Analysis of the Mechanical Behavior of Porcine Graft Fixation in a Polyurethane Block Using a 3D-printed PLA Interference Screw / Análise do comportamento mecânico da fixação do enxerto suíno em um bloco de poliuretano usando um parafuso de interferência PLA impresso em 3D

Abstract Objective The interest in using 3D printing in the healthcare field has grown over the years, given its advantages and potential in the rapid manufacturing of personalized devices and implants with complex geometries. Thus, the aim of the present study was to compare the mechanical fixation behavior of a 3D-printed interference screw, produced by fused deposition modeling of polylactic acid (PLA) filament, with that of a titanium interference screw. Methods Eight deep flexor porcine tendons, approximately 8 mm wide and 9 cm long, were used as graft and fixed to a 40 pounds-per-cubic-foot (PCF) polyurethane block at each of its extremities. One group was fixed only with titanium interference screws (group 1) and the other only with 3D-printed PLA screws (BR 20 2021 018283-6 U2) (group 2). The tests were conducted using an EMIC DL 10000 electromechanical universal testing machine in axial traction mode. Results Group 1 (titanium) obtained peak force of 200 ± 7 N, with mean graft deformation of 8 ± 2 mm, and group 2 (PLA) obtained peak force of 300 ± 30 N, and mean graft deformation of 7 ± 3 mm. Both the titanium and PLA screws provided good graft fixation in the polyurethane block, with no slippage or apparent deformation. In all the samples, the test culminated in graft rupture, with around 20 mm of deformation in relation to the initial length. Conclusion The 3D-printed PLA screw provided good fixation, similar to that of its titanium counterpart, producing satisfactory and promising results.

Resumo Objetivo O interesse em utilizar a impressão 3D na área da saúde tem crescido ao longo dos anos, dadas as suas vantagens e o seu potencial na rápida fabricação de dispositivos e implantes personalizados com geometrias complexas. Assim, o objetivo do presente estudo foi comparar o comportamento de fixação mecânica de um parafuso de interferência impresso em 3D, produzido pela modelagem fundida de deposição do filamento de ácido polilático (PLA), com o de um parafuso de interferência de titânio. Métodos Oito tendões suínos flexores profundos, de aproximadamente 8 mm de largura e 9 cm de comprimento, foram utilizados como enxerto e fixados em um bloco de poliuretano de 40 PCF em cada uma de suas extremidades. Um grupo foi fixado apenas com parafusos de interferência de titânio (grupo 1) e o outro apenas com parafusos PLA impressos em 3D (BR 20 2021 018283-6 U2) (grupo 2). Os testes foram realizados utilizando uma máquina de teste universal eletromecânica EMIC DL 10.000 no modo de tração axial. Resultados O grupo 1 (titânio) obteve força máxima de 200 ± 7 N com deformação média do enxerto de 8 ± 2 mm, e a força máxima do grupo 2 (PLA) foi de 300 ± 30 N e deformação média do enxerto de 7 ± 3 mm. Ambos os parafusos de titânio e PLA forneceram boa fixação de enxerto no bloco de poliuretano, sem deslizamento ou deformação aparente. Em todas as amostras o teste culminou na ruptura do enxerto, com cerca de 20 mm de deformação em relação ao comprimento inicial. Conclusão O parafuso PLA impresso em 3D proporcionou boa fixação, semelhante à de sua contraparte de titânio, produzindo resultados satisfatórios e promissores.

Mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion lesion / 中国修复重建外科杂志

OBJECTIVE@#To explore the mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesion.@*METHODS@#A clinical data of 39 patients with PASTA lesions, who underwent the arthroscopic "mini incision" transtendon repair and met the selected criteria between May 2017 and April 2021, was retrospectively analyzed. There were 13 males and 26 females, with an average age of 63.7 years (range, 43-76 years). Nine patients underwent trauma history, and no obvious inducement was found in the other 30 patients. The main clinical symptom was shoulder pain with positive hug resistance test. The interval from symptom onset to operation was 3-21 months (mean, 8.3 months). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, American Association of Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up.@*RESULTS@#All incisions healed by first intention with no complications such as incision infection or nerve injury. All patients were followed up 24-71 months (mean, 46.9 months). The VAS, UCLA, and ASES scores significantly improved at 24 months after operation when compared with preoperative ones ( P<0.05). The ROMs of forward flexion and external rotation of the shoulder joint significantly increased at 3 and 24 months, and further increased at 24 months compared to 3 months, with significant differences ( P<0.05). However, the ROM of abduction of the shoulder joint at 3 months did not significantly improve compared with that before operation ( P>0.05), and it was significantly greater at 24 months than before operation and at 3 months after operation ( P<0.05). At last follow-up, the patients were very satisfied with the effectiveness in 30 cases (76.9%), satisfied in 5 cases (12.8%), and dissatisfied in 4 cases (10.3%). At 6 months after operation, 31 patients underwent reviews of MRI scans, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing, and 3 patients underwent tendon re-tear.@*CONCLUSION@#Arthroscopic "mini incision" transtendon repair in treatment of PASTA lesion could obtain satisfying mid-term effectiveness with low risk of tendon re-tear.

