ABSTRACT
Com a chegada da cirurgia robótica na cirurgia do joelho no Brasil em 2021, novos questionamentos são feitos para que possamos compreender como essa nova tecnologia pode ser assimilada no contexto da saúde e da realidade do país. As novas tendências no financiamento da saúde relacionadas ao setor privado fazem questionar de que maneira novos procedimentos podem ser incorporados, buscando o equilíbrio entre o avanço tecnológico e a acessibilidade baseada em custos e desfechos relacionados à qualidade de vida dos pacientes.
With the arrival of robotic surgery in knee surgery in Brazil in 2021, new questions are asked so that we can understand how this new technology can be assimilated in the context of health and the reality of the country. The new trends in health financing related to the private sector raises the question of how new procedures can be incorporated seeking a balance between technological advancement and accessibility based on costs and outcomes related to the quality of life of patients.
Subject(s)
Cost-Benefit Analysis , Arthroplasty, Replacement, Knee , Robotic Surgical ProceduresABSTRACT
Objective: To determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia. Methods: Sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL) was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB) and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3) were measured. Results: In the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm. Conclusion: The guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL...
Objetivo: Determinar os pontos de referência para a saída do fio-guia tibial em relação à cortical posterior da tíbia. Métodos: Foram usados para este estudo 16 joelhos de cadáveres frescos. Através de uma escopia e com um guia milimetrado, foi feita a passagem de três fios-guias a 0, 10 e 15 mm distalmente em relação à crista posterior da tíbia. Foram feitas dissecções e foi determinada a região do centro da inserção tibial do ligamento cruzado posterior (LCP) em cada joelho. Foram medidas as distâncias entre o centro da inserção tibial do LCP e a borda tibial posterior (CB) e entre o centro da inserção tibial do LCP e os fios 1-2 e 3 (CF1-CF2-CF3). Resultados: Nos joelhos dissecados, encontramos o centro da inserção tibial do LCP a 1,09 cm ± 0,06 da borda tibial posterior. As distâncias entre os fios 1,2 e 3 e o centro da inserção tibial do LCP foram respectivamente 1,01 ± 0,08; 0,09 ± 0,05 e 0,5 ± 0,05. Conclusão: A saída do fio- guia a 10 mm distalmente em relação à crista posterior da tíbia representa a melhor posição para tentar reproduzir o centro anatômico do LCP...
Subject(s)
Humans , Cadaver , Posterior Cruciate LigamentABSTRACT
O lipossarcoma é uma neoplasia rara, originária de células mesenquimais primitivas e, entre os sarcomas, é o tipo histológico mais frequente. Os autores relatam o caso de um lipossarcoma localizado em região de joelho e coxa posterior distal direita de um paciente de 40 anos, jogador de tênis.
Lipossarcoma is an uncommon malignant tumor. It originates in the mesenchymal cells, and is the most common of the soft tissue sarcomas. The authors report a case of a 40 year-old male tennis player with lipossarcoma in the posterior right knee and distal thigh region.
Subject(s)
Humans , Male , Middle Aged , Bone Neoplasms , Knee , Liposarcoma , Sports , TennisABSTRACT
OBJETIVO: Avaliar radiograficamente a altura patelar de atletas com diagnóstico de tendinopatia crônica do aparelho extensor do joelho (TCAE). MÉTODOS: Na amostra foram avaliados radiograficamente 65 pacientes (110 joelhos) com idade entre 15 e 40 anos e de diferentes modalidades esportivas com e sem diagnóstico de tendinopatia crônica do aparelho extensor do joelho (jumper's knee). Os atletas foram divididos em dois grupos: aqueles com diagnóstico de TCAE (grupo 1: 38 atletas - 56 joelhos) e um grupo que denominamos de controle (grupo 2: 27 atletas - 54 joelhos). RESULTADOS: No grupo 1 tivemos 18 atletas que apresentavam a doença bilateralmente na ocasião dos exames. Para a medida da altura patelar utilizamos os índices radiográficos de Insall e Salvati e Blackburne e Peel. CONCLUSÃO: A presença de patela alta no grupo de atletas com tendinopatia crônica do aparelho extensor do joelho foi significante maior do que a observada no grupo controle.
OBJECTIVES: To carry out a radiographic evaluation of patellar height in athletes diagnosed with chronic tendinopathy of the knee extensor mechanism; METHODS: Radiographic assessments were carried out on 65 patients (110 knees) aged between 15 and 40 years, who practiced different kinds of sports, some with of chronic tendinopathy of the knee extensor mechanism (jumper's knee) and others without. The athletes were divided into two groups: those with diagnosed "jumper's knee" (group 1:38 athletes - 56 knees) and a control group (group 2:27 athletes - 54 knees). In group 1, 18 of the athletes presented the condition in both knees on examination. The height of the patella was measured using the Insall-Salvati and Blackburne-Peel x-ray methods. CONCLUSION: The presence of a high patella in the group of athletes with chronic tendinopathy of the knee extensor mechanism was significantly higher than in the control group.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Athletic Injuries , Patella , Tendinopathy/diagnosis , Tendinopathy/rehabilitation , Age and Sex Distribution , Brazil , Cross-Sectional Studies , Knee , Magnetic Resonance ImagingABSTRACT
CONTEXT AND OBJECTIVE: Patellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy. METHODS: Palpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded. RESULTS: Of the total number of individuals evaluated, 124 (39 percent) felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3 percent) received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity. CONCLUSIONS: Palpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands.