Knotless Anchors in Acetabular Labral Repair: A Biomechanical Comparison.

PURPOSE: To analyze the failure mechanism, stiffness, and pullout strength of acetabular knotless suture anchors. METHODS: Seven suture anchors were tested in high-density (0.48 g/cc) synthetic blocks. The anchors were implanted perpendicular to the bone block. The anchor's suture(s) were tied around a loop of 8 high-strength nonabsorbable sutures and pulled in line with the anchor at a rate of 1 mm/s until failure. The following knotless anchors were tested: Stryker Knotilus 3.5, Arthrex Pushlock 2.9, Linvatec PopLok 2.8, Linvatec PopLok 3.3, ArthroCare SpeedLock HIP (3.4-mm), and Smith & Nephew Bioraptor Knotless 2.9. The standard knot tying Smith & Nephew Bioraptor 2.9 mm served as a baseline for comparison. RESULTS: Stiffness was highest in the Pushlock, the SpeedLock HIP, and Knotilus. At 1 mm displacement, the SpeedLock HIP exhibited significantly higher load than all other anchors, excluding the Pushlock and PopLok 3.3 (P ≤ .012 for all comparisons). Excluding the SpeedLock HIP and Knotilus, the Pushlock displayed significantly higher load than all other anchors at 2-mm displacement (P ≤ .015 for all comparisons). Maximum load was the highest for the Knotilus and Bioraptor knotted anchor (P < .001 compared with all other anchors). CONCLUSIONS: All knotless suture anchors used in hip arthroscopy, except for the Knotilus 3.5, failed by suture pullout from the anchor. The 2 anchors with the highest maximum load, the Knotilus 3.5 and knotted Bioraptor 2.9, failed by suture failure; however, these anchors displayed the lowest stiffness and load at 1 mm displacement among all anchors tested. Stiffness and loads at clinically relevant displacements, not maximum load alone, may be most important in predicting anchor clinical performance during the early phases of labral healing. CLINICAL RELEVANCE: Knotless suture anchors tend to fail by suture pullout from the anchor, yet the stiffness of these constructs suggests that minimal displacement of the repair will occur under physiologic loads.

Predicting Prolonged Hospital Stays in Elderly Patients With Hip Fractures Managed During the COVID-19 Pandemic in Chile: An Artificial Neural Networks Study.

Background: Prolonged length of stay (LOS) after a hip fracture is associated with increased mortality. Purpose: We sought to create a model to predict prolonged LOS in elderly Chilean patients with hip fractures managed during the COVID-19 pandemic. Methods: Employing an official database, we created an artificial neural network (ANN), a computational model corresponding to a subset of machine learning, to predict prolonged LOS (≥14 days) among 2686 hip fracture patients managed in 43 Chilean public hospitals during 2020. We identified 18 clinically relevant variables as potential predictors; 80% of the sample was used to train the ANN and 20% was used to test it. The performance of the ANN was evaluated via measuring its discrimination power through the area under the curve of the receiver operating characteristic curve (AUC-ROC). Results: Of the 2686 patients, 820 (30.2%) had prolonged LOS. In the training sample (2,125 cases), the ANN correctly classified 1,532 cases (72.09%; AUC-ROC: 0.745). In the test sample (561 cases), the ANN correctly classified 401 cases (71.48%; AUC-ROC: 0.742). The most relevant variables to predict prolonged LOS were the patient's admitting hospital (relative importance [RI]: 0.11), the patient's geographical health service providing health care (RI: 0.11), and the patient's surgery being conducted within 2 days of admission (RI: 0.10). Conclusions: Using national-level big data, we developed an ANN that predicted with fair accuracy prolonged LOS in elderly Chilean patients with hip fractures during the COVID-19 pandemic. The main predictors of a prolonged LOS were unrelated to the patient's individual health and concerned administrative and organizational factors.

Consequences of the COVID-19 Syndemic for Nutritional Health: A Systematic Review.

