Uso de medidas espaço-temporais da marcha para determinar o retorno ao esporte pós-reconstrução do LCA / Use of spatiotemporal gait parameters to determine return to sports after ACL reconstruction

Objetivo: Comparar os parâmetros espaço temporais da marcha de sujeitos hígidos e pacientes submetidos à reconstrução do LCA, classificando o status de normalidade. Método: Quatorze sujeitos hígidos e oito com reconstrução do LCA há aproximadamente um ano caminharam enquanto o movimento era capturado por um sistema de câmeras infravermelhas. Os instantes de contato inicial e retirada do pé do solo foram determinados e as seguintes variáveis dependentes, as quais foram comparadas entre os grupos por meio do teste Mann-Whitney(α=0,05), foram calculadas: percentual de tempo no apoio duplo inicial, percentual de tempo no apoio simples, percentual de tempo no apoio duplo terminal, comprimento da passada e velocidade da marcha. Inicialmente, foi aplicada uma regressão logística a todas as variáveis dependentes para determinar os sujeitos hígidos e aqueles com reconstrução do LCA. Resultados: Os dois grupos não apresentaram diferenças em nenhum parâmetro espaço temporal da marcha(p > 0,05), apesar da cinemática angular do joelho permanecer alterada,como evidenciado por um estudo anterior com a amostra similar.Conclusão: A regressão classificou todos os sujeitos como hígidos,inclusive aqueles do grupo com reconstrução do LCA, sugerindo que as variáveis espaço temporais aplicadas nesse estudo não devem ser usadas como critério isolado de retorno incondicional às atividades esportivas. Nível de Evidência III, Estudo de Caso Controle.

Objective: To compare gait spatiotemporal parameters of healthyand ACL reconstructed subjects in order to classify the status of gaitnormality. Methods: Fourteen healthy subjects and eight patientssubmitted to ACL reconstruction walked along a walkway while thelower limbs movement was captured by an infrared camera system.The frames where the initial contact and toe-off took place were determinedand the following dependent variables, which were comparedbetween groups through the Mann-Whitney test (α=0.05) were calculated:percentage of time in initial double stance, percentage of timein single stance, percentage of time in terminal double stance, stridelength and gait velocity. Initially, all variables were compared betweengroups using a Mann-Whitney test. A logistic regression was applied,including all dependent variables, to create a model that could differentiatehealthy and ACL reconstructed subjects. Results: ACLreconstructed group showed no differences in any spatiotemporalparameter of gait (p > 0.05) in relation to the control group, althoughthe angular kinematic differences of the knee remained altered, asevidenced in a study with a similar sample. Conclusion: The regressionclassified all subjects as healthy, including the ACL reconstructedgroup, suggesting the spatiotemporal variables should not be usedas the sole criterion of return to sports activities at the same level asprior to injury. Level of Evidence III, Case Control Study.

Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons / Resultados funcionais da reconstrução do ligamento cruzado anterior com o terço central do ligamento patelar e os tendões flexores

To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL) using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G), by means of the Knee Society Score (KSS) and the Lysholm scale. METHODS: This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. RESULTS: From the statistical analysis, it could be seen that the patients' functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results ( p= >0.05), in all the comparisons. CONCLUSIONS: The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery.

Avaliar a função dos joelhos em pacientes submetidos à reconstrução do ligamento cruzado anterior (LCA), com o terço central do ligamento da patela (TP) ou os tendões flexores mediais do joelho (semitendíneo e grácil quádruplos: ST-G) ipsilaterais, por meio do Knee Society Score (KSS) e da escala de Lysholm. MÉTODOS: Estudo longitudinal, prospectivo e randomizado, com 40 pacientes submetidos à reconstrução do LCA por via artroscópica, de setembro de 2013 a agosto de 2014, dos quais 37 eram do sexo masculino e três do feminino, com de 16 a 52 anos, enumerados de forma aleatória de 1 a 40. Os números pares foram submetidos à correção cirúrgica com os tendões do ST-G e os números impares com o TP. Foram aplicados para a avaliação funcional o KSS e a escala de Lysholm na noite anterior ao procedimento cirúrgico e com seis meses de pós-operatório. RESULTADOS: Em análise estatística foi possível observar que no pós-operatório a capacidade funcional dos pacientes foi significativamente maior do que no pré-operatório. Há fortes evidências de que ambas as terapêuticas sejam similares em seus resultados (p = > 0,05), em todas as comparações. CONCLUSÕES: Os resultados da reconstrução do LCA, independentemente do tipo de enxerto, são similares na recuperação funcional do joelho e na melhoria da qualidade de vida. Não foi possível identificar melhor método de tratamento cirúrgico. A experiência clínica, a técnica do cirurgião e o paciente são quem ditam a escolha do tipo de enxerto que deverá ser usado para a cirurgia do LCA.

