ( p = 0.01). There was asignificant improvement in knee proprioception following ACL reconstruction compared to preoperative findings ( p = 0.003). There was no correlation between ligament laxity measurements and outcome scores. A significant correlation was found preoperatively between outcome scores and proprioception measurements. This correlation was not found post-operatively. Pre-operative proprioception testing had asignificant correlation (r = 0.46) with post-operative proprioception ( p = 0.006). Conclusion Patients with an ACL rupture had a proprioceptive deficit which improved following ligament reconstruction. Knee outcome scores had a better correlation with proprioception than ligament laxity. Proprioception may be a superior objective measure than ligament laxity in quantifying functional knee deficits and outcomes in patients with ACL ruptures. Level of Evidence III Therapeutic Study; Prospective Longitudinal Case-Control Study.

Resumo Objetivo Os métodos comumente usados para medir a propriocepção resultaram em relatos conflitantes sobre a propriocepção do joelho com ruptura do ligamento cruzado anterior (LCA) e a influência da reconstrução do LCA. Métodos A propriocepção de 100 indivíduos (50 pacientes com ruptura unilateral do LCA confirmada à radiologia e artroscopia e 50 controles normais) foi avaliada por estabilometria postural dinâmica em apoio unipodal. A lassidão ligamentar do joelho instrumentado e suas pontuações de desfechos também foram medidas. Dos 50 pacientes do grupo LCA, 34 foram submetidos à reconstrução e reavaliados no período pós-operatório. Resultados O grupo LCA apresentou deficiência proprioceptiva significativa em relaçãoaojoelho contralateral ( p < 0,001) e ao grupo controle ( p = 0,01). A propriocepção do joelho melhorou de maneira significativa após a reconstrução do LCA em relação aos achados pré-operatórios ( p = 0,003). Não houve correlação entre as medidas de lassidão ligamentar e as pontuações de desfechos. Além disso, observamos uma correlação significativa entre as pontuações de desfechos e as medidas de propriocepção antes da cirurgia. Essa correlação não foi detectada no período pós-operatório. O teste pré-operatório de propriocepção teve correlação significativa ( r = 0,46) com a propriocepção pós-operatória ( p = 0,006). Conclusão Os pacientes com ruptura do LCA apresentaram déficit proprioceptivo que melhorou após a reconstrução ligamentar. As pontuações de desfecho do joelho tiveram melhor correlação à propriocepção do que a lassidão ligamentar. A proprio-cepção pode ser uma medida objetiva superior à lassidão ligamentar na quantificação de déficits funcionais e desfechos do joelho em pacientes com ruptura do LCA. Nível de Evidência III Estudo Terapêutico; Estudo de Caso-Controle Longitudinal Prospectivo.

Synovium and blood capillaries at the femoral attachment of anterior cruciate ligament are significantly abundant than those at the tibial attachment / Sinovial y capilares sanguíneos en la inserción femoral del ligamento cruzado anterior son significativamente más abundantes que los de la inserción tibial

SUMMARY: The anterior cruciate ligament (ACL) is a ligament that mainly controls the anterior and rotational mobility of the knee joint, and its surface is covered by a synovial membrane with large number of blood vessels. In general, nutritional supply to the ligament is from many capillaries in the adjacent synovium. However, statistical studies of the capillaries distributed to the ACL are insufficient. In this study, we examined cross-sectional histological images of the femoral attachment (femoral level), middle level of the tendon (middle level), and tibial attachment (tibial level) of the ACL and statistically analyzed blood capillary distribution among the three levels. The ACLs of 10 cadavers were divided into 5 equal sections, and 4mm-thick paraffin sections were made at the femoral level, middle level, and tibial level, and then hematoxylin-eosin (HE) staining were performed. The area of each transverse section was measured using Image-J 1.51n (U. S. National Institutes of Health, Bethesda, MD, USA). Fiber bundles of the ACL were relatively small and sparse in cross-sectional area at the femoral level and became larger and denser toward the tibial level. Many blood levels. The synovium at the attachment of ACL covered the surface of the fiber bundle and also penetrated deeply between the fiber bundles. In particular, the blood capillaries were densely distributed in the synovium at the femoral attachment rather than another two levels. Indeed, the number of capillaries were also most abundant in the femoral level. The cross-sectional ACL area at the femoral level is significantly small, however, the blood capillaries were most abundant. Therefore, when the ACL is injured, its reconstruction with preservation of the femoral ligamentous remnant may be clinically useful for remodeling of the grafted tendon.

