Lesiones del ligamento cruzado posterior / Posterior cruciate ligament injuries

Fundamento: la lesión del ligamento cruzado posterior es infrecuente, lo provocan los traumas de alta energía y se acompaña de lesiones asociadas de partes blandas y óseas.Objetivo: profundizar los conocimientos en relación a las lesiones del ligamento cruzado posterior de la rodilla.Métodos: se realizó la búsqueda de la información desde el primero de diciembre de 2016 hasta el 31 de enero de 2017 y se emplearon las siguientes palabras: posterior cruciate ligament injuries y posterior cruciate ligament reconstruction, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 254 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 51 citas seleccionadas para realizar la revisión, todas ellas de los últimos tres años, donde se incluyeron tres libros.Desarrollo: se abordan los factores relacionados con la biomecánica y anatomía del ligamento cruzado posterior. Se hace referencia al mecanismo de producción, diagnóstico basado en elementos clínicos e imaginológicos. La indicación quirúrgica es abordada de manera precisa, así como las diferentes técnicas. En relación al tratamiento quirúrgico de las lesiones combinadas se describe el tiempo de realización. Para culminar se hace referencia a las complicaciones divididas en preoperatoria, transoperatoria y posoperatorias.Conclusiones: las lesiones del ligamento cruzado posterior son tratadas de forma quirúrgica rara vez en caso de ser aisladas, no así en lesiones combinadas donde se requiere de reparación(AU)

Background: posterior cruciate ligament lesions are uncommon and are generally caused by high energy trauma, usually associated to soft tissue and bone lesions.Objective: to deepen into knowledge about lesions of the posterior cruciate ligament.Methods: a search in the databases PubMed, Hinari, SciELO and Medline was done through the information locator EndNote by using the following words: posterior cruciate ligament injuries and posterior cruciate ligament reconstruction, resulting in a total of 254 articles which 51 of them selected for review, all of them in the last three years, including three books.Development: important aspects related to the anatomy of the posterior cruciate ligament and biomechanics are pointed out. Mechanism of injury and diagnosis based on clinical and imaging were described. Surgical indications were stated as well as operative techniques. In regards to combined lesions surgical time was pointed out to perform it. Surgical complications were divided by preoperative, transoperative and postoperative ones.Conclusions: isolated lesions of the posterior cruciate ligament are seldom treated surgically, but combined lesions do, because reconstructive procedures are needed(AU)

Satisfacción percibida por pacientes y profesionales participantes de una vía clínica del ligamento cruzado anterior / Satisfaction perceived by outpatients and health professionals participating in a clinical pathway after anterior cruciate ligament reconstruction

Introducción. El propósito de este estudio fue evaluar el grado de satisfacción y la calidad asistencial percibida por los pacientes que finalizaron una vía clínica tras la reconstrucción del ligamento cruzado anterior y determinar el grado de satisfacción de los profesionales que participaron en ella. Material y métodos. Estudio observacional transversal. Se incluyeron 42 pacientes que finalizaron la vía clínica. Cumplimentaron una encuesta de satisfacción con 37 ítems: 32 recogían las respuestas en escala tipo Likert con puntuaciones de 1 «muy insatisfecho» a 5 «muy satisfecho», y el resto permitían responder «sí» o «no». Además se entregó una encuesta a los profesionales que participaron. Resultados. Los aspectos mejor valorados del servicio de traumatología fueron la percepción de mejoría de la inestabilidad de la rodilla tras la cirugía y el grado de satisfacción con el servicio (4,5±0,7). El servicio de rehabilitación destacó por la facilidad para conseguir una cita (4,3±0,7). El grado de confianza que transmite el médico rehabilitador y conocer su nombre fueron aspectos con buenas puntuaciones (4,5±0,7). Los ítems con mejor calificación para el fisioterapeuta fueron su preparación y el grado de confianza que transmite (4,5±0,7). El grado de satisfacción global fue del 88,1%; 23 ítems se correlacionaron estadísticamente con la satisfacción global (p<0,001). El 100% de los profesionales se manifestaron «ligeramente de acuerdo» y «muy de acuerdo» con el desarrollo de la vía clínica. Conclusiones. El estudio ha demostrado que existe un alto grado de satisfacción entre los usuarios y los profesionales participantes de la vía clínica (AU)

Introduction. The aim of this study was to evaluate patient satisfaction and perceived quality of care among patients undergoing a clinical pathway after reconstruction of the anterior cruciate ligament and to determine the degree of satisfaction health professionals participating in the pathway. Material and methods. Cross-sectional observational study. We included 42 patients who finished the clinical pathway. The patients completed a satisfaction survey with 37 items: 32 items elicited Likert-like responses with scores of 1 ‘very dissatisfied’ to 5 ‘highly satisfied’ and the rest elicited a ‘yes/no’ response. A survey was given to the professionals involved. Results. The most positively valued aspects of the Department of Orthopaedic Surgery were the perceived improvement in knee instability after surgery and the degree of satisfaction with the department (4.5±.7). The Rehabilitation Department scored highly on ease of obtaining an appointment (4.3±.7). The highest-rated aspects were the trust inspired by the physiatrist and knowing the patient's name (4.5±.7). The items most highly scored by physiotherapists were their training and the degree of trust they inspired (4.5±.7). Overall satisfaction was 88.1%, and 23 items were statistically correlated with overall satisfaction (P<.001). All of the health professionals reported they ‘slightly agreed’ or ‘strongly agreed’ with the development of the clinical pathway. Conclusions. This study shows that there is a high level of satisfaction between outpatients and health professionals involved in the clinical pathway (AU)

Reconstrucción del ligamento cruzado anterior asistida por artroscopia, evolución a los 2 años / Reconstruction of the Anterior Cruciate Ligament Arthroscopically Assisted, a Two Year Evolution