Cinemática fisiológica de rodilla en futbolistas amateur: análisis 3D / Physiological kinematics of the knee in amateur soccer players: a 3D analysis

La lesión del ligamento cruzado anterior (LCA) tiene un alta prevalencia en jugadores de fútbol. En esta disciplina, las carreras con cambios de dirección son frecuentes y pueden ser un factor de riesgo para el desarrollo de lesiones del LCA sin contacto. Objetivo: Describir en futbolistas jóvenes los rangos cinemáticos fisiológicos de rodilla sometida a tareas funcionales con cambios bruscos de dirección. Método: En una muestra de ocho futbolistas con rodillas clínicamente sanas, se evaluó, mediante un sistema de análisis de movimiento 3D, la cinemática de la rodilla de apoyo durante la ejecución de tres tareas funcionales, dos de estas implicaron cambios de dirección en 90° (CD90°) y 180° (CD180°), la tercera golpear un balón (GB). Los rangos fisiológicos de movimiento (ROM) fueron registrados y comparados en la misma rodilla en tres planos diferentes (T-Transversal; F-Frontal; S-Sagital). Resultados: Los rangos fisiológicos obtenidos fueron para las tareas funcionales CD90°: T 11°(13-8), F 5.6° (11-4) y S 22°(30-17); para CD180°: T 9°(12-8), F 6.3°(8-5) y S 17.6°(21-14); y para GB: T 9°(10-5), F 3.8°(10-2), y S 9.6°(15-6). El ROM fue significativamente mayor en el plano transversal para la tarea CD90°. El el plano sagital el ROM fue mayor para CD90° comparado con GB (p<.05), sin embargo no hubo diferencias respecto a la tarea CD180°. No existen diferencias del ROM en el plano frontal. Conclusión: Se logró describir los rangos cinemáticos fisiológicos de la rodilla durante la ejecución de tres tareas funcionales que implicaron cambios bruscos de dirección en futbolistas amateur. En la muestra evaluada, la prueba que produjo una mayor exigencia de los rangos articulares de rodilla en los planos transversal y sagital fue la prueba con cambio de dirección en 90°...

Anterior cruciate ligament (ACL) lesions are frequent among soccer players. In this sport cutting movements are usually made while running and may be a risk factor in developing non-contact ACL injuries. Purpose: To describe the physiological kinematics of the knee during sudden change of direction movements in amateur soccer players. Methods:Eight amateur soccer players without previous injuries were analysed. The kinematics of the support knee were evaluated using 3D motion analysis while executing 3 common manoeuvres: two of them involved a change of direction at 90° and 180° (CD90° and CD180°), and the third while kicking a ball (GB). Physiological articular ranges of motion (ROM) were recorded and compared for the same knee in three different planes (T-Transversal; F-Frontal; S-Sagittal). Results: The physiological ranges obtained were, for manouvre CD90°: T 11°(13-8), F 5.6° (11-4) and S 22°(30-17); for CD180°: T 9°(12-8), F 6.3°(8-5) and S 17.6°(21-14); and for GB: T 9°(10-5), F 3.8°(10-2), and S 9.6°(15-6). ROM was significantly greater in the transversal plane for the CD90° manoeuvre (P<.05). In the sagittal plane, ROM was greater for the CD90° when compared to the GB (P<.05), but no differences were seen when compared to the CD180° manoeuvre (P>.05). There were no differences in ROM in the frontal plane. Conclusion: A description of the physiological kinematic ranges of the knee during three sudden changes of direction manoeuvres in amateur soccer players was presented. According to our results, change of direction in 90° demands a higher range of motion in both the transversal and sagittal planes...

Interpretación de la maniobra de pivote mediante el uso de acelerómetros en pacientes que acuden a consulta ortopédica / Interpretation of the pivot test using accelerometers in the orthopedic practice

Los ligamentos cruzados (LC) de la rodilla, anterior (A) y posterior (P), localizados dentro de la articulación, unen fémur y tibia, dando estabilidad sobre la dirección anteroposterior de un hueso sobre otro. El LCA puede lesionarse mediante rotaciones provocadas en algún deporte que implique giro con el pie apoyado sobre el suelo. Las lesiones del LCA se determinan con maniobras como la de Lachman, cajón y pivote. Se utilizan acelerómetros que permiten graficar la maniobra de pivote en pacientes que acuden a consulta ortopédica, utilizando la prueba de KT1000 como estándar de oro. El trabajo ha sido aprobado por el Comité de Ética del Hospital. Estudio descriptivo entre casos y controles. Resultados: 92 pacientes aceptaron participar mediante consentimiento informado, nueve casos resultaron con KT1000 positivo, de los negativos, seleccionamos nueve controles afines a edad y género. Alteraciones de KT1000 fueron mayores en mujeres (78%) y en 67% de los casos la pierna alterada fue la derecha. Los resultados promedio de KT1000 en casos fue de 5.44 mm, en controles de 0.66 mm. Los acelerómetros permitieron graficar la maniobra de pivote y observamos gráficas similares tanto en casos y controles, solamente se muestran diferencias notables en un paciente masculino con KT1000 de 15 mm que fue sometido a reparación de LCA izquierdo, la maniobra se realizó al estar sedado. Concluimos que el paciente, en estado consciente, pone resistencia en la maniobra, a diferencia de la obtenida con anestesia, y que el uso de acelerómetros permite documentar la maniobra de pivote observando diferencias entre un LCA normal y uno lesionado.

The anterior (A) and posterior (P) cruciate ligaments (CL) of the knee, located inside the joint, connect the femur and the tibia and thus provide stability in the anteroposterior axis of one bone over the other. The anterior cruciate ligament (ACL) may be injured as a result of rotation when practicing a sport involving turning with the foot on the ground. ACL injuries are diagnosed with maneuvers like the Lachman, drawer and pivot. Accelerometers were used to plot the pivot maneuver in patients seeing the orthopedist surgeon using the KT1000 test as gold standard. This case-control descriptive study was approved by the Hospital's Ethics Committee. Results: 92 patients accepted to participate through an informed consent; nine cases were KT1000 positive, and nine age- and gender-matched controls were selected among KT1000 negative patients. KT1000 alterations were greater among females (78%) and in 67% of cases the right leg was affected. Mean KT1000 results were 5.44 mm in cases and 0.66 mm in controls. Accelerometers allowed plotting the pivot maneuver and the resulting charts for cases and controls were similar. Remarkable differences were seen only in one male patient with a 15 mm KT1000, who underwent repair of the left ACL; the maneuver was performed under sedation. We concluded that conscious patients oppose the maneuver, unlike anesthetized patients, and that the use of accelerometers helps document the pivot maneuver which, in turn, helps detect differences between a normal ACL and an injured one.

Actualización en las lesiones del ligamento cruzado anterior. Análisis de los resultados mediante TAC y escalas clínicas / Current status of the ACL repair. Clinical scales and TAC results

Se realizó una revisión bibliográfica sobre el estado actual de las ligamentoplastias del LCA, incluyendo bases anatómicas, funcionales y tratamiento quirúrgico, así como un estudio retrospectivo de las ligamentoplastias del LCA mediante técnica SAC con más de 10 años de evolución. En dicho estudio se valoran parámetros clínicos y radiológicos mediante escalas clínicas y TAC, estableciendo relaciones entre la posición y ensanchamiento de los túneles con los resultados clínicos a largo plazo.

We performed a literature review on the current status of the ACL repair, including anatomical basis, functional and surgical treatment, as well as a retrospective study of the ACL repair by SAC technique with over 10 years of evolution. This study evaluated clinical and radiological parameters, clinical scales and TAC by establishing relationships between the position and broadening of the tunnels with long-term clinical results.

Partial tearing of the anterior cruciate ligament: diagnosis and treatment / Lesão parcial do ligamento cruzado anterior: diagnóstico e tratamento

Partial tears of the anterior cruciate ligament (ACL) are common and represent 10-27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction) and classical (anatomical) reconstruction...

Lesões parciais do ligamento cruzado anterior (LCA) são comuns e representam 10%-27% das totais. As principais razões para atenção ao feixe não rompido são biomecânicas, vasculares e proprioceptivas. A permanência do feixe serve ainda de proteção durante o processo cicatricial. A definição dessa lesão é controversa, baseada na anatomia, no exame clínico, na medida da translação, nos exames de imagem e na artroscopia. Seu tratamento vai depender da frouxidão e da instabilidade existentes. O tratamento conservador é opcional para casos sem instabilidade, com enfoque na reabilitação motora. O tratamento cirúrgico é desafiador, pois exige correto posicionamento dos túneis ósseos e conservação dos remanescentes do feixe rompido. O teste do pivot-shift sob anestesia, os achados à ressonância magnética, o nível e o tipo de atividade esportiva prévia e o aspecto artroscópico dos remanescentes e suas propriedades mecânicas auxiliarão o ortopedista no processo decisório entre o tratamento conservador, o tratamento cirúrgico com reforço do LCA nativo (reconstrução seletiva) ou a reconstrução clássica (anatômica)...

Diagnostic accuracy of Magnetic Resonance Imaging in assessment of Meniscal and ACL tear: correlation with arthroscopy

To determine the diagnostic accuracy of magnetic resonance imaging [MRI] in injuries related to anterior cruciate ligament and menisci and compare its effectiveness with that of arthroscopy. This retrospective cross-sectional study was conducted in the department of Radiology and Medical Imaging of Dallah Hospital, Riyadh, Kingdom of Saudi Arabia from September 2012 to March 2014. Fifty four patients [including 30 men and 24 women] with internal derangement of knee referred from the orthopedic consulting clinics underwent MR imaging followed by arthroscopic evaluation. The presence of meniscal and ligamentous abnormality on the imaging was documented by two trained radiologist. Findings were later compared with arthroscopic findings. The sensitivity, specificity and accuracy of MR imaging for menisci and ACL injury were calculated: 100% sensitivity, 88.4% specificity, 90% positive predictive value, 100% negative predictive value, and 94.4% accuracy were noted for medial meniscal injury. Similarly, MR had sensitivity of 85.7%, specificity of 95%, positive predictive value of 85.7%, negative predictive value of 95%, and accuracy of 92.5% for lateral meniscal injuries. Likewise, anterior cruciate ligament had 91.6% sensitivity, 95.2% specificity, 84.6% positive predictive value, 97.5% negative predictive value, and 94.4% accuracy. MRI is extremely helpful in identifying meniscal and anterior cruciate ligaments tears. MR imaging has high negative predictive value making it better choice as screening tool compared to diagnostic arthroscopic evaluation in most patients with soft tissue trauma to knee

[Screening tests for neuromuscular defects affecting non-contact ACL injury- a review article]

In addition to high cost of treatment, anterior cruciate ligament tear leads to lesser participation in sports, secondary injury and mental problems. Therefore, prevention of ACL injury in athletes is a top priority in many studies. The aim of this study was to conduct a review over screening tests for neuromuscular imbalance causing non-contact ACL injuries. Scientific citations search engines such as PubMed, Medline, and Science Direct were looked for relevant articles using the following keywords: "Screening Test", "Neuromuscular Imbalance" and "Non-Contact ACL Injury" during the previous two decades. Hop tests have high reliability and there is a statistically significant correlation between lower extremity symmetry index of this test and isokinetic knee extensor strength. Static and dynamic balance tests have high reliability and validity and their results have correlation with ACL injury. Both double-leg squat test and single leg squat test are used to assess poor neuromuscular control of the trunk, dynamic flexibility, strength of hip, and balance. Modified Landing Error Scoring System Tests are used to identify movement patterns that increase the risk of non-contact ACL injury. In order to identify the most common neuromuscular imbalance related to ACL injuries, we used tuck jump test. Video drop-jump screening test was used to assess valgus alignment in knee. Familiarity with reliable and valid screening tests related to non- contact ACL injuries will be of benefit to researchers specialized in ACL for prevention of injuries. They will be able to select appropriate tests to identify neuromuscular imbalance in people at risk of ACL injury. Therefore, researchers can provide more specific corrective exercise programs

Prevalencia de lesiones asociadas a rotura aguda de ligamento cruzado anterior / Acute rupture of anterior cruciate ligament associated with any lesions. Prevalence