Confinement at home, quarantine, and social distancing are some measures adopted worldwide to prevent the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2), which has been generating an important alteration in the routines and qualities of life of people. The impact on health is still being evaluated, and consequences in the nutritional field are not entirely clear. The study objective was to evaluate the current evidence about the impact that preventive measures of physical contact restriction causes in healthy nutrition. A systematic review was carried out according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" PRISMA Group and Cochrane method for rapid systematic reviews. Searching was performed in six electronic databases and evaluated articles published between 2010 and 2020, including among their participants adult subjects who had been exposed to the preventive measures of physical contact restriction. Seven studies met the selection criteria and reported an overall increase in food consumption, weight, Body Mass Index (BMI), and a change in eating style. Findings suggest that healthy nutrition is affected by preventive measures to restrict physical contact as a result of the COVID-19 syndemic.

The Effect of Resection Size in the Treatment of Cam-Type Femoroacetabular Impingement in the Typical Patient With Hip Arthroscopy: A Biomechanical Analysis.

BACKGROUND: Arthroscopic osteochondroplasty may improve range of motion and relieve pain in patients with symptomatic hip impingement. Femoral neck fracture is a risk of this procedure because of the weakening of the proximal femur. To our knowledge, there are no biomechanical studies in young human cadaveric bone evaluating the effect of osteochondroplasty on femoral neck strength. PURPOSE/HYPOTHESIS: The purpose was to evaluate loads to fracture in young human cadavers after resection depths of 25% and 40% at the head-neck junction. We hypothesized that both depths will maintain ultimate loads to failure above previously published loads, as well as above physiologic weightbearing loads. STUDY DESIGN: Descriptive laboratory study. METHODS: Cadaveric proximal femoral specimens (6 matched pairs, under the age of 47 years) were divided into 2 groups: 25% or 40% of the diameter at the head-neck junction was resected. The length of the resection was 2 cm and the width of the resection was determined by the length of the anterolateral quadrant at the head-neck junction in all cases. A compressive load was applied directly to the femoral head. Peak load, stiffness, and energy to fracture were compared between groups. RESULTS: The average peak load to fracture after 25% resection (7347 N) was significantly higher than after the 40% resection (5892 N) (P = .010). The average energy to fracture was also significantly higher in the 25% resection group (30.2 J vs 19.2 J; P = .007). The average stiffness was higher in the 25% group, although not statistically significant (P = .737). CONCLUSION: Resection depths of 25% and 40% at the anterolateral quadrant of the femoral head-neck junction may be safe at previously described functional loads such as standing and walking in the age range more typically seen in patients undergoing hip arthroscopy. Loads to fracture were significantly higher than previously reported using older cadaveric specimens. CLINICAL RELEVANCE: Currently, most surgeons limit weightbearing after femoral osteochondroplasty in part because of risk of femoral neck fracture. Given the higher observed loads to fracture, young patients could possibly bear weight sooner after surgery, although postoperative protocols should be individualized based on patient age, weight, bone density, amount of bone resected, concomitant procedures, and potential compliance with activity restrictions.

BM-MSCs differentiated to chondrocytes for treatment of full-thickness cartilage defect of the knee.