El ligamento cruzado anterior (LCA) es un ligamento que controla principalmente la movilidad anterior y rotacional de la articulación de la rodilla, y su superficie está cubierta por una membrana sinovial con gran cantidad de vasos sanguíneos. En general, el suministro de nutrientes al ligamento proviene de muchos capilares en la sinovial adyacente. Sin embargo, los estudios estadísticos de los capilares distribuidos en el LCA son insuficientes. En este estudio, examinamos imágenes histológicas trans- versales de la inserción femoral (nivel femoral), el nivel medio del tendón (nivel medio) y la inserción tibial (nivel tibial) del LCA y analizamos estadísticamente la distribución de los capilares sanguíneos entre los tres niveles. Los LCA de 10 cadáveres se dividieron en 5 secciones iguales y se realizaron cortes en parafina de 4 µm de espesor a nivel femoral, medio y tibial, y luego se realizó tinción con hematoxilina-eosina (HE). El área de cada sección transversal se midió utilizando Image-J 1.51n (Institutos Nacionales de Salud de EE. UU., Bethesda, MD, EE. UU.). Los haces de fibras del LCA eran relativamente pequeños y escasos en el área de la sección transversal a nivel femoral y se hicieron más grandes y más densos hacia el nivel tibial. La membrana sinovial en la unión del LCA cubría la superficie del haz de fibras y también penetraba profundamente entre entre los haces de fibras. En particular, los capilares sanguíneos estaban densamente distribuidos en la unión femoral de la sinovial respecto a los otros dos niveles. De hecho, el número de capilares también fue más abundante a nivel femoral. El área transversal del LCA a nivel femoral era significativamente pequeña, sin embargo, los capilares sanguíneos fueron los más abundantes. Por lo tanto, cuando hay una lesión del LCA su reconstrucción con preservación del ligamento femoral remanente puede ser clínicamente útil para remodelar el tendón injertado.

Relationship of the Cruciate and Meniscofemoral Ligaments with the Knee Osteology. An Anatomical Study / Relação dos ligamentos cruzados e meniscofemorais com a osteologia do joelho: Um estudo anatômico

Abstract Objective To analyze the dimensions of the posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), the presence of meniscus-femoral ligaments MFLs in human knees, and the correlation with the dimensions of the knee skeleton. Methods Anatomical study on 29 specimens of human knees in which we measured the length and width of the cruciate and meniscus-femoral ligaments and the dimensions of femoral and tibia condyles and the femoral notch. The ACL length was calculated with different degrees of knee flexion. The relationship between the ligaments and bone dimensions were analyzed. Results The length of the ACL and the PCL were similar. Posterior MFL was more frequent and longer than the anterior MFL. We found the posterior MFL in the 72.41% of the knees and anterior MFL in 20.69%. The ACL presented 30% of its maximum length up to 60°, approximately half of its length between 90° and 120°, reaching its maximum length at 170°. We found a strong correlation between the length of the ACL and that of the PCL (p= 0.001). However, the lengths of the ACL and PCL were not related with the bone dimensions. Conclusion We have found no correlations between the cruciate and MFLs and the anatomical dimensions of the intercondylar notch and the proximal tibia and distal femur. The presence of the posterior MFL was more frequent and longer than that of the anterior ligament.

Resumo Objetivo Analisar as dimensões do ligamento cruzado posterior (LCP), do ligamento cruzado anterior (LCA), a presença de ligamentos meniscofemorais (LMFs) em joelhos humanos e a correlação com as dimensões do esqueleto do joelho. Métodos Estudo anatômico em 29 espécimes de joelhos humanos nos quais medimos o comprimento e a largura dos ligamentos cruzado e meniscofemoral e as dimensões dos côndilos femorais e tibiais e do entalhe femoral. O comprimento do LCA foi calculado com diferentes graus de flexão do joelho. Analisou-se a relação entre os ligamentos e as dimensões ósseas. Resultados O comprimento do LCA e do LCP foram semelhantes, LMF posterior foi mais frequente e mais longo do que o LMF anterior. Foram encontradas LMF posterior em 72,41% dos joelhos e LMF anterior em 20,69%. O LCA apresentou 30% de seu comprimento máximo até 60°, aproximadamente metade de seu comprimento entre 90° e 120°, atingindo seu comprimento máximo com flexão de 170°. Encontramos uma forte correlação entre o comprimento do LCA e do LCP (p= 0,001). No entanto, os comprimentos do LCA e do LCP não estavam relacionados com as dimensões ósseas. Conclusão Não encontramos correlações entre os ligamentos cruzado e meniscofemoral e as dimensões anatômicas do entalhe intercondilar e da tíbia proximal e do fêmur distal. A presença do LMF posterior foi mais frequente e maior que a do ligamento anterior.

