Rotura do tendão semimembranoso ­ Relato de caso de uma rara rotura tendínea / Semimembranous tendon rupture ­ Case report of a rare tendon rupture

Contexto: A rotura da inserção distal do tendão semimembranoso é uma lesão ocasionada no tendão de um dos músculos do grupo isquiotibiais, acarretando dor no joelho. Para o diagnóstico da lesão do tendão semimembranoso, a ressonância magnética é a principal modalidade de imagem. Descrição do caso: Homem de 63 anos acusa dor no joelho esquerdo há 1 semana. Apresenta melhora da dor com repouso e medicação. Ao exame físico, apresenta teste de Waldron positivo e testes de McMurray e Appley negativos, com edema articular, sem hematomas, apresentando limitação à movimentação devido à dor. A ressonância magnética apresenta a rotura do semimembranoso, e o tratamento foi realizado com medicação analgésica e anti-inflamatória. Discussão: Essa rotura é rara, e surge de uma força em valgo em uma perna hiperextendida externamente. O uso de esteroides anabolizantes pode aumentar o risco de rotura do tendão. Contudo, a ultrassonografia é um método de fácil acesso e é cada vez mais utilizada. O diagnóstico é realizado por meio de ressonância magnética. Seu tratamento pode ser realizado com anti-inflamatórios ou reparo cirúrgico. Conclusão: Relatamos um caso de rotura do tendão semimembranoso, composta por uma sintomatologia como dor no joelho, que pode ser tratada com anti-inflamatório ou reparo cirúrgico.

Outcome of percutaneous reconstruction of chronic lateral collateral ligament rupture / 中华创伤杂志(英文版)

PURPOSE@#Many techniques have been described for the reconstruction of chronic lateral collateral ligament (LCL) rupture with different autograft options. The advantages of percutaneous LCL reconstruction include small incisions, minimal soft tissue disruption, less postoperative pain, and speedy rehabilitation and recovery. The aim of this study was to report the functional outcome of percutaneous LCL reconstruction and overall patient satisfaction in Africans.@*METHODS@#This prospective and interventional study involving 51 patients with chronic LCL rupture who had percutaneous LCL reconstruction using peroneus longus autograft was conducted between January 2021 and December 2022 in National Orthopaedic Hospital, Dala-Kano, Nigeria. The inclusion criteria were patients between the ages of 18 and 45 years with chronic isolated LCL and not more than 1 injury of knee ligament. Exclusion criteria were active infection, and multi-ligament knee injury requiring 2-staged surgery. The knee functions were assessed preoperatively, 3 months, 6 months, and 12 months postoperatively using the Lysholm scoring system. Patient satisfaction with the outcome of the treatment was assessed using a 5-point Likert scale. Relevant information was recorded into Microsoft Excel sheet and data was analyzed using SPSS version 23.0 for windows. The paired samples t-test was used to compare the clinical outcomes as continuous variables. Statistical significance was considered at p < 0.05.@*RESULTS@#The mean age of the patients was (30.10 ± 5.90) years. The median time from injury to surgery was 7 months (ranging from 3 to 28 months). The mean follow-up period was (14.07 ± 3.13) months. The mean preoperative and 1-year postoperative Lysholm scores were 44.33 ± 12.97 and 97.96 ± 1.23, respectively.@*CONCLUSION@#Percutaneous LCL reconstruction using peroneus longus autograft significantly improves patient knee function and results in excellent patient satisfaction.

Progress on study of factors influencing the prognosis and complications of surgery for discoid meniscus injury in children / 中国骨伤

The discoid meniscus is a common congenital meniscal malformation that is prevalent mainly in Asians and often occurs in the lateral discoid meniscus. Patients with asymptomatic discoid meniscus are usually treated by conservative methods such as observation and injury avoidance, while patients with symptoms and tears need to be treated surgically. Arthroscopic saucerization combined with partial meniscectomy and meniscus repair is the most common surgical approach., and early to mid-term reports are good. The prognostic factors are the patient's age at surgery、follow-up time and type of surgery. Some patients experience complications such as prolonged postoperative knee pain, early osteoarthritis, retears and Osteochondritis dissecans. The incidence of prolonged postoperative knee pain was higher and the incidence of Osteochondritis dissecans was the lowest. Retears of the lateral meniscus is the main reason for reoperation.

Effect of nerve growth factor on elderly degenerative knee osteoarthritis pain / 中国骨伤

OBJECTIVE@#To explore effect of nerve growth factor (NGF) antibody on knee osteoarthritis (KOA) pain model was evaluated by in vitro model.@*METHODS@#Thirty male SPF rats aged 28-week-old were divided into blank group (10 rats with anesthesia only). The other 20 rats were with monoiodoacetate (MIA) on the right knee joint to establish pain model of OA, and were randomly divided into control group (injected intraperitoneal injection of normal saline) and treatment group (injected anti-NGF) intraperitoneal after successful modeling, and 10 rats in each group. All rats were received retrograde injection of fluorogold (FG) into the right knee joint. Gait was assessed using catwalk gait analysis system before treatment, 1 and 2 weeks after treatment. Three weeks after treatment, right dorsal root ganglia (DRG) were excised on L4-L6 level, immunostained for calcitonin gene-related peptide (CGRP), and the number of DRGS was counted.@*RESULTS@#In terms of gait analysis using cat track system, duty cycle, swing speed and print area ratio in control and treatment group were significantly reduced compared with blank group (P<0.05). Compared with control group, duty cycle and swing speed of treatment group were significantly improved (P<0.05), and there was no significant difference in print area ratio between treatment group and blank group (P>0.05). The number of FG-labeled DRG neurons in control group was significantly higher than that in treatment group and blank group (P<0.05). The expression of CGRP in control group was up-regulated, and differences were statistically significant compared with treatment group (P<0.05).@*CONCLUSION@#Intraperitoneal injection of anti-NGF antibody inhibited gait injury and upregulation of CGRP in DRG neurons. The results suggest that anti-nerve growth factor therapy may be of value in treating knee pain. NGF may be an important target for the treatment of knee OA pain.