BACKGROUND: Full-thickness articular cartilage injury of the knee is a major cause of disability. The aim of this study is to assess the outcome of patients treated with differentiated to chondrocytes bone marrow mesenchymal stem cells (BM-MSCs) cultured on a collagen type I/III (Chondro-Gide®) scaffold. The secondary aim was to confirm the absence of adverse events. METHODS: Fifteen patients (19 knees) with symptomatic full-thickness cartilage defects of the knee were enrolled. Bone marrow was harvested from the iliac crest, BM-MSCs were prepared, and expanded cells were grown in a standard medium or in a standard culture medium containing TGF-ß. BM-MSCs differentiated to chondrocytes were seeded in a porcine collagen type I/III scaffold (Chondro-Gide®) and cultured in TGF-ß containing media. After 4 weeks, the membrane was sutured on the cartilage defect. All patients underwent plain radiographs (antero-posterior, lateral, and axial view of the patella) and MRI of the affected knee. The Oxford knee score, the Lyhsolm scale, and the VAS score were administered to all patients. At final follow-up a MRI for the study of articular cartilage was undertaken. RESULTS: The mean size of the cartilage lesions was 20 × 17 mm (range, 15 × 10 mm-30 × 30 mm). At final follow-up, the median Oxford knee score and Lyhsolm scale scores significantly improved from 29 (range 12-39; SD 7.39) to 45 (range 24-48; SD 5.6) and from 55.5 (range 25-81; SD 17.7) to 94.5 (58-100; SD 10.8), respectively. Pain, according to the VAS score, significantly improved. Sixty percent of patients reported their satisfaction as excellent, 20% as good, 14% as fair, and 1 patient as poor. CONCLUSION: The treatment of full-thickness chondral injuries of the knee with differentiated to chondrocytes BM-MSCs and Chondro-Gide® scaffold showed encouraging outcomes. Further studies involving more patients, and with longer follow-up, are required to evaluate the effectiveness of the treatment and the long-term results.

Surgical correction of "cam-type" femoroacetabular impingement: a cadaveric comparison of open versus arthroscopic debridement.

PURPOSE: The goal of this study was to compare open and arthroscopic surgical techniques for "cam-type" femoroacetabular impingement in terms of feasibility and reliability. METHODS: We used 5 fresh-frozen cadaver specimens (10 hips). Anteroposterior and cross-table radiographs were taken for each. The head-neck union diameter was measured for each. The amount of bone resection at the anterolateral quadrant of the head-neck union was planned for each, with specific references to width, length, depth, and position. One side was randomly assigned to the open group and the other to the arthroscopic group. Surgical time, position of the osteotomy, and variation of the length, width, and depth of the final osteotomy with respect to the proposed dimensions were compared. RESULTS: In all specimens partial resection of the anterior-lateral femoral head-neck junction with improvement of the femoral head-neck offset was accomplished. A statistically significant difference (P < .05) was observed for surgical time between the open and arthroscopic groups (shorter in open group). CONCLUSIONS: When comparing surgical precision, no statistically significant differences were found between the open and arthroscopic procedures in any of the measurements. The depth and width of the osteoplasty were reliably obtained by the arthroscopic technique. However, there was a tendency to underestimate the osteoplasty length with the arthroscopic procedure. Positioning the osteoplasty was also less reliable with the arthroscopic procedure than with the open procedure because of the tendency to place the osteoplasty more posterior and distally than intended. CLINICAL RELEVANCE: Surgical resection of the femoral neck prominence and/or part of the anterolateral neck has been reported to improve femoral head offset and alleviate impingement. This study attempts to document the accuracy of this resection when done arthroscopically compared with an open procedure.

Treatment of osteonecrosis of the femoral head by core decompression and implantation of fully functional ex vivo-expanded bone marrow-derived mesenchymal stem cells: a proof-of-concept study.

BACKGROUND: Based on several attributes involved in bone formation, bone marrow-resident mesenchymal stem cells (MSCs) have been employed in the treatment of patients suffering from femoral head osteonecrosis. Due to the low content of MSCs in the bone marrow, ex vivo expansion procedures are utilized to increase the cell number. Customarily, before administration of the resulting expanded cell product MSCs to the patient, its cellular identity is usually evaluated according to a set of "minimal phenotypic" markers, which are not modified by ex vivo processing. However, MSC functional ("reparative") markers, which are severely impaired along the ex vivo expansion routine, are usually not assessed. PATIENTS AND METHODS: In this proof-of-concept study, a cohort of five avascular osteonecrosis patients received an instillation of ex vivo-expanded autologous MSCs, manufactured under controlled conditions, with an aim to protect their functional ("reparative") capacity. RESULTS AND CONCLUSION: Outcomes of this study confirmed the safety and effectiveness of the MSC-based therapy used. After a follow-up period (19-54 months), in all patients, the hip function was significantly improved and pain intensity markedly reduced. As a corollary, no patient required hip arthroplasty.

