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1.
Am J Sports Med ; 49(13): 3479-3487, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34623936

RESUMO

BACKGROUND: A new anterior cruciate ligament (ACL) injury after ACL reconstruction is a feared outcome. PURPOSE: To study the risk of new knee injuries in female soccer players 5 to 10 years after primary unilateral ACL reconstruction and to compare players who returned to soccer with (1) players who did not return and (2) knee-healthy soccer players (controls). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Demographic, soccer-specific, and surgical data were recorded at baseline for 317 female soccer players (mean ± SD age, 20.1 ± 2.7 years) 1.6 ± 0.7 years after ACL reconstruction and for 119 matched controls (mean age, 19.5 ± 2.5 years). Data on new knee injuries and soccer-playing status were collected 5 to 10 years after ACL reconstruction via a questionnaire. RESULTS: Among players with ACL reconstruction, 222 (70%) responded at a mean 6.5 ± 1.0 years after primary ACL reconstruction. We compared 3 cohorts: (1) among 163 players with ACL reconstruction who returned to soccer, 68 (42%) sustained 44 reruptures and 29 contralateral ruptures; (2) among 59 players with ACL reconstruction who did not return to soccer, 11 (19%) sustained 9 reruptures and 2 contralateral ruptures; and (3) among 113 knee-healthy controls, 12 (11%) sustained 13 ACL injuries. Players who returned had a >2-fold higher risk of a new ACL injury than players who did not return (risk ratio, 2.24; 95% CI, 1.27-3.93; P = .005) and a 4-fold higher risk than controls (risk ratio, 3.93; 95% CI, 2.23-6.91; P <.001). A new ACL, meniscal, or cartilage injury was the most frequent new knee injury. Among players who returned to soccer, 68% reported a new knee injury, and they had a 2- to 5-times higher risk of any new knee injury and knee surgery than players who did not return and controls. CONCLUSION: Two-thirds of female soccer players with ACL reconstruction who returned to soccer sustained a new knee injury within 5 to 10 years; 42% had a new ACL injury. Their risk of a new knee injury and knee surgery was 2 to 5 times greater than that for players who did not return and for knee-healthy controls. New injury may have negative consequences for long-term knee health and should be a critical consideration in the decision to return to play.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Futebol , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/cirurgia , Volta ao Esporte , Adulto Jovem
2.
Am J Sports Med ; 49(10): 2651-2658, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34283648

RESUMO

BACKGROUND: Studies investigating biomechanical risk factors for knee injuries in sport-specific tasks are needed. PURPOSE: To investigate the association between change of direction (COD) biomechanics in a 180-degree pivot turn and knee injury risk among youth team sport players. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 258 female and male basketball and floorball players (age range, 12-21 years) participated in the baseline COD test and follow-up. Complete data were obtained from 489 player-legs. Injuries, practice, and game exposure were registered for 12 months. The COD test consisted of a quick ball pass before and after a high-speed 180-degree pivot turn on the force plates. The following variables were analyzed: peak vertical ground-reaction force (N/kg); peak trunk lateral flexion angle (degree); peak knee flexion angle (degree); peak knee valgus angle (degree); peak knee flexion moment (N·m/kg); peak knee abduction moment (N·m/kg); and peak knee internal and external rotation moments (N·m/kg). Legs were analyzed separately and the mean of 3 trials was used in the analysis. Main outcome measure was a new acute noncontact knee injury. RESULTS: A total of 18 new noncontact knee injuries were registered (0.3 injuries/1000 hours of exposure). Female players sustained 14 knee injuries and male players 4. A higher rate of knee injuries was observed in female players compared with male players (incidence rate ratio, 6.2; 95% CI, 2.1-21.7). Of all knee injuries, 8 were anterior cruciate ligament (ACL) injuries, all in female players. Female players displayed significantly larger peak knee valgus angles compared with male players (mean for female and male players, respectively: 13.9°± 9.4° and 2.0°± 8.5°). No significant associations between biomechanical variables and knee injury risk were found. CONCLUSION: Female players were at increased risk of knee and ACL injury compared with male players. Female players performed the 180-degree pivot turn with significantly larger knee valgus compared with male players. However, none of the investigated variables was associated with knee injury risk in youth basketball and floorball players.