Calculation of the Minimal Important Clinical Difference of the Lysholm and IKDC Scores After Anterior Cruciate Ligament Reconstruction / Cálculo da mínima diferença clínica importante dos escores Lysholm e IKDC após reconstrução do ligamento cruzado anterior

Abstract Objective To calculate the minimal important clinical difference (MICD) value for the Lysholm and International Knee Documentation Committee (IKDC) scores in a sample of patients submitted to anterior cruciate ligament reconstruction. Methods Primary, observational, retrospective, analytical study of participants submitted to anterior cruciate ligament reconstruction from March 2019 to December 2020 by the same surgeon, with a minimum follow-up of 6 months, analysis of knee function in the pre- and postoperative period by the Lysholm and IKDC scores, and answer to an anchor question at 6 months postoperatively for the calculation of the MICD of each score. Results A total of 59 patients participated in the study, with a mean age of 27.1 ± 5.7 years old. In the comparison between pre- and postoperative scores of all groups, there was an increase in values with statistical significance after intervention. The MICD was 5.5 for the Lysholm score, and the MICD value for the IKDC score could not be determined. Conclusion For the Lysholm score, the calculation of the MICD value by the anchor question method in the sample evaluated was 5.5. It was not possible to determine the value of the MICD for the IKDC score.

Resumo Objetivo Calcular o valor da mínima diferença clinicamente importante (MDCI) para os escores de Lysholm e International Knee Documentation Commitee (IKDC) na amostra de pacientes submetidos a reconstrução de ligamento cruzado anterior. Métodos Estudo primário, observacional, retrospectivo, analítico, de participantes submetidos a reconstrução do ligamento cruzado anterior no período de março de 2019 a dezembro de 2020, pelo mesmo cirurgião, com seguimento mínimo de 6 meses, análise da função do joelho no período pré e pós-operatório pelos escores de Lysholm e IKDC, e resposta a uma pergunta âncora aos 6 meses de seguimento pós-operatório, para o MDCI de cada escore. Resultados Participaram do estudo 59 pacientes, com média de idade de 27,1 ± 5,7 anos. Na comparação dos escores pré- e pós-operatórios de todos os grupos, observa-se aumento dos valores com significância estatística após a intervenção. A MDCI foi de 5,5 para o escore de Lysholm, não tendo sido possível determinar o valor para o IKDC. Conclusão O cálculo do valor da MDCI pelo método da pergunta âncora, na amostra avaliada, foi de 5,5 para o escore de Lysholm. Não foi possível determinar o valor da MDCI para o IKDC.

Resultados a 3 años tras técnica de reconstrucción anatómica semitendinoso-recto interno 4 fascículos del ligamento cruzado anterior en las mujeres: estudio de casos y controles / Outcome of 4-strand semitendinosus-gracilis anterior ligament reconstruction in women: A matched-cohort study

Introducción: Las mujeres presentan un riesgo elevado de rotura del ligamento cruzado anterior (LCA). Sin embargo, los resultados tras la cirugía reconstructiva son dispares en la literatura. El propósito de este estudio fue analizar los resultados en las mujeres tras cirugía reconstructiva del LCA, y compararlos con los resultados de los hombres. Material y métodos: Estudio retrospectivo de una base de datos prospectiva de pacientes intervenidos mediante reconstrucción anatómica semitendinoso-recto interno 4 fascículos del LCA entre enero de 2017 y diciembre de 2018. Para la valoración de los pacientes se utilizó la escala de actividad deportiva de Tegner, la escala de Lysholm, la escala EVA y el formulario IKDC subjetivo y objetivo. Se determinó la significación clínica con la diferencia mínima clínicamente importante y el estado de síntomas aceptable del paciente. Resultados: Se incluyeron en el estudio 33 mujeres y 99 hombres. El seguimiento medio de los pacientes fue de 36 meses. Las puntuaciones se incrementaron significativamente en los cuestionarios de valoración funcional en las mujeres al final del seguimiento, con resultados similares a los hombres. Solo se detectó una menor puntuación media significativa en las mujeres en el cuestionario IKDC subjetivo en aquellas menores de 25 años comparadas con los hombres. El porcentaje de pacientes que alcanzaron la significación clínica fue similar entre mujeres y hombres. Conclusiones: A los 3 años de seguimiento tras la reconstrucción anatómica semitendinoso-recto interno 4 fascículos del LCA, las mujeres presentaron una mejoría con significación estadística y clínica en los cuestionarios de valoración, sin diferencias con respecto a los hombres.(AU)