Comparative study of the neural differentiation capacity of mesenchymal stromal cells from different tissue sources: An approach for their use in neural regeneration therapies.

Mesenchymal stem cells (MSCs) can trans/differentiate to neural precursors and/or mature neurons and promote neuroprotection and neurogenesis. The above could greatly benefit neurodegenerative disorders as well as in the treatment of post-traumatic and hereditary diseases of the central nervous system (CNS). In order to attain an ideal source of adult MSCs for the treatment of CNS diseases, adipose tissue, bone marrow, skin and umbilical cord derived MSCs were isolated and studied to explore differences with regard to neural differentiation capacity. In this study, we demonstrated that MSCs from several tissues can differentiate into neuron-like cells and differentially express progenitors and mature neural markers. Adipose tissue MSCs exhibited significantly higher expression of neural markers and had a faster proliferation rate. Our results suggest that adipose tissue MSCs are the best candidates for the use in neurological diseases.

Dickkopf-1 reduces hypertrophic changes in human chondrocytes derived from bone marrow stem cells.

The in vitro process of chondrogenic differentiation of mesenchymal stem cells (MSCs) induces a pre-apoptotic hypertrophic phenotype, guided by the active status of the WNT/߭catenin pathway. To achieve a stable chondrocyte phenotype for cartilage tissue engineering, it is necessary to gain a better understanding of specific genes that regulate the cartilage tissue phenotype. RNA sequencing (RNA-seq) analysis of tissue samples from bone, cartilage, growth plate and muscle show that Dickkopf-1 (DKK1), a natural WNT canonical signaling inhibitor, is expressed in cartilage tissue. This observation reinforces the concept that inhibition of the WNT/߭catenin pathway is critical for preventing avoid chondrocyte hypertrophy in vitro. We used two doses of DKK1 in a pellet cell culture system to inhibit the terminal differentiation of chondrocytes derived from bone marrow mesenchymal stem cells (MSCs). Bone marrow MSCs were cultured in chondrogenic induction medium with 50 and 200 ng/ml of DKK1 for 21 days. The highest doses of DKK1 reduce ߭catenin expression and nuclear localization at day 21, concomitant with reduced expression and activity of hypertrophy markers collagen type X (COL10A1) and alkaline phosphatase (ALPL), thus decreasing the pre-hypertrophic chondrocyte population. Furthermore, DKK1 stimulated expression of collagen type II (COL2A1) and glycosaminoglycans (GAGs), which represent healthy articular cartilage markers. We conclude that exogenous DKK1 impedes chondrocyte progression into a prehypertrophic stage and stimulates expression of healthy articular cartilage markers by blocking the WNT/߭catenin pathway. Hence, DKK1 may promote a mature healthy articular cartilage phenotype and facilitate cartilage tissue engineering for joint repair.

Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel.

PURPOSE: The purpose of this study was to determine if the use of platelet concentrate (PC) and bone plug (BP) does accelerate the healing process in anterior cruciate ligament (ACL) reconstruction. METHODS: One hundred and eight patients requiring ACL reconstruction were prospectively randomized into 4 groups: control (27 patients), PC (26 patients), BP (28 patients), and a combination of PC and BP (27 patients). Magnetic resonance imaging (MRI) studies were carried out at both 3 and 6 months postsurgery. Maturation of the graft was evaluated at the femoral tunnel using MRI maturation criteria defined by a low-intensity signal, absence of osteoligamentous interface, and no widening of the femoral tunnel. RESULTS: Three months after surgery, no differences were found among the groups regarding MRI maturation criteria. Six months postsurgery, 78% of the patients in the control group had a low-intensity signal, while in the PC group the low-intensity signal was present in 100% of the patients (P = .036). No statistical differences were observed regarding the osteoligamentous interface between the various groups. Finally, tunnel widening was seen in 11% of the patients of the BP group versus 41% of the patients in the control group (P = .047), but no statistical difference was seen with the other groups. CONCLUSIONS: The use of PC had an enhancing effect on the graft maturation process evaluated only by MRI signal intensity, without showing any significant effect in the osteoligamentous interface or tunnel widening evolution. The use of a BP effectively prevented tunnel widening. The BP and PC combination did not show a synergic effect as compared to PC or BP individually. LEVEL OF EVIDENCE: Level II, lesser quality randomized controlled trial.