Retrospective analysis and comparison of total internal disability preservation technique and standardized reconstruction technique / 中国骨伤

OBJECTIVE@#To investigate the efficacy and clinical results of total internal protection technique in anterior cruciate ligament reconstruction.@*METHODS@#A total of 56 patients undergoing anterior cruciate ligament reconstruction treated from January 2018 to December 2019 were selected. According to the different surgical methods, they were divided into total internal reconstruction group and standard bone tunnel group. There were 21 patients in the total internal reconstruction group, including 15 males and 6 females, aged from 20 to 48 with an average of (35.6±6.7) years old, and 35 patients in the standard tibial tunnel group, including 26 males and 9 females, aged 22 to 51 years old with an average of (33.7±9.6) years old. Preoperative examination of Lachman test was positive, magnetic resonance indicated anterior cruciate ligament rupture. There were no significant differences between the two groups in age, sex, body mass index, time from injury to ACL reconstruction, combined meniscus injury and operation method, operation time, ligament diameter, ligament length and other general information. Postoperative evaluation included operation duration, length and diameter of transplanted tendon after braid. International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score and perioperative complications 2 years after surgery.@*RESULTS@#Both groups were followed up, ranging from 24 to 30 months with an average of (26.9±3.4) months. Postoperative incision healing was good, and no failure or joint infection occurred at the last follow-up. There was no statistically significant difference between the two groups in IKDC score, Lysholm score and Tegner score before, 1 year and 2 years after surgery. However, IKDC score, Lysholm score and Tegner score at 1 year and 2 years after surgery.@*CONCLUSION@#The same postoperative function and stability of knee joint can be obtained by both the residual whole technique and the standardized reconstruction technique. In the residual whole group, only the semitendinosus muscle is taken, and the femoral thin muscle is retained, with greater tibial bone mass preserved, which is safe and effective in clinical practice.

Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA).@*METHODS@#The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups ( P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded.@*RESULTS@#There was no significant difference in total blood loss and hidden blood loss between the two groups ( P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups ( P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups ( P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation ( P<0.05), but there was no significant difference between the two groups on the 3rd day after operation ( P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant ( P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups ( P>0.05).@*CONCLUSION@#The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.

Effects of higher femoral tunnels on clinical outcomes, MRI, and second-look findings in double-bundle anterior cruciate ligament reconstruction with a minimal 5-year follow-up / 中华医学杂志(英文版)

BACKGROUND@#To perform anatomical anterior cruciate ligament reconstruction (ACLR), tunnels should be placed relatively higher in the femoral anterior cruciate ligament (ACL) footprint based on the findings of direct and indirect femoral insertion. But the clinical results of higher femoral tunnels (HFT) in double-bundle ACLR (DB-ACLR) remain unclear. The purpose was to investigate the clinical results of HFT and lower femoral tunnels (LFT) in DB-ACLR.@*METHODS@#From September 2014 to February 2016, 83 patients who underwent DB-ACLR and met the inclusion and exclusion criteria were divided into HFT-ACLR (group 1, n = 37) and LFT-ACLR (group 2, n = 46) according to the position of femoral tunnels. Preoperatively and at the final follow-up, clinical scores were evaluated with International Knee Documentation Committee (IKDC), Tegner activity, and Lysholm score. The stability of the knee was evaluated with KT-2000, Lachman test, and pivot-shift test. Cartilage degeneration grades of the International Cartilage Repair Society (ICRS) were evaluated on magnetic resonance imaging (MRI). Graft tension, continuity, and synovialization were evaluated by second-look arthroscopy. Return-to-sports was assessed at the final follow-up.@*RESULTS@#Significantly better improvement were found for KT-2000, Lachman test, and pivot-shift test postoperatively in group 1 ( P >0.05). Posterolateral bundles (PL) showed significantly better results in second-look arthroscopy regarding graft tension, continuity, and synovialization ( P <0.05), but not in anteromedial bundles in group 1. At the final follow-up, cartilage worsening was observed in groups 1 and 2, but it did not reach a stastistically significant difference ( P >0.05). No statistically significant differences were found in IKDC subjective score, Tegner activity, and Lysholm score between the two groups. Higher return-to-sports rate was found in group 1 with 86.8% (32/37) vs. 65.2% (30/46) in group 2 ( P = 0.027).@*CONCLUSION@#The HFT-ACLR group showed better stability results, better PL, and higher return-to-sports rate compared to the LFT-ACLR group.

Risk Factors for Symptomatic Cyclops Lesion Formation after Anterior Cruciate Ligament Reconstruction / Fatores de risco para formação de lesão cyclops sintomática após a reconstrução do ligamento cruzado anterior

Abstract Objective To evaluate the incidence of symptomatic cyclops lesions requiring surgical treatment after anterior cruciate ligament (ACL) reconstruction and to establish possible intraoperative risk factors related to it. Methods Three hundred and eighty-nine patients aged between 18 and 50 years who underwent primary ACL reconstruction were retrospectively evaluated. Patients were divided into groups according to the presence or absence of symptomatic cyclops lesions, and their characteristics were compared. Patients with associated lesions that required additional surgical procedures (except anterolateral extra-articular procedures) were not included. The rate of symptomatic cyclops lesions was recorded and the following parameters were evaluated: age, gender, time from injury to surgery, graft type and diameter, femoral tunnel perforation technique, fixation type, presence of knee hyperextension, preservation of the ACL remnant, associated anterolateral extra-articular procedure, associated meniscal injury and participation in sports. Results 389 patients were evaluated and 26 (6.7%) patients developed cyclops. The patients with and without cyclops lesions did not differ in age, time from injury to surgery, graft type or diameter, surgical technique, femoral fixation method, presence of knee hyperextension, remnant preservation and associated meniscal injury. The group with cyclops lesion had a higher proportion of females (10 (38.4%) vs 68 (18.7%); OR = 2.7; p= 0.015), higher proportion of extra-articular reconstruction (18 (11.8%) vs 8 (3.4%); OR = 3.8; p= 0.001) and higher proportion of sports practice (23 (8.6%) vs 3 (2.5%); OR = 3.6; p= 0.026). Conclusion In our series, 6.7% of the patients required arthroscopic removal of cyclops lesions. Female gender, associated extra-articular reconstruction and sports practice were factors related to this lesion. Remnant preservation had no relationship with cyclops lesion formation.