Effect of creatine and sildenafil citrate on the physical performance of mice / Efecto de la creatina y del citrato de sildenafil sobre el desempeño físico de ratones / Efeito da creatina e do citrato de sildenafila sobre o desempenho físico de camundongos

ABSTRACT Introduction: The use of substances to enhance sports performance among professional and amateur athletes is increasing. Such substances may either be included in the group of dietary supplements or fall into pharmacological classes. Every substance used for this purpose is called an ergogenic agent. The number of ergogenic options available increases every day, favoring overuse and use without proper guidance. Among the dietary supplements, we highlight the use of creatine, a substance widespread in sports. Among the pharmacological groups, many drugs are used. Recently the use of sildenafil citrate by professional athletes from various predominantly aerobic sports modalities was reported in the media. Objective: To compare and demonstrate the responses caused by physical training associated with the use of creatine and sildenafil citrate in mice. Methods: A swim training protocol was applied and then an electrophysiograph was used in order to obtain parameters related to contraction intensity, the area under the curve and the percentage drop. Results: The responses obtained demonstrated the ergogenic action of creatine because it altered the parameters used for measurement. The use of sildenafil citrate did not yield satisfactory results to frame the drug as an ergogenic agent. Conclusion: Creatine has an ergogenic effect, reducing the percentage drop after 10 seconds, while sildenafil demonstrated no ergogenic potential and, interestingly, resulted in weaker responses when compared to the exercise groups. Evidence level II; Comparative prospective study .

RESUMEN Introducción: El uso de sustancias con el objetivo de aumentar el rendimiento deportivo entre atletas profesionales y amateurs es creciente. Tales sustancias pueden formar parte del grupo de suplementos alimentarios o integrar clases farmacológicas. Toda sustancia empleada para ese fin es denominada agente ergogénico. El número de opciones entre los agentes ergogénicos aumenta cada día, favoreciendo así su uso excesivo y sin la debida orientación. Entre los suplementos alimentarios, se destaca el uso de creatina, sustancia muy difundida en el medio deportivo. Ya entre los grupos farmacológicos, muchas sustancias son usadas. Recientemente, fue divulgado entre los medios de comunicación el uso de citrato de sildenafil por atletas profesionales, de varias modalidades deportivas, predominantemente las aeróbicas. Objetivos: Comparar y demostrar las respuestas ocasionadas por el entrenamiento físico, asociadas al uso de creatina y citrato de sildenafil en ratones. Métodos: Se aplicó un protocolo de entrenamiento de natación y, a continuación, se usó un electrofisiógrafo con el objetivo de obtener parámetros referentes a la intensidad de contracción, al área bajo la curva y a la caída porcentual. Resultados: Las respuestas obtenidas demuestran acción ergogénica de la creatina, visto que alteraron los parámetros empleados para la medición. Ya el uso de citrato de sildenafil no presentó resultados satisfactorios para encuadrar al fármaco como agente ergogénico. Conclusión: La creatina presenta efecto ergogénico porque reduce la caída porcentual después de 10 segundos, mientras que el sildenafil no presentó potencial ergogénico y, curiosamente, demostró respuestas inferiores cuando comparado a los grupos de ejercicio. Nivel de evidencia II; Estudio prospectivo comparativo .

RESUMO Introdução: O uso de substâncias com o objetivo de aumentar o rendimento esportivo entre atletas profissionais e amadores é crescente. Tais substâncias podem fazer parte do grupo de suplementos alimentares ou integrar classes farmacológicas. Toda substância empregada para esse fim é denominada de agente ergogênico. O número de opções entre os agentes ergogênicos aumenta a cada dia, favorecendo assim o uso em demasia e sem a devida orientação. Entre os suplementos alimentares, salientamos a utilização de creatina, substância muito difundida no meio esportivo. Já entre os grupos farmacológicos, muitas substâncias são utilizadas. Recentemente, foi divulgado entre os meios de comunicação o uso de citrato de sildenafila por atletas profissionais de várias modalidades esportivas, predominantemente as aeróbicas. Objetivos: Comparar e demonstrar as repostas ocasionadas pelo treinamento físico, associadas ao uso de creatina e citrato de sildenafila em camundongos. Métodos: Aplicou-se um protocolo de treinamento de natação e, a seguir, empregou-se um eletrofisiógrafo com objetivo de obter parâmetros referentes à intensidade de contração, à área sob a curva e à queda percentual. Resultados: As respostas obtidas demonstram ação ergogênica da creatina, visto que alteraram os parâmetros empregados para a mensuração. Já a utilização de citrato de sildenafila não apresentou resultados satisfatórios para enquadrar o fármaco como agente ergogênico. Conclusão: A creatina apresenta efeito ergogênico porque reduz a queda percentual após 10 segundos, já a sildenafila não apresentou potencial ergogênico e, curiosamente, demonstrou respostas inferiores quando comparado aos grupos de exercício. Nível de evidência II; Estudo prospectivo comparativo .

