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1.
Rev. bras. ortop ; 56(1): 24-30, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1288658

ABSTRACT

Abstract The present research aims to compare the outcomes from the combined reconstruction of the anterior cruciate ligament (ACL) and of the anterolateral ligament (ALL) with the standard isolated ACL reconstruction in patients with chronic ACL injury. To do so, a meta-analysis was carried out to determine whether the combined ACL and ALL reconstruction would lead to a significant improvement in knee function according to the International Knee Documentation Committee (IKDC), the Lysholm test and KT-2000 evaluation scores and lower graft rupture rates in comparison with isolated reconstruction. To identify randomized controlled trials (RCTs) comparing the combined ACL and ALL reconstruction with the isolated ACL reconstruction, papers published between 2010 and 2019 were searched in the MEDLINE, EMBASE, SPORTDiscus, LILACS and Cochrane Central Register of Controlled Trials databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The stability of the knee joint is only marginally improved with the combined reconstruction of ACL and ALL, and both reconstruction techniques show functional results. The main outcomes sought were patient function and graft stability and rupture rates after ACL reconstruction. Out of the 421 studies identified, 6 were included in our meta-analysis. Study quality (internal validity) was assessed using the Cochrane risk-of-bias tool; in general, the studies included presented moderate-quality evidence. The graft rupture rate was higher in patients undergoing isolated ACL reconstruction (relative risk, 0.22; 95% confidence interval, 0.12 to 0.41; p < 0.00001).


Resumo O objetivo da presentepesquisa é comparar, por meio de uma metanálise, os resultados da reconstrução combinada do ligamento cruzado anterior (LCA) e do ligamento anterolateral (LLA), comparado com a reconstrução isolada padrão, em pacientes com lesão crônica do ligamento cruzado anterior. Buscando alcançar o objetivo da pesquisa, foi realizada uma meta-análise para determinar se a combinação da reconstrução combinada LCA e LLA levaria àmelhoria significativa da função do joelho, medida pelos escores de avaliação International Knee Documentation Committee (IKDC), Lysholm, KT-2000 e menor taxa de ruptura do enxerto, em comparação com a reconstrução isolada. Para identificar ensaios clínicos randomizados (ECR) comparando a reconstrução combinada do LCA e LLA com a reconstrução isolada do LCA, foram pesquisados artigos publicados entre 2010 e 2019 nas bases MEDLINE, EMBASE, SPORTDiscus, LILACS e Cochrane Central RegisterofControlledTrials e seguiram os critérios de Itens de Relatórios Preferidos para Revisões Sistemáticas e Metanálises (PRISMA). A estabilidade da articulação do joelho é apenas marginalmente aprimorada com a reconstrução combinada de LCA e LLA, e ambas as técnicas de reconstrução mostram resultados funcionais. Os principais desfechos procurados foram a função do paciente e as taxas de estabilidade e ruptura do enxerto após a reconstrução do LCA. Dos 421 estudos identificados, 6estudos foram incluídos em nossa meta-análise. A qualidade do estudo (validade interna) foi avaliada usando o instrumento Cochrane risco-de-viés; em geral, foi encontrada uma qualidade moderada de evidências dos estudos incluídos. Os pacientes submetidos à reconstrução isolada do LCA mostraram maior taxa de ruptura do enxerto (RR 0,22; índice de confiança [IC]95%: 0,12-0,41; p< 0,00001).


Subject(s)
Rupture , Wounds and Injuries , Anterior Cruciate Ligament , Anterior Cruciate Ligament Injuries , Knee Joint , Ligaments
2.
Rev. bras. ortop ; 56(1): 47-52, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288647

ABSTRACT

Abstract Objective The objective of the present study was to evaluate the relationship between patients with anterior cruciate ligament (ACL) injury by indirect trauma and increased posterior tibial inclination. Methods Retrospective study, performed by analysis of medical records and digital radiographs of patients, present in a database of a tertiary orthopedic hospital. The sample consisted of two groups, the first group consisting of patients diagnosed with ACL injury by indirect trauma, and a control group matched by age. Results Each group consisted of 275 patients, whose measurements of posterior tibial inclination were measured by three specialists. It was observed that the group of patients with ACL lesion presented a significantly higher tibial slope (in degrees) than the control group in the total sample and in the subsamples stratified by gender. The best cutoff point for the first group was identified as a posterior tibial inclination ≥ 8º, achieving a sensitivity of 63.3% and a specificity of 62.5%. The first group also had a tibial slope ratio ≥ 8º (63.3%), significantly higher than the control group (37.5%), with an odds ratio of 2.8. Conclusion It was concluded that the increase of the posterior tibial inclination is associated with an increased risk for injury of the ACL by indirect trauma, mainly for values ≥ 8º.