Resumo Objetivo Avaliar a incidência de lesões cyclops sintomáticas que precisam de tratamento cirúrgico após a reconstrução do ligamento cruzado anterior (LCA) e estabelecer os possíveis fatores de risco intraoperatórios relacionados a elas. Métodos Trezentos e oitenta e nove pacientes com idades entre 18 e 50 anos submetidos à reconstrução primária do LCA foram avaliados de forma retrospectiva. Os pacientes foram divididos em grupos de acordo com a presença ou ausência de lesões cyclops sintomáticas e suas características foram comparadas. Não foram incluídos pacientes com lesões associadas que necessitassem de outros procedimentos cirúrgicos (à exceção de procedimentos extra-articulares ântero-laterais). A taxa de lesões cyclops sintomáticas foi registrada e os seguintes parâmetros foram avaliados: idade, sexo, tempo da lesão à cirurgia, tipo e diâmetro do enxerto, técnica de perfuração do túnel femoral, tipo de fixação, presença de hiperextensão do joelho, preservação do LCA remanescente, associação a procedimento extra-articular ântero-lateral, lesão de menisco associada e participação em esportes. Resultados Dos 389 pacientes avaliados, 26 (6,7%) desenvolveram lesão cyclops. Os pacientes com e sem lesão cyclops não diferiram quanto à idade, tempo da lesão à cirurgia, tipo ou diâmetro do enxerto, técnica cirúrgica, método de fixação femoral, presença de hiperextensão do joelho, preservação do LCA remanescente e lesão de menisco associada. O grupo com lesão cyclops apresentou mais mulheres (10 [38,4%] vs. 68 [18,7%]; razão de probabilidades [OR] = 2,7; p= 0,015), maior proporção de reconstrução extra-articular (18 [11,8%] vs. 8 [3,4 %]; OR = 3,8; p= 0,001) e maior proporção de prática esportiva (23 [8,6%] vs. 3 [2,5%]; OR = 3,6; p= 0,026). Conclusão Em nossa série, 6,7% dos pacientes necessitaram de remoção artroscópica das lesões cyclops. O sexo feminino, a reconstrução extra-articular associada e a prática esportiva foram fatores relacionados a essa lesão. A preservação do menisco remanescente não foi associada à formação de lesões cyclops.

Internal Structural Connections in the Popliteus Tendon Complex with Posterior Cruciate Ligament and Clinical Implications / Conexiones Estructurales Internas en el Complejo Tendón Poplíteo con Ligamento Cruzado Posterior e Implicaciones Clínicas

SUMMARY: At present, the anatomical relationship the mid-portion of popliteus tendon complex (PTC) and the surrounding tissues is still unclear, especially its relationship to the posterior cruciate ligament (PCL). It affected the anatomical reconstruction of the posterolateral complex (PLC) injury. A total of 30 cases of the adult human knee joint fixed with formalin were used. Sagittal sections were made in 14 knee joints by the P45 plastination technique and dissection of 16 cases of knee joints. The P45 section revealed that the popliteus muscle fascia ran superiorly over the posterior edge of the tibial intercondylar eminence, and turned forward to be integrated into the PCL. Laterally, near the posterior edge of the lateral tibial plateau, the popliteus tendon penetrates through the articular capsule (AC), where two dense fibrous bundles were given off upwards by the popliteus tendon: one was the ventral fiber bundle, which ran superiorly over the posterior edge of the tibial plateau and then moved forwards to connect with the lateral meniscus; the dorsal fibers bundle ascended directly and participated in the AC. Meanwhile, the popliteus muscle dissection showed that at the posterior edge of the platform of the lateral condyle of the tibia, at the tendon-muscle transition, the PTC and AC were anchored to PCL.

En la actualidad, la relación anatómica entre la porción media del complejo tendinoso poplíteo (CTP) y los tejidos circundantes aún no está clara, especialmente su relación con el ligamento cruzado posterior (LCP). Esto afecta la reconstrucción anatómica de la lesión del complejo posterolateral (LCP). Se utilizaron un total de 30 casos de articulaciones de rodillas humanas de individuos adultos fijadas con formalina. Se realizaron cortes sagitales en 14 articulaciones de rodilla mediante la técnica de plastinación P45 y disección de 16 casos de articulaciones de rodilla. La sección P45 reveló que la fascia del músculo poplíteo discurría superiormente sobre el margen posterior de la eminencia intercondílea tibial y giraba hacia delante para integrarse en el LCP. Lateralmente, cerca del margen posterior de la platillo tibial lateral, el tendón poplíteo penetra a través de la cápsula articular (CA), donde el tendón poplíteo desprendió hacia arriba dos haces fibrosos densos: uno era el haz de fibras ventral, que corría superiormente sobre el margen posterior de la meseta tibial y luego se movió hacia adelante para conectar con el menisco lateral; el haz de fibras dorsales ascendía directamente y participaba en la CA. Por su parte, la disección del músculo poplíteo mostró que en el margen posterior del platillo del cóndilo lateral de la tibia, en la transición tendón-músculo, el CTP y el AC estaban anclados al LCP.

Calculation of the Minimal Important Clinical Difference of the Lysholm and IKDC Scores After Anterior Cruciate Ligament Reconstruction / Cálculo da mínima diferença clínica importante dos escores Lysholm e IKDC após reconstrução do ligamento cruzado anterior

Abstract Objective To calculate the minimal important clinical difference (MICD) value for the Lysholm and International Knee Documentation Committee (IKDC) scores in a sample of patients submitted to anterior cruciate ligament reconstruction. Methods Primary, observational, retrospective, analytical study of participants submitted to anterior cruciate ligament reconstruction from March 2019 to December 2020 by the same surgeon, with a minimum follow-up of 6 months, analysis of knee function in the pre- and postoperative period by the Lysholm and IKDC scores, and answer to an anchor question at 6 months postoperatively for the calculation of the MICD of each score. Results A total of 59 patients participated in the study, with a mean age of 27.1 ± 5.7 years old. In the comparison between pre- and postoperative scores of all groups, there was an increase in values with statistical significance after intervention. The MICD was 5.5 for the Lysholm score, and the MICD value for the IKDC score could not be determined. Conclusion For the Lysholm score, the calculation of the MICD value by the anchor question method in the sample evaluated was 5.5. It was not possible to determine the value of the MICD for the IKDC score.