Introducción: la lesión del ligamento cruzado anterior es frecuente en poblaciones físicamente activas. Método: se realizó un estudio cuasi experimental con el objetivo de evaluar los resultados de la reconstrucción del ligamento cruzado anterior mediante la técnica hueso-tendón-hueso asistida por artroscopia. El universo de estudio lo conformaron13 pacientes atendidos entre 1/6/2009 y 30/4/2010, con diagnóstico de lesión del ligamento cruzado anterior que cumplieron con los criterios de inclusión. Como escala de evaluación se utilizó el formulario del grupo de estudio de rodilla de la Sociedad Suiza de Ortopedia (OAK). Resultados: predominó el sexo masculino (69,8 por ciento) y una media de edad de 29,8 años. El nivel de actividad alto fue de 61,5 por ciento. Prevaleció la ruptura total del ligamento cruzado anterior (76,9 por ciento). El formulario OAK, antes de la cirugía, mostró puntajes máximos por categoría muy bajos: dolor/derrame (10,8 vs.18,9 de 20 puntos máximos con p = 0,001); rango de movimiento/fuerza (11,0 vs.13,8 de 15 puntos máximos con p = 0,004); estabilidad (17,0 vs. 38,8 de 40 puntos máximos con p = 0,001) y función (10,9 vs. 23,3 de 25 puntos máximos con p de 0,001). Los resultados globales cualitativos y cuantitativos mostraron diferencias significativas (49,0 vs. 98,4 de 100 puntos máximos con p = 0,001). A los 2 años de evolución el 69,2 por ciento realizaba sus actividades habituales. Conclusiones: la técnica en cuestión mostró resultados excelentes en 92,3 por ciento de los casos(AU)

Introduction: The anterior cruciate ligament injury is common in physically active populations. Method: A quasi-experimental study was conducted with the objective of evaluating the results of anterior cruciate ligament reconstruction using the technique bone-tendon-bone assisted by arthroscopy. The universe of study was made up by 13 patients treated from June, 2009 to April, 2010, who had diagnosis of anterior cruciate ligament injury and who met the inclusion criteria. As evaluation scale, the form of the knee study group of the Swiss Society of Orthopedics (OAK) is used. Results: The majority (69.8 percent) was male and the average age was 29.8 years. The high level of activity was 61.5 percent. Total rupture of the anterior cruciate ligament (76.9 percent) prevailed. OAK form before surgery showed very low maximum scores by category: pain / effusion (10, 8 vs. 18, 9 de 20 maximum scores p = 0,001); range of motion / force (11.0 vs. 13.8 15 maximum points with p = 0.004); stability (17.0 vs. 38.8 40 peaks with p = 0.001) and function (10.9 vs. 23.3 25 peaks with p 0.001). The qualitative and quantitative overall results showed significant differences (49.0 vs. 98.4 100 maximum points with p = 0.001). At 2 years of evolution 69.2 percent performed their usual activities. Conclusions: this technique showed excellent results in 92,3 percent of the cases(AU)

Uso de medidas espaço-temporais da marcha para determinar o retorno ao esporte pós-reconstrução do LCA / Use of spatiotemporal gait parameters to determine return to sports after ACL reconstruction

Objetivo: Comparar os parâmetros espaço temporais da marcha de sujeitos hígidos e pacientes submetidos à reconstrução do LCA, classificando o status de normalidade. Método: Quatorze sujeitos hígidos e oito com reconstrução do LCA há aproximadamente um ano caminharam enquanto o movimento era capturado por um sistema de câmeras infravermelhas. Os instantes de contato inicial e retirada do pé do solo foram determinados e as seguintes variáveis dependentes, as quais foram comparadas entre os grupos por meio do teste Mann-Whitney(α=0,05), foram calculadas: percentual de tempo no apoio duplo inicial, percentual de tempo no apoio simples, percentual de tempo no apoio duplo terminal, comprimento da passada e velocidade da marcha. Inicialmente, foi aplicada uma regressão logística a todas as variáveis dependentes para determinar os sujeitos hígidos e aqueles com reconstrução do LCA. Resultados: Os dois grupos não apresentaram diferenças em nenhum parâmetro espaço temporal da marcha(p > 0,05), apesar da cinemática angular do joelho permanecer alterada,como evidenciado por um estudo anterior com a amostra similar.Conclusão: A regressão classificou todos os sujeitos como hígidos,inclusive aqueles do grupo com reconstrução do LCA, sugerindo que as variáveis espaço temporais aplicadas nesse estudo não devem ser usadas como critério isolado de retorno incondicional às atividades esportivas. Nível de Evidência III, Estudo de Caso Controle.

Objective: To compare gait spatiotemporal parameters of healthyand ACL reconstructed subjects in order to classify the status of gaitnormality. Methods: Fourteen healthy subjects and eight patientssubmitted to ACL reconstruction walked along a walkway while thelower limbs movement was captured by an infrared camera system.The frames where the initial contact and toe-off took place were determinedand the following dependent variables, which were comparedbetween groups through the Mann-Whitney test (α=0.05) were calculated:percentage of time in initial double stance, percentage of timein single stance, percentage of time in terminal double stance, stridelength and gait velocity. Initially, all variables were compared betweengroups using a Mann-Whitney test. A logistic regression was applied,including all dependent variables, to create a model that could differentiatehealthy and ACL reconstructed subjects. Results: ACLreconstructed group showed no differences in any spatiotemporalparameter of gait (p > 0.05) in relation to the control group, althoughthe angular kinematic differences of the knee remained altered, asevidenced in a study with a similar sample. Conclusion: The regressionclassified all subjects as healthy, including the ACL reconstructedgroup, suggesting the spatiotemporal variables should not be usedas the sole criterion of return to sports activities at the same level asprior to injury. Level of Evidence III, Case Control Study.