Resumo Objetivo O objetivo do presente estudo foi avaliar a relação entre pacientes com lesão do ligamento cruzado anterior (LCA) por trauma indireto e o aumento da inclinação posterior da tíbia. Métodos Estudo retrospectivo, realizado por análise de prontuários e radiografias digitais de pacientes, presentes em banco de dados de um hospital terciário de ortopedia e traumatologia. A amostra foi composta por dois grupos, sendo o primeiro formado por pacientes com diagnóstico de lesão do LCA, por trauma indireto, e um grupo controle pareado por idade. Resultados Cada grupo foi formado por 275 pacientes, cujas medidas de inclinação tibial posterior foram aferidas por 3 especialistas. Observou-se que o grupo dos pacientes com lesão do LCA apresentou slope tibial (em graus) significativamente maior que o grupo controle na amostra total e nas subamostras estratificadas por gênero. Identificou-se como o melhor ponto de corte (cutoff) para o primeiro grupo uma inclinação tibial posterior ≥ 8º, atingindo uma sensibilidade de 63,3% e uma especificidade de 62,5%. O primeiro grupo também apresentou proporção de slope tibial ≥ 8º (63,3%), significativamente maior que o grupo controle (37,5%), com razão de chances de 2,8. Conclusão Concluiu-se que o aumento da inclinação tibial posterior está associado com um maior risco para lesão do LCA por trauma indireto, principalmente para valores ≥ 8º,


Subject(s)
Humans , Tibia , Anterior Cruciate Ligament , Knee Injuries , Ligaments
3.
Rev. Pesqui. Fisioter ; 11(1): 135-144, Fev. 2021. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1253110

ABSTRACT

INTRODUÇÃO: A postura anterior da cabeça é considerada o desequilíbrio postural musculoesquelético mais comum, causando protrusão da cabeça anterior ao tronco. Os órgãos internos são interconectados e fixados posteriormente à coluna por meio das membranas de suporte. A tensão nessas membranas de suporte pode ainda causar restrições mecânicas, afetando a mobilidade do órgão visceral e a estrutura musculoesquelética associada em um mecanismo de mão dupla. OBJETIVO: Explorar o efeito da manipulação visceral específica de órgão na postura, incapacidade, força e dor em indivíduos com dor cervical crônica inespecífica. De acordo com a hipótese deste estudo, a manipulação visceral tem como objetivo explorar o efeito da manipulação da fáscia específica do órgão na postura, incapacidade, força e dor em indivíduos com dor cervical crônica inespecífica. MATERIAL E MÉTODO: cinco indivíduos com dor cervical inespecífica crônica com postura anterior da cabeça foram recrutados usando o método de amostragem de conveniência. Este estudo foi conduzido em um departamento de Fisioterapia de um hospital multi-especializado reconhecido, Mohali. Os indivíduos foram encaminhados após o diagnóstico de dor cervical crônica dos departamentos. Uma única sessão de manipulação visceral placebo foi administrada na primeira semana, seguida de uma única sessão de manipulação visceral da cúpula pleural e ligamentos pericárdicos na segunda semana. Aplicação móvel de tela de postura (postura), unidade de biofeedback de pressão (ativação muscular), Índice de Incapacidade Pescoço e Escalas Visuais Analógicas foram utilizados para medir os resultados pré e pós. RESULTADO: a comparação entre os grupos do desfecho mostrou diferença estatisticamente significativa na EAV (p = 0,001), aplicação da triagem postural (p = 0,02) e NDI (p = 0,07). Não foram observadas mudanças significativas no desfecho força. CONCLUSÃO: Sessão única de manipulação visceral da cúpula pleural e ligamentos pericárdicos pode se beneficiar na melhora da postura anterior da cabeça, incapacidade cervical e redução da dor.


INTRODUCTION: Forward head posture is considered to be the most common musculoskeletal postural imbalance causing protrusion of head anterior to trunk. Internal organs are interconnected and attached posteriorly to the spine through the support membranes. Tension in these support membranes may further cause mechanical restrictions, thereby affecting the mobility of the visceral organ and associated musculoskeletal structure in a two-way mechanism. OBJECTIVE: To explore the effect of organ-specific visceral manipulation on posture, disability, strength, and pain in subjects with chronic non-specific neck pain. According to this study hypothesis visceral manipulation aim to explore the effect of organ-specific fascia manipulation on posture, disability, strength, and pain in subjects with chronic non-specific neck pain. MATERIAL AND METHOD: Five subjects with chronic non-specific neck pain with forwarding head posture were recruited using a convenience sampling method. This study was conducted in a Physiotherapy department of a recognized multispecialty hospital, Mohali. Subjects were referred after diagnosis from chronic neck pain from the departments. A single session of placebo visceral manipulation was administered in the first week, followed by a single session of visceral manipulation of the pleural dome and pericardial ligaments in the second week. Posture screen mobile application (posture), Pressure biofeedback unit (muscular activation), Neck Disability Index, and Visual Analog Scales were used to measure the pre and post outcomes. RESULT: Between-group comparison of the outcome showed a statistically significant difference in the VAS (p=0.001), Posture screening application (p=0.02), and NDI (p=0.07). No significant changes were observed in the strength outcome. CONCLUSION: Single session of visceral manipulation for the pleural dome and pericardial ligaments may benefit in improving the forward head posture, neck disability and reducing the pain.


Subject(s)
Chronic Pain , Neck Pain , Ligaments
4.
Article in Chinese | WPRIM | ID: wpr-888243

ABSTRACT

Ligaments are dense fibrous connective tissue that maintains joint stability through bone-to-bone connections. Ligament tears that due to sports injury or tissue aging usually require surgical intervention, and transplanting autologous, allogeneic, or artificial ligaments for reconstruction is the gold standard for treating such diseases in spite of many drawbacks. With the development of materialogy and manufacturing technology, engineered ligament tissue based on bioscaffold is expected to become a new substitute, which can lead to tissue regeneration by simulating the structure, composition, and biomechanical properties of natural tissue. This paper reviewed some recently published


Subject(s)
Animals , Bionics , Bone and Bones , Humans , Ligaments , Tissue Engineering , Wound Healing
5.
Article in Chinese | WPRIM | ID: wpr-878733

ABSTRACT

Median arcuate ligament syndrome(MALS)is compression of the celiac trunk by the median arcuate ligament.Median arcuate ligament release is the corner stone for the surgical treatment of MALS.Open surgery,laparoscopic surgery,and robot-assisted surgery have been developed,among which laparoscopic surgery has been proposed as the preferred approach in view of its minimal trauma and short hospital stay.Auxiliary celiac plexus neurolysis could further alleviate the patient's discomfort.Moreover,vascular reconstitution is of vital importance in the case of persistent stenosis in the celiac artery despite of median arcuate ligament decompression.Vascular reconstruction has satisfactory long-term patency rate,while endovascular treatment is less invasive.This article aims to summarize the consensuses and advances and shed light on the surgical treatment of MALS.


