Is Femoral Version Associated with Changes in Hip Muscle Strength in Females with Symptomatic Femoroacetabular Impingement? / A versão femoral está associada a alterações na força dos músculos do quadril em mulheres com impacto femoroacetabular sintomático?

Abstract Objective The aim of the present study was to evaluate the association between femoral anteversion and hip muscle strength in subjects with femoroacetabular impingement syndrome. Method The femoral version angles described in the arthro-magnetic resonance images and isokinetic tests were retrospectively evaluated from July 2016 to December 2017. The inclusion criteria were: a) femoral version evaluated by the same radiologist; b) α angle ≥ 55°; and c) no limiting pain during the isokinetic test. Flexion/extension, abduction/ adduction, and internal/external rotation peak torques were evaluated at 30° per second in 5 repetitions. The correlation between femoral version and muscle strength was evaluated by simple linear regression at a 5% significance level. Results A total of 37 females filled the inclusion criteria, and 51 symptomatic hips were evaluated. There was no correlation of the femoral anteversion in the flexion, extension, abduction, adduction, external rotation and internal rotation peak torques. Conclusion Femoral anteversion did not show a correlation with hip muscle strength in females with symptomatic femoroacetabular impingement.

Resumo Objetivo O objetivo deste estudo foi avaliar a associação da anteversão femoral e da força dos músculos do quadril em indivíduos com síndrome do impacto femoroacetabular. Método Os ângulos de versão femoral descritos nas imagens de ressonância magnética articular e os testes isocinéticos foram avaliados retrospectivamente entre julho de 2016 e dezembro de 2017. Os critérios de inclusão foram: a) versão femoral avaliada pelo mesmo radiologista; b) ângulo α ≥ 55°; e c) ausência de dor limitante durante o teste isocinético. Os picos de torque em flexão/extensão, abdução/adução e rotação interna/externa foram avaliados a 30°/s em 5 repetições. A correlação entre a versão femoral e a força muscular foi avaliada por meio de regressão linear simples, com nível de significância estatística de 5%. Resultados Um total de 37 mulheres atenderam aos critérios de inclusão. Foram avaliados 51 quadris sintomáticos. Não houve correlação da anteversão femoral nos picos de torque em flexão, extensão, abdução, adução, rotação externa e rotação interna. Conclusão A anteversão femoral não foi correlacionada à força dos músculos do quadril em mulheres com impacto femoroacetabular sintomático.

Biomechanical performance of Bio Cross-Pin and EndoButton for ACL reconstruction at femoral side: a porcine model

Abstract Introduction The method of graft fixation is critical in anterior cruciate ligament (ACL) reconstruction surgery. Success of surgery is totally dependent on the ability of the implant to secure the graft inside the bone tunnel until complete graft integration. The principle of EndoButton is based on the cortical suspension of the graft. The Cross-Pin is based on graft expansion. The aim of this study was to evaluate the biomechanical performance of EndoButton and Bio Cross-Pin to fix the hamstring graft at femoral side of porcine knee joints and evaluate whether they are able to support of loading applied on graft during immediate post-operative tasks. Methods Fourteen ACL reconstructions were carried out in porcine femurs fixing superficial flexor tendons with Titanium EndoButton (n = 7) and with 6 × 50 mm HA/PLLA Bio Cross-Pin (n = 7). A cyclic loading test was applied with 50-250 N of tensile force at 1 Hz for 1000 cycles. The displacement was measured at 20, 100, 500 and 1000 load cycles to quantify the slippage of the graft during the test. Single-cycle load-to-failure test was performed at 50 N/mm to measure fixation strength. Results The laxity during cyclic loading and the displacement to failure during single-cycle test were lower for the Bio Cross-Pin fixation (8.21 ± 1.72 mm) than the EndoButton (11.20 ± 2.00 mm). The Bio Cross-Pin (112.22 ± 21.20 N.mm–1) was significantly stiffer than the EndoButton fixation (60.50 ±10.38 N.mm–1). There was no significant difference between Bio Cross-Pin (failure loading: 758.29 ± 188.05 N; yield loading: 713.67 ± 192.56 N) and EndoButton strength (failure loading: 672.52 ± 66.56 N; yield loading: 599.91 ± 59.64 N). Both are able to support the immediate post-operative loading applied (445 N). Conclusion The results obtained in this experiment indicate that the Bio Cross-Pin technique promote stiffer fixation during cyclic loading as compared with EndoButton. Both techniques are able to support the immediate post-operative loading applied.