Recuperación de la fuerza muscular del cuádriceps en pacientes post operados de ligamento cruzado anterior, en un plazo de tres meses - Centro Médico Naval Cirujano Mayor Santiago Távara / Recovery of the muscle strength of the quadriceps in patients post operated of anterior cruciate ligament, in a period of three months - Naval Medical Center Surgeon Major Santiago Tavara

Objetivos: Determinar la recuperación de la fuerza muscular del cuádriceps en pacientes post operados de Ligamento cruzado anterior, en un lapso de tres meses. Determinar la variación del trofismo muscular del muslo en pacientes post operados de ligamento cruzado anterior, en un plazo de tres meses. Material y Métodos: El presente estudio es Analítico, Observacional y de tipo Longitudinal. Se realizó en 20 pacientes, entre los 20 y 50 años de edad, con diagnóstico médico de post operado de ligamento cruzado anterior, que se encuentran en el programa de Medicina Física y Rehabilitación del Centro Médico Naval Cirujano Mayor Santiago Távara. La fuerza muscular se evaluó en dos momentos, la primera evaluación se realizó al finalizar la etapa inflamatoria (tercera semana post quirúrgica) y la segunda, tres meses después. El instrumento que se utiliza para la medida de la fuerza, es el test de fuerza máxima o también llamado test de resistencia máxima (1RM), cuyo índice de confiabilidad oscila entre 0.92 a 0.98. La estimación del valor de 1RM fue por medio de la ecuación de Brzycki y para la categorización de la fuerza muscular, se utilizó la escala de Vivian Heyward. Resultados: Los pacientes post operados de ligamento cruzado anterior muestran un 37,5 por ciento de incremento en la fuerza muscular de los cuádriceps después de tres meses de haber iniciado el programa de rehabilitación física. Al iniciar el tratamiento fisioterapéutico el 80 por ciento los pacientes presentan una fuerza muscular que los ubica dentro de una categoría mala; tres meses después de iniciado el tratamiento fisioterapéutico, el 95 por ciento de los pacientes se ubican dentro de la categoría buena.

Objectives: To determine the percentage recovery of quadriceps muscle strength in patients undergoing post anterior cruciate ligament, within three months. Material and Methods: This study is analytical, Longitudinal Observational and type. It was performed in 20 patients, between 20 and 50 years of age with medical diagnosis of post anterior cruciate ligament surgery, found in the program of Physical Medicine and Rehabilitation Medical Center Naval Surgeon Mayor Santiago Tavara. Muscle strength was assessed in two stages, the first evaluation was conducted at the end of the inflammatory stage (third week post-surgical) and the second, three months later. The instrument used to measure the strength, is the maximum force test also called maximum resistance test (1RM) whose reliability index ranges from 0.92 to 0.98. The estimate of the value of 1RM was through the equation Brzycki and categorization of muscle strength, the scale of Vivian Heyward was used. Results: The patients undergoing post ACL show a 37.5 per cent increase in quadriceps muscle strength after three months of starting the physical rehabilitation program. When you start the physical therapy 80 per cent of patients have a muscular force that falls into a bad category; three months later, 95 per cent of patients are placed in the right category.

Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons / Resultados funcionais da reconstrução do ligamento cruzado anterior com o terço central do ligamento patelar e os tendões flexores

To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL) using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G), by means of the Knee Society Score (KSS) and the Lysholm scale. METHODS: This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. RESULTS: From the statistical analysis, it could be seen that the patients' functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results ( p= >0.05), in all the comparisons. CONCLUSIONS: The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery.

Avaliar a função dos joelhos em pacientes submetidos à reconstrução do ligamento cruzado anterior (LCA), com o terço central do ligamento da patela (TP) ou os tendões flexores mediais do joelho (semitendíneo e grácil quádruplos: ST-G) ipsilaterais, por meio do Knee Society Score (KSS) e da escala de Lysholm. MÉTODOS: Estudo longitudinal, prospectivo e randomizado, com 40 pacientes submetidos à reconstrução do LCA por via artroscópica, de setembro de 2013 a agosto de 2014, dos quais 37 eram do sexo masculino e três do feminino, com de 16 a 52 anos, enumerados de forma aleatória de 1 a 40. Os números pares foram submetidos à correção cirúrgica com os tendões do ST-G e os números impares com o TP. Foram aplicados para a avaliação funcional o KSS e a escala de Lysholm na noite anterior ao procedimento cirúrgico e com seis meses de pós-operatório. RESULTADOS: Em análise estatística foi possível observar que no pós-operatório a capacidade funcional dos pacientes foi significativamente maior do que no pré-operatório. Há fortes evidências de que ambas as terapêuticas sejam similares em seus resultados (p = > 0,05), em todas as comparações. CONCLUSÕES: Os resultados da reconstrução do LCA, independentemente do tipo de enxerto, são similares na recuperação funcional do joelho e na melhoria da qualidade de vida. Não foi possível identificar melhor método de tratamento cirúrgico. A experiência clínica, a técnica do cirurgião e o paciente são quem ditam a escolha do tipo de enxerto que deverá ser usado para a cirurgia do LCA.

Cinemática fisiológica de rodilla en futbolistas amateur: análisis 3D / Physiological kinematics of the knee in amateur soccer players: a 3D analysis

La lesión del ligamento cruzado anterior (LCA) tiene un alta prevalencia en jugadores de fútbol. En esta disciplina, las carreras con cambios de dirección son frecuentes y pueden ser un factor de riesgo para el desarrollo de lesiones del LCA sin contacto. Objetivo: Describir en futbolistas jóvenes los rangos cinemáticos fisiológicos de rodilla sometida a tareas funcionales con cambios bruscos de dirección. Método: En una muestra de ocho futbolistas con rodillas clínicamente sanas, se evaluó, mediante un sistema de análisis de movimiento 3D, la cinemática de la rodilla de apoyo durante la ejecución de tres tareas funcionales, dos de estas implicaron cambios de dirección en 90° (CD90°) y 180° (CD180°), la tercera golpear un balón (GB). Los rangos fisiológicos de movimiento (ROM) fueron registrados y comparados en la misma rodilla en tres planos diferentes (T-Transversal; F-Frontal; S-Sagital). Resultados: Los rangos fisiológicos obtenidos fueron para las tareas funcionales CD90°: T 11°(13-8), F 5.6° (11-4) y S 22°(30-17); para CD180°: T 9°(12-8), F 6.3°(8-5) y S 17.6°(21-14); y para GB: T 9°(10-5), F 3.8°(10-2), y S 9.6°(15-6). El ROM fue significativamente mayor en el plano transversal para la tarea CD90°. El el plano sagital el ROM fue mayor para CD90° comparado con GB (p<.05), sin embargo no hubo diferencias respecto a la tarea CD180°. No existen diferencias del ROM en el plano frontal. Conclusión: Se logró describir los rangos cinemáticos fisiológicos de la rodilla durante la ejecución de tres tareas funcionales que implicaron cambios bruscos de dirección en futbolistas amateur. En la muestra evaluada, la prueba que produjo una mayor exigencia de los rangos articulares de rodilla en los planos transversal y sagital fue la prueba con cambio de dirección en 90°...