Subject(s)
Celiac Artery/surgery , Constriction, Pathologic/surgery , Decompression, Surgical , Humans , Laparoscopy , Ligaments/surgery , Median Arcuate Ligament Syndrome/surgery
7.
J. oral res. (Impresa) ; 9(6): 457-465, dic. 31, 2020. ilus, tab
Article in English | LILACS | ID: biblio-1178939

ABSTRACT

Soft tissue calcifications can indicate the presence of more serious, potentially life-threatening pathologies. Therefore, their study can lead to an early diagnosis of those conditions that have not yet become clinically apparent. Main objective: To determine the prevalence of calcifications in soft tissues of the head and neck in cone beam computed tomography images obtained from the Oral and Maxillofacial Radiology Service at Universidad Andrés Bello (UNAB), Viña del Mar, Chile. Material and Methods: Retrospective, cross-sectional, quantitative study. A total of 288 images of cone beam computed tomography (CBCT) were used. Images were obtained at random from the database of the Oral and Maxillofacial Radiology Service at UNAB, Viña Del Mar, between 2014 and 2019. Results: A prevalence of 59.72% of soft tissue calcifications was obtained. The most prevalent were: tonsilloliths and calcified stylohyoid ligament, accounting for 30.65% and 45.56%, respectively. Conclusion: A high prevalence of soft tissue calcifications was found in a population that has not been studied previously; therefore, it is important that the dentist perform a detailed analysis of the cone beam computed tomography.


Introducción: Las calcificaciones en tejidos blandos pueden indicar patologías más graves, que incluso pueden comprometer la vida. Por lo tanto, investigarlas puede conducir a un diagnóstico temprano de aquellas que aún no se han manifestado clínicamente. Objetivo principal: determinar la prevalencia de calcificaciones en tejidos blandos de cabeza y cuello en tomografía computarizada de haz cónico del Servicio de Radiología Oral y Maxilofacial de la UNAB, Viña del Mar, Chile. Material y Métodos: Estudio retrospectivo, transversal, cuantitativo. Se utilizaron 288 volúmenes de tomografía computarizada de haz cónico (CBCT, por las iniciales en inglés de Cone Beam Computed Tomography), obtenidas al azar, de la base de datos del Servicio de Radiología Oral y Maxilofacial de la Universidad Andrés Bello (UNAB), Viña del Mar entre 2014 y 2019. Resultados: Se obtuvo una prevalencia de 59.72% de calcificaciones en tejidos blandos. Las más prevalentes fueron: tonsilolitos, con un 30,65% y ligamento estilohioídeo calcificado, con un 45,56%. Conclusión: Se encontró una alta prevalencia de calcificaciones en tejidos blandos en una población que no ha sido estudiada previamente, por ello es importante que el odontólogo realice un análisis detallado de la tomografía computarizada de haz cónico.


Subject(s)
Humans , Male , Female , Calcinosis/diagnostic imaging , Cone-Beam Computed Tomography/methods , Head/diagnostic imaging , Neck/diagnostic imaging , Palatine Tonsil/diagnostic imaging , Calcinosis/epidemiology , Chile , Prevalence , Retrospective Studies , Ligaments
8.
Rev. bras. ortop ; 55(6): 771-777, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156205

ABSTRACT

Abstract Objective To evaluate different femoral fixation devices for medial patellofemoral ligament reconstruction and compare their effectiveness regarding fixation strength up to failure in porcine knees. Methods Thirty porcine knees were used, divided into three groups of 10 knees. The removed grafts were dissected from the extensor tendons of porcine feet. In each group, the graft was fixed to the femur with an interference screw, an anchor, or adductor tenodesis. The three methods were subjected to biomechanical tests using a universal Tensile testing machine at a speed of 20 mm/minute. Results The highest average linear resistance under lateral traction occurred in group 1, "screw fixation" (185.45 ± 41.22 N), followed by group 2, "anchor fixation" (152.97 ± 49, 43 N); the lower average was observed in group 3, "tenodesis fixation" (76.69 ± 18.90 N). According to the fixed error margin (5%), there was a significant difference between groups (p < 0.001); in addition, multiple comparison tests (between group pairs) also showed significant differences. Variability was small, since the variance coefficient was lower than 33.3%. Conclusion Interference screws in bone tunnels and mountable anchors fixation with high resistance wire are strong enough for femoral fixation in porcine medial patellofemoral ligament reconstruction. Adductor tenodesis, however, was deemed fragile for such purpose.