A Modified Flexor Tendon Suture Technique Combining Kessler and Loop Lock Flexor Tendon Sutures

OBJECTIVES: In the present study, a novel single knot tenorrhaphy was developed by combining the modified Kessler flexor tendon suture (MK) with the loop lock technique. METHODS: A total of 48 porcine flexor digitorum profundus tendons were collected and randomly divided into six groups. The tendons were transversely cut and then repaired using six different techniques, the MK method, double knot Kessler-loop lock flexor tendon suture (DK), and single knot Kessler-loop lock flexor tendon suture (SK), each in combination with the epitendinous suture (P), and the same three techniques without P. Furthermore, by performing the load-to-failure tests, the biomechanical properties and the time taken to complete a repair, for each tenorrhaphy, were assessed. RESULTS: Compared to the MK+P method, DK+P was more improved, thereby enhancing the ultimate tensile strength. The SK+P method, which required fewer knots than DK+P, was easier to perform. Moreover, the SK+P repair increased the force at a 2-mm gap formation, while requiring lesser knots than DK+P. CONCLUSION: As opposed to the traditional MK+P method, the SK+P method was improved and exhibited better biomechanical properties, which may facilitate early mobilization after the repair.

Ultrasound anatomy and needle-knife insertion approach of common tendon lesions in knee osteoarthritis based on meridian sinew theory / 中国针灸

OBJECTIVE@#To explore the ultrasonic anatomical characteristics and needle-knife insertion approach of common tendon lesions in knee osteoarthritis (KOA), so as to provide the references for accurate release of KOA by needle- knife along tendon lesions based on meridian sinew theory.@*METHODS@#Sixty patients with one-knee KOA were selected. High-frequency musculoskeletal ultrasound was used to collect sonograms at the anatomical positions of "Hedingci" "Binwaixia" "Binneixia" and "Yinlingshang". The anatomic levels were marked on the sonograms. The anatomic levels and sonographic features of lesions were compared and analyzed, and the relevant data of needle-knife simulation approach was measured.@*RESULTS@#The "Hedingci" lesions were mainly located at the attachment of quadriceps tendon to patella and suprapatellar bursa. The "Binwaixia" and "Binneixia" lesions were mainly located at the attachment of retinaculum patellae laterale and retinaculum patellae mediale to patella and infrapatellar fat pad. The "Yinlingshang" lesions were mainly located at the attachment of goose foot tendon to medial tibial condyle and bursa of goose foot. With "Hedingci" as an example, when the needle-knife entry point was 1 cm above the patella, the attachment of quadriceps tendon to patella was released, and the average depth of needle-knife was (3.60±0.10) cm, and the needle body was perpendicular to the skin. The average depth of needle-knife for releasing suprapatellar bursa was (2.35±0.17) cm, and the needle body was 45° towards head.@*CONCLUSION@#The musculoskeletal ultrasound could clearly show the local detailed anatomical level, ultrasonic characteristics and anatomical level of common tendon lesions of KOA, and could improve the accuracy of needle-knife along tendon lesions with non-direct vision, which has important reference value for needle-knife medical standardization and standardized operation.

Biomechanical evaluation of a novel transtibial posterior cruciate ligament reconstruction using high-strength sutures in a porcine bone model / 中华医学杂志(英文版)

BACKGROUND@#Multiple techniques are commonly used for posterior cruciate ligament (PCL) reconstruction. However, the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable. The purpose of this study was to compare the biomechanical properties among three different tibial fixation procedures for transtibial single-bundle PCL reconstruction.@*METHODS@#Thirty-six porcine tibias and porcine extensor tendons were randomized into three fixation study groups: the interference screw fixation (IS) group, the transtibial tubercle fixation (TTF) group, and TTF + IS group (n = 12 in each group). The structural properties of the three fixation groups were tested under cyclic loading and load-to-failure. The slippage after the cyclic loading test and the stiffness and ultimate failure load after load-to-failure testing were recorded.@*RESULTS@#After 1000 cycles of cyclic testing, no significant difference was observed in graft slippage among the three groups. For load-to-failure testing, the TTF + IS group showed a higher ultimate failure load than the TTF group and the IS group (876.34 ± 58.78 N vs. 660.92 ± 77.74 N [P < 0.001] vs. 556.49 ± 65.33 N [P < 0.001]). The stiffness in the TTF group was significantly lower than that in the IS group and the TTF + IS group (92.77 ± 20.16 N/mm in the TTF group vs. 120.27 ± 15.66 N/m in the IS group [P = 0.001] and 131.79 ± 17.95 N/mm in the TTF + IS group [P < 0.001]). No significant difference in the mean stiffness was found between the IS group and the TTF + IS group (P = 0.127).@*CONCLUSIONS@#In this biomechanical study, supplementary fixation with transtibial tubercle sutures increased the ultimate failure load during load-to-failure testing for PCL reconstruction.

Progress on effect of osteoporosis on rotator cuff repair / 中国骨伤

The rate of rotator cuff injury repair and retear is high in elderly patients due to the combination of different degrees of osteoporosis. To solve this problem, many surgeons try to reduce retear rate of rotator cuff injuries in these patients by increasing the initial fixation strength of anchors and changing local bone conditions. The rapid advances of tissue engineering have made it possible to use growth factors as an aid. However, repair of rotator cuff injury with osteoporosis is still a great challenge for clinical workers. How to better increase anchor fixation strength, improve micro-environment of tendon and bone healing, reduce the rotator cuff retear rate have become the research focus in recent years. The paper reviewed literatures on the relationshipbetween osteoporosis and rotator cuff injury, effect of osteoporosis in rotator cuff tendon healing, methods of reducing osteoporosis on rotator cuff tendon healing, in order to guide clinical treatment, improve operative effect and postoperative satisfaction.

Effects of tenectomy of the medial head of the deep digital flexor on the hindlimbs of healthy horses / Efeitos da tenectomia da cabeça medial do tendão flexor digital profundo nos membros posterior de cavalos saudáveis

The tenectomy of the medial head of the deep digital flexor (TMHDDF) is a minimally studied surgery used in cases of dorsal subluxation of the proximal interphalangeal joint of the hindlimb in horses. The TMHDDF was evaluated in six healthy horses by the degree of lameness, perimeter of the surgical site, the angle of the distal articular joints, and the linear and angular measures of the hoof. Thus, TMHDDF of the right hindlimb was performed and the contralateral limb was used as a control. Both, right and left limbs were evaluated before surgery, as well as at 15, 30, and 60 days after surgery aiming to evaluate the effects of the surgical procedure in healthy limbs. Data were compared by analysis of variance regarding days and limbs. Values below the significant level (P< 0.05) were analyzed using the Tukey's test. TMHDDF caused a mild increase of the toe length and the height of lateral heel (0.2cm in both), as well as a decrease of the angle of the proximal interphalangeal joint (2°) when comparing the left hindlimb to the right hindlimb, 30 and 60 days after surgery. Overall, TMHDDF did not cause significant changes in the evaluated variables up to the 60 days of surgery.(AU)

A tenectomia da cabeça medial do flexor digital profundo (TCMFDP) é uma técnica cirúrgica pouco estudada, indicada para equinos com subluxação dorsal da articulação interfalângica proximal do membro pélvico. A TCMFDP foi avaliada em seis equinos hígidos no grau de claudicação; na perimetria da área operada; nos ângulos articulares distais; e nas medidas lineares e angulares de parâmetros dos cascos. Nesse sentido, foi realizada a TCMFDP do membro pélvico direito, permanecendo o esquerdo como controle. Ambos os membros foram avaliados nos momentos pré-operatório (0) e 15, 30 e 60 dias após a cirurgia, sendo objetivo avaliar os efeitos do procedimento cirúrgico em membros hígidos. Para comparação dos dados entre momentos e membros, foi realizada análise de variância. Os valores inferiores ao de significância (P<0,050) foram submetidos ao teste de Tukey. A TCMFDP provocou discreto aumento (0,2cm, em ambos) do comprimento de pinça e da altura do talão lateral e redução no ângulo da articulação interfalângica proximal (2°) na comparação com o membro pélvico esquerdo aos 30 e 60 dias após a cirurgia no contralateral. Em geral, a TCMFDP não causou alterações influentes nos aspectos avaliados até 60 dias do experimento.(AU)

Evaluation of three superior oblique surgical weakening procedures for A-pattern strabismus / Avaliação de três tipos de cirurgia de enfraquecimento dos músculos superiores oblíquos no estrabismo com padrão em A

ABSTRACT Purpose: To evaluate three superior oblique surgical weakening procedures for correcting A-pattern strabismus: tenectomy, superior oblique hang-back recession, and that involving the use of superior oblique suture spacers. Methods: The inclusion criteria were A-pattern strabismus ≥10Δ and horizontal deviation ≥10Δ, with no other ocular abnormality and a follow-up period of ≥6 months. The 24 patients (mean age, 16.3 ± 8.1 years; mean postoperative follow-up, 9.63 ± 3.11 months) were randomly divided into three groups of 8 patients each. Sigmascan® Pro 5.0 software was used to measure the degree of torsion pre- and postoperatively. Results: Preoperatively, the mean angles of A-pattern deviation were 19.33Δ° ± 3.53Δ° (tenectomy group), 15.71Δ° ± 1.11Δ° (hang-back recession group), and 14.62Δ° ± 1.18Δ° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean angles of A-pattern deviation were 4.67Δ° ± 0.67Δ° (tenectomy group), 6.29Δ° ± 1.48Δ° (hang-back recession group), and 4.38Δ° ± 1.03Δ° (suture spacers group), with no statistically significant difference in the correction in A-pattern strabismus among the three groups. Preoperatively, the mean torsional angles were +5.4° ± 3.9° (tenectomy group), +5.6° ± 4.9° (hang-back recession group), and +6.0° ± 3.3° (suture spacers group); these values did not differ significantly. At the final follow-up examination, the mean torsional angles were + 0.3° ± 5.6° (tenectomy group), +0.5° ± 4.6° (hang-back recession group), and +0.2° ± 5.2° (suture spacers group), with no statistically significant difference in the intorsion correction among the three groups. Conclusion: All three superior oblique weakening procedures were effective for correcting A-pattern strabismus and fundus intorsion.

RESUMO Objetivo: Avaliar três procedimentos de debilitamento dos músculos oblíquos superiores para a correção de estrabismo com padrão em A: tenectomia, sutura em rédea (hang-back recession) e o uso de espaçadores de sutura oblíqua superior. Métodos: Os critérios de inclusão foram estrabismo padrão em A ≥10Δ e desvio horizontal ≥10Δ, sem outras anormalidades oculares e tempo de acompanhamento ≥6 meses. Os 24 pacientes (média de idade de 16,3 ± 8,1 anos; média de seguimento pós-operatório de 9,63 ± 3,11 meses) foram divididos aleatoriamente em três grupos de 8 pacientes cada. O programa Sigmascan® Pro 5.0 foi utilizado para medir o grau de torção no pré e pós-operatório. Resultados: No pré-operatório, a média e o desvio padrão dos ângulos de padrão em A foram de 19,33Δ° ± 3,53Δ° (grupo da tenectomia), 15,71Δ° ± 1,11Δ° (grupo da sutura em rédea), 14,62Δ° ± 1,18Δ° (grupo de espaçadores de sutura); esses valores não diferiram significativamente. No exame pós-operatório, a média e o desvio padrão dos ângulos de desvio do padrão em A foram de 4,67Δ° ± 0,67Δ° (grupo da tenectomia), 6,29Δ° ± 1,48Δ° (grupo da sutura em rédea), 4,38Δ° ± 1,03Δ° (grupo de espaçadores de sutura), sem diferença estatisticamente significativa na correção do estrabismo padrão em A entre os três grupos. No pré-operatório, os ângulos médios de torção foram de +5,4o ± 3,9° (grupo de tenectomia), +5,6° ± 4,9° (grupo da su­tura em rédea), e +6,0° ± 3,3° (grupo de espaçadores de sutura), esses valores não diferiram significativamente. No pós-operatório, os ângulos médios de torção foram de +0,3° ± 5,6° (grupo da tenectomia), +0,5° ± 4,6° (grupo da sutura em rédea), e +0,2° ± 5,2° (grupo de espaçadores de sutura), sem diferença estatisticamente significativa na correção da intorção entre os três grupos. Conclusão: Os três procedimentos de debili­tamento dos músculos oblíquos superiores foram efetivos para a correção do estrabismo com padrão em A e da intorção ocular observada na fundoscopia.

Tratamento cirúrgico da instabilidade do ombro através da transferência do tendão longo do bíceps trans-subescapular / Surgical treatment of shoulder instability with trans-subscapularis transfer of the biceps long tendon

RESUMO O objetivo deste trabalho é descrever, em cadáver, a técnica de transferência do tendão longo do bíceps para o tratamento da instabilidade anterior do ombro. Nesta técnica, o tendão longo do bíceps braquial é desinserido do tubérculo supraglenoidal e transferido para a borda anterior da cavidade glenoidal, através da tenotomia do subescapular, reproduzindo o efeito tirante e aumentando o batente anterior. A técnica é de fácil execução, minimizando os riscos da transferência do processo coracoide e pode ser uma opção para o tratamento da instabilidade glenoumeral.

ABSTRACT Our objective is to describe the long biceps tendon transfer technique for the treatment of shoulder anterior instability. In this procedure, the long tendon of the biceps brachii is detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity through a subscapularis tenotomy, reproducing the sling effect and increasing the anterior block. The technique is easy to perform and minimizes the risks of the coracoid process transfer. In conclusion, the transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.

Reconstrucción del ligamento cruzado anterior con tendón cuadricipital. Evaluación a 5 años. Trabajo para optar a Miembro Titular / ACL reconstruction with quadricipital tendon

Introducción: El propósito de este estudio es evaluar los resultados postoperatorios de la reconstrucción del ligamento cruzado anterior (LCA) utilizando el tendón cuadricipital. Método: Cuatrocientas cuarenta y ocho reconstrucciones de LCA utilizando el tendón cuadricipital fueron evaluados retrospectivamente a los 5 años postoperatorio. Se utilizaron para dicha evaluación escalas funcionales de Lysholm y de IKDC, Escala de Actividad de Tegner y resultados objetivos de traslación tibial anterior (KT1000). Adicionalmente, las complicaciones y comorbilidades fueron también analizadas. Resultados: El Score de Lysholm mejoro en el postoperatorio de 64 a 93.1 puntos promedio. El análisis artrométrico demostró que 389 rodillas (87%) presentaron una diferencia menor a 3mm. Dentro de las comorbilidades un 3.4% de los pacientes presentaron dolor anterior de rodilla en el postoperatorio alejado. Conclusión: La utilización del tendón cuadricipital para la reconstrucción del LCA demuestra ser técnica reproducible, con una mejoría, en los pacientes, tanto subjetiva como objetivamente, con bajas tasas de complicaciones y morbilidades. Tipo de estudio: Serie de casos. Nivel de Evidencia: IV

Introduction: The purpose of this study is to evaluate the postoperative results of anterior cruciate ligament reconstruction (ACL) using the quadricipital tendon. Method: Four hundred and forty-eight reconstructions of ACL using the quadricipital tendon were retrospectively evaluated at 5 years postoperatively. Functional scales of Lysholm and IKDC, Tegner Activity Scale and objective results of anterior tibial translation (KT1000) were used for this evaluation. Additionally, complications and comorbidities were also analyzed. Results: The Lysholm Score improved in the postoperative period from 64 to 93.1 average points. Arthrometric analysis showed that 389 knees (87%) had a difference of less than 3mm. Among the comorbidities, 3.4% of the patients presented anterior knee pain in the remote postoperative period. Conclusion: The use of the quadricipital tendon for the reconstruction of the ACL proves to be reproducible technique, with an improvement, in patients, both subjectively and objectively, with low rates of complications and morbidities. Type Study: Case series. Level of evidence: IV

Tratamento pós-operatório de tenorrafias dos tendões flexores da mão: uma revisão narrativa / Post-operative treatment of tenorrhaphies of the flexor tendons of the hand: a narrative review

Objetivos: Revisar a literatura quanto à conduta pós-operatória mais adequada para o tratamento das lesões dos tendões flexores da mão. Métodos: Foi realizada uma pesquisa na base de dados MEDLINE/PUBMED, com as seguintes palavras indexadas "digitorum profundus tendon", "digitorum superficialis tendon", "hand tendon injuries", "hand tendon repair", "hand tendon surgery", "early passive mobilization", "controlled active motion", "flexor tendon repair surgery", "postoperative hand rehabilitation". A data de seleção se restringiu entre os anos de 2010 a 2018. Foram encontrados 149 artigos e, desses, 9 foram escolhidos para a análise deste estudo, por atenderem os critérios de inclusão. Resultados: É consenso entre os artigos analisados que o movimento dos dígitos após a cirurgia é fundamental para a recuperação do déficit motor da mão. O movimento na intensidade apropriada previne rupturas e aderências tendíneas. Além do movimento, há um impasse quanto ao modo de imobilização do punho. Conclusão: A análise dos estudos indica que a melhor opção de tratamento pós-operatório é a mobilização ativa precoce, pelo fato de o índice de adesão tendínea ser baixíssimo. Resta dúvida se a posição do punho pode interferir no índice de ruptura dos tendões.

Objectives: To review the literature on the most appropriate postoperative question for the treatment of injuries of the flexor tendons of the hand. Methods: A search was performed in the MEDLINE / PUBMED database, with the following words indexed "digitorum profundus tendon", "digitorum superficialis tendon", "hand tendon injuries", "hand tendon repair", "hand tendon surgery", "early passive mobilization, "" controlled active motion, "" flexor tendon repair surgery, "" postoperative hand rehabilitation. "The selection date was restricted between 2010 and 2018. 149 articles were found and 9 were selected for analysis of this study, because they met the inclusion criteria. Results: It is a consensus among the articles that concern the movement of patients after surgery is fundamental, for a recovery of the motor deficit of the hand. The movement in the struggle for correction prevents tendinous ruptures and adhesions. In addition, there is a stalemate regarding the mode of immobilization of the wrist. Conclusion: The analysis of the studies indicates that the best option for postoperative treatment is active early mobilization, because the tendon adhesion index is very low. Whether the wrist position may interfere with tendon rupture rates remains to be questioned.

A Biomechanical Analysis of the Interlock Suture and a Modified Kessler-Loop Lock Flexor Tendon Suture

OBJECTIVE: In this work, we attempted to develop a modified single-knot Kessler-loop lock suture technique and compare the biomechanical properties associated with this single-knot suture technique with those associated with the conventional modified Kessler and interlock suture techniques. METHODS: In this experiment, a total of 18 porcine flexor digitorum profundus tendons were harvested and randomly divided into three groups. The tendons were transected and then repaired using three different techniques, including modified Kessler suture with peritendinous suture, interlock suture with peritendinous suture, and modified Kessler-loop lock suture with peritendinous suture. Times required for suturing were recorded and compared among groups. The groups were also compared with respect to 2-mm gap load, ultimate failure load, and gap at failure. RESULTS: For tendon repair, compared with the conventional modified Kessler suture technique, the interlock and modified Kessler-loop lock suture techniques resulted in significantly improved biomechanical properties. However, there were no significant differences between the interlock and modified Kessler-loop lock techniques with respect to biomechanical properties, gap at failure, and time required. CONCLUSIONS: The interlock and modified Kessler-loop lock techniques for flexor tendon sutures produce similar mechanical characteristics in vitro.

