Artroplastía de rodilla en pacientes con poliomielitis y déficit de extensores. Revisión y experiencia en nueve casos / Knee arthroplasty in patients with poliomyelitis and extensor mechanism deficiency. Review and experience in nine cases

Objetivos: Comunicar los resultados clínicos y funcionales de pacientes con síndrome pospolio sometidos a una artroplastia total de rodilla y evaluar si la elección de la prótesis está condicionada por el déficit funcional del cuádriceps. Materiales y Métodos: Se evaluó a pacientes con síndrome pospolio en su condición de déficit muscular y con escalas funcionales de tiempo de caminata en 10 m, distancia caminada en 2 min, y tiempo levántate y anda, y el Knee Society Score antes de la artroplastia de rodilla y un año después. Resultados: Los valores funcionales que impactaban directamente en la calidad de vida mejoraron notablemente en todos los pacientes. No se hallaron diferencias significativas en el Knee Society Score entre los casos más graves con déficit del cuádriceps con recurvatum y aquellos con menor afectación, pero las escalas funcionales sí mostraron una diferencia significativa entre estos subgrupos. Conclusiones: La artroplastia total de rodilla es una alternativa terapéutica válida en esta compleja enfermedad, que logra aliviar el dolor, recupera la función y mejora la calidad de vida. La restauración de la estabilidad mediante diseños de prótesis constreñidas es un factor clave en la recuperación de un patrón de marcha funcional en los pacientes con recurvatum. Los pacientes con fuerza del cuádriceps que vencen la resistencia de la gravedad tienen un resultado funcional equiparable al de los pacientes sin síndrome pospolio y no requieren prótesis abisagradas. Nivel de Evidencia: IV

Objectives: To report the clinical and functional outcomes of patients affected with post-polio syndrome (PPS) treated with total knee arthroplasty, evaluating whether the choice of the prosthesis is conditioned by the quadriceps functional deficit. Materials and Methods: Patients with PPS were evaluated in their muscle deficit condition and with functional tests such as 10-meter walk test (10MWT), 2-minute walk test (2MWT) and timed up and go test (TUG), as well as KSS preoperatively and 1 year after knee arthroplasty. Results: All patients significantly improved functional values that directly impacted their quality of life. The KSS did not present significant differences between the most severe cases with quadriceps deficit with recurvatum and those with less involvement, but the functional tests did show a significant difference between these subgroups. Conclusions: Total knee arthroplasty is a valid treatment alternative in this complex pathology, providing the patient with pain relief, recovery of function and improving their quality of life. The restoration of stability through constrained prosthetic designs is a key factor in the recovery of a functional gait pattern in patients with recurvatum. Patients with quadriceps strength who overcome the resistance of gravity have functional outcomes comparable to non-PPS patients and do not require hinged prostheses. Level of Evidence: IV

The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses

SUMMARY PURPOSE In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.

RESUMO OBJETIVO Neste estudo observacional prospectivo, objetivamos investigar o papel da espessura do músculo quadríceps femoral (QFMT) comprimido (mc) e não comprimido (uc) medida pela ultrassonografia (USG) na detecção do risco nutricional em pacientes de terapia intensiva (ICPs) com status de volume diferente. MÉTODOS Cinquenta e cinco pacientes foram incluídos. As medidas direita, esquerda e total de ucQFMT e mcQFMT foram obtidas por um dispositivo USG padrão nas primeiras 48 horas após a admissão na UTI. O exame clínico e o dispositivo USG foram usados para determinar o status volumétrico dos pacientes. Sofa, Apache II, escores Nutric modificados e dados demográficos foram coletados. RESULTADOS Houve diferença significativa entre o risco nutricional dos pacientes em termos de medidas da QTFMT esquerda, direita e total (p=0,025, p=0,039; p=0,028, respectivamente), necessidade de ventilação mecânica (p=0,014), presença de infecção (p=0,019) e sepse (p=0,006). Não houve diferença significativa entre os diferentes status de volume em termos de medidas de mcQFMT. Na análise de variância múltipla, verificou-se que as medidas da FCFMT estavam independentemente associadas a alto risco nutricional (p=0,019, Exp (B)=0,256, 95%CI=0,082-0,800 para escore Nutric modificado ≥ 5) e maior risco nutricional (p=0,009, Exp (B)=0,144, 95%CI=0,033-0,620 para o escore Nutric modificado ≥ 6). O valor total de mcQFMT abaixo de 1,36 cm foi um preditor de maior risco nutricional com sensibilidade de 79% e especificidade de 70% (ASC=0,749, p=0,002, razão de verossimilhança = 2,04). CONCLUSÃO A medida ultrassonográfica do mcQFMT total pode ser usada como um novo parâmetro de avaliação de risco nutricional em ICPs médicas com diferentes status de volume. Assim, pacientes que podem se beneficiar de uma terapia nutricional agressiva podem ser facilmente identificados nesses grupos de pacientes.