Resumo Objetivo Avaliar diferentes dispositivos de fixação femoral na reconstrução do ligamento patelofemoral medial para comparar sua eficácia quanto à força de fixação até a falha em joelhos suínos. Métodos Foram ensaiados 30 joelhos de suínos subdivididos em 3 grupos de 10 joelhos. Os enxertos retirados foram dissecados de tendões extensores das patas dos suínos. Cada grupo teve o enxerto fixado ao fêmur com parafuso de interferência, âncora, ou tenodese no tendão adutor. Os 3 métodos foram submetidos à testes biomecânicos utilizando uma máquina universal de ensaio de tração com uma velocidade de 20 mm/min. Resultados Verificamos que a média mais elevada da resistência linear sob tração lateral (185,45 ± 41,22 N) ocorreu no grupo 1: "fixação por parafuso," seguido do grupo 2: "fixação por âncora" (152,97 ± 49,43 N), e a média foi menor no grupo 3: "fixação por tenodese" (76,69 ± 18,90 N). Para a margem de erro fixada (5%), comprovou-se a diferença significativa entre os grupos (p < 0,001) e também através dos testes de comparações múltiplas (entre os pares de grupos) verificou-se a ocorrência de diferenças significativas. A variabilidade expressada por meio do coeficiente de variação mostrou-se reduzida, já que a referida medida foi inferior a 33,3%. Conclusão O uso de parafusos de interferência no túnel ósseo de joelhos porcinos é suficientemente forte para fixação femoral na reconstrução do ligamento patelofemoral medial, assim como a fixação com âncoras montáveis com fio de alta resistência. Entretanto, a tenodese no tendão adutor mostrou-se frágil para essa finalidade.


Subject(s)
Animals , Orthopedic Fixation Devices , Swine , Tendons , Traction , Effectiveness , Biomechanical Phenomena , Bone and Bones , Suture Techniques , Transplants , Models, Animal , Tenodesis , Patellofemoral Joint , Femur , Ligaments , Methods
9.
Rev. bras. ortop ; 55(6): 800-803, Nov.-Dec. 2020. graf
Article in English | LILACS | ID: biblio-1156198

ABSTRACT

Abstract Intraarticular dislocation of the patella is an uncommon condition, with displacement in the horizontal or vertical plane, which may be associated with total or partial lesion/rupture of the quadriceps tendon, with osteochondral or collateral ligament injury. Risk factors are ligament laxity, patellar hypermobility, high patella, and trochlear dysplasia. This condition is more common in young people and may require blood reduction. Cases of intraarticular dislocation of the patella are rare events, requiring diagnostic suspicion and differentiated management. The aim of the present study is to report a rare case of intraarticular dislocation of the patella, as well as its clinical condition, diagnosis, management and literature review.


Resumo Luxação intra-articular da patela é uma afecção incomum, podendo ocorrer deslocamento no plano horizontal ou vertical; pode se associar com lesão/ruptura do tendão do quadríceps, total ou parcial, com lesão osteocondral ou dos ligamentos colaterais. Fatores de risco são: frouxidão ligamentar, hipermobilidade patelar, patela alta e displasia troclear, e é mais comum em jovens, podendo necessitar de redução cruenta. Casos de luxação intra-articular da patela são eventos raros, sendo necessários uma suspeição diagnóstica e um manejo diferenciado. O objetivo deste trabalho é relatar um caso raro de luxação intra-articular da patela, assim como seu quadro clínico, diagnóstico, conduta e revisão da literatura.


Subject(s)
Humans , Female , Aged , Patella , Risk Factors , Collateral Ligaments , Patellar Dislocation , Joint Dislocations , Joint Instability , Knee Joint , Ligaments
10.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1154-1162, July-Aug. 2020. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1131491

ABSTRACT

This study set out to determine normal values for acoustic radiation force impulse (ARFI) elastography of the superficial digital flexor tendon, deep digital flexor tendon, accessory ligament of the deep digital flexor tendon and suspensory ligament in horses. Twenty-four horses were submitted to conventional sonographic assessment and elastography imaging (quantitative ARFI method) of distal forelimb tendons and ligaments at nine anatomical regions. Elastograms depicted tendons and ligaments in orange to red tones consistent with greater stiffness. Shear wave velocity was higher in the longitudinal compared to the cross-sectional plane but did not differ significantly between the left and right forelimbs. The suspensory ligament was stiffer compared to remaining structures in the cross-sectional plane. Ligaments were stiffer than tendons and the deep digital flexor tendon was stiffer than the superficial digital flexor tendon in the longitudinal plane. Target structures were stiffer in male compared to female horses and stiffness tended to increase with age. ARFI elastography proved to be a feasible and reproducible imaging modality for assessment of distal forelimb tendons and ligaments in horses. Qualitative features derived from stiffness quantification in these structures can be applied to horses with musculoskeletal disorders, as well as to other animal species.(AU)


Este trabalho objetivou estabelecer valores de referência por meio da elastografia ARFI ("Acoustic Radiation Force Impulse") do tendão flexor digital superficial, tendão flexor digital profundo, ligamento acessório inferior e ligamento suspensor do boleto em equinos hígidos. Vinte e quatro equinos foram submetidos aos exames ultrassonográfico e elastográfico (método ARFI quantitativo) dos tendões e ligamentos da porção distal do membro torácico, em nove regiões anatômicas diferentes. Os elastogramas mostraram tendões e ligamentos de coloração alaranjada a vermelha, que representam maior rigidez. Não houve diferenças em relação ao membro avaliado; as velocidades de cisalhamento foram maiores nos planos longitudinais. No plano transversal, os ligamentos suspensores foram mais rígidos em comparação aos demais. No plano longitudinal, os ligamentos mostraram-se mais rígidos que os tendões, e o tendão flexor digital profundo, mais rígido que o tendão flexor digital superficial. As estruturas mostraram-se mais rígidas nos machos, e houve uma tendência à maior rigidez em animais mais velhos. A elastografia ARFI comprovou ser um método viável e reprodutível para avaliação dos tendões e ligamentos dos membros torácicos de equinos. As características qualitativas obtidas a partir da rigidez dessas estruturas podem ser utilizadas para testes em equinos com distúrbios musculoesqueléticos e também em outras espécies animais.(AU)