Resumo Objetivo Calcular o valor da mínima diferença clinicamente importante (MDCI) para os escores de Lysholm e International Knee Documentation Commitee (IKDC) na amostra de pacientes submetidos a reconstrução de ligamento cruzado anterior. Métodos Estudo primário, observacional, retrospectivo, analítico, de participantes submetidos a reconstrução do ligamento cruzado anterior no período de março de 2019 a dezembro de 2020, pelo mesmo cirurgião, com seguimento mínimo de 6 meses, análise da função do joelho no período pré e pós-operatório pelos escores de Lysholm e IKDC, e resposta a uma pergunta âncora aos 6 meses de seguimento pós-operatório, para o MDCI de cada escore. Resultados Participaram do estudo 59 pacientes, com média de idade de 27,1 ± 5,7 anos. Na comparação dos escores pré- e pós-operatórios de todos os grupos, observa-se aumento dos valores com significância estatística após a intervenção. A MDCI foi de 5,5 para o escore de Lysholm, não tendo sido possível determinar o valor para o IKDC. Conclusão O cálculo do valor da MDCI pelo método da pergunta âncora, na amostra avaliada, foi de 5,5 para o escore de Lysholm. Não foi possível determinar o valor da MDCI para o IKDC.

Monoaxial Mechanical Tests on Porcino Knee Ligaments / Ensaios mecânicos monoaxiais nos ligamentos do joelho porcino

Abstract The failure of ligament reconstruction has different risk factors, among which we can highlight the period before its incorporation, which is a mechanically vulnerable period. Loss of resistance over time is a characteristic of living tissues. Dissection with bone insertions of the cruciate ligaments of animal models is not described; however, it is essential for monoaxial assays to extract information from tests such as relaxation. The present work describes the dissection used for the generation of a test body for the performance of nondestructive tests to evaluate the mechanical behavior. We performed dissection of four porcino knee ligaments, proposing a dissection technique for the cruciate ligaments with bone inserts for comparison with collateral ligaments. The ligaments were submitted to relaxation tests and had strain gauges placed during the tests. The results showed viscoelastic behavior, validated by strain gauges and with a loss over time; with some ligaments presenting with losses of up to 20%, a factor to be considered in future studies. The present work dissected the four main ligaments of the knee demonstrating the posterior approach that allows maintaining their bone insertions and described the fixation for the monotonic uniaxial trials, besides being able to extract the viscoelastic behavior of the four ligaments of the knee, within the physiological limits of the knee.

Resumo A falha da reconstrução ligamentar tem diferentes fatores de risco, dentre os quais podemos destacar o período antes da sua incorporação, o qual configura um período mecânico vulnerável. A perda de resistência ao longo do tempo é uma característica dos tecidos vivos. A dissecção com as inserções ósseas dos ligamentos cruzados de modelos animais não é descrita; todavia, para os ensaios monoaxiais, é fundamental extrair as informações de ensaios como os de relaxação. O presente trabalho realiza a descrição da dissecção utilizada para a geração de corpo de prova para a realização de ensaios não destrutivos para avaliar o comportamento mecânico. Realizamos dissecção de quatro ligamentos de joelho porcino, propondo uma técnica de dissecção para os ligamentos cruzados com as inserções ósseas para comparação com os colaterais. Os ligamentos foram submetidos a testes de relaxação e foram colocadas strain gauges durante os testes. Os resultados mostraram comportamento viscoelástico, validado pelas strain gauges e com uma perda ao longo do tempo, sendo que, em alguns ligamentos, as perdas chegaram a até 20%, fator este a ser considerado em trabalhos futuros. O presente trabalho dissecou os quatro principais ligamentos do joelho, demonstrando a abordagem posterior que permite manter as suas inserções ósseas e descrevendo a fixação para os ensaios uniaxiais monotônicos, além de ter conseguido extrair o comportamento viscoelástico dos quatro ligamentos do joelho dentro dos limites fisiológicos do joelho.

Atletas de Taekwondo apresentam desequilíbrio muscular entre os músculos flexores e extensores do joelho: achados preliminares / Taekwondo athletes have muscle imbalance between knee flexors and extensions: preliminary findings / Los atletas de Taekwondo presentan un desequilibrio muscular entre los flexores y los extensores de la rodilla: hallazgos preliminares

Durante a prática de taekwondo com movimentos repetitivos, sistematizados e com certa sobrecarga de treino, o indivíduo pode gerar possíveis adaptações orgânicas que resultam em problemas posturais com grandes chances de desencadear desequilíbrio muscular. Objetivo: Verificar a presença de desequilíbrio entre os grupos musculares agonistas e antagonistas da articulação do joelho e entre membros dominantes e não dominantes de praticantes de taekwondo por meio da dinamometria isocinética. Método: Estudo transversal, observacional e descritivo realizado com nove praticantes de taekwondo do sexo masculino. Utilizou-se um dinamômetro isocinético para investigar o pico de torque, pico de torque por peso corporal, trabalho total, potência média, relação agonista/antagonista e índice de fadiga. Os dados dos membros dominante e não dominante foram comparados por meio do teste t-student para amostras pareadas. Foram calculados o intervalo de confiança de 95% da diferença média, o tamanho de efeito e o poder das análises. Resultados: Os músculos extensores dos membros dominante e não dominante apresentaram diferença média significante de 15,49 Nm (IC95% 7,27; 23,70; p=0,002) para pico de torque e de 22,64% (IC95% 11,83; 33,46; p=0,001) para pico de torque por peso corporal a 60°/s, representando tamanho de efeito médio. Conclusão: Os atletas de taekwondo apresentaram maior pico de torque e maior pico de torque por peso corporal dos músculos extensores do joelho a 60º/s no lado dominante. A relação agonista/ antagonista foi inferior a 60% e mais da metade dos atletas apresentaram uma diferença maior que 10% no pico de torque flexor no lado não dominante.

