Diagnostic Tools for Acute Anterior Cruciate Ligament Injury: GNRB, Lachman Test, and Telos

PURPOSE: The purpose of this study is to compare the accuracy of the GNRB arthrometer (Genourob), Lachman test, and Telos device (GmbH) in acute anterior cruciate ligament (ACL) injuries and to evaluate the accuracy of each diagnostic tool according to the length of time from injury to examination. MATERIALS AND METHODS: From September 2015 to September 2016, 40 cases of complete ACL rupture were reviewed. We divided the time from injury to examination into three periods of 10 days each and analyzed the diagnostic tools according to the time frame. RESULTS: An analysis of the area under the curve (AUC) of a receiver operating characteristic curve showed that all diagnostic tools were fairly informative. The GNRB showed a higher AUC than other diagnostic tools. In 10 cases assessed within 10 days after injury, the GNRB showed statistically significant side-to-side difference in laxity (p<0.001), whereas the Telos test and Lachman test did not show significantly different laxity (p=0.541 and p=0.413, respectively). CONCLUSIONS: All diagnostic values of the GNRB were better than other diagnostic tools in acute ACL injuries. The GNRB was more effective in acute ACL injuries examined within 10 days of injury. The GNRB arthrometer can be a useful diagnostic tool for acute ACL injuries.

Evaluation of Clinical Applicability of Stress Radiography for Shoulder Instability: Correlation between the Degree of Displacement and the Physical Examinations / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to examine the clinical applicability of stress radiography in patients presenting with shoulder instability. MATERIALS AND METHODS: Fifty-six patients diagnosed with shoulder instability and 20 healthy volunteers participated in the study. Degree of displacement of the humeral head as measured on stress radiography using a Telos GA-IIE device was compared with the results of the physical examinations. Four types of stress radiography were captured while applying 15 daN of force anteriorly (AER0 and AER60) and posteriorly (PER0 and PER60) at two different positions: (1) 90° of abduction combined with 0° of external rotation, and (2) 90° of abduction combined with 60° of external rotation. RESULTS: The degree of displacement of affected shoulders of 44 patients showed significantly larger displacement than normal shoulders (p<0.05), and the comparison between 56 affected shoulders of the patients and 40 normal shoulders of the volunteers showed significantly larger displacement only in PER0 and PER60 of the patients (p<0.05). Among the four radiographs of affected shoulders, AER60 showed significantly less displacement (p=0.046). The anterior drawer test under anesthesia of 16 patients who underwent surgery for anterior instability showed positive correlation with AER0 (Spearman's rho=0.56, p<0.024). Significantly larger anterior displacement of the load and shift test was observed in the subgroup with anterior displacement more than 3 mm (p=0.028), and higher positive frequency of the Kim's test was observed in the subgroup with posterior displacement more than 3 mm (p=0.005). CONCLUSION: Stress radiography using a Telos GA-IIE device could discriminate the affected shoulder. Although it could not replace individual physical examinations, the degree of displacement correlates with some physical examinations for shoulder instability.

Aspectos fundantes na clínica do envelhecimento: o ambiente, o cuidado e o Telos / Foundational aspects in ageing clinic: environment, care, and the Telos

Esse artigo discute e apresenta – a partir da experiência clínica-institucional e acadêmica do autor – a implantação e coordenação de um serviço de psicologia clínica para idosos no Sistema Único de Saúde, o SUS. Na atualidade, observamos que o mundo envelhece de forma acelerada, tendo em vista as melhores condições de saúde e saneamento, somadas aos avanços tecnológicos da medicina. Nesse mesmo ritmo, a população brasileira envelhece de maneira significativa. O Brasil será o sexto país com o maior número de pessoas idosas no mundo até 2025. Assim, o trabalho discorre a partir da teoria psicanalítica winnicottiana sobre o processo maturacional, e das contribuições de Safra sobre os aspectos fundantes na clínica com idosos, tais como: as diferentes funções do ambiente ao longo do processo maturacional, em especial na velhice; os cuidados psicológicos específicos ao paciente idoso destacando: a constituição da desconstrução do self, e, por fim, apresenta ponderações sobre o Telos acerca do sonho último, e o sentido da vida diante do processo de revisão da vida presentes na velhice.

This article discusses and presents - from the institutional-clinical and academic experience of the author – the deployment and coordination of a clinical psychology service for the elderly in the SUS (Sistema Único de Saúde). Currently, we observe that the world is ageing at an accelerated rate, in view of the improved health and sanitation conditions, coupled with technological advances in medicine. At that same pace, the Brazilian population ages significantly, and Brazil will be the sixth country with the highest number of senior citizens in the world by 2025. Thus, the work discourses – from the winnicottian psychoanalytic theory - on the maturational process, and the contributions of Safra to the foundational aspects of the clinic with the elderly, such as: the different functions of the environment along the maturational process, especially in old age; the elderly-specific psychological care, highlighting the constitutionof the self-deconstructi on and, finally, it presents considerations on the Telos regarding the ultimate dream, and the meaning of life in the face of the life review process existing in old age.

Comparison Analysis of Stress Radiography for the Evaluation of Posterior Knee Laxity / 中国运动医学杂志

Objective Stress radiography provides an objective tool to measure posterior knee instability.This study was conducted to evaluate the intraobserver and interobserver reliability of measurements using Telos device to quantify posterior knee instability,compared wim KT-1000 and PDT test for consistency analysis.Methods From October 2008 to June 2009,68 stress radiographs in 34 patients with posterior knee instability were taken using Telos device.The amount of posterior displacement on the radiographs was measured independently by 2 surgeons on 2 separate occasions.Changes in intraclass correlation coefficients(ICCs)were examined to assess the intraobserver and interobserver reliability of the measurement,and were compared with those from KT-1000 and PDT test for consistency analysis.Results Intraobserver ICC was 0.992,while interobserver ICC Was 0.991.There was no significant difierence between Telos and KT-1000 in pair-t test.The data from Telos device was consistent with KT-1000.The coincident ratio Of PDT test was 20% while the posterior displacement of the tibia calculated on stress radiography was 5-10 mm.The coincident ratio of the PDT was 71.4% while the posterior displacement of the tibia calculatcd from stress radiography was 10-15 mm.Conclusion Using Telos device for stress radiograph provides a reproducible method to quantify posterior knee instability,and the consistency between Telos divece and KT-1000 was reliable.The coincident ratio of the PDT test with stress radiography increased when the posterior displacement of the tibia from stress view became more severe.