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1.
PLoS One ; 17(1): e0262553, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35015790

RESUMO

Echo intensity (EI) is a novel tool for assessing muscle quality. EI has traditionally been reported as the mean of the pixel histogram, with 0 and 255 arbitrary units (A.U.) representing excellent and poor muscle quality, respectively. Recent work conducted in youth and younger and older adults suggested that analyzing specific EI bands, rather than the mean, may provide unique insights into the effectiveness of exercise and rehabilitation interventions. As our previous work showed deterioration of muscle quality after knee joint immobilization, we sought to investigate whether the increase in EI following disuse was limited to specific EI bands. Thirteen females (age = 21 yrs) underwent two weeks of left knee immobilization and ambulated via crutches. B-mode ultrasonography was utilized to obtain images of the immobilized vastus lateralis. The percentage of the total number of pixels within bands of 0-50, 51-100, 101-150, 151-200, and 201-255 A.U. was examined before and after immobilization. We also sought to determine if further subdividing the histogram into 25 A.U. bands (i.e., 0-25, 26-50, etc.) would be a more sensitive methodological approach. Immobilization resulted in a decrease in the percentage of pixels within the 0-50 A.U. band (-3.11 ± 3.98%), but an increase in the 101-150 A.U. (2.94 ± 2.64%) and 151-200 A.U. (0.93 ± 1.42%) bands. Analyses of variance on the change scores indicated that these differences were large and significant (%EI0-50 vs. %EI101-150: p < .001, d = 1.243); %EI0-50 vs. %EI151-200: p = .043, d = 0.831). The effect size for the %EI51-100 versus %EI101-150 comparison was medium/large (d = 0.762), but not statistically significant (p = .085). Further analysis of the 25 A.U. bands indicated that the percentage of pixels within the 25-50 A.U. band decreased (-2.97 ± 3.64%), whereas the 101-125 (1.62 ± 1.47%) and 126-150 A.U. (1.18 ± 1.07%) bands increased. Comparison of the 50 A.U. and 25 A.U. band methods found that 25 A.U. bands offer little additional insight. Though studies are needed to ascertain the factors that may influence specific bands, changes in EI during muscle disuse are not homogeneous across the pixel histogram. We encourage investigators to think critically about the robustness of data obtained from EI histograms, rather than simply reporting the EImean value, in muscle quality research.


Assuntos
Exercício Físico , Traumatismos do Joelho/fisiopatologia , Força Muscular , Músculo Esquelético/fisiopatologia , Músculo Quadríceps/fisiopatologia , Adulto , Feminino , Humanos , Traumatismos do Joelho/reabilitação , Músculo Esquelético/diagnóstico por imagem , Músculo Quadríceps/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia/métodos , Adulto Jovem
2.
PLoS One ; 16(11): e0259678, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34758053

RESUMO

Meniscus tears of the knee are among the most common orthopedic knee injury. Specifically, tears of the posterior root can result in abnormal meniscal extrusion leading to decreased function and progressive osteoarthritis. Despite contemporary surgical treatments of posterior meniscus root tears, there is a low rate of healing and an incidence of residual meniscus extrusion approaching 30%, illustrating an inability to recapitulate native meniscus function. Here, we characterized the differential functional behavior of the medial and lateral meniscus during axial compression load and dynamic knee motion using a cadaveric model. We hypothesized essential differences in extrusion between the medial and lateral meniscus in response to axial compression and knee range of motion. We found no differences in the amount of meniscus extrusion between the medial and lateral meniscus with a competent posterior root (0.338mm vs. 0.235mm; p-value = 0.181). However, posterior root detachment resulted in a consistently increased meniscus extrusion for the medial meniscus compared to the lateral meniscus (2.233mm vs. 0.4705mm; p-value < 0.0001). Moreover, detachment of the posterior root of the medial meniscus resulted in an increase in extrusion at all angles of knee flexion and was most pronounced (4.00mm ± 1.26mm) at 30-degrees of knee flexion. In contrast, the maximum mean extrusion of the lateral meniscus was 1.65mm ± 0.97mm, occurring in full extension. Furthermore, only the medial meniscus extruded during dynamic knee flexion after posterior root detachment. Given the differential functional behaviors between the medial and lateral meniscus, these findings suggest that posterior root repair requires reducing overall meniscus extrusion and recapitulating the native functional responses specific to each meniscus.


Assuntos
Meniscos Tibiais/fisiologia , Menisco/fisiologia , Amplitude de Movimento Articular/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiologia , Extremidade Inferior/fisiologia
3.
J Sports Sci Med ; 20(3): 457-465, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34267585

RESUMO

The round house kick (RHK) is a common technique in taekwondo (TKD). The kicking action originates from the dynamic stability of the pivot leg. However, some knee injuries are caused by more difficult kicking strategies, such as kicks to the opponent's head. This study analyses the effects on TKD players in the lower extremity kinematic and neuromuscular reactions from different kicking heights. This study recruited 12 TKD players (age=20.3 ± 1.3 years, height = 1.72 ± 0.09 m, mass = 62.17 ± 9.45 kg) with no previous lower extremity ligament injuries. All athletes randomly performed 3 RHK at different heights (head, chest, and abdomen), repeating each kick 5 times. During the RHK action, the kinematics and muscle activations of the pivot leg were collected using six high-speed cameras and electromyography devices. The results found that during the RHK return period a high kicking position demonstrated larger knee valgus with the straight knee, and more hamstring activation on the pivot leg. The RHK pivot foot for TKD players encountered more risk of injury from high target kicking. The hamstring muscle played an important stabilizing role. It is recommended that sports medicine clinicians or sports coaches use this information to provide further protective injury prevention strategies.


Assuntos
Perna (Membro)/fisiologia , Artes Marciais/fisiologia , Músculo Esquelético/fisiologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Fenômenos Biomecânicos , Eletromiografia , Feminino , Músculos Isquiossurais/fisiologia , Quadril/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiologia , Masculino , Amplitude de Movimento Articular , Fatores de Risco , Análise e Desempenho de Tarefas , Adulto Jovem
4.
J Orthop Sports Phys Ther ; 51(6): 298-304, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33971732

RESUMO

OBJECTIVE: To examine the associations of knee injury, radiographic osteoarthritis severity, and quadriceps strength with knee pain exacerbation during walking. DESIGN: Within-person knee-matched case-control study. METHODS: Participants from the Osteoarthritis Initiative who completed a 20-m walking test at the 24-month visit were included. Pain exacerbation was defined as an increase in pain intensity of 1 or more on a numeric rating scale (0 as no pain and 10 as the worst imaginable pain) while completing the 20-m walking test. We used conditional logistic regression to assess the relation of recent knee injury, Kellgren-Lawrence (KL) grade, and quadriceps strength to unilateral knee pain exacerbation during walking. RESULTS: We included 277 people who experienced unilateral knee pain exacerbation during the walking test. Recent knee injury was associated with pain exacerbation during walking, with an odds ratio of 3.4 (95% confidence interval [CI]: 1.3, 9.2). Compared with knees with a KL grade of 0, the odds ratios of pain exacerbation during walking were 1.3 (95% CI: 0.7, 2.7), 3.3 (95% CI: 1.5, 7.1), and 8.1 (95% CI: 3.1, 21.1) for knees with KL grades of 2, 3, and 4, respectively. Painful knees with a deficit in quadriceps strength of greater than or equal to 4% had a 1.4-fold (95% CI: 1.0, 1.9) higher risk of pain exacerbation during walking than their pain-free counterparts. CONCLUSION: Recent knee injury, more severe radiographic osteoarthritis, and lower quadriceps strength were associated with an increased risk of knee pain exacerbation during walking. J Orthop Sports Phys Ther 2021;51(6):298-304. Epub 10 May 2021. doi:10.2519/jospt.2021.9735.


Assuntos
Artralgia/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Força Muscular/fisiologia , Osteoartrite do Joelho/fisiopatologia , Músculo Quadríceps/fisiopatologia , Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia , Teste de Caminhada
5.
J Knee Surg ; 34(6): 599-604, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33648008

RESUMO

Posterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Traumatismos do Joelho , Ligamento Cruzado Posterior/lesões , Lesões do Menisco Tibial , Algoritmos , Doenças das Cartilagens/complicações , Doenças das Cartilagens/diagnóstico , Doenças das Cartilagens/fisiopatologia , Doenças das Cartilagens/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/fisiopatologia , Cartilagem Articular/cirurgia , Humanos , Traumatismos do Joelho/complicações , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Meniscos Tibiais/fisiopatologia , Meniscos Tibiais/cirurgia , Osteoartrite/etiologia , Ligamento Cruzado Posterior/fisiopatologia , Ligamento Cruzado Posterior/cirurgia , Lesões do Menisco Tibial/diagnóstico , Lesões do Menisco Tibial/fisiopatologia , Lesões do Menisco Tibial/cirurgia
6.
J Vasc Surg ; 74(3): 804-813.e3, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33639233