La rotura aguda de ligamento cruzado anterior (LCA) frecuentemente se asocia a lesiones de distintas estructuras en la rodilla por lo cual es importante identificarlas para realizar un adecuado tratamiento. El examen físico sigue siendo el principal método para diagnosticarlas, a su vez la resonancia nuclear magnética (RNM) es el estudio complementario de elección para acompañarlo. El objetivo de este trabajo es analizar las lesiones y la frecuencia con que se asocian a la rotura de ligamento cruzado anterior (LCA), visual izadas con claridad en la resonancia nuclear magnética (RNM). Material y Métodos: Se evaluaron retrospectivamente 71 pacientes con lesión aguda de ligamento cruzado anterior (LCA), de los cuales 18 sufrieron rotura aislada del mismo, y en el resto, 53 pacientes, se evidenciaron lesiones asociadas a aquella mediante examen físico y resonancia nuclear magnética (RNM). Durante el examen físico se realizaron además del interrogatorio previo, maniobras semiológicas para identificar: lesión de ligamento cruzado anterior (LCA), lesiones meniscales, lesión de ligamento cruzado posterior (LCP), lesión de ligamento lateral interno (LLI) y ligamento lateral externo (LLE), lesión de complejo posteroexterno (CPE), presencia y cuantificación clínica de aumento de líquido intra articular. En cuanto a la resonancia nuclear magnética (RNM) se utilizaron secuencias Tl, T2 Y STIR obteniéndose cortes sagitales, axiales, coronales y oblicuos. Resultados: Asociadas a la rotura aguda de ligamento cruzado anterior (LCA) se encontraron las siguientes lesiones: contusión ósea en cóndilo femoral y platillo tibial externo llamado "bonebruise" , lesiones de estructuras como meniscos externo e interno, ligamentos lateral interno y externo, ligamento cruzado posterior, complejo postero-externo y fractura de platillo tibial. Conclusiones: Es de suma importancia reconocer lesiones asociadas a la rotura aguda de ligamento cruzado...

The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

BACKGROUND: Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. METHODS: Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. RESULTS: The clinical success rate was 95.4% and the HSS scores were 93.9 +/- 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. CONCLUSIONS: The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.

Lessons Learnt from an Atypical Mycobacterium Infection Post-Anterior Cruciate Ligament Reconstruction

Infections following anterior cruciate ligament reconstruction are rare, with no previous reports citing Mycobacterium abscessus as the culprit pathogen. A 22-year-old man presented twice over three years with a painful discharging sinus over his right tibia tunnel site necessitating repeated arthroscopy and washout, months of antibiotic therapy, and ultimately culminating in the removal of the implants. In both instances, M. abscessus was present in the wound cultures, along with a coinfection of Staphyloccocus aureus during the second presentation. Though rare, M. abscessus is an important pathogen to consider in postoperative wounds presenting with chronic discharging sinuses, even in healthy non-immunocompromised patients. This case illustrates how the organism can cause an indolent infection, and how the removal of implants can be necessary to prevent the persistence of infection. Coinfection with a second organism is not uncommon and necessitates a timely change in treatment regime as well.

Proprioceptive deficit in individuals with unilateral tearing of the anterior cruciate ligament after active evaluation of the sense of joint position / Déficit proprioceptivo em indivíduos com ruptura unilateral do ligamento cruzado anterior após a avaliação ativa do senso de posição articular

Objective: To ascertain whether the proprioceptive deficit in the sense of joint position continues to be present when patients with a limb presenting a deficient anterior cruciate ligament (ACL) are assessed by testing their active reproduction of joint position, in comparison with the contralateral limb. Methods: Twenty patients with unilateral ACL tearing participated in the study. Their active reproduction of joint position in the limb with the deficient ACL and in the healthy contralateral limb was tested. Meta-positions of 20% and 50% of the maximum joint range of motion were used. Proprioceptive performance was determined through the values of the absolute error, variable error and constant error. Results: Significant differences in absolute error were found at both of the positions evaluated, and in constant error at 50% of the maximum joint range of motion. Conclusion: When evaluated in terms of absolute error, the proprioceptive deficit continues to be present even when an active evaluation of the sense of joint position is made. Consequently, this sense involves activity of both intramuscular and tendon receptors...

Objetivo: Verificar se o déficit proprioceptivo no SPA permanece quando pacientes com um membro LCA deficiente são avaliados por meio do teste de reprodução ativa da posição articular, em comparação com o membro contralateral. Métodos: Participaram do estudo 20 pacientes com ruptura unilateral do LCA. Foi feito o teste de reprodução ativa da posição articular no membro LCA deficiente e contralateral saudável. Foram usadas as posições meta de 20% e 50% da amplitude articular máxima. O desempenho proprioceptivo foi determinado por meio dos valores de erro absoluto (EA), erro variável (EV) e erro constante (EC). Resultados: Diferenças significativas foram encontradas para o EA em ambas as posições avaliadas e para o EC em 50% AAM. Conclusão: O déficit proprioceptivo quando avaliado pelo EA permanece mesmo quando a avaliação do senso de posição articular é ativa e, consequentemente, envolve a atividade de receptores intramusculares e tendíneos...