Anterior cruciate ligament (ACL) lesions are frequent among soccer players. In this sport cutting movements are usually made while running and may be a risk factor in developing non-contact ACL injuries. Purpose: To describe the physiological kinematics of the knee during sudden change of direction movements in amateur soccer players. Methods:Eight amateur soccer players without previous injuries were analysed. The kinematics of the support knee were evaluated using 3D motion analysis while executing 3 common manoeuvres: two of them involved a change of direction at 90° and 180° (CD90° and CD180°), and the third while kicking a ball (GB). Physiological articular ranges of motion (ROM) were recorded and compared for the same knee in three different planes (T-Transversal; F-Frontal; S-Sagittal). Results: The physiological ranges obtained were, for manouvre CD90°: T 11°(13-8), F 5.6° (11-4) and S 22°(30-17); for CD180°: T 9°(12-8), F 6.3°(8-5) and S 17.6°(21-14); and for GB: T 9°(10-5), F 3.8°(10-2), and S 9.6°(15-6). ROM was significantly greater in the transversal plane for the CD90° manoeuvre (P<.05). In the sagittal plane, ROM was greater for the CD90° when compared to the GB (P<.05), but no differences were seen when compared to the CD180° manoeuvre (P>.05). There were no differences in ROM in the frontal plane. Conclusion: A description of the physiological kinematic ranges of the knee during three sudden changes of direction manoeuvres in amateur soccer players was presented. According to our results, change of direction in 90° demands a higher range of motion in both the transversal and sagittal planes...

Interpretación de la maniobra de pivote mediante el uso de acelerómetros en pacientes que acuden a consulta ortopédica / Interpretation of the pivot test using accelerometers in the orthopedic practice

Los ligamentos cruzados (LC) de la rodilla, anterior (A) y posterior (P), localizados dentro de la articulación, unen fémur y tibia, dando estabilidad sobre la dirección anteroposterior de un hueso sobre otro. El LCA puede lesionarse mediante rotaciones provocadas en algún deporte que implique giro con el pie apoyado sobre el suelo. Las lesiones del LCA se determinan con maniobras como la de Lachman, cajón y pivote. Se utilizan acelerómetros que permiten graficar la maniobra de pivote en pacientes que acuden a consulta ortopédica, utilizando la prueba de KT1000 como estándar de oro. El trabajo ha sido aprobado por el Comité de Ética del Hospital. Estudio descriptivo entre casos y controles. Resultados: 92 pacientes aceptaron participar mediante consentimiento informado, nueve casos resultaron con KT1000 positivo, de los negativos, seleccionamos nueve controles afines a edad y género. Alteraciones de KT1000 fueron mayores en mujeres (78%) y en 67% de los casos la pierna alterada fue la derecha. Los resultados promedio de KT1000 en casos fue de 5.44 mm, en controles de 0.66 mm. Los acelerómetros permitieron graficar la maniobra de pivote y observamos gráficas similares tanto en casos y controles, solamente se muestran diferencias notables en un paciente masculino con KT1000 de 15 mm que fue sometido a reparación de LCA izquierdo, la maniobra se realizó al estar sedado. Concluimos que el paciente, en estado consciente, pone resistencia en la maniobra, a diferencia de la obtenida con anestesia, y que el uso de acelerómetros permite documentar la maniobra de pivote observando diferencias entre un LCA normal y uno lesionado.

The anterior (A) and posterior (P) cruciate ligaments (CL) of the knee, located inside the joint, connect the femur and the tibia and thus provide stability in the anteroposterior axis of one bone over the other. The anterior cruciate ligament (ACL) may be injured as a result of rotation when practicing a sport involving turning with the foot on the ground. ACL injuries are diagnosed with maneuvers like the Lachman, drawer and pivot. Accelerometers were used to plot the pivot maneuver in patients seeing the orthopedist surgeon using the KT1000 test as gold standard. This case-control descriptive study was approved by the Hospital's Ethics Committee. Results: 92 patients accepted to participate through an informed consent; nine cases were KT1000 positive, and nine age- and gender-matched controls were selected among KT1000 negative patients. KT1000 alterations were greater among females (78%) and in 67% of cases the right leg was affected. Mean KT1000 results were 5.44 mm in cases and 0.66 mm in controls. Accelerometers allowed plotting the pivot maneuver and the resulting charts for cases and controls were similar. Remarkable differences were seen only in one male patient with a 15 mm KT1000, who underwent repair of the left ACL; the maneuver was performed under sedation. We concluded that conscious patients oppose the maneuver, unlike anesthetized patients, and that the use of accelerometers helps document the pivot maneuver which, in turn, helps detect differences between a normal ACL and an injured one.