A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report.

PURPOSE: Our purpose was to develop an alternative method to divide the acetabulum and femoral head into different zones based on anatomic landmarks clearly visible during arthroscopy to facilitate reporting the geographic location of intra-articular injuries. METHODS: Two vertical lines are positioned across the acetabulum aligned with the anterior and posterior limits of the acetabular notch. A horizontal line is positioned aligned with the superior limit of the notch perpendicular to the previous lines. The lines divide the acetabulum into 6 zones. Numbers are assigned to each zone in consecutive order. Zone 1 is the anterior-inferior acetabulum. The numbers progress around the notch until zone 5 is assigned to the posterior-inferior acetabulum. Zone 6 is the acetabular notch. The same method is applied to the femoral head. Six experienced hip arthroscopists were instructed in the zone and clock-face methods and were asked to identify and describe the geographic locations of lesions at the acetabular rim, acetabular cartilage, and femoral head in the same cadaveric specimen. RESULTS: The zone method was more reproducible than the clock-face method in the geographic description of intra-articular injuries on the acetabulum and the femoral head. CONCLUSIONS: Among a group of expert hip arthroscopists, the zone method was more reproducible than the clock-face method. CLINICAL RELEVANCE: The presented method divides the acetabulum into 6 different zones based on the acetabular notch. The zones are the same for right- and left-side hips. The same method is applied for the femoral head allowing, for the first time, a geographic description of pathology.

Use of Three-dimensional Printing in Orthopaedic Surgical Planning.

BACKGROUND: Three-dimensional (3D) printing is a technique based on overlapping layers of a material (eg, plastic, clay, and metal). The widespread implementation of 3D printers has resulted in a notable increase in use. Fields such as construction, engineering, and medicine benefit from this technique. AIM: The use of 3D printed scale models permits better surgical planning and results. METHODS: The models were created based on CT images of seven patients (age range, 5 to 61 years) with different pathologies who were candidates for surgery. RESULTS: Surgical time decreased as a result of detailed surgical planning with printed models. This technique also was associated with a decrease in bleeding, a reduction in the amount of anesthesia required, and greater precision. In some patients, a change in surgical strategy was noted, thus allowing for a reduction in the number of surgeries and the aggressiveness of surgery. Finally, the preoperative practice (virtual and physical osteotomies using cutting tools) that was performed in two cases allowed the surgeon to evaluate the different approach alternatives and establish the best strategy. CONCLUSIONS: The use of 3D-printed anatomic models has improved surgical planning, especially for patients in whom the conventional techniques are insufficient for establishing a proper strategy. The extra information provided by 3D-printed models can lead to a better intervention strategy, which is beneficial for patients because it decreases the risks, procedure times, and recovery times.

The effect of ketoprophen on lumbar spinal fusion healing in a rabbit model. Laboratory investigation.

OBJECT: Several reports have shown that nonsteroidal antiinflammatory drugs (NSAIDs) have an inhibitory effect in osteogenesis and reduce heterotopic ossification in humans. A deleterious effect of NSAIDs in posterolateral intertransverse process fusion has also been suggested. The authors used a validated rabbit model to try to determine the influence of the NSAID ketoprophen on the fusion rate in lumbar spinal arthrodesis. METHODS: Thirty New Zealand male rabbits underwent posterolateral (intertransverse process) bilateral spinal fusions at a single level, using autologous bone graft obtained from both iliac crests. The animals were randomized after the operation, so that 15 rabbits received ketoprophen as a postoperative analgesic and the other 15 received the postoperative analgesic tramadol. The animals were killed 8 weeks after surgery, and fusion status was determined by inspection, palpation, anteroposterior radiographs, and histological analysis. RESULTS: A solid fusion was obtained in eight rabbits (53%), and pseudarthrosis in seven rabbits (47%) in each group. CONCLUSIONS: These findings suggest that the use of ketoprophen after intertransverse spinal fusion at a single level does not decrease the fusion rate, compared with tramadol.