Assuntos
Lesões do Ligamento Cruzado Anterior , Basquetebol , Traumatismos do Joelho , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/etiologia , Fenômenos Biomecânicos , Criança , Estudos de Coortes , Feminino , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/etiologia , Articulação do Joelho , Masculino , Adulto Jovem
3.
Artigo em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1248721

RESUMO

Las fracturas osteocondrales (FOC) traumáticas de rodilla en la edad pediátrica, son lesiones que acompañan hasta un 30% de las luxaciones agudas de rótula (LAR). Si no se mantiene una elevada sospecha clínica, es frecuente su retraso diagnóstico, pudiendo generar potenciales complicaciones. A propósito, presentamos el caso de una paciente de 12 años con una FOC post LAR que pasó inadvertida en la primera consulta, requiriendo la fijación del fragmento osteocondral con tornillos HCS a los 5 meses, logrando un excelente resultado funcional a los 54 meses de seguimiento.


Traumatic osteochondral fractures (OCF) of the knee in pediatric age are injuries that accompany up to 30% of acute patellar dislocations (APD). If high clinical suspicion is not maintained, its diagnostic delay is frequent, and may generate potential complications. Incidentally, we present the case of a 12-year-old patient with a post-APD OCF that went unnoticed in the first consultation, requiring fixation of the osteochondral fragment with HCS screws at 5 months. Achieving an excellent functional result at 54 months follow-up.


As fraturas osteocondrais traumáticas (FOC) do joelho em idade pediátrica são lesões que acompanham até 30% das luxações agudas da patela (LAP). Se uma alta suspeita clínica não for mantida, seu atraso no diagnóstico é frequente e pode gerar complicações potenciais. A propósito, apresentamos o caso de um paciente de 12 anos com FOC pós-LAP que passou despercebido na primeira consulta, exigindo fixação do fragmento osteocondral com parafusos HCS em 5 meses. Obtendo um excelente resultado funcional aos 54 de acompanhamento.


Assuntos
Humanos , Feminino , Criança , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Parafusos Ósseos , Imageamento por Ressonância Magnética , Seguimentos , Resultado do Tratamento , Luxação Patelar/complicações , Fixação de Fratura , Traumatismos do Joelho/etiologia
5.
Radiol Oncol ; 55(3): 268-273, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-33792213

RESUMO

INTRODUCTION: The aim of the study was to review the appearances of Morel-Lavallée (ML) lesions on magnetic resonance imaging (MRI). PATIENTS AND METHODS: 14 patients diagnosed with the ML lesion on MRI were analysed retrospectively (mean age = 35 years). Mechanism of injury, time frame from injury to MRI, location, shape, T1 and proton-density fat-suppression (PDFS) signal intensity (SI), presence of a (pseudo)capsule, septations or nodules within the collection, mass effect and fluid-fluid levels were analyzed. The Mellado and Bencardino classification was utilized to classify the lesions. RESULTS: In most cases, mechanism of injury was distortion. Mean time frame between the injury and MRI was 17 days. Lesions were located around the knee in 9 patients and in the peritrochanteric region in 5 patients. Collections were fusiform in 12 patients and oval in 2 patients. 9 collections were T1 hypointense and PDFS hyperintense. 4 collections had intermediate T1 and high PDFS SI. 1 collection had intermediate T1 and PDFS SI. (Pseudo)capsule was noted in 3 cases. Septations or nodules were found in 4 cases. According to the Mellado and Bencardino, collections were classified as seroma (type 1) in 9, subacute hematoma (type 2) in 1 and chronic organizing hematoma (type 3) in 4 cases. CONCLUSIONS: Characteristic features of ML lesion include a fusiform fluid collection between the subcutaneous fat and the underlying fascia after shearing injury. Six types can be differentiated on MRI, with the seroma, the subacute hematoma and the chronic organizing hematoma being the commonest.