RESUMO

OBJECTIVE: Traumatic popliteal vascular injuries are associated with the highest risk of limb loss of all peripheral vascular injuries. A method to evaluate the predictors of amputation is needed because previous scores could not be validated. In the present study, we aimed to provide a simplified scoring system (POPSAVEIT [popliteal scoring assessment for vascular extremity injuries in trauma]) that could be used preoperatively to risk stratify patients with traumatic popliteal vascular injuries for amputation. METHODS: A review of patients sustaining traumatic popliteal artery injuries was performed. Patients requiring amputation were compared with those with limb salvage at the last follow-up. Of these patients, 80% were randomly assigned to a training group for score generation and 20% to a testing group for validation. Significant predictors of amputation (P < .1) on univariate analysis were included in a multivariable analysis. Those with P < .05 on multivariable analysis were assigned points according to the relative value of their odds ratios (ORs). Receiver operating characteristic curves were generated to determine low- vs high-risk scores. An area under the curve of >0.65 was considered adequate for validation. RESULTS: A total of 355 patients were included, with an overall amputation rate of 16%. On multivariate regression analysis, the risk factors independently associated with amputation in the final model were as follows: systolic blood pressure <90 mm Hg (OR, 3.2; P = .027; 1 point), associated orthopedic injury (OR, 4.9; P = .014; 2 points), and a lack of preoperative pedal Doppler signals (OR, 5.5; P = .002; 2 points [or 1 point for a lack of palpable pedal pulses if Doppler signal data were unavailable]). A score of ≥3 was found to maximize the sensitivity (85%) and specificity (49%) for a high risk of amputation. The receiver operating characteristic curve for the validation group had an area under the curve of 0.750, meeting the threshold for score validation. CONCLUSIONS: The POPSAVEIT score provides a simple and practical method to effectively stratify patients preoperatively into low- and high-risk major amputation categories.


Assuntos
Determinação da Pressão Arterial , Técnicas de Apoio para a Decisão , Artéria Poplítea/diagnóstico por imagem , Ultrassonografia Doppler , Lesões do Sistema Vascular/diagnóstico , Adulto , Amputação , Pressão Sanguínea , Feminino , Fraturas Ósseas/diagnóstico , Humanos , Escala de Gravidade do Ferimento , Luxações Articulares/diagnóstico , Luxações Articulares/fisiopatologia , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/lesões , Artéria Poplítea/fisiopatologia , Artéria Poplítea/cirurgia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/terapia , Adulto Jovem
7.
J Knee Surg ; 34(5): 499-508, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33618405

RESUMO

Posterior cruciate ligament (PCL) injuries are often encountered in the setting of other knee pathology and sometimes in isolation. A thorough understanding of the native PCL anatomy is crucial in the successful treatment of these injuries. The PCL consists of two independent bundles that function in a codominant relationship to perform the primary role of resisting posterior tibial translation relative to the femur. A secondary role of the PCL is to provide rotatory stability. The anterolateral (AL) bundle has a more vertical orientation when compared with the posteromedial (PM) bundle. The AL bundle has a more anterior origin than the PM bundle on the lateral wall of the medial femoral condyle. The tibial insertion of AL bundle on the PCL facet is medial and anterior to the PM bundle. The AL and PM bundles are 12-mm apart at the center of the femoral origins, while the tibial insertions are more tightly grouped. The different spatial orientation of the two bundles and large distance between the femoral centers is responsible for the codominance of the PCL bundles. The AL bundle is the dominant restraint to posterior tibial translation throughout midrange flexion, while the PM bundle is the primary restraint in extension and deep flexion. Biomechanical testing has shown independent reconstruction of the two bundles that better reproduces native knee biomechanics, while significant differences in clinical outcomes remain to be seen. Stress X-rays may play an important role in clinical decision-making process for operative versus nonoperative management of isolated PCL injuries. Strong understanding of PCL anatomy and biomechanics can aid surgical management.


Assuntos
Traumatismos do Joelho , Articulação do Joelho , Ligamento Cruzado Posterior , Fenômenos Biomecânicos , Fêmur/anatomia & histologia , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/anatomia & histologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/anatomia & histologia , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/fisiologia , Ligamento Cruzado Posterior/cirurgia , Reconstrução do Ligamento Cruzado Posterior/métodos , Amplitude de Movimento Articular , Rotação , Tíbia/anatomia & histologia
8.
Sci Rep ; 11(1): 3642, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574469

RESUMO

The degeneration of radial tie fibres of the central meniscal layer, and thinning of its lamellar layer results in increased intensity signals on magnetic resonance imaging, making it difficult to differentiate from true meniscal tear. This study aimed to assess the rate of encountered MRI grades 1 and 2 intrasubstance meniscal changes, and to set guidelines to report these changes based on predicted clinical outcome. A systematic review approach was employed using search engines, libraries, and databases (Google Scholar, ERIC, PubMed, and Medline) to search for scholarly sources on meniscal lesions and their significance in MRI published between 1 January 2000 and 30 June 2019. It retrieved 2750 abstracts, out of which 2738 were excluded and 13 studies meeting inclusion criteria were meta-analysed. It found an association between intrasubstances meniscal changes and outcomes. It resulted that intrasubstance meniscal changes were preservable through the protective functioning of the meniscus. Other than weight gain, no other significant risk factor of developing true meniscal tears later in life was found. It is important to examine intrasubstance meniscal change when patients suffer from mechanical meniscal symptoms especially in old age.


Assuntos
Traumatismos do Joelho/fisiopatologia , Meniscos Tibiais/fisiopatologia , Menisco/diagnóstico por imagem , Lesões do Menisco Tibial/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Artroscopia/métodos , Feminino , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/diagnóstico por imagem , Menisco/fisiopatologia , Pessoa de Meia-Idade , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/epidemiologia
9.
Knee Surg Sports Traumatol Arthrosc ; 29(2): 342-351, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32152692

RESUMO

PURPOSE: To compare the effect of the lateral meniscus (LM) complete radial tear at different tear sites on the load distribution and transmission functions. METHODS: A compressive load of 300 N was applied to the intact porcine knees (n = 30) at 15°, 30°, 60°, 90°, and 120° of flexion. The LM complete radial tears were created at the middle portion (group M), the posterior portion (group P), or the posterior root (group R) (n = 10, each group), and the same loading procedure was followed. Finally, the recorded three-dimensional paths were reproduced on the LM-removed knees. The peak contact pressure (contact area) in the lateral compartment and the calculated in situ force of the LM under the principle of superposition were compared among the four groups (intact, group M, group P, and group R). RESULTS: At all the flexion angles, the peak contact pressure (contact area) was significantly higher (lower) after creating the LM complete radial tear as compared to that in the intact state (p < 0.01). At 120° of flexion, group R represented the highest peak contact pressure (lowest contact area), followed by group P and group M (p < 0.05). The results of the in situ force carried by the LM were similar to those of the tibiofemoral contact mechanics. CONCLUSION: The detrimental effect of the LM complete radial tear on the load distribution and transmission functions was greatest in the posterior root tear, followed by the posterior portion tear and the middle portion tear in the deep-flexed position. Complete radial tars of the meniscus, especially at the posterior root, should be repaired to restore the biomechanical function.


Assuntos
Traumatismos do Joelho/fisiopatologia , Meniscos Tibiais/fisiopatologia , Lesões do Menisco Tibial/fisiopatologia , Animais , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/fisiopatologia , Pessoa de Meia-Idade , Pressão , Amplitude de Movimento Articular , Estresse Mecânico , Suínos , Suporte de Carga
10.
J Knee Surg ; 34(7): 784-792, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31914474