Propriedades mecânicas de dois padrões de sutura e dois tipos de fios aplicados às tenorrafias dos equinos / Tenorrhaphy in horses: comparison of the mechanical properties of two different suture patterns and suture materials

As lesões traumáticas dos membros que resultam em secções tendíneas são problemas comuns na clínica equina. Diversas complicações têm sido associadas à reparação dos tendões nessa espécie. O objetivo do presente trabalho foi avaliar biomecanicamente dois padrões de sutura e dois diferentes materiais aplicados às tenorrafias. Vinte e quatro peças de tendão flexor digital profundo de equinos foram seccionadas e suturadas em padrão locking loop duplo (grupo 1, com polipropileno; grupo 2, com poliglactina) ou em padrão locking loop simples associado à sutura de epitendão (grupo 3, com polipropileno; grupo 4, com poliglactina). Os corpos de prova foram submetidos a ensaios mecânicos de tração, em que se determinaram valores de força mínima, força máxima e pico de força, além do afastamento observado entre os cotos durante o pico máximo de força. Para avaliação dos resultados, foram utilizados os métodos ANOVA e os não paramétricos de Kruskal-Wallis e Mann-Whitney (P<0,05). Os maiores valores de força máxima foram documentados no grupo 3. Os valores de força mínima foram maiores nos grupos 3 e 4 que nos grupos 1 e 2, mas não diferiram significativamente entre os grupos 3 e 4. Os valores de pico de força foram maiores nos grupos 1 e 2 que no grupo 4, mas não diferiram significativamente no grupo 3. O afastamento foi maior nos grupos 1 e 2 quando comparados aos grupos 3 e 4. O padrão locking loop simples, com sutura de epitendão, atingiu maior resistência quando avaliado afastamento de até 3 milímetros entre os cotos tendíneos, sendo considerado padrão de escolha para aplicação clínica, tendo em vista os resultados obtidos neste trabalho.(AU)

Traumatic distal limb injuries resulting in tendon rupture are common in equine practice. Several complications have been associated with tendon repair in horses. The aim of this study was to compare the biomechanical properties of two tenorrhaphy techniques using two different suture materials. Twenty-four equine deep digital flexor tendon specimens were transected and sutured with the double locking loop pattern (polypropylene, group 1; polyglactin, group 2) or the single locking loop pattern with peripheral epitendon suture (polypropylene, group 3; polyglactin, group 4). Specimens were submitted to mechanical strain testing. Maximum, minimum and peak strain, and maximum, minimum and peak gap formation were evaluated. ANOVA and the non-parametric Kruskal-Wallis and Mann-Whitney tests were used (P<0.05). Higher maximum strength values were documented in group 3. Minimum strength values were higher in groups 3 and 4 than 1 and 2, but did not differ significantly between groups 3 and 4. Peak strength values were higher in groups 1 and 2 than 4, but did not differ significantly from group 3. Gap formation was greater in groups 1 and 2 than 3 and 4. The single locking loop pattern with epitendon suture performed with polypropylene had greater resilience, yielded lesser gap formation (3 mm) and is the pattern of choice for clinical application based on the results of this study.(AU)

Luxación congénita de rodilla: a propósito de un caso / Congenital knee dislocation: case report

Resumen: La luxación congénita de rodilla es una patología poco frecuente con una etiología desconocida. En algunos casos se le considera una patología aislada mientras que en otros pueden observarse patologías asociadas o síndromes. El tratamiento de la luxación congénita de rodilla depende de la gravedad y flexibilidad de la deformidad y en la bibliografía pueden encontrarse desde enyesados seriados o arnés de Pavlik hasta plastías del tendón cuadricipital u osteotomías femorales. Presentamos un caso de una luxación congénita que se trató mediante enyesado seriado y que evolucionó favorablemente.

Abstract: Congenital knee dislocation is an infrequent condition with unknown etiology. In some cases it occurs as an isolated condition, while in others it coexists with associated conditions or syndromes. The treatment of congenital knee dislocation is driven by the severity and flexibility of the deformity. The literature includes from serial casting or the Pavlik harness to quadriceps tendon plasty or femoral osteotomies. We report herein the case of a congenital dislocation treated with serial casting with a good outcome.

Precisión de los cirujanos artroscopistas al medir por ecografía estructuras tendinosas sin tener experiencia previa en la utilización de este método / Precision of arthroscopic surgeons using ultrasound for the first time to measure tendon structures

Resumen: Antecedentes: Se evalúa la precisión de un grupo de cirujanos artroscopistas sin experiencia en la utilización de la ecografía al medir estructuras tendinosas en el hombro y la cadera. Métodos: Participaron 22 alumnos y tres profesores en un curso de formación teórico-práctico de un día de duración. Se realizaron dos tandas de mediciones, donde cada alumno identificó el eje menor, el mayor y el área de sección transversal (AST) del tendón del bíceps, el grosor del supraespinoso y el eje menor, mayor y el AST del psoas-ilíaco. Se establecieron como valores de referencia las medias de las dos mediciones realizadas por cada uno de los profesores del curso. Resultados: Evaluando las dos mediciones realizadas por los alumnos en cada una de las estructuras, no se logró una correlación significativa en ninguno de los casos, obteniendo siempre una p > 0.05. Salvo en la medición del AST del bíceps, donde de manera significativa se realizó una infraestimación; en el resto de las siete mediciones hubo una marcada tendencia a sobredimensionar las estructuras tanto en la primera como en la segunda medición, siendo esto altamente significativo (p < 0.05). Conclusiones: La ecografía es un método útil para identificar estructuras por parte de los cirujanos artroscopistas. Sin embargo, la marcada tendencia a sobredimensionarlas con respecto a los valores tomados como referencia hace pensar que la realización de cursos de capacitación y la práctica diaria son indispensables para perfeccionar la utilización del método.