Assuntos
Desenluvamentos Cutâneos/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/lesões , Adolescente , Adulto , Idoso , Criança , Desenluvamentos Cutâneos/classificação , Desenluvamentos Cutâneos/etiologia , Fascia Lata/diagnóstico por imagem , Fascia Lata/lesões , Feminino , Hematoma/diagnóstico por imagem , Humanos , Infecções/diagnóstico por imagem , Traumatismos do Joelho/classificação , Traumatismos do Joelho/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Seroma/diagnóstico por imagem , Fatores de Tempo , Ferimentos não Penetrantes/classificação , Ferimentos não Penetrantes/etiologia , Adulto Jovem
6.
Cochrane Database Syst Rev ; 2: CD008823, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33630309

RESUMO

BACKGROUND: Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings. OBJECTIVES: To determine the effect of walking as a physical activity intervention on blood pressure and heart rate. SEARCH METHODS: We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA: Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings. MAIN RESULTS: A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times. AUTHORS' CONCLUSIONS: Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.


Assuntos
Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Hipertensão/terapia , Caminhada/fisiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Viés , Diástole , Feminino , Humanos , Traumatismos do Joelho/etiologia , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Sístole , Fatores de Tempo , Caminhada/classificação , Adulto Jovem
7.
Med Sci Sports Exerc ; 53(1): 102-107, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32769811

RESUMO

PURPOSE: Despite the health benefits of running, the prevalence of running-related injuries (RRI) remains high. The underlying risk factors between these injuries are still not well understood. Therefore, the aim of this study was to compare biomechanical, anthropometric, and demographic injury risk factors between different locations in injured recreational runners. METHODS: In this retrospective case-control analysis, 550 injured runners (49.6% female) with a medically diagnosed RRI were included. All runners had undergone an instrumented treadmill analysis to determine habitual footstrike pattern, vertical instantaneous load rate, peak vertical ground reaction force (vGRF) and cadence. Injuries were classified by location according to a recent consensus statement. A logistic regression model was used to determine the association between the biomechanical parameters and RRI locations. Because injuries can be associated with age, sex, and body mass index, these variables were also entered into the logistic regression. RESULTS: Strike pattern and peak vGRF were the only biomechanical variable distinguishing an injury from the group of injuries. A midfoot strike differentiated Achilles tendon injuries (odds ratio [OR], 2.27; 90% confidence interval [CI], 1.17-4.41) and a forefoot strike distinguished posterior lower leg injuries (OR, 2.59; 90% CI, 1.50-4.47) from the rest of the injured group. Peak vGRF was weakly associated with hip injuries (OR, 1.14; 90% CI, 1.05-1.24). Female sex was associated with injuries to the lower leg (OR, 2.65; 90% CI, 1.45-4.87) and hip/groin (OR, 2.22; 90% CI, 1.43-3.45). Male sex was associated with Achilles tendon injuries (OR, 1.923; 90% CI, 1.094-3.378). CONCLUSIONS: Sex, foot strike pattern, and vGRF were the only factors that distinguished specific injury locations from the remaining injury locations.


Assuntos
Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Corrida/lesões , Tendão do Calcâneo/lesões , Tendão do Calcâneo/fisiopatologia , Adulto , Fatores Etários , Fenômenos Biomecânicos , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Pé/fisiologia , Traumatismos do Pé/etiologia , Traumatismos do Pé/fisiopatologia , Marcha , Virilha/lesões , Virilha/fisiopatologia , Lesões do Quadril/etiologia , Lesões do Quadril/fisiopatologia , Humanos , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Adulto Jovem
9.
J Sports Sci ; 39(9): 992-1000, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33283656

RESUMO

The open stance forehand has been hypothesized to be more traumatic for knee injuries in tennis than the neutral stance forehand. This study aims to compare kinematics and kinetics at the knee during three common forehand stroke stances (attacking neutral stance ANS, attacking open stance AOS, defensive open stance DOS) to determine if the open stance forehand induces higher knee loadings and to discuss its potential relationship with given injuries. Eight advanced tennis players performed eight repetitions of forehand strokes with each stance (ANS: forward run and stroke with feet parallel with the hitting direction, AOS: forward run and stroke with feet perpendicular to the hitting direction, DOS: lateral run and stroke with feet perpendicular to the hitting direction) at maximal effort. All the trials were recorded with an optoelectronic motion capture system. The flexion-extension, abduction-adduction, external-internal rotation angles, intersegmental forces and torques of the right knee were calculated. Ground reaction forces were measured with a forceplate. The DOS increases vertical GRF, maximum knee flexion and abduction angles, range of knee flexion-extension, peak of compressive, distractive and medial knee forces, peak of knee abduction and external rotation torques. Consequently, the DOS appears potentially more at risk for given knee injuries.