The effect of prenatal exposure to 1800 MHz electromagnetic field on calcineurin and bone development in rats

PURPOSE: To investigated the effects of exposure to an 1800 MHz electromagnetic field (EMF) on bone development during the prenatal period in rats. METHODS: Pregnant rats in the experimental group were exposed to radiation for six, 12, and 24 hours daily for 20 days. No radiation was given to the pregnant rats in the control group. We distributed the newborn rats into four groups according to prenatal EMF exposure as follows: Group 1 was not exposed to EMF; groups 2, 3, and 4 were exposed to EMF for six, 12, and 24 hours a day, respectively. The rats were evaluated at the end of the 60th day following birth. RESULTS: Increasing the duration of EMF exposure during the prenatal period resulted in a significant reduction of resting cartilage levels and a significant increase in the number of apoptotic chondrocytes and myocytes. There was also a reduction in calcineurin activities in both bone and muscle tissues. We observed that the development of the femur, tibia, and ulna were negatively affected, especially with a daily EMF exposure of 24 hours. CONCLUSION: Bone and muscle tissue development was negatively affected due to prenatal exposure to 1800 MHz radiofrequency electromagnetic field.

¿Existe infiltración grasa del cuádriceps en la lesión crónica del tendón patelar? / Is there fatty infiltration of the quadriceps in the chronic rupture of the patellar tendon?

No existen modelos que evalúen los cambios morfológicos musculares en roturas crónicas del aparato extensor de la rodilla. Objetivos: 1) Describir un nuevo modelo experimental de lesión crónica de tendón patelar; y 2) evaluar macroscópica e histológicamente la evolución, a través del tiempo, de la degeneración del cuádriceps con este modelo. Hipótesis: Existe fibrosis e infiltración grasa progresiva del cuádriceps a través del tiempo. Materiales y método: Se realiza transección del tendón patelar en 20 ratones BKS, machos, adultos, divididos en 4 grupos de 5 animales cada uno, siendo sacrificados a la 1era, 2da, 4ta y 12va semanas. A todos los ratones sacrificados se les extrajo el cuádriceps derecho (intervención) e izquierdo (control). Se realizó evaluación macroscópica, análisis morfométrico e histológico por 2 patólogos independientes y ciegos. Los resultados se analizaron estadísticamente con Test T de Student y Test de Wilcoxon (p<0,05). Resultados: Macroscopia: tejido amarillento en grupo intervenido con variables morfométricas alteradas progresivamente de manera significativa desde la 2da semana. Histología: infiltración grasa con atrofia numérica de fibras musculares, progresiva en el tiempo, significativa desde la 4ta semana, llegando a infiltración grasa severa a las 12 semanas con porcentaje de fibrosis menor al 6 por ciento en todos los casos.Conclusiones: Este nuevo modelo de lesión de tendón patelar se asocia a pérdida de continuidad persistente del aparato extensor con cambios estructurales del cuádriceps. Estos cambios incluyen atrofia muscular macroscópica e infiltración grasa con atrofia numérica de fibras musculares progresiva, significativa a partir de la 2da semana...