Subject(s)
Animals , Tendons/diagnostic imaging , Elasticity Imaging Techniques/veterinary , Horses , Ligaments/diagnostic imaging , Musculoskeletal System/diagnostic imaging
11.
Rev. MVZ Córdoba ; 25(2): 71-80, mayo-ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1340775

ABSTRACT

RESUMEN Objetivo. Determinar los parámetros morfométricos ultrasonográficos de los tendones y ligamentos metacarpales palmares de caballos criollos colombianos clínicamente sanos. Materiales y métodos. Treinta caballos criollos colombianos clínicamente sanos de 6.4 ± 2.5 años se evaluaron en diferentes zonas del departamento de Córdoba (Colombia). Se midieron las variables área transversal (cm2), ancho latero medial (ALM) (cm) y espesor dorso palmar (EDP) (cm) en las estructuras de la región metacarpiana en los dos miembros anteriores mediante ultrasonografía. Resultados. La ecografía reveló que el área transversal del ligamento suspensorio fue la estructura de mayor área en las regiones proximales (1A, 1B y 2A), tanto para la extremidad izquierda como para la derecha. Por otro lado, no hubo una diferencia significativa (p>0.05) entre la extremidad izquierda y derecha para las mediciones de las estructuras en cualquier zona, y no hubo una diferencia significativa entre los grupos de edades e índice de masa corporal (IMC) de los caballos. Conclusiones. Se obtuvieron valores de referencia para los tendones y ligamentos en la región metacarpiana palmar en equinos proporcionando una guía de referencia cuando se sospechan condiciones patológicas metacarpo en equinos.


ABSTRACT Objective. To determine the ultrasonographic morphometric parameters of the palmar metacarpal tendons and ligaments of clinically healthy Colombian creole horses. Materials and methods. Thirty clinically healthy Colombian creole horses of 6.4 ± 2.5 years were evaluated in different areas of the department of Córdoba (Colombia). The variables cross-sectional area (cm2), medial lateral width (ALM) (cm) and dorsal palmar thickness (EDP) (cm) in the structures of the metacarpal region in the two anterior members were measured by means of ultrasound. Results. Ultrasonography revealed that the transverse area of the suspensory ligament was the structure with the largest area in the proximal regions (1A, 1B and 2A), for both the left and right limbs. On the other hand, there was no significant difference (P> 0.05) between left and right limb for measurements of structures in any area, and there was no significant difference between age groups and body mass index (BMI) of horses. Conclusions. Reference values for tendons and ligaments in the palmar metacarpal region were obtained in equines providing a reference guide when metacarpal pathological conditions in equines are suspected.


Subject(s)
Animals , Tendons , Ultrasonography , Horses , Anatomy , Ligaments
12.
Int. j. morphol ; 38(2): 472-476, abr. 2020. graf
Article in Spanish | LILACS | ID: biblio-1056464

ABSTRACT

El ligamento tibiofibular anterior suele presentar un fascículo distal independiente de la banda principal, denominado fascículo distal del ligamento tibiofibular anterior (FD-LTFA). Este discurre oblicuamente, cubriendo sus fibras más inferiores la zona anterolateral de la articulación talocrural. Su presencia se asocia a pellizcamiento del tobillo en esta zona, el cual puede producir un desgaste cartilaginoso de la cara anterolateral de la tróclea talar. El propósito de este estudio fue determinar la presencia y biometría del FD-LTFA, y su relación con la troclea talar en tobillos de un grupo de individuos Chilenos. En este estudio se utilizaron 30 miembros inferiores de cadáveres de individuos adultos. Se evaluó en el fascículo distal: Ancho en la inserción tibial, ancho en la inserción fibular, longitud del margen superior, longitud del margen inferior y el espesor. Se determinó si había contacto talar por parte del FD-LTFA y se observó desgaste articular en la superficie del domo talar, a nivel de la región de contacto del mencionado ligamento. El FD-LTFA fue encontrado en un 76,7 % de los casos, su anchura a nivel del sitio de fijación tibial fue de 5,30 mm (± 1,4) y a nivel fibular 4,43 mm (± 0,85). En cuanto a su longitud en el margen superior fue de 14,26 mm (± 3,66) y a nivel del margen inferior fue de 16,74 mm (± 2,91). Su espesor fue de 2,1 mm (± 0,36). En las 23 muestras de tobillo con presencia del FD-LTFA, hubo contacto talar en el 100 % de los casos y desgaste articular en esta zona en 3 de ellas (13,04 %). Los datos biométricos aportados por este estudio complementarán el conocimiento anatómico del FD-LTFA en la población Chilena.