Early complications of operatively treated proximal humeral fractures.

Minimal information exists regarding early complications after operatively treated proximal humeral fractures. Of the 82 shoulders that had osteosynthesis, 42 had a (nonmedical) complication, with 21 requiring further surgery. Of 42 shoulders with complications, 12 were related to incomplete reduction, 16 had loss of anatomic fracture fixation, 9 had delayed healing, 3 had an infection, 1 had rotator cuff failure, and 1 had loose bodies. Fixed-angle plates had lower rates of initial malpositioning and resultant malunion. Of the 22 shoulders requiring hemiarthroplasty, 14 had an early complication. Of these, 7 had complications relating to implant insertion or tuberosity malreduction at the index operation and 7 had problems with tuberosity healing. The rate of complications after operative treatment of proximal humeral fractures is high. All efforts at fracture fragment fixation with osteosynthesis and hemiarthroplasty should be directed at obtaining anatomic fracture fixation that resists displacement.

Mesenchymal stem cell therapy in the treatment of hip osteoarthritis.

This study was performed to investigate the safety and efficacy of the intra-articular infusion of ex vivo expanded autologous bone marrow-derived mesenchymal stem cells (BM-MSC) to a cohort of patients with articular cartilage defects in the hip. The above rationale is sustained by the notion that MSCs express a chondrocyte differential potential and produce extracellular matrix molecules as well as regulatory signals, that may well contribute to cure the function of the damaged hip joint. A cohort of 10 patients with functional and radiological evidences of hip osteoarthritis, either in one or both legs, was included in the study. BM-MSC (the cell product) were prepared and infused into the damaged articulation(s) of each patient (60 × 106 cells in 3 weekly/doses). Before and after completion of the cell infusion scheme, patients were evaluated (hip scores for pain, stiffness, physical function, range of motion), to assess whether the infusion of the respective cell product was beneficial. The intra-articular injection of three consecutive weekly doses of ex vivo expanded autologous BM-MSC to patients with articular cartilage defects in the hip and proved to be a safe and clinically effective treatment in the restoration of hip function and range of motion. In addition, the statistical significance of the above data is in line with the observation that the radiographic scores (Tönnis Classification of Osteoarthritis) of the damaged leg(s) remained without variation in 9 out of 10 patients, after the administration of the cell product.

Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. Surgical technique.

BACKGROUND: In patients with symptomatic hip impingement, surgical resection of the femoral head-neck junction may improve the range of motion and relieve pain. A risk of this procedure is fracture. We evaluated the amount of resection of the anterolateral aspect of the femoral head-neck junction that can be done safely. METHODS: Cadaveric proximal femoral specimens (fifteen matched pairs) were divided into three groups: 10%, 30%, or 50% of the diameter of one femoral neck was removed, and the contralateral femoral neck was left intact to serve as the control. A compressive load was applied directly to the femoral head. Peak load, stiffness, and energy to fracture were compared among the groups. RESULTS: The energy to fracture differed significantly (p = 0.0015) among the 10%, 30%, and 50% resection groups. The peak load after the 50% resection was significantly less (p = 0.0025) than that after the 10% or 30% resection. With the numbers available, there was no significant difference in peak load between the 10% and 30% resections. CONCLUSIONS: Resection of up to 30% of the anterolateral quadrant of the head-neck junction did not significantly alter the load-bearing capacity of the proximal part of the femur. However, a 30% resection significantly decreased the amount of energy required to produce a fracture. Thirty percent should be considered to be the greatest feasible amount of resection because of the change in the pattern of the femoral head-neck response to axial loads that we observed.

Cartilage restoration technique of the hip.