Assuntos
Fenômenos Biomecânicos/fisiologia , Traumatismos do Joelho/etiologia , Articulação do Joelho/fisiologia , Postura/fisiologia , Tênis/fisiologia , Adulto , Humanos , Cinética , Masculino , Movimento/fisiologia , Amplitude de Movimento Articular , Corrida/fisiologia , Tênis/lesões , Torque
10.
J Sports Med Phys Fitness ; 61(4): 582-591, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33092324

RESUMO

BACKGROUND: Ankle Kinesio-taping (KT) is being globally used an intervention to provide the ankle joint complex with sufficient support against sudden excessive mechanical stress during various activities. However, its effects on proximal joints are unclear. This study investigated the impact of ankle KT on ankle-knee joint coupling in sagittal, frontal and transverse planes. METHODS: Adopting a pretest post-test study design, 30 collegiate athletes with chronic ankle instability performed 3 single-leg drop landings in each non-taped and Kinesio-taped conditions and their movement kinematics were recorded using 6 optoelectronic cameras. RESULTS: The ankle angular velocities in sagittal (P=0.038, d=0.64) and transverse planes (P=0.001, d=0.95) decreased after KT application, while the knee internal rotation velocities increased (P=0.020, d=0.51). The coupling angles revealed that the ankle movement ratios significantly decreased in 3 planes in comparison with knee movement ratios. CONCLUSIONS: Outcomes of this study illustrated that application of ankle KT leaves the individuals with a stiffer ankle joint, which increases the mechanical stresses to this joint and decreases its stiffness in absorbing the applied shocks. Further, ankle KT application resulted in more knee internal rotation moments and may increase the risk of knee injuries during landing after a long-term usage in patients with instability ankle sprain.


Assuntos
Traumatismos do Tornozelo/prevenção & controle , Fita Atlética/efeitos adversos , Instabilidade Articular/prevenção & controle , Traumatismos do Joelho/etiologia , Adulto , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/fisiologia , Masculino , Rotação/efeitos adversos
11.
J Knee Surg ; 34(3): 338-350, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31470450

RESUMO

Extensor mechanism disruption following total knee arthroplasty (TKA) is a devastating complication that causes high failure rates. There is controversy on what is the best way to do an extensor mechanism reconstruction. This study aims to compare both allograft and synthetic reconstructive techniques for success, reoperation, and infection rates and functional outcomes. The search on PubMed, MEDLINE, Embase, BIOSIS, and Cochrane databases was performed on March 15, 2019, using the following keyword groups: (1) "extensor mechanism" and "total knee arthroplasty," (2) "extensor mechanism" and "knee arthroplasty," (3) "extensor mechanism" and "revision total knee arthroplasty," and (4) "extensor mechanism" and "revision knee arthroplasty". Only studies on extensor mechanism disruption after TKA that included sufficient data to compare these two surgical techniques were included. Meta-analysis was performed with random effect model using the DerSimonian-Laird method. Thirty studies were included. The overall success rate of the reconstruction was 73.3% (95% confidence interval [CI]: 0. 651, 0.814). The success rate of allograft (72.8%, 95% CI: 0.626, 0.829) was not significantly different from synthetic material (78%, 95% CI: 0.707, 0.852, p = 0.416). There was no significant difference in revision rates between allograft (14.2%, 95% CI: 0.095, 0.189) and synthetic material (16%, 95% CI: 0.096, 0.223, p = 0.657). The overall relative risk of infection was 4.301 (95% CI: 1.885, 9.810). There was no significant difference in relative risk of infection between allograft (3.886, 95% CI: 1.269, 11.903) and synthetic material (4.851, 95% CI: 1.433, 16.419, p = 0.793). No statistically significant difference was found in mean postoperative Knee Society score (73.109 [95% CI: 67.296, 78.922] vs. 72.679 [95% CI: 69.184, 76.173], p = 0.901) between allograft and mesh reconstruction groups. There were no significant differences in overall failures, infections, functional outcomes, or revision reconstructions between allograft and synthetic material extensor mechanism reconstructions. Our results demonstrate the difficulty in treating this serious injury, independent of technique, as well as the significant risk for overall failure and infection.