The anterior tibiofibular ligament usually presents an independent distal fascicle of the main band, denominated distal fascicle of the anterior tibiofibular ligament (DF-ATiFL). Which obliquely passes, covering its most inferior fiber to the anterolateral corner of the talocrural articulation. Its presence is associated with the anterolateral impingement of the ankle in this area, which can produce cartilage wear of the anterolateral surface of the talar trochlea. The purpose of this study was to determine the presence and biometry of DF-ATiFL and its relation with the talar trochlea on the ankles of a group of Chilean individuals. Thirty inferior members were used in this study, all from adult individuals. It was evaluated: Width of the tibial insertion, width of the fibular insertion, length of the top margin, length of the bottom margin, and the thickness. It was determined whether there was talar contact by the distal fascicle of the anterior tibiofibular ligament. Also, it was observed the articular wear on the surface of the talar dome, at the level of the contact region of the distal fascicle of the anterior tibiofibular ligament. The DFATiFL was found in 76.7 % of the cases, its width at the level of the place of tibial fixation was 5.30 mm (± 1.40), and at the fibular level 4.43 mm (± 0.85). Regarding its length on the top margin was 14.26 mm (± 3.66), and at the bottom, the margin level was 16.74 mm (± 2.91). Its thickness was 2.1 mm (± 0.36). In the 23 ankles samples with the presence of DF-ATiFL, there was talar contact in 100 % of the cases and articular wear in this area in 3 of them (13.04 %). The biometric data contributed by this study will supplement the anatomical knowledge of the distal fascicle of the anterior tibiofibular ligament on the Chilean population.


Subject(s)
Humans , Tibia/anatomy & histology , Fibula/anatomy & histology , Ligaments/anatomy & histology , Ankle/anatomy & histology , Talus/anatomy & histology
13.
Article in Korean | WPRIM | ID: wpr-811451

ABSTRACT

PURPOSE: This study aimed to investigate the effect of hospital-based intensive rehabilitation program after ankle ligament operation.METHODS: A total of 35 patients were included in this randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Home-based exercise was conducted in the control group. Outcomes were evaluated at baseline, 12 weeks, and 16 weeks. The primary outcome was measured using the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the American Orthopedic Foot and Ankle Society (AOFAS) score, ankle strength measured using an isokinetic device, fall index measured using a Tetrax posturography device, and the Berg Balance Scale.RESULTS: Significant improvements in FAOS, AOFAS, ankle strength, and fall index were found in the intervention group after performing the hospital-based rehabilitation (all p<0.05) and these improvements were sustained at T2 (all p<0.05). Between-group comparisons demonstrated significantly greater improvements in FAOS, AOFAS, ankle strength, and fall index in the intervention group than those in the control group at both T1 (all p<0.05), and T2 (all p<0.05).CONCLUSION: The rehabilitation program in this study improved postoperative pain, sports function, quality of life, and strength and balance of the ankle significantly better than home-based self-care. Therefore, we recommend hospital-based systematic rehabilitation programs after surgical treatment for chronic ankle instability.


Subject(s)
Ankle , Foot , Humans , Ligaments , Orthopedics , Pain, Postoperative , Quality of Life , Recovery of Function , Rehabilitation , Self Care , Sports
14.
Article in Korean | WPRIM | ID: wpr-811286

ABSTRACT

PURPOSE: Pediatric intra-articularproximal phalangeal head fractures of the big toe are very rare and few studies on this have been published. The purpose of this study is to present the diagnostic approach and surgical management of these extremely rare fractures, which might be easily underestimated or misdiagnosed.MATERIALS AND METHODS: The study retrospectively reviewed all the patients who were diagnosed as intra-articular proximal phalangeal head fracture of the big toe and who underwent surgical intervention in our institution. The size of the bony fragment and hallux valgus interphalangeus angle were measured on the preoperative X-rays. The size and rotation of the osteochondral fragment, the presence of avascular necrosis, ligamentous injury and soft tissue entrapment were assessed on the preoperative magnetic resonance images (MRIs). The radiologic and functional evaluation were performed at 1 year postoperatively.RESULTS: The average size of the bony fragments measured on the X-rays was 4.1 mm in width and 2.3 mm in length. Two cases showed hallux valgus interphalangeus. Preoperative MRI was performed in four cases and the average size of any osteochondral lesion was 5.3 mm in width, 3.9 mm in length, and 4.7 mm in height. Rotation of the osteochondral fragment was observed in one patient, and soft tissue entrapment was noted in two patients. Postoperatively, successful bony union was achieved in all the patients and the average time to union was 74.4 days.CONCLUSION: Intra-articular proximal phalangeal head fractures of the big toe are very rare and often neglected due to incomplete ossification in the pediatric population. It is important to suspect the presence of this intra-articular fracture and to appropriately implement further evaluation. Nonunion of chronic cases as well as acute fractures can be successfully treated through open reduction and internal fixation using multiple K-wires.


Subject(s)
Hallux Valgus , Hallux , Head , Humans , Intra-Articular Fractures , Ligaments , Magnetic Resonance Imaging , Necrosis , Retrospective Studies
15.
Article in English | WPRIM | ID: wpr-811283

ABSTRACT

Isolated posterolateral corner (PLC) injury associated with a Schatzker type 2 fracture is a very rare combination of injuries. A male who was driving a motor vehicle was injured after a collision accident. The plain radiographs and computed tomography scans of the knee showed a Schatzker type 2 fracture of the tibial plateau, mostly in the anterolateral portion of tibial plateau, and an avulsion fragment on the fibular tip. Magnetic resonance imaging showed no injury to cruciate ligaments, medial collateral ligament, or any meniscal injury. We performed an open reduction operation and internal fixation for treating the fracture. Six months later, he complained of instability. At 11 months later after initial operation, we performed the second operation for stabilizing the PLC. We present here a rare case of an isolated PLC injury associated with a Schatzker type 2 fracture. We discuss the mechanism of injury and review similar cases.