Introduction: Women carry out a greater risk of anterior cruciate ligament (ACL) rupture. However, outcomes following ACL reconstruction remain unclear. The aim of this study was to analyze the outcomes in women following ACL reconstruction and compare these outcomes with men. Material and methods: Retrospective study of a prospective database of patients treated with ACL reconstruction between January 2017 and December 2018. Outcome measures included Tegner activity scale, Lysholm scale, EVA scale, and IKDC evaluation form. Clinical significance was measured with minimally clinical important difference, and patient acceptable symptom state. Results: A total of 33 women were matched with 99 men. The mean follow-up was 36 months. Women showed significant improvement from preoperative PROs to the latest follow-up, with no differences between groups. In patients under 25 years old, there was less significant IKDC subjective score in women compared to men. There were no significant differences in frequency of patients achieving MCID and PASS in women compared with men. Conclusions: At 3-year following 4-strand semitendinosus-gracilis anterior ligament reconstruction, women showed significant improvements in PROs, with no differences compared to men.(AU)

[Translated article] Three years follow-up outcome of 4-strand semitendinous-gracilis anterior ligament reconstruction in women: A matched-cohort study / Resultados a 3 años tras técnica de reconstrucción anatómica semitendinoso-recto interno 4 fascículos del ligamento cruzado anterior en las mujeres: estudio de casos y controles

Introduction: Women carry out a greater risk of anterior cruciate ligament (ACL) rupture. However, outcomes following ACL reconstruction remain unclear. The aim of this study was to analyze the outcomes in women following ACL reconstruction and compare these outcomes with men. Material and methods: Retrospective study of a prospective database of patients treated with ACL reconstruction between January 2017 and December 2018. Outcome measures included Tegner activity scale, Lysholm scale, EVA scale, and IKDC evaluation form. Clinical significance was measured with minimally clinical important difference, and patient acceptable symptom state. Results: A total of 33 women were matched with 99 men. The mean follow-up was 36 months. Women showed significant improvement from preoperative PROs to the latest follow-up, with no differences between groups. In patients under 25 years old, there was less significant IKDC subjective score in women compared to men. There were no significant differences in frequency of patients achieving MCID and PASS in women compared with men. Conclusions: At 3-year following 4-strand semitendinosus-gracilis anterior ligament reconstruction, women showed significant improvements in PROs, with no differences compared to men.(AU)

Introducción: Las mujeres presentan un riesgo elevado de rotura del ligamento cruzado anterior (LCA). Sin embargo, los resultados tras la cirugía reconstructiva son dispares en la literatura. El propósito de este estudio fue analizar los resultados en las mujeres tras cirugía reconstructiva del LCA, y compararlos con los resultados de los hombres. Material y métodos: Estudio retrospectivo de una base de datos prospectiva de pacientes intervenidos mediante reconstrucción anatómica semitendinoso-recto interno 4 fascículos del LCA entre enero de 2017 y diciembre de 2018. Para la valoración de los pacientes se utilizó la escala de actividad deportiva de Tegner, la escala de Lysholm, la escala EVA y el formulario IKDC subjetivo y objetivo. Se determinó la significación clínica con la diferencia mínima clínicamente importante y el estado de síntomas aceptable del paciente. Resultados: Se incluyeron en el estudio 33 mujeres y 99 hombres. El seguimiento medio de los pacientes fue de 36 meses. Las puntuaciones se incrementaron significativamente en los cuestionarios de valoración funcional en las mujeres al final del seguimiento, con resultados similares a los hombres. Solo se detectó una menor puntuación media significativa en las mujeres en el cuestionario IKDC subjetivo en aquellas menores de 25 años comparadas con los hombres. El porcentaje de pacientes que alcanzaron la significación clínica fue similar entre mujeres y hombres. Conclusiones: A los 3 años de seguimiento tras la reconstrucción anatómica semitendinoso-recto interno 4 fascículos del LCA, las mujeres presentaron una mejoría con significación estadística y clínica en los cuestionarios de valoración, sin diferencias con respecto a los hombres.(AU)