Abstract: Background: The precision of a group of arthroscopic surgeons using ultrasound for the first time was assessed when measuring shoulder and hip tendon structures. Methods: Twenty-two students and 3 professors participated in a one-day theoretical-practical course. Two measurement rounds were conducted, during which each student identified the greater and lesser axes and the cross-sectional area of the biceps tendon, the supraspinous depth, as well as the lesser and greater axes and the cross-sectional area of the iliac psoas. The mean of the two measurements made by each of the course professors was considered as the reference value. Results: When the 2 measurements made by each of the students of each of the structures were assessed, no significant correlation was found in any of the cases, with a p > 0.05. With the exception of the cross-sectional area of the biceps, where there was a significant undersizing of the structure, in the remaining 7 measurements a marked trend to oversize the structures was seen in both the first and second measurements, with a high statistical significance (p < 0.05). Conclusions: Ultrasound is a useful method through which arthroscopic surgeons can identify structures. However, the marked trend to oversize structures compared to the reference values leads to think that the training courses and the daily practice are essential to improve the method.

Flexor Digitorum Superficialis and Flexor Digitorum Profundus with separated sheaths, a new normal variation in human / Flexor superficial de la y Flexor profundo de los con vainas separadas, una nueva variación normal en humanos

Case description: A 25 years old man presented with a laceration on radial side of proximal phalanx of 4th finger (zone II flexor) which was due to cut with glass. Clinical findings: The sheaths of Tendons of flexor digitorum sperficialis and profundus were not the same and each tendon had a separate sheath. Treatment and outcome: The tendons were reconstructed by modified Kessler sutures, after 15 months the patient had a 30 degrees of extension lag even after physiotherapy courses. Clinical relevance: This is the first reported of such normal variation in human hand tendon anatomy.

Descripción del caso: Se presentó un hombre de 25 años con una laceración en la parte radial de la falange proximal del cuarto dedo de la mano (zona flexor II) causada por el corte con un vidrio. Hallazgos clínicos: Las cubiertas de los tendones del flexor digitorum sperficialis y profundus estaban separadas en diferentes cubiertas. Tratamiento y resultado: Los tendones se reconstruyeron por la suturas modificadas de Kessler. Después de 15 meses el paciente presentó una pérdida del 30% en la extensión , aun después de la fisioterapia. Relevancia clínica: Es el primer reporte de la variación en la anatomía de la mano.

Tratamiento artroscópico de las calcificaciones del subescapular. Reporte de un caso y revisión de la bibliografía / Arthroscopic treatment of subscapularis tendon calcification. Case report and bibliographic revision

Las calcificaciones del manguito rotador afectan mayormente al tendón del supraespinoso. El compromiso del tendón del subescapular es menos frecuente y sólo unos pocos casos han sido reportados. Presentamos un caso de una calcificación del subescapular en un paciente sin respuesta al tratamiento conservador, que fue tratado con la remoción completa de la misma y la posterior reparación del defecto residual con un arpón de doble sutura reforzada. Un año luego de la cirugía el paciente se presentaba sin dolor, con movilidad completa y sin restos de calcio en los estudios postoperatorios. La combinación de la remoción completa de la calcificación y la subsecuente reparación del defecto con arpones en forma artroscópica puede resultar en excelentes resultados funcionales, sin comprometer la integridad del manguito rotador en pacientes con calcificaciones del subescapular. Nivel de Evidencia: V...

The supraspinatus tendon is the most common tendon associated with the calcific tendinosis of the rotator cuff. The subscapularis tendon is rarely affected, and only a few prior cases have been reported. We present a case of a subscapularis tendon calcification in a patient with a failed conservative treatment that was treated arthroscopically with complete removal of the calcific deposit and posterior repair of the defect with suture anchors. One year after surgery the patient had no pain, he had full range of motion and there were not residual calcium deposits in the postoperative studies. The combination of complete calcium removal and posterior repair with suture anchors can led to excellent functional outcomes without compromising the integrity of the rotator cuff in patients with calcifications of the subscapularis tendon. Level Of Evidence: V...

Tumor de células gigantes de vaina tendinosa en paquete adiposo de Hoffa: reporte de caso / Giant cell tumor of tendon sheath in Hoffa´s fat pad. Case report

Se presenta un caso de gonalgia aguda atraumática de causa tumoral localizada paquete adiposo de Hoffa en un paciente pediátrico. Se realizó resección en bloque con asistencia artroscópica. El diagnóstico de tumor de células gigante de vaina tendinosa fue confirmado mediante histopatología. Nivel de evidencia: V...

We report a case of acute atraumatic knee pain due to a soft tissue tumor in Hoffa’s fat pad in a pediatric patient. An arthroscopically assisted en bloc resection was performed. The diagnosis of giant cell tumor of tendon sheath was confirmed through histopathology study. Level of Evidence: V...

Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer

Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable. This article describes the method that I have used for tendon surgery.