During taekwondo practice with the repetitive motions, systematized and with certain training overload, the person can generate possible organic adaptations that result in postural problems with a great chances of triggering muscle imbalance. Objective: To verify the presence of imbalance between agonist and antagonist muscle groups of knee joint and between dominant and non-dominant limbs through isokinetic dynamometry. Methods: Cross-sectional, observational and descriptive study realized with nine male taekwondo practitioners. An isokinetic dynamometer was used to investigate the peak torque, peak torque by body weight, total work, average power, agonist/antagonist ratio and fatigue index. Data from the dominant and non-dominant limbs were compared by t-student test for pared samples. The 95% confidence interval of the mean difference, the effect size and the power of analyses power were calculated. Results: The extensor muscles of the dominant and non-dominant limbs showed mean difference of 15,49 Nm (IC95% 7,27; 23,70; p=0,002) for peak torque and of 22,64% (IC95% 11,83; 33,46; p=0,001) for peak torque by body weight at 60°/s, representing average effect size. Conclusion: The taekwondo athletes had higher peak torque and higher peak torque by body weight of the knee extensors muscles in the dominant side. The agonist/ antagonist ratio was less than 60% and more than half of the athletes showed a difference greater than 10% in the peak flexor torque on the non-dominant side.

Durante la práctica de taekwondo con los movimientos repetitivos, sistematizados y con cierta sobrecarga de entrenamiento, la persona puede generar posibles adaptaciones orgánicas que deriven en problemas posturales con grandes posibilidades de desencadenar desequilibrios musculares. Objetivo: Verificar la presencia de desequilibrio entre grupos musculares agonistas y antagonistas de la articulación de la rodilla y entre miembros dominantes y no dominantes mediante dinamometría isocinética. Métodos: Estudio transversal, observacional y descriptivo realizado con nueve practicantes masculinos de taekwondo. Se utilizó un dinamómetro isocinético para investigar el par máximo, el par máximo por peso corporal, el trabajo total, la potencia media, la relación agonista/antagonista y el índice de fatiga. Los datos de las extremidades dominantes y no dominantes se compararon mediante la prueba t- student para muestras de pared. Se calcularon el intervalo de confianza del 95% de la diferencia media, el tamaño del efecto y la potencia de los análisis. Resultados: Los músculos extensores de los miembros dominantes y no dominantes mostraron una diferencia media de 15,49 Nm (IC95% 7,27; 23,70; p=0,002) para el par máximo y de 22,64% (IC95% 11,83; 33,46; p=0,001) para el par máximo por peso corporal a 60°/s, lo que representa el tamaño medio del efecto. Conclusiones: Los atletas de taekwondo presentaron un mayor par máximo y un mayor par máximo por peso corporal de los músculos extensores de la rodilla en el lado dominante. La relación agonista/antagonista fue inferior al 60% y más de la mitad de los atletas mostraron una diferencia superior al 10% en el pico de par flexor en el lado no dominante.

Después de una cirugía de ligamento cruzado anterior, ¿cuándo puedo manejar? Evaluación postoperatoria de habilidades de conducción y de reacción de frenado / After anterior cruciate ligament surgery, when can I drive? Postoperative assessment of driving skills and braking reaction

Introducción: La mayoría de las personas que se someten a una reconstrucción del LCA están en edad de conducir, por lo tanto, es importante saber cuándo es seguro para el paciente reanudar la conducción. El objetivo de este trabajo es evaluar de manera prospectiva cuándo los pacientes recuperan las habilidades de manejo y de reacción de frenado después de la reconstrucción primaria de LCA, y compararlos con un grupo control de voluntarios sanos. Materiales y métodos: estudio prospectivo de una serie de pacientes que se sometieron a reconstrucción primaria del LCA utilizando injerto semitendinoso y recto interno. Se excluyeron pacientes en los que se empleó otro tipo de injerto o se les realizó otro gesto quirúrgico y laborales. Se evaluó la capacidad de volver a manejar de manera segura a las 2-3 semanas y a las 4-5 semanas postoperatorias mediante test de reacción simple y de resistencia a la monotonía, y se compararon los resultados con un grupo control de voluntarios sanos. Resultados: en total fueron ciento sesenta y seis pacientes, treinta fueron casos y ciento treinta y seis, controles. Se hallaron diferencias significativas (p = 0.03) entre los casos y controles en las pruebas realizadas tempranamente en cuanto a la aprobación, y no, de los test. Según el promedio en segundos obtenido en cada test realizado, se observan diferencias significativas en el primera prueba de resistencia a la monotonía (p = 0.0001) a favor del grupo control. Discusión: de acuerdo a la prueba de reacción simple y al test a la monotonía evaluados en nuestro trabajo, los pacientes que se someten a reconstrucción del LCA con autoinjertos de ST-RI están en condiciones de manejar un automóvil luego de las 4-5 semanas de la cirugía

Introduction: Most people who undergo ACL reconstruction are of driving age, it is important to know when it is safe for the patient to resume driving. The objective of this work was to prospectively evaluate when patients recover driving skills and brake reaction skills after ACL reconstruction and compare them with a control group of healthy volunteers. Materials and methods: prospective study of a series of patients who underwent primary ACL reconstruction using semitendinosus and medial rectus graft. Patients in whom another type of graft was used, or another surgical and labor gesture was performed, were excluded. The ability to return to driving safely at 2-3 weeks and 4-5 weeks postoperatively was evaluated using the simple reaction and resistance to monotony tests, and the results were compared with a control group of healthy volunteers.Results: a total of 166 patients, 30 are cases and 136 controls. Significant differences (p = 0.03) were found between cases and controls in the tests carried out early in terms of passing and not passing the tests. The relationship according to the average in seconds obtained in each test carried out, significant differences are observed in the first test of resistance to monotony (p = 0.0001) in favor of the control group. Discussion: according to the simple reaction test and the monotony test evaluated in our study, patients who undergo ACL reconstruction with ST-RI autografts are able to drive a car 4-5 weeks after surgery

Displasia troclear. ¿Cuándo indicar una trocleoplastia? / Trochlear Dysplasia. When to indicate a trochleoplasty?