Subject(s)
Collateral Ligaments , Humans , Knee , Ligaments , Magnetic Resonance Imaging , Male , Motor Vehicles , Tibial Fractures
16.
Hip & Pelvis ; : 42-49, 2020.
Article in English | WPRIM | ID: wpr-811155

ABSTRACT

PURPOSE: To identify potential differences in interportal capsulotomy size and cross-sectional area (CSA) using the anterolateral portal (ALP) and either the: (i) standard anterior portal (SAP) or (ii) modified anterior portal (MAP).MATERIALS AND METHODS: Ten cadaveric hemi pelvis specimens were included. A standard arthroscopic ALP was created. Hips were randomized to SAP (n=5) or MAP (n=5) groups. The spinal needle was placed at the center of the anterior triangle or directly adjacent to the ALP in the SAP and MAP groups, respectively. A capsulotomy was created by inserting the knife through the SAP or MAP. The length and width of each capsulotomy was measured using digital calipers under direct visualization. The CSA and length of the capsulotomy as a percentage of total iliofemoral ligament (IFL) side-to-side width were calculated.RESULTS: There were no differences in mean cadaveric age, weight or IFL dimensions between the groups. Capsulotomy CSA was significantly larger in the SAP group compared with the MAP group (SAP 2.16±0.64 cm2 vs. MAP 0.65±0.17 cm2, P=0.008). Capsulotomy length as a percentage of total IFL width was significantly longer in the SAP group compared with the MAP group (SAP 74.2±14.1% vs. MAP 32.4±3.7%, P=0.008).CONCLUSION: The CSA of the capsulotomy and the percentage of the total IFL width disrupted are significantly smaller when the interportal capsulotomy is performed between the ALP and MAP portals, compared to the one created between the ALP and SAP. Surgeons should be aware of this fact when performing hip arthroscopy.


Subject(s)
Arthroscopy , Cadaver , Hip , Hip Joint , Joint Capsule , Ligaments , Needles , Pelvis , Surgeons
17.
Article in Chinese | WPRIM | ID: wpr-828233

ABSTRACT

OBJECTIVE@#To explore short-term clinical effect of surgical treatment for ankle fracture with complete rupture of deltoid ligament in young and middle-aged patients.@*METHODS@#From January 2016 to March 2019, 21 young and middle-aged patients with ankle joint fracture and complete rupture of the deltoid ligament were treated with internal fixation and repair of the medial deltoid ligament, including 16 males and 5 females, aged from 21 to 52 years old with an average of (38.6±7.3) years old, the time from injury to operation ranged from 1 to 7 days with an average of (3.8±1.5) days. Fracture healing time and complications were observed, changes of medial malleolus clearance before and after operation were compared, American Orthopaedic Foot and Ankle Society (AOFAS) score wasused to evaluate function of ankle joint at 18 months after operation.@*RESULTS@#Twenty-one patients were followed up from 18 to 26 months with an average of (21.7±1.2) months. The incisions were healed at stageⅠ, and fracture healing time ranged from 8 to 12 weeks with an average of (9.5±1.6) weeks. No wound infection, failure of internal fixation, and nerve injury occurred. Medial malleoius space decreased from (5.83±0.32) mm before operation to (2.69±0.25) mm after operation. Postoperative AOFAS score at 18 months was 91.43±4.14, 14 patients got excellent results, 6 good and 1 fair.@*CONCLUSION@#On the basis of stable fixation of fracture, repair of deltoid ligament could help restoring the medial anatomy of ankle joint in young and middle-aged patients, and could achieve good short term clinical effect.


Subject(s)
Adult , Ankle Fractures , Ankle Injuries , Ankle Joint , Female , Fracture Fixation, Internal , Humans , Ligaments , Male , Middle Aged , Treatment Outcome , Young Adult
18.
Article in Chinese | WPRIM | ID: wpr-879357

ABSTRACT

Ligament tissue engineering is currently a novel approach to the treatment of ligament injury, which can replace the deficiency of autografts. Ligament tissue engineering consists of four basic elements:seed cells, nanoscaffolds, growth factors, and mechanical stimulation. At present, the main problem in ligament tissue engineering is how to control seed cells to ligament cells more controllly. The study found that each physical property of the natural bio ligament and mechanical stimulation (uniaxial stretching) plays an important role in the differentiation of stem cells into ligament cells. Therefore, the design of nanofiber scaffolds must consider the elastic modulus of the material and the material. Structure(material arrangement, porosity and diameter, etc.), elastic modulus and material structure in different ranges will guide cells to differentiate into different lineages. Considering that the ligament is the main force-bearing tissue of the human body, mechanical stimulation is also essential for stem cell differentiation, especially uniaxial stretching, which best meets the stress of the ligament in the body. A large number of studies have found the frequency and amplitude of stretching. And time will also lead the cells to differentiate in different directions. RhoA/ROCK plays a regulatory role in cytoskeletal remodeling and cell differentiation. It is also found that RhoA/ROCK protein participates in the process of nanofiber arrangement and uniaxial stretching to guide stem cells to differentiate into ligament cells, specifically how to influence stem cell differentiation. It is not clear at present that understanding the effects of physical properties on stem cell differentiation and understanding the mechanism of action of RhoA/ROCK protein will provide a new theoretical basis for further optimization of ligament tissue engineering.