Lesión del ligamento cruzado anterior: ¿ es la disminución en la movilidad de la cadera un factor predisponente ? / Predisposing factors of hip hypermotility in anterior cruciate ligament injuries

Introducción: La lesion del ligamento cruzado anterior (LCA) es una de las patologias musculoesqueleticas mas frecuentes. Numerosos factores predisponentes han sido identificados intrinsecamente en la articulacion. El objetivo de este trabajo es analizar la relacion existente entre una hipomotilidad de cadera y la presencia concomitante de una lesion de LCA en deportistas recreacionales. Materiales y Método: Se incluyo en forma prospectiva a pacientes deportistas recreacionales entre 18 y 40 anos (48 con una lesion primaria de LCA confirmada por RMN y 53 controles voluntarios). Se midieron ambas rotaciones en decubito supino y los resultados fueron analizados estadisticamente con la prueba de t test. Resultados: Se analizaron los datos y resultaron estadisticamente significativos en cuanto a una disminucion de movilidad en la cadera homolateral a la rodilla afectada por la lesion del ligamento, tanto para la rotacion interna [RI] (p=0.001) como para la rotacion externa [RE] (p=0.016). El analisis comparativo con el grupo control mostro que existe una asociacion entre rotura de LCA y una hipomotilidad de cadera a expensas en mayor medida de una disminucion en la RI (p=0,002), puesto que la comparacion de la RE en ambos grupos no resulta estadisticamente significativa (p=0.936). Conclusión: Existe una fuerte asociacion entre la lesion del LCA y hipomotilidad de la cadera, principalmente a expensas de la rotacion interna en deportistas recreacionales. No solo encontramos esta asociacion entre voluntarios y pacientes con la lesion sino tambien en el miembro contralateral a la lesion LCA. Por tal motivo creemos de vital importancia el cribado de factores de riesgo para asi implementar planes de prevencion. Nivel de Evidencia: II. Tipo de Estudio: Prospectivo...

Introduction: Numerous intrinsic predisposing factors have been identified within the knee joint in ACL injuries. However, several studies have showed the influence of the hip on the knee biomechanics. The aim of this paper is to analyze the relationship between a hip hypomotility and the concomitant presence of an ACL injury in recreational athletes. Method: We prospectively evaluated 48 recreational athletes with ACL injury confirmed with MRI and 53 volunteer controls without ACL injuries between 18 and 40 years of age. Internal rotation [IR] and external rotation [ER] were measured and analyzed. Results: A significant decrease in hip range of motion was found in the ipsilateral hip, both for IR (p=0.001) and ER (p=0.016). Comparative analysis with the control group showed an association between ACL tear and hypomotility hip mainly because of IR lessening (p=0.002), since the comparison of the ER in both groups was not statistically significant (p=0.936). Conclusion: There is a strong association between ACL injury and hip hypomotility , not only but mainly due to a decrease in IR. Moreover, we found not only this association between volunteers and patients, but in the same patient compared to the unaffected side. Therefore, we believe that is especially important to identify risk factors in order to prevent these lesions. Level of Evidence: IV. Type of study: Case Series. Retrospective...

Height of the foot longitudinal arch and anterior cruciate ligament injuries

Avaliar a associação entre a altura do arco longitudinalmedial do pé e lesões por não-contato do ligamento cruzadoanterior. Métodos: Cento e cinco pacientes foram incluídos nesteestudo de caso-controle. O grupo dos casos compreendeu52 pacientes com lesão por não-contato do ligamento cruzadoanterior. Cinquenta e três indivíduos sem história de sintomasem relação aos pés ou joelhos compuseram o grupo controle.Uma avaliação antropométrica do índice do arco ósseo foi realizada,que consistiu na mensuração da razão entre a altura doosso navicular até o chão e a distância do ponto mais posteriorde suporte do calcâneo até a primeira articulação metatarso--falangeana. Sexo, altura, peso, índice de massa corpórea efrequência de prática desportiva também foram avaliados. Resultados:Indivíduos do grupo de casos tiveram arcos longitudinaismediais significativamente mais altos que os indivíduosdo grupo controle. Conclusão: Indivíduos com ruptura do ligamentocruzado anterior apresentaram arcos mais altos que oscontroles correspondentes, sugerindo uma associação entreum arco longitudinal medial do pé alto e lesão do ligamentocruzado anterior do joelho. Nível de Evidência III, Estudode Caso-Controle...