There are no models that evaluate the morphological changes of the muscles in chronic ruptures of the extensor apparatus of the knee. Objectives: 1) To describe a new model of chronic rupture of the patellar tendon; and 2) To macroscopically and histologically evaluate progressive quadriceps muscle degeneration. Hypothesis: There is progressive fibrosis and fatty infiltration of the quadriceps muscle. Materials and method: A complete transection was performed on the right patellar tendon of 20 male, adult, BKS mice, divided into 4 groups of 5 animals. The animals were sacrificed at the 1st, 2nd, 4th, and 12th week after the indicated procedure. After sacrificing the animals, both quadriceps muscles were resected and evaluated macroscopically, morphometrically, and histologically by 2 independent, blinded pathologists. Statistical analysis was performed using Student t test, and Wilcoxon's test (P<.05). Results:Macroscopy yellowish muscle tissue with significant progressive morphological changes beginning at week 2. Histology: progressive fatty infiltration with numerous atrophies of the muscle fibres, becoming significant after the 4th week, reaching severe fatty infiltration at week 12, with little fibrous tissue in less than 6 percent of the muscle. Conclusions: This new model of patellar tendon chronic rupture is associated with persistent discontinuity of the knee extensor mechanism and structural changes of the quadriceps muscle. These changes include muscle atrophy and progressive fatty infiltration beginning at the 2nd week after the injury...

Influence of transcutaneous electrical stimulation on heterotopic ossification: an experimental study in Wistar rats

Heterotopic ossification (HO) is a metaplastic biological process in which there is newly formed bone in soft tissues, resulting in joint mobility deficit and pain. Different treatment modalities have been tried to prevent HO development, but there is no consensus on a therapeutic approach. Since electrical stimulation is a widely used resource in physiotherapy practice to stimulate joint mobility, with analgesic and anti-inflammatory effects, its usefulness for HO treatment was investigated. We aimed to identify the influence of electrical stimulation on induced HO in Wistar rats. Thirty-six male rats (350-390 g) were used, and all animals were anesthetized for blood sampling before HO induction, to quantify the serum alkaline phosphatase. HO induction was performed by bone marrow implantation in both quadriceps of the animals, which were then divided into 3 groups: control (CG), transcutaneous electrical nerve stimulation (TENS) group (TG), and functional electrical stimulation (FES) group (FG) with 12 rats each. All animals were anesthetized and electrically stimulated twice per week, for 35 days from induction day. After this period, another blood sample was collected and quadriceps muscles were bilaterally removed for histological and calcium analysis and the rats were killed. Calcium levels in muscles showed significantly lower results when comparing TG and FG (P<0.001) and between TG and CG (P<0.001). Qualitative histological analyses confirmed 100% HO in FG and CG, while in TG the HO was detected in 54.5% of the animals. The effects of the muscle contractions caused by FES increased HO, while anti-inflammatory effects of TENS reduced HO.

Idiopathic fibrosis of the quadriceps muscle: a case report with magnetic resonance imaging and pathological findings.

BACKGROUND: Idiopathic fibrosis of the quadriceps muscle can be defined as progressive loss of knee flexion due to fibrosis within the muscle developed in early childhood. A few cases have been reported, but these did not detail the MRI and pathological findings. MATERIAL AND METHOD: A 28-year-old woman presented with difficulty in sitting and inability to bend both knees completely. The clinical evaluation, radiological examination, MRI, treatment and muscle pathology were demonstrated RESULTS: The knee flexions were limited in both knee joints. Magnetic resonance imaging of both thighs showed marked quadriceps muscle atrophy with fat infiltration and fibrous band. Intraoperative findings demonstrated fibrous band of vastus intermedius and vastus lateralis muscles which correlated with the MRI. The histological findings also revealed loose connective tissue separating muscle fibers and large fibrous band Z-plasty and release of the fibrotic muscles were performed. The result of the surgery was good CONCLUSION: This is the first report to correlate MRI and pathological findings of idiopathic fibrosis of the quadriceps muscle. Late diagnosis and treatment may produce irreversible changes of femoral condyles and patella. Clinical awareness with history, physical examination and radiographic findings which included MRI help in confirming the diagnosis and demonstrating the extent of fibrosis before surgery.