RESUMO

Medial meniscotibial ligament (MTL) lesions may go unrecognized and untreated and have detrimental impact on knee biomechanics and joint pathology. Therefore, this study was designed to compare the biomechanical impact of midbody MTL disruption to corresponding peripheral medial meniscal (PMM) tears in anterior cruciate ligament (ACL) intact and ACL-deficient cadaveric knees. Cadaveric knees (n = 12; 6 matched pairs) were tested for laxity and ACL strain under anterior, valgus, and external rotation loading at 0, 30, and 90 degree of flexion. Knees were randomly assigned to ACL-intact (n = 6) or ACL-deficient (n = 6) groups. Large midbody MTL disruption or corresponding PMM tears were created (n = 3/group) and knees retested. PMM tears were repaired arthroscopically with inside-out suturing, and MTL lesions were repaired with suture anchors via an open approach. Knees were retested after repair. Biomechanical testing data were compared for statistically significant differences. Large MTL and PMM lesions were associated with significant increases in ACL strain, anterior laxity at 0, 30, and 90 degrees (p = 0.006), valgus laxity (p = 0.0012), and external rotation laxity (p = 0.0003) compared with intact knees. Repair of each lesion restored knee stability and reduced ACL strain to intact levels. In ACL-deficient knees, there was significantly increased anterior, valgus, and external rotation laxity compared with the ACL-intact state and MTL and PMM lesions further increased laxity at all angles. However, differences were not statistically significant and repair of meniscal lesions alone did not restore stability to ACL-deficient knees. These results highlight the need to recognize medial MTL injury and perform an appropriate repair procedure to restore knee stability and protect against excessive ACL strain.


Assuntos
Ligamento Cruzado Anterior/fisiologia , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Fenômenos Biomecânicos , Cadáver , Fáscia , Feminino , Humanos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/fisiopatologia , Masculino , Menisco , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Rotação , Âncoras de Sutura , Suturas
11.
Knee Surg Sports Traumatol Arthrosc ; 29(4): 1025-1034, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32451621

RESUMO

PURPOSE: The purpose of this study was to evaluate the influence of tibial tunnel position in pullout repair for a medial meniscus (MM) posterior root tear (MMPRT) on postoperative MM extrusion. METHODS: Thirty patients (median age 63 years, range 35-72 years) who underwent transtibial pullout repairs for MMPRTs were included. Three-dimensional computed tomography images of the tibial surface were evaluated using a rectangular measurement grid for assessment of tibial tunnel position and MM posterior root attachment. Preoperative and postoperative MM medial extrusion (MMME) and posterior extrusion (MMPE) at 10° and 90° knee flexion were measured using open magnetic resonance imaging. RESULTS: Tibial tunnel centers were located more anteriorly and more medially than the anatomic center (median distance 5.8 mm, range 0-9.3 mm). The postoperative MMPE at 90° knee flexion was significantly reduced after pullout repair, although there was no significant reduction in MMME or MMPE at 10° knee flexion after surgery. In the correlation analysis of the displacement between the anatomic center to the tibial tunnel center and improvements in MMME, and MMPE at 10° and 90° knee flexion, there was a significant positive correlation between percentage distance and improvement of MMPE at 90° knee flexion. CONCLUSION: This study demonstrated that the nearer the tibial tunnel position to the anatomic attachment of the MM posterior root, the more effective the reduction in MMPE at 90° knee flexion. Our results emphasize that an anatomic tibial tunnel should be created in the MM posterior root to improve the postoperative MMPE and protect the articular cartilage in a knee flexion position. Placement of an anatomic tibial tunnel significantly improves the MMPE at 90° of knee flexion after MM posterior root pullout repair. LEVEL OF EVIDENCE: IV.


Assuntos
Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Lesões do Menisco Tibial/cirurgia , Adulto , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Imageamento Tridimensional/métodos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Período Pós-Operatório , Amplitude de Movimento Articular , Ruptura/cirurgia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
12.
Int J Sports Med ; 42(4): 344-349, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33017852

RESUMO

Current recommendations for return-to-play decision-making involve comparison of the injured limb to the uninjured limb. However, the use of the uninjured limb as a comparison for hop testing lacks empirical evidence. Thus, the purpose of this study was to determine the effects of lower extremity injury on limb symmetry and performance on the single-leg hop for distance. Two-hundred thirty-six adolescent athletes completed the single-leg hop for distance before the beginning of the season (pre-injury). Forty-four adolescent athletes sustained a lower extremity injury (22 ankle and 12 knee) and missed at least three days of sports participation. All individuals had completed the single-leg hop for distance before the beginning of the season (pre-injury) and at discharge (post-injury). Injured limb single-leg hop for distance significantly decreased at return-to-play from pre-injury with a mean decrease of 48.9 centimeters; the uninjured limb also significantly decreased, with a mean decrease of 33.8 centimeters. Limb symmetry did not significantly change pre- to post-injury with a mean difference of 1.5%. Following a lower extremity injury, single-leg hop for distance performance degrades not only for the injured limb but also the uninjured limb. However, limb symmetry did not change following a lower extremity injury.