Estudio clínico sobre dos técnicas para la construcción de las roturas del ligamento cruzado anterior (L. C. A.): Rigid Fix(R) y Aperfix / Clinical study about two texhniques for reconstruction of anterior cruciate ligament ruptures (A. C. L.): Rigid Fix(TM) y Aperfix(TM)

Introducción y objetivos: La reconstrucción del Ligamento Cruzado Anterior (L.C.A.) es uno de los 10 procedimientos más frecuentes en Cirugía Ortopédica en U.S.A. La reparación mediante hueso tendón hueso (H.T.H.) resistiría 2977 N. El semitendinoso y recto interno, resistirían 1216 N y 838 N, respectivamente. Nuestro objetivo fue comparar clínicamente la técnica (H.T.H. Rigid Fix), con la ligamentoplastia con pata de ganso (Aperfix). Material y métodos: Estudio observacional, descriptivo y retrospectivo de 64 pacientes. Seguimiento 1-5 años. HTH: 31 casos (48.4%). Aperfix 33 casos (51.6%). Las variables analizadas fueron filiación, exploración clínica pre y postquirúrgica, RNM, escala Lysholm, aspectos quirúrgicos y complicaciones, entre otros. Los tests estadísticos empleados fueron t de Student, U de Mann Whitney y Chi Cuadrado. Análisis mediante S.P.S.S. 15.0. Resultados: Lysholm pre y postoperatorio de 14 ± 7.5 puntos y 86.7 ± 9.9 puntos, respectivamente. Hubo diferencias estadísticamente significativas, (p<0.05), a favor de H.T.H. en tiempo quirúrgico (62.7 ± 10.6 minutos Vs 79 ± 15.6 minutos), tiempo rehabilitador (115.1 ± 30.5 días Vs 139.8 ± 31.8 días), tiempo de baja (132.9 ± 20 días Vs 155.3 ± 41.4 días) o Lachmann postquirúrgico negativo (100% Vs 45% de los casos). Sin embargo, hubo mayor reducción del espacio articular con H.T.H. (9.7% Vs 0%). Conclusiones: La reparación del L.C.A. en nuestra experiencia, requeriría menor tiempo quirúrgico, rehabilitador y presentaría un Lachmann postquirúrgico menor con H.T.H. frente a Aperfix. No habría diferencias clínicas entre ambos sistemas, en la escala Lysholm

Introduction and objectives: Reconstruction of Anterior Cruciate Ligament (ACL) is one of the 10 most common procedures in orthopedic surgery in U.S.A. Repair by means of Patellar Tendon resists 2977 N. gracilis and semitendinosus, resist 1216 N and 838 N, respectively. Our objective was to compare clinical results of two surgical techniques (Bone- Patellar tendon-Bone Graft: B.P.B. Rigid Fix(TM) with hamstring tendons (Aperfix(TM)). Material and methods: Observational, descriptive and retrospective study of 64 patients. Follow up: 1-5 years. B.P.B.: 31 cases (48.4%). Hamstring tendons: 33 cases (51.6%). Variables analyzed were affiliation, pre and postoperative clinical examination, MRI, Lysholm scale, surgical aspects and complications, among others. Statistical tests used were Student t, Mann Whitney and Chi Square. Analysis by S.P.S.S. 15.0. Level IV of evidence. Results: pre and postoperative Lysholm score was 14 ± 7.5 and 86.7 ± 9.9 points, respectively. There were statistically significant differences (p <0.05), in favor of patellar tendon in operative time (62.7 ± 10.6 minutes vs 79 ± 15.6 minutes), rehabilitation time (115.1 ± 30.5 days vs 31.8 ± 139.8 days), time whithout working (132.9 ± 20 days vs 155.3 ± 41.4 days) or negative postsurgical Lachmann (100% vs 45% of cases). However, there was a greater reduction in joint space with patellar tendon (9.7% vs. 0%). Conclusions: Repair of L.C.A. in our experience, requires minor surgical time, rehabilitation time and present a lower postoperative Lachmann’s test,with B.P.B. Rigid Fix(TM). There would be no clinical differences between the two systems about Lysholm's score

Efectos y resultados de una vía clínica en las lesiones del ligamento cruzado anterior / Effects and results of a clinical pathway for anterior cruciate ligament injuries

Introducción: Presentamos nuestra experiencia tras la implantación de una herramienta de gestión clínica con el objetivo de analizar los efectos y los resultados de una vía clínica en las lesiones del ligamento cruzado anterior (LCA) mediante la evaluación de la rehabilitación acelerada después de la reconstrucción del LCA. Material y métodos: Participaron los pacientes intervenidos de ligamentoplastia del LCA con autoinjerto tendinoso tetrafascicular de isquiotibiales con o sin reparación de lesiones meniscales entre enero de 2010 y diciembre de 2012. Los criterios de evaluación fueron el grado de cumplimiento, los indicadores de efectividad en la atención clínica, la densidad de variaciones y el indicador de satisfacción. Para estudiar la posible asociación entre las variables cualitativas usamos el test de Chi-cuadrado. Resultados: Se incluyeron 113 hombres y 15 mujeres con edades comprendidas entre 15 y 49 años. El 86,3% realizaban algún tipo de deporte, siendo el fútbol el más practicado. Encontramos que el 84,38% finalizaron la vía clínica, el 7,03% padecieron efectos adversos graves y el 11,35% presentaron alguna variación, causada en un 5,44% por la decisión del paciente. El 89,86% estuvieron satisfechos con el desarrollo del programa. Se halló una tendencia a la asociación estadística (p = 0,059) entre la realización de actividad deportiva previa y la cumplimentación de la vía clínica, lo que podría confirmarse aumentando el tamaño muestral. Conclusión: La evaluación de la vía clínica en las lesiones del LCA obtuvo resultados cercanos a los estándares propuestos en aspectos como el cumplimiento y la satisfacción del paciente (AU)

Introduction: We present our experience following the implementation of a clinical management tool. The aim of this study was to analyze the effects and results of a clinical pathway for anterior cruciate ligament (ACL) lesions by evaluating accelerated rehabilitation after ACL reconstruction. Material and methods: Patients who underwent ACL reconstruction with hamstring tendon autograft with or without repair of meniscal injuries participated in this study between January 2010 and December 2012. Evaluation criteria were the degree of compliance, effectiveness indicators in clinical care, the density of variations, and satisfaction indicators. The Chi-square test was used to study the possible association between qualitative variables. Results: We included 113 men and 15 women aged between 15 and 49 years. The 86.3% performed some type of sport, football being the most practiced. A total of 84.38% completed the clinical pathway, serious adverse effects occurred in 7.03%, and some variations took place in 11.35%; of these, 5.44% were due to the patient's decision. Most patients (89.86%) were satisfied with the program's development. A trend to a statistically significant association (P = .059) was found between the occurrence of previous sports activity and the completion of the clinical pathway. This association could be confirmed by increasing the sample size. Conclusion: The evaluation of the clinical pathway in ACL injuries found that the results were close to the proposed standards in aspects such as compliance and patient satisfaction (AU)