Assuntos
Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos dos Tendões/cirurgia , Aloenxertos , Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Humanos , Artropatias/etiologia , Artropatias/cirurgia , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/cirurgia , Patela/lesões , Polipropilenos , Implantação de Prótese/métodos , Amplitude de Movimento Articular , Reoperação , Telas Cirúrgicas , Traumatismos dos Tendões/etiologia , Transplante Homólogo , Resultado do Tratamento
12.
JBJS Case Connect ; 10(4): e20.00282, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33350620

RESUMO

CASE: A 19-year-old woman with a history of Hoffa fat pad syndrome underwent infrapatellar fat pad synovectomy and subsequently developed extensor mechanism disruption secondary to iatrogenic patellar tendon injury. She received a modified extensor mechanism patella-patellar tendon-tibial tubercle allograft to restore extensor function with satisfactory results at 2-year follow-up. We also review alternative techniques that were considered for her extensor mechanism repair. CONCLUSION: The patient demonstrated satisfactory outcomes, similar to other established techniques. This modified extensor mechanism allograft reconstruction may be an effective alternative for patients experiencing acute extensor mechanism disruptions.


Assuntos
Traumatismos do Joelho/cirurgia , Ligamento Patelar/transplante , Traumatismos dos Tendões/cirurgia , Aloenxertos , Artroscopia/efeitos adversos , Feminino , Humanos , Doença Iatrogênica , Traumatismos do Joelho/etiologia , Ligamento Patelar/lesões , Sinovectomia/efeitos adversos , Traumatismos dos Tendões/etiologia , Adulto Jovem
13.
J Am Acad Orthop Surg ; 28(22): 914-922, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32796370

RESUMO

Cartilage injuries in the knee are common and can occur in isolation or in combination with limb malalignment, meniscus, ligament, and bone deficiencies. Each of these problems must be addressed to achieve a successful outcome for any cartilage restoration procedure. If nonsurgical management fails, surgical treatment is largely based on the size and location of the cartilage defect. Preservation of the patient's native cartilage is preferred if an osteochondral fragment can be salvaged. Chondroplasty and osteochondral autograft transfer are typically used to treat small (<2 cm) cartilage defects. Microfracture has not been shown to be superior to chondroplasty alone and has potential adverse effects, including cyst and intralesional osteophyte formation. Osteochondral allograft transfer and matrix-induced autologous chondrocyte implantation are often used for larger cartilage defects. Particulated juvenile allograft cartilage is another treatment option for cartilage lesions that has good to excellent short-term results but long-term outcomes are lacking.


Assuntos
Cartilagem da Orelha/lesões , Cartilagem da Orelha/cirurgia , Traumatismos do Joelho/patologia , Traumatismos do Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Autoenxertos , Mau Alinhamento Ósseo/complicações , Condrócitos/transplante , Cartilagem da Orelha/patologia , Extremidades , Humanos , Traumatismos do Joelho/etiologia , Ligamentos , Tratamentos com Preservação do Órgão/métodos , Resultado do Tratamento
14.
Wounds ; 32(5): 142-145, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32804666

RESUMO

OBJECTIVE: The purpose of this study is to describe cases of traumatic exposure during the early postoperative period in patients with a total knee replacement (TKR) and to report the treatments instituted and complications of this adverse event. METHODS: A retrospective review of postoperative patients with TKR performed at the Universidade de São Paulo from 2001 to 2017 who subsequently were treated at the emergency room due to trauma to the TKR region accompanied by surgical wound dehiscence in deep planes and implant exposure was conducted. The initial treatment, evolution, and complications of each patient were reported. RESULTS: In 16 years, there were 3224 TKRs performed at the study institution. Among this population, 4 (0.1%) patients had trauma dehiscence of the surgical wound during the immediate postoperative period. All patients were women between the ages of 64 and 88 years with comorbidities (eg, diabetes mellitus and/or hypertension). The mean time between the surgery and trauma was 6.7 ± 6.2 days. All patients underwent surgical cleaning, debridement with polyethylene exchange, and primary closure of the surgical wound and received adjuvant treatment with broad-spectrum antibiotic therapy. Of the 4 patients affected, 3 developed an infection, 3 required new surgery after initial cleaning, 2 lost their prostheses, and 1 lost a limb, requiring a transfemoral amputation. CONCLUSIONS: Traumatic dehiscence with implant exposure during the initial postoperative period of TKR is an infrequent event (0.1%) with a high potential for complications (75%), which may lead to loss of the prosthesis and even the limb. Measures should be taken to prevent falls and gather reports from several centers to broaden the knowledge of this rare event, identify prognostic factors, and define the best treatment algorithm.