Assuntos
Traumatismos da Perna/fisiopatologia , Desempenho Físico Funcional , Recuperação de Função Fisiológica/fisiologia , Volta ao Esporte/fisiologia , Adolescente , Traumatismos do Tornozelo/fisiopatologia , Basquetebol/lesões , Intervalos de Confiança , Tomada de Decisões , Feminino , Futebol Americano/lesões , Guias como Assunto , Humanos , Traumatismos do Joelho/fisiopatologia , Perna (Membro)/anatomia & histologia , Extremidade Inferior/lesões , Masculino , Estudos Prospectivos , Voleibol/lesões
13.
Sports Health ; 13(2): 111-115, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32723000

RESUMO

CONTEXT: A strict rehabilitation protocol is traditionally followed after microfracture, including weightbearing restrictions for 2 to 6 weeks. However, such restrictions pose significant disability, especially in a patient population that is younger and more active. EVIDENCE ACQUISITION: An extensive literature review was performed through PubMed and Google Scholar of all studies through December 2018 related to microfracture, including biomechanical, basic science, and clinical studies. For inclusion, clinical studies had to report weightbearing status and outcomes with a minimum 12-month follow-up. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: Review of biomechanical and biology studies suggest new forming repair tissue is protected from shear forces of knee joint loading by the cartilaginous margins of the defect. This margin acts as a shoulder to maintain axial height and allow for tissue remodeling up to at least 12 months after surgery, well beyond current weight bearing restriction trends. A retrospective case-control study showed that weightbearing status postoperatively had no effect on clinical outcomes in patients who underwent microfracture for small chondral (<2 mm2) defects. In fact, 1 survey showed that many orthopaedic surgeons currently do not restrict weightbearing after microfracture. CONCLUSION: This clinical literature review suggests that weightbearing restrictions may not be required after microfracture for isolated tibiofemoral chondral lesions of the knee. STRENGTH OF RECOMMENDATION TAXONOMY: C.


Assuntos
Artroplastia Subcondral/reabilitação , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Traumatismos do Joelho/cirurgia , Suporte de Carga , Fenômenos Biomecânicos , Cartilagem Articular/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia
14.
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
15.
Knee Surg Sports Traumatol Arthrosc ; 29(6): 1952-1959, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32965546

RESUMO

PURPOSE: The Simple Knee Value (SKV) is an outcome score in which patients are asked to grade their knee function as a percentage of that of a normal knee. The primary aim of this study was to validate the SKV by measuring its correlation with existing knee-related PROMs. METHODS: This was a prospective study conducted at a teaching hospital to assess the SKV's validity. The study enrolled 47 young patients (16-54 years old), 49 older patients (≥ 55 years) and 30 healthy controls. A paper questionnaire consisting of the Lysholm, IKDC, KOOS, WOMAC and SKV was given to subjects three times (enrolment, 1-month preoperative visit and 6 months postoperative visit). The criterion validity of the SKV was determined by correlating it to existing knee PROMs using the Spearman correlation coefficient (S). SKV test-retest reliability was assessed by the intraclass correlation coefficient (ICC) between two time points (initial consultation at enrolment and preoperative visit, reflecting the same clinical condition). Responsiveness to change was determined by comparing the SKV scores before and after surgery (enrolment consultation and 6 months postoperative). Discriminative ability was determined by comparing the SKV distribution in patients and controls. RESULTS: There was a strong and significant correlation between the SKV and the gold standard Lysholm, IKDC, KOOS and WOMAC in the younger patients and the older patients (p < 0.0001). The reliability between the SKV at the initial consultation and before surgery was excellent (ICC 0.862, 95% CI 0.765; 0.921) in the younger patients, and moderate (ICC 0.506, 95% CI 0.265; 0.688) in the older patients. The SKV was responsive to change in both patient groups (p < 0.0001 for the SKV before versus 6 months after surgery). Like the other knee-specific PROMs (p < 0.0001), the SKV was able to distinguish between patients and controls (p < 0.0001). CONCLUSIONS: The SKV is valid as it is significantly correlated to existing knee PROMs. It is also reliable, responsive to change and discriminating. Its simplicity gives it many advantages and it can be used by physicians in their daily practice. LEVEL OF EVIDENCE: Level II.