La preactivación neuromuscular durante la maniobra evasiva de salto lateral no se asocia con alteraciones posturales en atletas de ultimate: un estudio transversal / Neuromuscular pre-activation during side-cutting maneuver is not associated with postural changes in ultimate athletes: A cross-sectional study

Introducción: Un patrón de preactivación neuromuscular anormal durante la maniobra evasiva de salto lateral (MESL) ha sido relacionado con la lesión del ligamento cruzado anterior. Sin embargo, se desconoce si dicho patrón neuromuscular está asociado con alteraciones posturales y anatómicas. Objetivo: Describir la frecuencia del patrón neuromuscular anormal durante la MESL y explorar su asociación con características posturales y anatómicas en deportistas de ultimate. Materiales y métodos: Se realizó un estudio tipo transversal, que incluyó atletas de ultimate a quienes se les realizó una evaluación de las características posturales, anatómicas y la actividad neuromuscular del muslo durante la MESL con electromiografía de superficie. Resultados: La frecuencia del patrón neuromuscular anormal durante la MESL fue del 22,6%. Se encontraron diferencias entre aquellos con y sin el patrón neuromuscular anormal en el cociente entre la preactivación del músculo vasto lateral (VL) y el músculo semitendinoso (ST) (0,46; IC 95%: 0,36 a 0,56; p < 0,001) y la diferencia entre la preactivación del músculo VL y el músculo ST (30,39%; IC 95%: 20,85 a 39,92; p < 0,001). No se encontró asociación de las características posturales y anatómicas con el patrón neuromuscular anormal luego de ajustar por edad, sexo, porcentaje de grasa e índice de masa corporal (p > 0,05). Conclusiones: Se encontró una frecuencia de preactivación neuromuscular anormal del 22,6%, la cual fue mayor en hombres que en mujeres. La preactivación neuromuscular anormal durante la MESL es independiente de las características posturales estáticas y anatómicas de los miembros inferiores en deportistas de ultimate

Introduction: An abnormal pattern of neuromuscular pre-activation during side-cutting maneuvers has been associated with anterior cruciate ligament injuries. However, it is not known if this neuromuscular pattern is associated with postural and anatomical alterations. Objective: To describe the frequency of abnormal neuromuscular patterns during side-cutting maneuvers and explore its association with postural and anatomical characteristics in ultimate sportsmen. Materials and methods: A cross-sectional study was carried out on ultimate athletes who underwent a postural and anatomic assessment and neuromuscular activity by surface electromyography of the thigh during the side-cutting maneuvers. Results: The frequency of abnormal neuromuscular pattern during side-cutting maneuver was 22.6%. Differences were found between those with and without abnormal neuromuscular pattern in the ratio of pre-activation of the vastus lateralis (VL) muscle and semitendinosus (ST) muscle (0.46; 95% CI: 0.36 to 0.56; P < .001) and the difference between pre-activation of the VL muscle and ST muscle (30.39%; 95% CI: 20.85 to 39.92; P < .001). There was no association between postural and anatomical characteristics and abnormal neuromuscular pattern after adjusting for age, sex, body fat percentage and body mass index (P > .05). Conclusions: A frequency of 22.6% abnormal neuromuscular pre-activation was found, which was higher in men than women. Abnormal neuromuscular pre-activation during side-cutting maneuver is independent of postural and anatomical characteristics of lower limb in ultimate athletes

Actualización en las lesiones del ligamento cruzado anterior. Análisis de los resultados mediante TAC y escalas clínicas / Current status of the ACL repair. Clinical scales and TAC results

Se realizó una revisión bibliográfica sobre el estado actual de las ligamentoplastias del LCA, incluyendo bases anatómicas, funcionales y tratamiento quirúrgico, así como un estudio retrospectivo de las ligamentoplastias del LCA mediante técnica SAC con más de 10 años de evolución. En dicho estudio se valoran parámetros clínicos y radiológicos mediante escalas clínicas y TAC, estableciendo relaciones entre la posición y ensanchamiento de los túneles con los resultados clínicos a largo plazo.

We performed a literature review on the current status of the ACL repair, including anatomical basis, functional and surgical treatment, as well as a retrospective study of the ACL repair by SAC technique with over 10 years of evolution. This study evaluated clinical and radiological parameters, clinical scales and TAC by establishing relationships between the position and broadening of the tunnels with long-term clinical results.

Partial tearing of the anterior cruciate ligament: diagnosis and treatment / Lesão parcial do ligamento cruzado anterior: diagnóstico e tratamento

Partial tears of the anterior cruciate ligament (ACL) are common and represent 10-27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction) and classical (anatomical) reconstruction...

Lesões parciais do ligamento cruzado anterior (LCA) são comuns e representam 10%-27% das totais. As principais razões para atenção ao feixe não rompido são biomecânicas, vasculares e proprioceptivas. A permanência do feixe serve ainda de proteção durante o processo cicatricial. A definição dessa lesão é controversa, baseada na anatomia, no exame clínico, na medida da translação, nos exames de imagem e na artroscopia. Seu tratamento vai depender da frouxidão e da instabilidade existentes. O tratamento conservador é opcional para casos sem instabilidade, com enfoque na reabilitação motora. O tratamento cirúrgico é desafiador, pois exige correto posicionamento dos túneis ósseos e conservação dos remanescentes do feixe rompido. O teste do pivot-shift sob anestesia, os achados à ressonância magnética, o nível e o tipo de atividade esportiva prévia e o aspecto artroscópico dos remanescentes e suas propriedades mecânicas auxiliarão o ortopedista no processo decisório entre o tratamento conservador, o tratamento cirúrgico com reforço do LCA nativo (reconstrução seletiva) ou a reconstrução clássica (anatômica)...