To evaluate the association between the height ofthe medial longitudinal arch of the foot and non-contact injuriesof the anterior cruciate ligament. Methods: One hundredand five patients were included in this case-control study. Thecase group consisted of 52 patients with non-contact injuryof the anterior cruciate ligament. Fifty-three individuals withno history of symptoms regarding to feet or knees comprisedthe control group. An anthropometric assessment of the bonyarch index was performed, which consisted of measuring theratio of the height between the navicular bone to the groundand the distance from the most posterior support point of thecalcaneus to the first metatarsal-phalangeal joint. Gender,height, weight, body mass index and the frequency of sportspractice were also evaluated. Results: Subjects in the casegroup had significantly higher medial longitudinal arches thanindividuals in the control group. Conclusion: Individuals withrupture of the anterior cruciate ligament had higher archesthan the corresponding controls, suggesting an associationbetween a high medial longitudinal arch of the foot and injuryof the anterior cruciate ligament. Level of Evidence III,Case-Control Study...

Epidemiology of sports injuries on collegiate athletes at a single center

Avaliar a incidência de lesões esportivas em atletas universitáriosde uma mesma instituição no período de 1993 a 2013.Métodos: Foram entrevistados atletas de 13 modalidades esportivassobre presença e tipo de lesão, tipo de tratamento e tempo deafastamento, tendo como base o questionário “Injury SurveillanceSystem” (ISS). Os dados foram analisados com gráficos e tabelasde prevalência de lesão por sexo, idade, esporte e local da lesão.Também foi analisado o tempo de afastamento médio dos atletas,se retornaram à prática do esporte e se apresentaram novas lesões.Resultados: Foi observado que 49,91% dos atletas apresentou algumtipo de lesão, com incidência semelhante entre os sexos; aslesões mais frequentes foram as do ligamento cruzado anterior (LCA)e o entorse de tornozelo; o tempo de afastamento médio foi de 11semanas. A lesão de maior impacto na carreira esportiva universitáriafoi a de LCA, principalmente em virtude do tempo de afastamentodos atletas. Conclusão: A lesão mais frequente, do LCA, ocorreucom maior incidência em esportes de quadra como handebol e vôleie apresentou o maior numero de casos tratados com cirurgia, assimcomo maior tempo médio de afastamento. Mais estudos precisamser realizados para a criação de uma base de dados maior com oobjetivo de programar medidas de prevenção para os atletas amadores.Nível de Evidencia IV, Estudo Epidemiológico...

To evaluate the incidence of sports injuries in collegeathletes from the same institution from 1993 to 2013.Methods: Athletes from 13 modalities were interviewedabout the presence and type of injury, type of treatmentand time of withdrawal, based on the questionnaire “InjurySurveillance System” (ISS). Data were analyzed with graphsand tables of injury prevalence by gender, age, site ofinjury and modality. We also analyzed the average time ofwithdrawal of athletes, returning to sports practice and newlesions. Results: It was observed that 49.91% of the athletesshowed some type of injury, with similar incidence betweengenders; the most frequent injuries were the anterior cruciateligament (ACL) and the ankle sprain; the average withdrawaltime was 11 weeks. ACL was the injury with greaterimpact on college sports career, especially given the timeof withdrawal. Conclusion: The most frequent injury, ACL,occurred most frequently in indoor sports such as handballand volleyball and had the highest number of cases treatedwith surgery and a longer average withdrawal time. Morestudies are needed to create a larger database in order toschedule preventive measures for amateur athletes. Level IVof Evidence, Epidemiological Study...