Subject(s)
Cell Differentiation , Environment , Humans , Ligaments , Research , Tissue Engineering , Tissue Scaffolds
19.
Rev. bras. ortop ; 54(6): 697-702, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1057951

ABSTRACT

Abstract Objective Comparative biomechanical analysis of tibial fixation strength for ligament reconstruction with interference screw compared with screw post and washer, and compared with the associated fixation of both methods (hybrid fixation). Method A total of 54 specimens were used (porcine tibias and bovine flexor digital tendons), which were divided into three groups with fixation types similar to those used in anterior cruciate ligament (ACL) reconstruction: 1) fixation with interference screw; 2) fixation with screw post and toothed washer over knot and suture strand; and )- fixation with screw post and washer combined with interference screw (hybrid fixation). The analyses were performed through pull-out biomechanical tensile tests to determine the stiffness and load to system failure (yield load). Results The hybrid fixation group presented a significantly higher final stiffness (59.10 ± 3.45 N/mm) in comparison to the other groups (p < 0.05) and a higher yield load (581.34 ± 33.48 N) compared to the interference screw group (p < 0.05). Conclusion Hybrid fixation had biomechanical advantages over the bovine digital flexor graft fixation system in swine tibia during tensile tests.


Resumo Objetivo Análise biomecânica comparativa da resistência da fixação tibial para reconstrução ligamentar com parafuso de interferência, comparada com parafuso do tipo poste com arruela, e com fixação associada entre os métodos (fixação híbrida). Métodos Foram utilizados 54 corpos de prova (tíbia suína e tendão digital bovino), que foram divididos em 3 grupos com tipos de fixação semelhantes àqueles utilizados na reconstrução do ligamento cruzado anterior: 1) fixação com parafuso de interferência; 2) fixação com parafuso do tipo poste com arruela dentada sobre nó e fios de sutura; e 3) fixação com parafuso do tipo poste com arruela combinada com parafuso de interferência (fixação híbrida). Os testes foram realizados por meio de ensaios biomecânicos de tração tipo pull-out para determinação da rigidez e carga para falha (yield load) do sistema. Resultados O grupo com fixação híbrida apresentou maior rigidez final (59,10 ± 3,45 N/mm) do que os demais grupos (p < 0,05), e carga superior para falha (581,34 ± 33,48 N) em relação ao grupo com parafuso de interferência (p < 0,05). Conclusão A fixação híbrida apresentou vantagens biomecânicas com relação ao sistema de fixação do enxerto de flexor digital bovino em tíbia suína durante os ensaios de tração.


Subject(s)
Animals , Swine , Tendons , Tibia , Traction , Cattle , Anterior Cruciate Ligament , Surgical Fixation Devices , Anterior Cruciate Ligament Reconstruction , Ligaments
20.
Arq. bras. med. vet. zootec. (Online) ; 71(5): 1469-1476, set.-out. 2019. graf
Article in English | VETINDEX, LILACS | ID: biblio-1038657

ABSTRACT

This study aimed to histologically evaluate the quality of tissue repair in equine suspensory ligament treated with two cell therapy protocols. All four limbs of six animals were operated simultaneously to remove a fragment in each ligament using a skin biopsy punch. Two days later, intralesional injections were performed using bone marrow mononuclear fraction (BM group), cultivated cells derived from adipose tissue (AT group), saline (positive control group), or no treatment (negative control group), in such way that each horse received all treatments. After sixty days biopsies were performed for histological analysis (H & E, Masson's trichrome and picrosirius red) and immunohistochemistry analysis (collagen type III). Histological findings (H & E and Masson's trichrome), birefringence intensity (through picrosirius) and collagen type III expression (through immunohistochemistry) were analyzed. Samples from treated groups had better birefringence intensity (P=0.007) and fiber alignment scores were superior compared to controls, though not statistically significant (P=0.08). Presence of inflammatory cells and intense staining for collagen type III occurred in all groups demonstrating an active healing process. In conclusion, both protocols resulted in improvement of tissue repair indicating their potential to be used as an adjuvant treatment of equine suspensory ligament disorders.(AU)


Este estudo teve como objetivo a avaliação histológica e imunoistoquímica do reparo do ligamento suspensório equino tratado com dois protocolos de terapia celular. Os quatro membros dos seis animais do experimento foram submetidos a procedimento cirúrgico em que um fragmento de cada ligamento foi retirado, utilizando-se punch de biópsia. Dois dias após o procedimento, aplicações intralesionais foram realizadas, por meio de aspirado de medula óssea (bone marrow-BM), células mesenquimais derivadas de tecido adiposo (adipose tissue-AT), solução salina (positive control group-PC) ou controle (negative control-NC). Após 60 dias, biópsias foram retiradas da região de reparo dos ligamentos e foram submetidas à análise histológica (HE, tricrômio de Masson, picrosírius red) e imunoistoquímica (colágeno tipo III). Diferentes variáveis histológicas (HE e tricrômio de Masson), a intensidade de birrefringência das fibras colágenas (picrosírius red) e a expressão de colágeno tipo III foram avaliadas. Os grupos tratados apresentaram maior birrefringência (P=0,007) e alinhamento de fibras (P=0,08) comparados ao controle, para o qual o resultado não se mostrou estatisticamente significativo. Achados histológicos e imunoistoquímicos demonstraram um processo ativo de reparo tecidual em todos os grupos. Concluiu-se que os dois protocolos de terapia celular apresentaram melhora no reparo tecidual, demonstrando potencial terapêutico adjuvante no tratamento de afecções do ligamento suspensório equino.(AU)


Subject(s)
Animals , Cell- and Tissue-Based Therapy/methods , Cell- and Tissue-Based Therapy/veterinary , Horses/anatomy & histology , Ligaments/anatomy & histology , Ligaments/chemistry , Immunohistochemistry/veterinary
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