La displasia troclear es una alteración anatómica frecuente en pacientes con inestabilidad patelar, representa, además, su principal factor de riesgo. A pesar de ello su diagnóstico e indicación quirúrgica siguen siendo un desafío para los cirujanos ortopédicos. En la presente revisión del tema se aborda la etiología, el proceso diagnóstico y clasificación basada en imágenes de esta patología, así como la indicación quirúrgica con base en la evidencia actual y la experiencia del autor senior del presente artículo

Trochlear dysplasia is a common anatomical abnormality in patients with patellar instability, representing their main risk factor. Despite this, its diagnosis and surgical indication remain a challenge for orthopedic surgeons.This topic review addresses the etiology, diagnostic process, and classification based on imaging, as well as the current surgical indication based on current evidence and the senior author's experience

Comparación cuantitativa de la ejecución de la maniobra de Lachman para su estandarización a través de software para dispositivo móvil / Quantitative comparison of the execution of the Lachman maneuver for its standardization through software for mobile devices

Introducción: la maniobra de Lachman es ampliamente empleada como recurso diagnóstico para detectar lesiones en el ligamento cruzado anterior (LCA) y, por su simplicidad, se tiende a pensar que no existe una variabilidad significativa en su ejecución. El presente estudio comparativo está centrado en utilizar los sensores integrados en un dispositivo móvil para encontrar, a través del índice de correlación intraclase, si las variaciones tanto intraobservador como interobservador son significativas. Materiales y métodos: se efectuaron dos ensayos llamados "Lachmatón", con doce residentes de ortopedia a modo de evaluadores y sujetos de prueba; el primer ensayo ayudó a identificar y describir las diferencias de los gestos de ejecución entre los evaluadores, mientras que el segundo permitió medir el incremento de la similitud de ejecución entre estos al ser instruidos, en contraste con el primer ensayo, donde no habían recibido ninguna instrucción; esto fue posible al medir la similitud características estadísticas y morfológicas de las señales adquiridas a través del índice de correlación intraclase. Resultados: se identificaron dos gestos importantes y que emiten señales con distinta forma al aplicarse, o no, a la ejecución de la maniobra: 1) fijar el pie y, 2) fijar el fémur. Se encontró una diferencia significativa entre ambos ensayos, así como entre los dos estilos más usados por los evaluadores. Conclusión: el uso de los sensores integrados en un dispositivo móvil para medir diferencias en la ejecución de la maniobra de Lachman ayudó a determinar los gestos que permiten una mayor reproducibilidad de esta maniobra. Nivel de Evidencia: III

Introduction: the Lachman maneuver was amplified as a diagnostic resource to detect injuries in the anterior cruciate ligament (ACL) and it tends to be thought, due to its simplicity, that there is no significant accumulation in its execution. This comparative study focuses on using the sensors integrated into a mobile device to find out whether the intraobserver or interobserver variations are significant, through the intraclass correlation coefficient. Materials and methods: two trials called "Lachmatón" will be carried out with twelve orthopedic residents as evaluators and test subjects; the first trial helped to identify and describe the differences in performance gestures between raters, while the second allowed measuring the increase in performance similarity between raters as instructors, in contrast to the first trial, where neither could instruction; This was possible by measuring the similarity of the statistical and morphological characteristics of the signals obtained through the intraclass achievement index.Results: two important gestures were identified, which emit signals in different ways when applied or not to the execution of the maneuver: 1) fix the foot and, 2) fix the femur. You will find that there is a significant difference between you and the evaluators. Conclusion: the use of sensors integrated into a mobile device to measure differences in the execution of the Lachman maneuver helped to determine the gestures that allow a greater reproducibility of this maneuver. Level of Evidence: III

¿Existen discrepancias entre la planificación preoperatoria y la evaluación intraoperatoria realizada por el cirujano en la artroplastia total de rodilla con asistencia robótica? / Are there discrepancies between preoperative planning and intraoperative evaluation by the surgeon in robotically assisted total knee arthroplasty?

Introducción: Existe poca evidencia respecto de la concordancia entre el plan preoperatorio mediante artroplastia total de rodilla asistida por robot y el plan posterior al balance protésico realizado por el cirujano. El objetivo de este trabajo es evaluar el grado de concordancia entre la planificación preoperatoria de la artroplastia total de rodilla con asistencia robótica semiactiva (Mako) y la planificación efectuada por el traumatólogo durante la cirugía. Materiales y métodos: estudio retrospectivo y descriptivo de prótesis primarias instaladas entre octubre de 2018 y junio de 2019 con planificación preoperatoria realizada por el software MAKOplasty®. Se excluyeron las prótesis no colocadas por el sistema robótico o con información clínica incompleta. Esto se comparó con la planificación intraoperatoria del traumatólogo. Variables analizadas: alineación coronal y sagital, rotación y tamaño de los componentes e inserto. Los datos se analizaron con el softwareSTATA v.16.0. Se realizó un análisis descriptivo univariante cualitativo, con un intervalo de confianza del 95%. Resultados: se incluyeron cincuenta y una rodillas operadas de cuarenta y nueve pacientes, el 69% fueron mujeres. El nivel de concordancia para el componente femoral fue: axial 86.3% (IC = 73.7 - 94.2), coronal 88.2% (IC = 76.1 - 95.5), sagital 88.2% (IC = 76.1 - 95.5). Componente tibial: axial 98% (IC = 89.5 ­ 99.9), coronal 96.1% (IC = 86.5 ­ 99.5), sagital 96.1% (IC = 86.5 ­ 99.5). Tamaño del componente: fémur 94.1% (IC = 83.7 ­ 98.7), tibia 84.3% (IC = 71.4 ­ 92.9), inserto 27.4% (IC = 15.8 ­ 41.7). Conclusión: la planificación preoperatoria mediante el uso de la asistencia robótica semiactiva de Mako presenta un buen nivel de concordancia con la planificada intraoperatoriamente, a excepción del tamaño del inserto. El traumatólogo es determinante en la modificación del plan preoperatorio. Nivel de Evidencia: III