Assuntos
Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Artroplastia , Artroplastia do Joelho , Feminino , Humanos , Joelho/fisiologia , Joelho/cirurgia , Traumatismos do Joelho/diagnóstico , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
16.
J Bone Joint Surg Am ; 103(2): 146-154, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33060427

RESUMO

BACKGROUND: The apparently physiological kinematics of the bicruciate-stabilized total knee arthroplasty (BCS TKA) systems have been attributed to the anterior and posterior post-cam mechanism. Although comparisons between TKA designs with either a retained or a sacrificed cruciate ligament have been conducted, we are not aware of any analyses of 2 implants with identical bearing geometry but different cruciate-ligament strategies under equal loading conditions. Knowledge about the kinematic effect of the different cruciate ligament strategies would potentially be valuable to facilitate preoperative planning and decision-making with regard to selecting the most appropriate implant for a patient. METHODS: This retrospective study included 20 patients: 10 treated with a BCS and 10 treated with a cruciate retaining (CR) TKA. Fluoroscopic analyses during high-flexion activities (unloaded flexion-extension and loaded lunge) were conducted at 24 months postsurgery. All patients completed the Knee Society Score, Forgotten Joint Score, and High-Flexion Knee Score questionnaires preoperatively and postoperatively. RESULTS: The BCS cohort showed greater femoral lateral rollback as well as a medial pivot in both activities. In contrast, the CR cohort showed a significant increase in anterior translation on the medial compartment as well as almost absent femoral lateral rollback. Higher clinical scores were observed in the BCS cohort. CONCLUSIONS: At 24 months postsurgery, despite equal bearing geometry, retention of the posterior cruciate ligament in the CR cohort apparently was insufficient to reduce anterior shift. The BCS cohort showed expected knee joint kinematics; however, the kinematics in this cohort could eventually benefit from a smooth transition between the interchanging surfaces. Further investigation should be focused on the surgical technique and its interaction with the TKA design. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia do Joelho/métodos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Fenômenos Biomecânicos , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
17.
Arch Phys Med Rehabil ; 102(4): 571-581, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33278366

RESUMO

OBJECTIVE: To develop an International Classification of Functioning, Disability and Health core set for patients with knee dysfunction. DESIGN: Cross-sectional study. SETTING: The study was conducted at all levels of care (general community, primary care units, rehabilitation clinics/centers, hospital). PARTICIPANTS: Participants (N=388) with knee dysfunction with or without clinical diagnosis of knee pathology, with or without complaint of pain, with or without instability, and/or with or without knee movement restriction of any type. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were assessed using the core sets for acute and postacute musculoskeletal conditions, the subjective form from the International Knee Documentation Committee scale, the self-report of general health and functionality, and the general health and functionality classified by the researcher. To identify the categories that best explain knee dysfunction, linear regression analyses were performed. RESULTS: Twenty-four categories were identified from the 75 core set categories for acute and postacute musculoskeletal conditions. Eleven categories belong to the component body functions, 3 represent body structures, 7 represent activities and participation, and 3 represent environmental factors. CONCLUSIONS: A core set for knee dysfunction that can be used at all levels of health care was proposed, which offers a system for disability assessment related to knee dysfunction, including environmental and social factors. These factors are important for a broad assessment because they include the multiple aspects of functionality, usually not considered in other knee dysfunction assessment instruments. Further analysis of the content and construct validity of the core set is required.


Assuntos
Artralgia/classificação , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Instabilidade Articular/classificação , Traumatismos do Joelho/classificação , Adulto , Idoso , Artralgia/fisiopatologia , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade
18.
Gait Posture ; 84: 192-197, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33360641