Graft tendon slippage with metallic and bioabsorbable interference screws under cyclic load: a biomechanical study in a porcine model

Introduction The rupture of the anterior cruciate ligament (ACL) is the most common type of knee injury. Reconstructive surgery is the ‘gold standard’ treatment. During the immediate post-operative period, the fixation of the graft is entirely dependent on the ability of the grafted implant to be secured inside the bone tunnel under the cyclical loads associated with daily tasks. Poor fixation can lead to graft slippage, thus impairing the healing and integration of the graft. The aim of this study was to evaluate the biomechanical performance of tendon graft fixation devices with metallic and bioabsorbable interference screws. Methods Twenty ACL reconstructions were carried out in porcine tibias using deep flexor tendons to fix 9 × 20 mm metallic (n=10) and PLLA 70/30 bioabsorbable screws (n=10). To verify the ability of a construct to resist immediate postoperative (PO) rehabilitation protocols for immediate load bearing, a cyclic loading test was applied with 50-250 N of tensile force at 1 Hz for 1000 cycles, and the displacement was measured at 10, 50, 100, 500 and 1000 load cycles to quantify the slippage of the graft during the test. After the cyclic loading test, a single-cycle load-to-failure test was applied. Results The slippage of the graft using metallic screws did not differ (P = 0.616) from that observed when using bioabsorbable screws. Conclusion The results obtained in this experiment indicate that metallic screws may promote a similar amount of graft slippage during low cyclic loading as bioabsorbable screws. Additionally, there was no difference in the biomechanical performance of these two types of screws during high failure loads.

Achados em ressonância magnética artrográfica de indivíduos com lesão do labrum acetabular / Magnetic resonance arthrographic findings in subjects with acetabular labral tears

OBJETIVO: Descrever os achados em artro RM de sujeitos com suspeita de lesão do labrum acetabular. MÉTODO: Foram analisadas 108 artro RM de quadris em 2007/2008. Dois radiologistas independentemente analisaram as imagens e foi considerada a resposta comum entre eles. Com base em seus pareceres observou-se o local e estadiamento das lesões labrais e condrais, as alterações anatômicas, e a presença de tendinite e bursite trocantérica. RESULTADO: As lesões labrais grau I ocorreram em 41 por cento dos casos, grau II em 31 por cento, e grau III em 29 por cento. O IFA tipo cam foi frequente em 36 por cento dos casos, tipo pincer em 11 por cento, e IFA misto em 13 por cento, nestes casos 57 por cento apresentaram lesão labral grau III, A lesão condral grau I foi observada em 51 por cento acetábulos, as de grau II em 13 por cento, e grau III em 18 por cento. CONCLUSÃO: As alterações morfológicas que provocam IFA do tipo cam foram as mais prevalentes. Em relação ao grau de lesão labral e condral foram predominantes as lesões grau I independente da presença ou do tipo de IFA, exceto em IFAs mistos onde houve predomínio de lesão labral grau III. Não foi observada uma relação entre o grau de lesão labral e condral.

OBJECTIVE: To describe the MR arthrographic findings in subjects with suspected acetabular labral tears of the hip. METHOD: 108 hip MRa results were analyzed in 2007-2008. Two radiologists independently interpreted the images, and the consensual answers between them were considered for analysis. Based on their opinions, information was obtained on the location, staging of the chondral and labral lesions, anatomic alterations, and the presence of trochanteric bursitis and tendonitis. RESULTS: 1st degree labral lesions occurred in 41 percent of cases, 2nd degree in 31 percent, and 3rd degree in 29 percent. The cam type FAI was common in 36 percent of cases, pincer FAI in 11 percent, and mixed cam-pincer FAI in 13 percent; in these cases 57 percent had grade III labral lesions. 1st degree chondral lesions were observed in 51 percent of acetabulum, 2nd degree in 13 percent, and 3rd degree in 18 percent. CONCLUSION: The morphologic alterations that cause cam type FAI were the most common. With respect to the degree of labral and chondral lesions, 1st degree lesions were the most common, irrespective of the presence or type of FAI, except in mixed cam-pincer FAIs, in which 3rd degree lesions were predominant. No relationship was observed between the degree of labral and chondral lesion.