Introduction: There is little evidence regarding the concordance between the preoperative plan using robotic-assisted total knee arthroplasty and that after the prosthetic balance by the surgeon. Our aim is to evaluate the level of agreement between the preoperative planning of total knee arthroplasty with semiactive robotic assistance (Mako) and the planning made by the orthopedic surgeon during the surgery. Materials and methods: descriptive study of prostheses installed between October 2018 and June 2019 with preoperative planning performed by the MAKOplasty® software. This was compared with intraoperative planning by the Orthopedic Surgeon. Variables analyzed: coronal and sagittal alignment, rotation and size of the components and insert. The data was analyzed with the STATA v.16.0 software. A qualitative univariate descriptive analysis was performed, with a 95% confidence interval. Results: fifty-one operated knees from forty-nine patients were included, 69% were women. The level of agreement was: Femoral component: axial 86.3% [CI = 73.7 - 94.2], coronal 88.2% [CI = 76.1 - 95.5], sagittal 88.2% [CI = 76.1 - 95.5]. Tibial component: axial 98% [CI = 89.5 - 99.9], coronal 96.1% [CI = 86.5 - 99.5], sagittal 96.1% [CI = 86.5 - 99.5]. Component size: femur 94.1% [CI = 83.7 - 98.7], tibia 84.3% [CI = 71.4 - 92.9], insert 27.4% [CI = 15.8 - 41.7]. Conclusion: preoperative planning through the use of Mako semiactive robotic assistance presents a good level of agreement with that planned intraoperatively, with the exception of the insert size. The orthopedic surgeon is decisive in modifying the preoperative plan. Level of Evidence: III

Osteotomía selectiva como tratamiento de la inestabilidad medial de rodilla / Selective osteotomy as a treatment for medial knee instability

Las fracturas de platillos tibiales son lesiones frecuentes. Una de sus complicaciones postoperatorias es la pérdida de reducción con desviación de los ejes en los planos coronal, sagital y axial. La depresión ósea genera incongruencia articular con pérdida de tensión de estructuras ligamentarias indemnes, causando una pseudo-laxitud con inestabilidad. Esto requiere de una corrección ósea para aumentar la tensión de dichas estructuras ligamentarias y lograr así recuperar la congruencia y estabilidad articular en todo el rango de movilidad. El objetivo del presente trabajo es reportar un caso de inestabilidad medial en un paciente joven, quien, tras una fractura de platillo tibial medial mal consolidada, requirió una osteotomía selectiva biplanar e intraarticular para corregir dicha deformidad

Tibial plateau fractures are frequent. Loss of reduction with axis deviation in the coronal, sagittal and axial planes is one of the postoperative complications.Bone depression generates joint incongruity with loss of tension in undamaged ligament structures resulting in pseudo-laxity with instability. This requires a bone correction to increase the tension of ligament structures, hence achieving the recovery of joint congruence and stability throughout the range of mobility.The objective of the current paper is to report a case of medial instability in a young patient, who suffered a medial tibial plateau fracture with poor bone consolidation, with consequent laxity and pain in the medial compartment, which required a selective biplanar and intra-articular osteotomy to correct such deformity.

Técnica quirúrgica para la reconstrucción del ligamento patelofemoral medial / Surgical technique for medial patellofemoral ligament reconstruction

La inestabilidad patelofemoral es uno de los problemas más frecuentes en pacientes jóvenes, y representa del 2 al 3% de todas las lesiones de rodilla. Significa una causa importante de morbilidad debido a la limitación de varias actividades de la vida diaria, y a largo plazo el surgimiento de artrosis. La inestabilidad patelofemoral es descripta como la deficiencia de la constricción pasiva que genera un desplazamiento lateral de la patela total o parcial de su posición normal con respecto a la tróclea. Los desórdenes patelofemorales son el resultado de una anatomía aberrante, están dados por una alteración en la alineación ósea y generan un desequilibrio biomecánico. Existen cuatro factores clásicos que generan inestabilidad patelar: patela alta, displasia troclear, alteración en la distancia (TT-TG) y excesiva inclinación patelar. Al generarse una luxación, el ligamento patelofemoral medial (LPFM) se ve afectado en al menos el 25% de los casos. El complemento diagnóstico se realiza a través de rayos X, tomografía computarizada y resonancia magnética. La restauración de la función por tratamiento quirúrgico ha mostrado resultados similares al conservador en primoluxaciones, sin embargo, se ha visto que la reconstrucción del ligamento patelofemoral medial presenta mejores resultados clínicos para el paciente. Hasta el momento, hemos intervenido diecinueve pacientes con la técnica descripta, para los cuales no hay reportada una reluxación de rótula y tienen una escala de Lysholm de 87 puntos que se encuentra dentro del parámetro "bueno".

Patellofemoral instability is one of the most frequent problems in young patients, and represents 2 to 3% of all knee injuries. It denotes an important cause of morbidity due to the limitation of various activities of daily living and in the long term the appearance of osteoarthritis. Patellofemoral instability is defined as the deficiency of passive constriction that generates a total or partial lateral displacement of the patella from its normal position with respect to the trochlea. Patellofemoral disorders are the result of an aberrant anatomy, they are given by an alteration in bone alignment and generates a biomechanical imbalance. There are four classic factors that generate patellar instability: high patella, trochlear dysplasia, alteration in distance (TT-TG) and excessive patellar inclination. When generating the dislocation, the medial patellofemoral ligament is affected in at least 25% of cases. The diagnostic complement is carried out through X-rays, computed tomography and nuclear magnetic resonance.Restoration of function surgical treatment has shown similar results to conservative treatment in primoluxations, however it has been seen that reconstruction of the medial patellofemoral ligament presents better clinical results for the patient.To date, nineteen patients we have been operated on with the technique described of whom there is no reported reluxation of the patella and who have a Lysholm scale of 85 points that is within a good parameter.