Reconstrucción de ligamento cruzado anterior: resultados funcionales / Reconstruction of the anterior cruciate ligament: functional results

Introducción: Las lesiones del ligamento cruzado anterior (LCA) son muy frecuentes y no tratarlas aumenta el riesgo de osteoartrosis en la rodilla, por lo que hoy se recomienda la reconstrucción quirúrgica sobre todo en gente activa como en el grupo de estudio. Materiales y Métodos: Se realizó un estudio observacional, descriptivo. Se evaluaron 48 pacientes a quienes se les realizó reconstrucción de LCA por abordaje único, con injerto autólogo, heterólogo o híbrido fijados con Sistemas Aperfix Cayenne, entre noviembre 2011 y octubre 2012. Solo se incluyeron pacientes con un mínimo de 6 meses post-operatorio los que fueron evaluados con las Escalas de Lysholm y Tegner. Resultados: La escala de Lysholm mostró resultados excelentes y buenos en un 68.7 por ciento y regulares en un 31 por ciento. El puntaje de la escala de Tegner pasó de 3,1 en el preoperatorio a 5.3 en el posoperatorio. La única complicación observada fue la sinovitis. Discusión: Se puede afirmar que los resultados funcionales de las Reconstrucciones de LCA fueron buenos independientemente del tipo de Injerto utilizado; resultados bastantes similares a los reportados en la literatura mundial.

Introduction: Anterior cruciate ligament injury (ACL) is one of the most common and not treating it increases the risk of osteoarthrosis in the knee, so nowadays its surgical reconstruction is recommended especially in active people. Methods: A retrospective study was carried out in order to determine the outcome of all patients who underwent an ACL reconstruction surgery using autograft, allograft or Hybrid graft fixed with Aperfix Cayenne System, from November 2011 to October 2012. Only were included patients with a minimum of 6 months post-operative which were evaluated with the Lysholm and Tegner scales. Results: Results were graded good and excellent in 68.7 per cent of the patients and fair in 31 per cent according to Lysholm. Furthermore, an increase in Tegner scale was well documented. The only complication observed in patients was a postoperative synovitis in some of them. Discussion: Our results has shown that the functional results was good, similar to those found up in overall existing medical literature.

Feasibility of utilizing the patellar ligament angle for assessing cranial cruciate ligament rupture in dogs

The patellar ligament angle (PLA) was assessed in 105 normal stifle joints of 79 dogs and 33 stifle joints of 26 dogs with a ruptured cranial cruciate ligament (CrCL). The PLA of stifles with complete CrCL rupture was significantly lower than that of normal stifles, particularly at a flexion angle of 60~80degrees in both plain and stress views. If the PLA was <90.55degrees on the stress view with a 60~80degrees flexion angle, the dog was diagnosed with a complete rupture of the CrCL with a sensitivity of 83.9% and specificity of 100%. In conclusion, measuring the PLA is a quantitative method for diagnosing complete CrCL rupture in canines.

A Comparison of the Fixation Strengths Provided by Different Intraosseous Tendon Lengths during Anterior Cruciate Ligament Reconstruction: A Biomechanical Study in a Porcine Tibial Model

BACKGROUND: The purpose of this study was to determine the tibial fixation strength provided by different intraosseous soft tissue graft lengths within the tibial tunnel. METHODS: Porcine tibial bones and digital flexor tendons were used for testing. Bone mineral densities of proximal tibial medial condyles were measured, and two-strand tendon bundles of 8 mm diameter were used. An intraosseous graft length of 2 cm was used in group 1 (n = 10), and a graft length of 4 cm was used in group 2 (n = 10). Tunnels were 4 cm in length and 8 mm in diameter. Tibial fixation was performed using a suture tied around a screw post with a washer and an additionally inserted 7 x 20 mm bioabsorbable screw. After applying preconditioning loading of 10 cycles, 1,000 cycles between 70-220 N were applied at a frequency of 1 Hz. Graft slippage and total graft movement were recorded. Ultimate tensile strength was measured by pull-out testing at an Instron crosshead speed of 1,000 mm/min. RESULTS: No significant intergroup difference was found for total graft movement after cyclic loading (slippage in group 1, 1.2 mm and group 2, 1.2 mm, respectively, p = 0.917; and total graft movement in group 1, 3.3 mm and group 2, 2.7 mm, respectively, p = 0.199). However, mean ultimate tensile strength in group 2 was significantly higher than that in group 1 (group 1, 649.9 N; group 2, 938 N; p = 0.008). CONCLUSIONS: In a porcine model, ultimate tensile strength was greater for a 4 cm long intraosseous flexor tendon in the tibial tunnel. However, no intergroup difference in graft slippage or total graft movement was observed. The results show that a 2 cm intraosseous graft length in the tibial tunnel is safe and has sufficient strength (> 450 N) for adequate rehabilitation after anterior cruciate ligament reconstruction.