Lesiones del ligamento cruzado anterior / Injuries in the anterior crutiate ligament

Fundamento: el ligamento cruzado anterior desempeña un papel muy importante en la estabilidad de la rodilla. La incidencia de esta afección es alta en pacientes que practican deportes de contacto y de no ser tratados de forma adecuada, los resultados son desfavorables.Objetivo: profundizar en los factores necesarios para el tratamiento adecuado de enfermos con esta lesión y evitar las complicaciones.Método: se realizó una revisión bibliográfica de un total de 300 artículos publicados en Pubmed, Hinari y Medline mediante el localizador de información Endnote, de ellos se utilizaron 52 citas seleccionadas para realizar la revisión, 48 de ellas de los últimos cinco años donde se incluyeron seis libros.Desarrollo: se discuten los aspectos relacionados con el diagnóstico clínico e imaginológico. Se aborda la clasificación de esta lesión en cuanto a varios aspectos como: tiempo, lesión de ligamentos u ósea, aislada o combinada y parcial o total. Se mencionan los parámetros para obtener resultados satisfactorios al considerar factores como la edad del enfermo, lesiones asociadas y tiempo de la lesión. Se relacionan los requisitos para la selección del implante y se mostró las ventajas y desventajas de cada tipo de injerto. Las complicaciones de esta cirugía están relacionadas con la técnica quirúrgica y médicas.Conclusiones: las lesiones del ligamento son entidades traumáticas que afectan por lo general a pacientes jóvenes. Para lograr un resultado satisfactorio en el tratamiento es necesario el conocimiento de su anatomía, clasificación, tipo de injerto a emplear según sus ventajas y desventajas(AU)

Background: the anterior crutiate ligament plays an important role in the stability of the knee. The incidence of this complaint is high in patients who practice contact sports and if it is not treated properly results can be unfavorable.Objective: to study in depth the necessary factors for the proper treatment of patients who suffer from this injury and how to avoid complications.Method: a bibliographic review of a total of 300 articles published in Pubmed, Hinari and Medline was conducted by means of the information localizer EndNote; 52 quotations of them were selected for making the review, among them 48 were from the last five years and six books were included.Development: aspects related to the imaging and clinical diagnosis, are discussed. The classification of this injury regarding some aspects like: time, ligament or osseous injury, isolated or combined, partial or total, is also discussed. The parameters to obtain satisfactory results when taking into account factors like age of the patient, associated injuries and time of the injury are mentioned. The requirements for the selection of the implant are listed and the advantages and disadvantages of each type of graft are shown. The complications of this surgery are related to the medical and surgical techniques.Conclusions: ligament injuries are traumatic complaints that generally affect young patients. To know about its anatomy, classification and type of graft to use according to its advantages and disadvantages is necessary to achieve a satisfactory result in the treatment(AU)

Fatores pré-operatórios preditivos de sucesso após a reconstrução do ligamento cruzado anterior

O ligamento cruzado anterior do joelho (LCA) é um dos ligamentos mais frequentemente lesionados. Depois de ocorrida a lesão, uma das opções de tratamento é a reconstrução cirúrgica (RLCA). Apesar de ser considerado um procedimento de sucesso, a taxa de retorno à atividade física prévia após a cirurgia pode variar de 19 a 82%. O objetivo deste estudo foi correlacionar asinformações obtidas na avaliação funcional pré-operatória com a avaliação após um ano de RLCA e, deste modo, analisar quais aspectos pré-operatórios podem influenciar no resultado pós-operatório. Metodologia: 19 pacientes com lesão do LCA foram avaliados no pré-operatório (PRE-OP) e após um ano de RLCA (POS-OP). Foram avaliados o torque muscular (TM) isocinéticode flexão e extensão de joelho (60°/s 180°/s), a translação tibial anterior (KT200) e função subjetiva (IKDC). A partir do TM foi calculado o delta percentual (Δ%) para mensurar o ganho de força do exame PRE-OP até o POS-OP. Estatística: Foi utilizado o teste t Studentpara a comparação entre os membros, etestes de correlaçãoforam aplicadospara estabelecer a existência de relação entre as variáveis.Resultado:Foram encontradas correlações positivas entre o TM extensor do membro não lesado a 60°/s PRE e POS-OP (r = 0,63 e p < 0,01); TM extensor do membro não lesado a 180°/s PRE e POS-OP (r = 0.48 e p = 0.04); TM flexor do membro lesado a 60°/s PRE e POS-OP (r = 0.59 e p < 0.01); TM flexor do membro lesado a 180°/s PRE e POS-OP (r = 0.49 e p = 0.03); TM flexor do membro não lesado a 60°/s PRE e POS-OP (r = 0.59 e p < 0.01). Correlações inversamente significativas foram observadas entre IKDC (POS-OP) e a translação tibial (PRE-OP) do membro não....

The anterior cruciate ligament (ACL) is one of the most frequently injured ligaments. After the injury, one of the treatment options is the surgical reconstruction (ACLR). Although it is considered a successful procedure, the rate of return to previous physical activity after surgery can vary from 19 to 82%. The objective of this study was to correlate information obtained in the preoperative (PRE-OP) functional evaluation with the evaluation one yearafter ACLR and analyze which preoperative aspects may influence postoperative (POS-OP) results.Methods: 19 patients with ACL injury were evaluated before ACL reconstruction and after one year. The evaluation was consisted in flexion and extension isokinetcmuscle torque (MT) at 60°/s 180°/s, anterior tibial translation (KT 2000) and a questionnaire of subjective assessment of knee function (IKDC). From the MT was calculated the percentage delta (Δ%) to measure the MT gain up from the PRE-OP test to the POS-OP. Statistics: T Student test was used for comparison among members, andcorrelations tests were used to establish the relationship between the variables. Result: Positive correlations were found between extensor MT of the uninjured limb at 60°/s, PRE and POST-OP (r = 0.63 and p <0.01); extensor MT of the uninjured member at 180°/s PRE and POST-OP (r = 0:48 p = 0:04); flexor MT of the injured limb at 60°/s PRE and POST-OP (r = 0:59 p <0.01); flexor MT of the injured limb at 180°/s PRE and POST-OP (r = 0:49 p = 0:03); flexor MT of member uninjured to 60°/s PRE and POST-OP (r = 0:59 p <0.01). Significant correlations were observed between IKDC (POS-OP) and the tibial translation (PRE-OP) of the uninjured limb (r = -0.46, p = 0.05); Δ% extensor at 180°/s of the injured limb and the IKDC (PRE-OP) (r = -0.60 p <0.01) and Δ% flexor at 180°/s of the injured limb and the IKDC (PRE-OP) (r = -0.60 p <0.01). Conclusion: The results suggest....