Reparación quirúrgica de rotura de tendón rotuliano con túneles transóseos: resultados funcionales a cinco años de seguimiento / Surgical repair of patellar tendon rupture using transosseous sutures

Introducción: Las roturas del tendón rotuliano son lesiones propias del paciente joven y deportista menor de cuarenta años. El objetivo de este trabajo es describir la técnica que utilizamos en nuestro centro y analizar los resultados funcionales del tratamiento de las roturas del tendón rotuliano empleando suturas transóseas como método de fijación. Materiales y métodos: se evaluó retrospectivamente a un grupo de diez pacientes con rotura aguda del tendón rotuliano, operados entre diciembre de 2014 y febrero de 2019. En todos se usaron suturas transóseas y en cuatro pacientes se realizó aumentación con cerclaje de alambre. El grupo de pacientes tenía una edad media de 36.4 años al momento de la cirugía. El tiempo promedio de seguimiento del grupo fue de doce meses. El protocolo de diagnóstico fue a través de la clínica e imágenes que comprendieron la radiografía y ecografía de partes blandas. Se documentó la evaluación funcional mediante la escala de Lysholm y los criterios del International Knee Documentation Committee (IKDC). Resultados: el promedio postoperatorio en la escala de Lysholm fue de 90 puntos (84-100) y según criterios del International Knee Documentation Committee, para el total de pacientes fue considerado normal o casi normal. Un paciente requirió tratamiento antibiótico en el postoperatorio. Conclusiones: la técnica utilizada en nuestro centro ha resultado sencilla desde el punto de vista técnico y de bajo costo desde lo económico, demostrando resultados clínicos excelentes. Por esta razón, se considera una opción válida en el tratamiento de las roturas agudas del tendón rotuliano. Tipo de Estudio: Serie de Casos. Nivel de Evidencia: IV

Introduction: Patellar tendon ruptures are typical injuries in young patients and athletes under forty years of age. The objective of this work is to describe the technique we use in our center and to analyze the functional results of the treatment of patellar tendon ruptures using transosseous sutures as a fixation method. Materials and methods: a group of ten patients with acute patellar tendon rupture, operated between December 2014 and February 2019, was retrospectively evaluated. Transosseous sutures were used in all of them and augmentation with wire cerclage was performed in four patients. The group of patients has a mean age of 36.4 years at the time of surgery. The group's average follow-up time was twelve months. The diagnostic protocol was through the clinic and images that included radiography and soft tissue ultrasound. The functional evaluation was documented using the Lysholm scale and the criteria of the International Knee Documentation Committee (IKDC). Results: the postoperative average on the Lysholm scale was 90 points (84-100) and according to the International Knee Documentation Committee criteria, all patients were considered normal or almost normal. One patient required antibiotic treatment postoperatively. Conclusions: the technique used in our center has been simple from a technical point of view and low cost from an economic point of view, demonstrating excellent clinical results. For this reason, it is considered a valid option in the treatment of acute patellar tendon ruptures.Type of study: Case Series. Level of Evidence: IV

Reconstrucción de ligamento cruzado anterior con isquiotibiales manteniendo su inserción tibial / ACL reconstruction with hamstring autograft maintaining tibial insertion

Introducción: La no desinserción tibial de semitendinoso-recto interno (ST-RI) parece constituir una opción para evitar la necrosis avascular en el proceso de ligamentización. El objetivo de nuestro trabajo es hacer una comparación entre ST-RI desinsertado versus ST-RI no desinsertado. Materiales y métodos: estudio comparativo, prospectivo, randomizado, doble ciego, para el que se formaron dos grupos. El grupo de estudio, conformado por treinta y ocho pacientes con plástica de LCA sin desinserción tibial de ST-RI; el grupo de control, de treinta y nueve pacientes con desinserción tibial. Se realizaron evaluaciones de RM a los seis meses del postoperatorio, se evaluaron el Coeficiente Señal ruido (CS) y la orientación del neoligamento en planos sagital, coronal y axial. La valoración clínica, a través de IKDC, Tegner Lysholm y KT-1000, fue efectuada por médicos en forma ciega.Resultados: el CS valorado por RM a los seis meses mostró diferencias significativas entre el grupo de estudio (14.4) y el de control (24.9) con un valor p <0.001. No existieron diferencias en cuanto a la orientación del injerto entre ambos grupos, ni en el plano sagital, coronal, ni axial. En cuanto al IKDC y Tegner Lysholm, sin diferencias entre grupos a los nueve meses. En el KT-1000 tampoco se encontraron diferencias entre grupos (p = 0.518).Discusión: la no desinserción tibial de ST-RI es una opción válida que podría evitar la fase de necrosis avascular de la ligamentización. Nuestros resultados, sustentados en RM, nos estimulan a utilizarla como una opción con cierta ventaja biológica.

Introduction: Non disinsertion of hamstring autograft tendons may result in avoiding cellular necrosis at the early stage of ligamentization process. The aim of this study was to compare between disinserted vs non disinserted hamstring autograft. Materials and methods: in this prospective, double-blind, randomised controlled trial, two groups were created. In the study group, hamstring tendon retraction (n=39) was performed. In the control group, maintaining tibial insertion (n=38) harvesting technique was used. Patients were evaluated with MRI after six months of follow-up. Graft maturity was evaluated with the signal-to-noise quotient (SNQ) and graft direction and orientation with sagittal, coronal, and axial views. Clinical outcomes were assessment of IKDC, Tegner-Lisholm activity level score and KT-1000 evaluation from a blind ortopaedic surgeon.Results: signal-to-noise quotient (SNQ) was significantly lower in non disinserted hamstring group (study group 14.4 vs control group 24.9-p = 0.001). There were no differences in graft direction between both groups. KT-1000 measurements showed no difference, the same as clinical outcomes assessment of IKDC and Tegner-Lisholm scores.Discussion: non disinserting hamstring tendons autograft is a valid option and may avoid the necrosis phase in ligamentization process. Our results, sustained on MRI imaging encourage us to use it with some biological advantage.