RESUMO

BACKGROUND: Soldiers that suffer a service-related knee musculoskeletal injury routinely develop joint osteoarthritis. Knee osteoarthritis is a substantial and costly problem among soldiers, yet it is unknown how body borne load and duration of walking impact knee adduction biomechanics linked to progression and severity of osteoarthritis. RESEARCH QUESTION: This study determined the adaptations in magnitude and variability of knee adduction joint angle (KAA) and moment (KAM) during prolonged walking with body borne load. METHODS: Thirteen recreationally active participants had knee biomechanics quantified while walking over-ground for 60-min at 1.3 m/s with three body borne loads (0, 15, and 30 kg). Magnitude and variability of KAA and KAM measures were quantified and submitted to a RM ANOVA to test the main effect and interactions between load (0, 15 and 30 kg) and time (0, 15, 30, 45 and 60 min). RESULTS: Body borne load increased peak KAM (p < 0.001), whereas time increased peak and range of KAA (both: p < 0.001). Specifically, peak KAM increased with each addition of body borne load (all: p < 0.025), and peak and range of KAA increased after 30 min of walking (both: p < 0.040). Neither body borne load, nor time had a significant effect on KAA or KAM variability (both: p > 0.05). SIGNIFICANCE: Prolonged walking with heavy body borne load increased knee adduction biomechanics related to osteoarthritis. Adding heavy body borne load increased in peak KAM whereas duration of walking increased KAA, knee biomechanics that may increase loading of the medial knee joint compartment and risk of OA at the joint.


Assuntos
Fenômenos Biomecânicos/fisiologia , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Caminhada/fisiologia , Suporte de Carga/fisiologia , Adulto , Feminino , Humanos , Masculino , Militares , Adulto Jovem
19.
Knee Surg Sports Traumatol Arthrosc ; 29(3): 672-681, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33201271

RESUMO

The posterior cruciate ligament (PCL) represents an intra-articular structure composed of two distinct bundles. Considering the anterior and posterior meniscofemoral ligaments, a total of four ligamentous fibre bundles of the posterior knee complex act synergistically to restrain posterior and rotatory tibial loads. Injury mechanisms associated with high-energy trauma and accompanying injury patterns may complicate the diagnostic evaluation and accuracy. Therefore, a thorough and systematic diagnostic workup is necessary to assess the severity of the PCL injury and to initiate an appropriate treatment approach. Since structural damage to the PCL occurs in more than one third of trauma patients experiencing acute knee injury with hemarthrosis, background knowledge for management of PCL injuries is important. In Part 1 of the evidence-based update on management of primary and recurrent PCL injuries, the anatomical, biomechanical, and diagnostic principles are presented. This paper aims to convey the anatomical and biomechanical knowledge needed for accurate diagnosis to facilitate subsequent decision-making in the treatment of PCL injuries.Level of evidence V.


Assuntos
Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/terapia , Ligamento Cruzado Posterior/lesões , Adulto , Fenômenos Biomecânicos , Feminino , Hemartrose/epidemiologia , Humanos , Joelho/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Ligamentos Articulares/anatomia & histologia , Ligamentos Articulares/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Masculino , Ligamento Cruzado Posterior/anatomia & histologia , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/fisiopatologia , Reconstrução do Ligamento Cruzado Posterior/métodos , Radiografia/métodos , Recidiva , Rotação , Tíbia/fisiopatologia , Adulto Jovem
20.
Methods Mol Biol ; 2230: 91-103, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33197010

RESUMO

Given the prevalence and the scope of the personal and societal burden of osteoarthritis (OA), investigators continue to be deeply interested in understanding the pathogenic basis of disease and developing novel disease modifying OA therapies. Because joint trauma/injury is considered a leading predisposing factor in the development of OA, and since posttraumatic OA is one of the most common forms of OA in general, large animal and rodent models of knee injury that accurately recapitulate the OA disease process have become increasingly widespread over the past decade. To enable study in the context of defined genetic backgrounds, investigative teams have developed standardized protocols for injuring the mouse knee that aim to induce a reproducible degenerative process both in terms of severity and temporal pacing of disease progression. The destabilization of the medial meniscus (DMM) is one of the most commonly employed surgical procedure in rodents that reproducibly models posttraumatic OA and allows for the study of disease progression from initiation to end-stage disease. The description provided here sets the stage for both inexperienced and established investigators to employ the DMM procedure, or other similar surgical destabilization methods, to initiate the development of posttraumatic OA in the mouse. Successful application of this method provides a preclinical platform to study the mechanisms driving the pathogenesis of posttraumatic OA and for testing therapeutic strategies to treat it.


Assuntos
Cartilagem Articular/crescimento & desenvolvimento , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Osteoartrite/cirurgia , Animais , Modelos Animais de Doenças , Progressão da Doença , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Meniscos Tibiais/fisiopatologia , Camundongos , Osteoartrite/fisiopatologia
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