Assuntos
Artroplastia do Joelho/efeitos adversos , Traumatismos do Joelho/complicações , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Traumatismos do Joelho/etiologia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Deiscência da Ferida Operatória/etiologia
15.
J Sports Med Phys Fitness ; 60(10): 1371-1376, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32608932

RESUMO

BACKGROUND: Although sites and types of injury frequently occurring in fencers have been well described, the type of injury caused by the use of fencing movements is still unknown. This study aimed to provide basic data for injury prevention by understanding the sports injury status in fencers. METHODS: A total of 584 South Korean fencers were included in the survey and were classified according to the injured site, cause of injury, and movement that causes injury. The collected data were analyzed using frequency analysis, χ2 tests, and logistic regression analysis to identify differences in sex, event type, age, and career. RESULTS: Female (P=0.001) and foil fencers (P=0.015) were more likely to experience injury than male and sabre and epee fencers. The incidence of injury was significantly higher according to age (P=0.001) and career (P=0.001). The ankle was the most frequently injured site (17.71%). Injuries most frequently occur during Fente movement (48.11%). Insufficient warm-up was the most common cause of injury (23.91%) in all groups. CONCLUSIONS: These results suggest that a specific warm-up program and strengthening exercises of the ankle and knee ligaments should be established to prevent injuries for fencers. Particularly, female, foil, adult, and experienced fencers should be more careful in preventing injuries.


Assuntos
Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Adolescente , Adulto , Distribuição por Idade , Traumatismos do Tornozelo/epidemiologia , Traumatismos do Tornozelo/etiologia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/prevenção & controle , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/fisiopatologia , Feminino , Humanos , Incidência , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/prevenção & controle , Masculino , Movimento , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Distribuição por Sexo , Exercício de Aquecimento , Adulto Jovem
16.
Ned Tijdschr Geneeskd ; 1642020 07 02.
Artigo em Holandês | MEDLINE | ID: mdl-32613786

RESUMO

The number of knee injuries in young children has risen sharply in recent years, due to more intensive participation in sporting activities by children at an increasingly lower age. This has led to more anterior cruciate ligament (ACL) ruptures. An ACL rupture has major consequences for the young athlete, but diagnosing this injury in a child can be difficult due to pain and anxiety. The criteria for appropriate treatment of an ACL rupture are not always clear for the child, the doctor, the parents and the sporting coach. Here we describe the diagnosis and possible treatment options for an ACL rupture in children based on three cases. We conclude that the incidence of ACL ruptures in children is a growing problem. There is a challenge for sports associations, sports clubs, trainers and parents to build in prevention programmes during weekly training sessions. The considerations to be taken into account concerning diagnosis and different treatment options show, once again, that children cannot simply be considered as small adults.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos em Atletas , Traumatismos do Joelho , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/etiologia , Lesões do Ligamento Cruzado Anterior/psicologia , Lesões do Ligamento Cruzado Anterior/terapia , Traumatismos em Atletas/psicologia , Traumatismos em Atletas/terapia , Criança , Comportamento Infantil , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/terapia , Masculino , Assistência ao Paciente , Ruptura , Esportes
17.
Knee ; 27(3): 642-648, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563418