Alongamento balístico versus sustentar e relaxar: comparação do ganho imediato e após 24 horas / Ballistic versus hold-relax stretching: comparison of immediate

Dentre os métodos de alongamento mais utilizados na prática clínica, encontram-se os métodos balístico e facilitação neuromuscular proprioceptiva (FNP) através da técnica de sustentar-relaxar. Poucos estudos analisaram por quanto tempo as alterações na amplitude de movimento (ADM) decorrentes da intervenção permanecem ou compararam a efetividade de dois tipos de carga sobre este tempo. Sendo assim, o objetivo deste estudo foi comparar qual método de alongamento aplicado à musculatura isquiotibial, dentre balístico e FNP do tipo sustentar-relaxar, é mais eficaz no ganho de ADM e na manutenção deste após 24 horas. Participaram do estudo 19 adultos jovens saudáveis. A avaliação da ADM foi realizada através da foto grametria antes, imediatamente após e 24 horas após a intervenção. Os métodos de alongamento foram aplicados de forma randomizada em uma sessão. Através dos resultados foi possível verificar que ambas as técnicas foram capazes de aumentar a ADM imediatamente após a aplicação (p = 0,001 para o balístico e p = 0,001 para o sustentar-relaxar) e manter por 24 horas após a aplicação (p = 0,023 para o balístico e p = 0,022 para o sustentar-relaxar). No entanto, na comparação entre os métodos, não houve diferença no ganho de ADM obtido. Confirma-se, portanto, a equivalente efetividade de ambos os métodos na obtenção e manutenção do ganho de ADM.

Ballistic and proprioceptive neuromuscular facilitation (PNF)through hold-relax technique are amongst the most used stretchingmethods in the clinical practice. Few studies have explored for howlong alterations in range of movement (ROM) dependent upon thestretching intervention have lasted or compared the effi cacy of diff erenttypes of stretching within a given load on this time. Th erefore,the aim of this study was to compare ballistic and PNF hold-relaxstretching and their eff ects in the hamstrings musculature related to ROM gain and its maintenance after 24 hours. 19 healthy young adults participated on the study. The ROM evaluation was carriedout through photogrammetry before, immediately after and after 24 hours the intervention. The stretching methods were randomly assigned in one session. It was possible to verify, through the results, that both techniques improved ROM immediately after intervention(p = 0,001 for ballistic and p = 0,001 for hold-relax) and theeff ects were maintained after 24 hours intervention (p = 0,023 forballistic and p = 0,022 for hold-relax). However, when comparingboth methods, no difference was found about the ROM gained. It has been then confi rmed the equal efficacy of both methods forimprovement and maintenance of ROM.

O efeito do exercício sobre a estabilidade anterior do joelho / Exercise's effect on the anterior knee stability

Objetivo: O objetivo do presente trabalho foi verificar na literatura os efeitos do exercício na estabilidade anterior do joelho. Método: Foi realizada busca no portal de periódicos da CAPES e pelo sistema comutação bibliográfica, sendo incluídos somente artigos em língua inglesa publicados no período de 1980 a 2007. Resultado: Os estudos analisados demonstraram que exercícios como corrida, cicloergômetro, voleibol, basquetebol, esqui, movimentos com mudanças bruscas de direção ou ziguezague são capazes de provocar um aumento momentâneo do deslocamento anterior da tíbia. Contudo, este resultado não foi evidenciado após a natação, exercício de extensão do joelho, e agachamento. Conclusão: O exercício pode provocar aumento da incursão anterior do joelho. Este aumento na incursão anterior é relatado em alguns trabalhos como passageiro, uma vez que a estabilidade retorna ao normal após período de recuperação.