Hip cartilage lesions represent a diagnostic challenge and can be an elusive source of pain. Treatment may present difficulties due to localization and spherical form of the joint and is most commonly limited to excision, debridement, thermal chondroplasty and microfractures. This chapter will focus in new technologies to enhance the standard techniques. These new technologies are based in stem cells therapies; as intra-articular injections of expanded mesenchymal stem cells, mononuclear concentrate in a platelet-rich plasma matrix and expanded mesenchymal stem cells seeded in a collagen membrane. This review will discuss the bases, techniques and preliminary results obtained with the use of stem cells for the treatment of hip cartilage lesions.

Comparative analysis of kinesiotherapy rehabilitation after hip arthroscopy, quantified by harris and vail hip scores: a retrospective study.

BACKGROUND: It has been proven that femoroacetabular impingement cases improve following arthroscopic surgery. However, rehabilitation has a major role in the patient's recovery. The protocol used by our institution consists of an evidence-based guideline for the different phases of rehabilitation. OBJECTIVE: Describe and determine the effectiveness of our institution's kinesiotherapy rehabilitation program during 2011-2016, comparing Harris and Vail Hip Scores scales (HHS and VHS, respectively) at the beginning of each treatment phase. MATERIALS AND METHODS: This is an observational, descriptive, longitudinal and retrospective study which, from a total of 684 subjects who underwent surgery, and 103 subjects who followed our institution's rehabilitation program, ultimately uses a sample of 48 subjects for analysis; these subjects were included because they completed the scales on the three occasions determined. RESULTS: Significant exact differences were found in: multivariate contrasts HHS (F=147.420; p=0.000); VHS (F=82,160; p=0,000). Mauchly's sphericity test: HHS (W=0.722; p=0.001); VHS (W=0.830; p=0.014). The within-subject effect showed significant exact differences in: HHS (F=169.451; p=0.000); VHS (F=115.387; p=0.000). CONCLUSION: Results showed significant exact differences p=0.00. In spite of its limitations, this study provides a guideline for a patient's safe return to daily life activities. LEVEL OF EVIDENCE: IV.

Evaluación de un protocolo de intervención en Terapia Sistémica Breve para personas expuestas a un evento estresante reciente / Evaluation of a Brief Systemic Therapy intervention protocol for people who have experienced a recent stressful event

Resumen Los eventos altamente estresantes son sucesos que potencialmente generan consecuencias negativas en las personas afectadas, como síntomas postraumáticos y depresivos. El presente estudio evalúa un protocolo de intervención preventiva, orientado a personas que han vivido un evento altamente estresante reciente, basado en la Terapia Sistémica Breve. Cuatro terapeutas aplicaron el protocolo a cuatro usuarias. Se entrevistó a estas ocho personas acerca de su experiencia en la aplicación y recepción del protocolo. Mediante escalas de fiabilidad y validez contrastada se evaluaron los cambios pre-post en sintomatología postraumática, sintomatología depresiva, crecimiento postraumático y satisfacción con la vida; también se midió la relación terapéutica. Los resultados muestran apreciaciones positivas en terapeutas y usuarias, el desarrollo de una relación terapéutica adecuada y avances en tres de los cuatro indicadores cuantitativos de cambio. Se concluye que el protocolo está en condiciones de utilizarse en estudios controlados.

Abstract Highly stressful events are occurrences that potentially create negative consequences for the affected people, such as post-traumatic and depressive symptoms. This study assesses a preventive intervention protocol, aimed to people who have lived a recent highly stressful event, based on the Brief Systemic Therapy. Four therapists applied the protocol to four female users. These eight persons were interviewed about the experience in relation to the application and reception of the protocol. Through contrasted reliability and validity scales, pre and post changes in posttraumatic symptomatology, depressive symptomatology, posttraumatic growth and satisfaction with life were assessed; the therapeutic relation was also measured. The results show positive appraisals in therapists and female users, the development of a proper therapeutic relation and progress in three out of four quantitative change indicators. It is concluded that the protocol is suitable to be used in controlled studies.