RESUMO

BACKGROUND: The development of heterotopic ossification (HO) might nullify any benefit of multiple-ligament reconstruction of the knee joint. The purpose of this study was to investigate the incidence and the specific explanatory factors for the development of HO after multiple-ligament reconstruction of the knee joint. METHODS: From January 2011 to June 2016, 72 consecutive patients with knee dislocations received multiple-ligament reconstructions, of which 57 (79%) were available for a minimum follow up of 12 months and were included in this study. Anteroposterior (AP) and lateral radiographs were reviewed for all patients. This knee dislocation cohort was separated into two groups based on the presence or absence of HO for comparisons. In addition, the HO group was divided into three subgroups based on a modified quadrant grading system introduced by the senior author for further evaluation. Multivariate logistic regression analysis was then performed to identify specific explanatory factors predicting development of HO in patients after multiple-ligament reconstructions of the knee joint. RESULTS: Among the 72 consecutive patients, 57 (79%) were available for the clinical evaluations with an average period of 28.4 months (range, 12-51 months). Twenty-one patients (37%) showed radiological evidence of HO. The HO group (n = 21) showed significantly inferior results of knee flexion angle compared with the non-HO group (n = 36) (HO group vs. non-HO group: 124 ± 13° vs. 132 ± 5°; P<0.01). According to the quadrant grading system, there were seven patients with grade I, nine with grade II, and five with grade III HO. Subgroup analysis further revealed that higher HO grade would lead to lower knee flexion angle. In addition, multivariate regression analysis showed that concomitant posterior cruciate ligament reconstruction was the only independent explanatory factor predicting the development of HO after multiple-ligament reconstruction of the knee joint (P=0.018; odds ratio, 8.75; 95% confidence interval, 1.69-39.7). CONCLUSION: In this cohort of knee dislocations, the incidence of HO development following multiple-ligament reconstruction was 37%, with grade III HO showing the most inferior range of motion outcome. Moreover, concomitant posterior cruciate ligament reconstruction was the only independent predictor for the development of HO.


Assuntos
Luxação do Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Ossificação Heterotópica/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adolescente , Adulto , Análise Fatorial , Feminino , Humanos , Incidência , Luxação do Joelho/classificação , Luxação do Joelho/diagnóstico por imagem , Luxação do Joelho/patologia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/patologia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Ligamentos Articulares/patologia , Masculino , Ossificação Heterotópica/classificação , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/patologia , Reconstrução do Ligamento Cruzado Posterior/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto Jovem
18.
BMC Musculoskelet Disord ; 21(1): 342, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493282

RESUMO

BACKGROUND: Extensor apparatus rupture is a severe complication after knee arthroplasty, but there have not been many reports on how to perform knee arthroplasty after chronic patellar ligament rupture. We reported a case of total knee arthroplasty (TKA) in a patient with severe osteoarthritis (OA) complicated by chronic patellar ligament rupture. CASE PRESENTATION: In this case, a 67-year-old male patient suffered from patellar ligament rupture due to trauma more than 20 years ago and did not undergo any formal treatment. Physical examination revealed a small amount of fluid and extension lag, and the patella was displaced upward by approximately 5.5 cm. The quadriceps were atrophic and weak. There was significant tenderness on the medial side of the left knee joint. Passive motion of the left knee joint ranged from full extension to 120° of flexion with discomfort during excessive flexion. Active flexion of the knee joint to 120°, and extensor lag was approximately 90°. We reconstructed the extensor apparatus through a quadriceps tendon V-Y quadricepsplasty and Krackow suture technique of the patellar ligament, and osteoarthritis was resolved with TKA. The visual analogue scale (VAS) score decreased from 5 points to 1 point after surgery. Six weeks later, the patient was able to walk normally without a walking stick, and the knee joint could stretch actively to approximately 30°. However, he had obvious extension lag. This problem improved 10 months after surgery. The AKS score increased from 35 to 95 10 months after surgery. The HSS score increased from 43 to 93. CONCLUSIONS: TKA and ligament reconstruction are options for the treatment of knee OA with chronic patellar ligament rupture. V-Y lengthening of the quadriceps femoris tendon after the Krackow suture technique of the patellar ligament with transpatellar tunnels may be a reasonable choice during TKA.