Prevalencia de lesiones asociadas a rotura aguda de ligamento cruzado anterior / Acute rupture of anterior cruciate ligament associated with any lesions. Prevalence

La rotura aguda de ligamento cruzado anterior (LCA) frecuentemente se asocia a lesiones de distintas estructuras en la rodilla por lo cual es importante identificarlas para realizar un adecuado tratamiento. El examen físico sigue siendo el principal método para diagnosticarlas, a su vez la resonancia nuclear magnética (RNM) es el estudio complementario de elección para acompañarlo. El objetivo de este trabajo es analizar las lesiones y la frecuencia con que se asocian a la rotura de ligamento cruzado anterior (LCA), visual izadas con claridad en la resonancia nuclear magnética (RNM). Material y Métodos: Se evaluaron retrospectivamente 71 pacientes con lesión aguda de ligamento cruzado anterior (LCA), de los cuales 18 sufrieron rotura aislada del mismo, y en el resto, 53 pacientes, se evidenciaron lesiones asociadas a aquella mediante examen físico y resonancia nuclear magnética (RNM). Durante el examen físico se realizaron además del interrogatorio previo, maniobras semiológicas para identificar: lesión de ligamento cruzado anterior (LCA), lesiones meniscales, lesión de ligamento cruzado posterior (LCP), lesión de ligamento lateral interno (LLI) y ligamento lateral externo (LLE), lesión de complejo posteroexterno (CPE), presencia y cuantificación clínica de aumento de líquido intra articular. En cuanto a la resonancia nuclear magnética (RNM) se utilizaron secuencias Tl, T2 Y STIR obteniéndose cortes sagitales, axiales, coronales y oblicuos. Resultados: Asociadas a la rotura aguda de ligamento cruzado anterior (LCA) se encontraron las siguientes lesiones: contusión ósea en cóndilo femoral y platillo tibial externo llamado "bonebruise" , lesiones de estructuras como meniscos externo e interno, ligamentos lateral interno y externo, ligamento cruzado posterior, complejo postero-externo y fractura de platillo tibial. Conclusiones: Es de suma importancia reconocer lesiones asociadas a la rotura aguda de ligamento cruzado...

The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

BACKGROUND: Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. METHODS: Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. RESULTS: The clinical success rate was 95.4% and the HSS scores were 93.9 +/- 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. CONCLUSIONS: The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.

Lessons Learnt from an Atypical Mycobacterium Infection Post-Anterior Cruciate Ligament Reconstruction

Infections following anterior cruciate ligament reconstruction are rare, with no previous reports citing Mycobacterium abscessus as the culprit pathogen. A 22-year-old man presented twice over three years with a painful discharging sinus over his right tibia tunnel site necessitating repeated arthroscopy and washout, months of antibiotic therapy, and ultimately culminating in the removal of the implants. In both instances, M. abscessus was present in the wound cultures, along with a coinfection of Staphyloccocus aureus during the second presentation. Though rare, M. abscessus is an important pathogen to consider in postoperative wounds presenting with chronic discharging sinuses, even in healthy non-immunocompromised patients. This case illustrates how the organism can cause an indolent infection, and how the removal of implants can be necessary to prevent the persistence of infection. Coinfection with a second organism is not uncommon and necessitates a timely change in treatment regime as well.

Proprioceptive deficit in individuals with unilateral tearing of the anterior cruciate ligament after active evaluation of the sense of joint position / Déficit proprioceptivo em indivíduos com ruptura unilateral do ligamento cruzado anterior após a avaliação ativa do senso de posição articular

Objective: To ascertain whether the proprioceptive deficit in the sense of joint position continues to be present when patients with a limb presenting a deficient anterior cruciate ligament (ACL) are assessed by testing their active reproduction of joint position, in comparison with the contralateral limb. Methods: Twenty patients with unilateral ACL tearing participated in the study. Their active reproduction of joint position in the limb with the deficient ACL and in the healthy contralateral limb was tested. Meta-positions of 20% and 50% of the maximum joint range of motion were used. Proprioceptive performance was determined through the values of the absolute error, variable error and constant error. Results: Significant differences in absolute error were found at both of the positions evaluated, and in constant error at 50% of the maximum joint range of motion. Conclusion: When evaluated in terms of absolute error, the proprioceptive deficit continues to be present even when an active evaluation of the sense of joint position is made. Consequently, this sense involves activity of both intramuscular and tendon receptors...

Objetivo: Verificar se o déficit proprioceptivo no SPA permanece quando pacientes com um membro LCA deficiente são avaliados por meio do teste de reprodução ativa da posição articular, em comparação com o membro contralateral. Métodos: Participaram do estudo 20 pacientes com ruptura unilateral do LCA. Foi feito o teste de reprodução ativa da posição articular no membro LCA deficiente e contralateral saudável. Foram usadas as posições meta de 20% e 50% da amplitude articular máxima. O desempenho proprioceptivo foi determinado por meio dos valores de erro absoluto (EA), erro variável (EV) e erro constante (EC). Resultados: Diferenças significativas foram encontradas para o EA em ambas as posições avaliadas e para o EC em 50% AAM. Conclusão: O déficit proprioceptivo quando avaliado pelo EA permanece mesmo quando a avaliação do senso de posição articular é ativa e, consequentemente, envolve a atividade de receptores intramusculares e tendíneos...