Assuntos
Artroplastia do Joelho , Traumatismos do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Ligamento Patelar/lesões , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Idoso , Humanos , Traumatismos do Joelho/etiologia , Masculino , Ligamento Patelar/cirurgia , Músculo Quadríceps/cirurgia , Radiografia , Amplitude de Movimento Articular , Ruptura/etiologia , Técnicas de Sutura , Resultado do Tratamento
19.
Med Sci Sports Exerc ; 52(12): 2608-2614, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32496368

RESUMO

INTRODUCTION: The purpose of this study was to compare leg, sagittal plane knee and ankle, and frontal plane ankle stiffness over the course of a prolonged treadmill run in neutral and stability footwear. METHODS: Thirteen male habitual rearfoot runners completed two biomechanical testing sessions in which they ran for 21 min at their preferred running speed in a neutral shoe, then changed either into the same neutral shoe or a stability shoe and ran a further 21 min on a force-instrumented treadmill. Three-dimensional kinematics and kinetics were recorded at the beginning and end of each 21-min interval. RESULTS: No differences were observed in leg stiffness between footwear conditions throughout the run (P > 0.05). Knee stiffness increased during the first 21 min (P = 0.009), whereas ankle stiffness reduced at minute 21 (P = 0.004) and minute 44 (P = 0.006). These changes were modulated by an increase in ankle joint compliance and knee joint moments. No differences were observed between footwear conditions for leg and sagittal plane lower extremity joint stiffness (P > 0.05). During the second half of the run, frontal plane ankle stiffness increased in the stability shoe but decreased in the neutral shoe (P = 0.019), attributed to reduced eversion range of motion caused by the added medial post. CONCLUSIONS: These results suggest that over the course of a prolonged treadmill run, shock attenuation strategies change, which may affect the knee joint.


Assuntos
Articulação do Tornozelo/fisiologia , Articulação do Joelho/fisiologia , Extremidade Inferior/fisiologia , Corrida/fisiologia , Sapatos , Adulto , Análise de Variância , Fenômenos Biomecânicos/fisiologia , Desenho de Equipamento , Frequência Cardíaca/fisiologia , Humanos , Traumatismos do Joelho/etiologia , Masculino , Corrida/lesões , Fatores de Tempo , Adulto Jovem
20.
Gait Posture ; 79: 71-79, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32361656

RESUMO

INTRODUCTION: Injury prevention programs for athletes are still limited by a lack of understanding of specific risk factors that can influence injuries within different sports. The majority of studies on volleyball have not considered the movement patterns when moving in different directions or in planned and unplanned block jump-landings. METHODS: This study investigated all planes mechanics between the lead and trail limb when moving in dominant and non-dominant directions, for both planned and unplanned jump-landings in thirteen semi-professional female volleyball players. Ankle, knee and hip joint kinematics, kinetics and joint stiffness were recorded. RESULTS: Our results showed statistically significant differences between the lead limb and the trail limb in the hip flexion angles, moments and velocity; in the knee flexion angles, moments, stiffness, power and energy absorption and in the ankle dorsiflexion, power and energy absorption, showing a tendency where the lead limb has a higher injury risk than the trail limb. When considering planned versus unplanned situations, there were statistically significant differences in knee flexion angles, moments, power and energy absorption; and hip contact angle, flexion angular velocity and energy absorption, with musculoskeletal adaptations in the planned situations. DISCUSSION: It appears that the role of the limb, either lead or trail, is more important than the limb dominance when performing directional jump-landings, with the lead limb having a higher implication on possible overuse injuries than the trail limb. Furthermore, planned movements showed a difference in strategy indicating greater implications to possible overuse injuries than in the unplanned situations which may be associated with more conscious thought about the movements. CONCLUSION: Coaches should consider unilateral coordination training in both landing directions for the lead and trail limb, and should adapt training to replicate the competition environment, using unplanned situations to minimize asymmetries to might reduce injury risks.


Assuntos
Articulação do Tornozelo/fisiopatologia , Articulação do Quadril/fisiopatologia , Traumatismos do Joelho/etiologia , Movimento , Voleibol/lesões , Traumatismos do Tornozelo/etiologia , Fenômenos Biomecânicos , Feminino , Lesões do Quadril/etiologia , Humanos , Articulação do Joelho/fisiopatologia , Fatores de Risco , Adulto Jovem
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