Radiographic Evaluation of Postoperative Alignment in Total Knee Arthroplasty / Avaliação radiográfica do alinhamento pós-operatório na artroplastia total de joelho

Abstract Objective To demonstrate the greater accuracy of panoramic radiographs of the lower limbs (long) in relation to short radiographs of the knee in the measurement of the mechanical axis of the lower limb after total knee arthroplasty (TKA). Methods A retrospective study was conducted to evaluate the accuracy of long and short postoperative radiographic images of 70 patients submitted to TKA in our service. The images were analyzed at random, at different times, by three orthopedists. In all images, the mechanical axis of the limb, femur and tibia were traced and femorotibial angles (FTAs) were calculated. The intraclass correlation coefficient (ICC) was calculated to evaluate the agreement of the measurement of the inter- and intra-observer mechanical axis. Results It was observed that there was high intra and interobserver agreement when panoramic radiographs were used, with minimum intra and interobserver ICC of 0.89, equivalent to a very strong agreement. On short radiographs in the anteroposterior incidence (AP) of the knee, the ICC showed moderate agreement, obtaining a maximum value of 0.75. Conclusion There is a significant difference in accuracy for the measurement of the mechanical axis of the lower limb, comparing long and short radiographs of the lower limb. Thus, for the proper measurement of the mechanical axis of the lower limb, we suggest the performance of long radiography in the postoperative period of TKA.

Resumo Objetivo Demonstrar a maior acurácia das radiografias panorâmicas de membros inferiores (longas) em relação às radiografias curtas do joelho na medida do eixo mecânico do membro inferior após a artroplastia total de joelho (ATJ). Métodos Foi realizado um estudo retrospectivo para avaliar a acurácia de imagens radiográficas longas e curtas pós-operatórias de 70 pacientes submetidos à ATJ em nosso serviço. As imagens foram analisadas ao acaso, em momentos distintos, por três ortopedistas. Em todas as imagens, o eixo mecânico do membro, do fêmur e da tíbia foram traçado,s e os ângulos femorotibiais (AFTs) foram calculados. O coeficiente de correlação intraclasse (CCI) foi calculado para avaliar a concordância da medida do eixo mecânico inter e intraobservador. Resultados Observou-se que houve alta concordância intra e interobservador quando utilizamos radiografias panorâmicas, apresentando CCI mínimo intrae interobservador de 0,89, equivalente a uma concordância fortíssima. Já nas radiografias curtas na incidência anteroposterior (AP) do joelho, o CCI mostrou-se com concordância moderada, obtendo valor máximo de 0,75. Conclusão Existe uma diferença significativa na acurácia para a medida do eixo mecânico do membro inferior, comparando-se radiografias longas e curtas do membro inferior. Assim, para a adequada mensuração do eixo mecânico do membro inferior, sugerimos a realização de radiografia longa no pós-operatório de ATJ.

Intra-articular Infiltration of Platelet-Rich Plasma versus Hyaluronic Acid in Patients with Primary Knee Osteoarthritis: Preliminary Results from a Randomized Clinical Trial / Infiltração intraarticular de plasma rico em plaquetas versus ácido hialurônico em pacientes com osteoartrose primária do joelho: Ensaio clínico randomizado com resultados preliminares

Abstract Objective The present study aimed to compare the effects of intraarticular infiltration of platelet-rich plasma with those of hyaluronic acid infiltration in the treatment of patients with primary knee osteoarthritis. Methods A randomized clinical trial was conducted with 29 patients who received an intraarticular infiltration with hyaluronic acid (control group) or platelet-rich plasma. Clinical outcomes were assessed using the visual analog scale for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire before and after the intervention. In addition, the posttreatment adverse effects were recorded. Categorical variables were analyzed using the chi-square and Fisher exact tests, whereas continuous variables were analyzed using the Student t test, analysis of variance, and the Wilcoxon test; all calculations were performed with the Stats package of the R software. Results An independent analysis of each group revealed a statistical difference within the first months, with improvement in the pain and function scores, but worsening on the 6th month after the procedure. There was no difference in the outcomes between the groups receiving hyaluronic acid or platelet-rich plasma. There was no serious adverse effect or allergic reaction during the entire follow-up period. Conclusion Intraarticular infiltration with hyaluronic acid or platelet-rich plasma in patients with primary knee gonarthrosis resulted in temporary improvement of functional symptoms and pain. There was no difference between interventions.

Resumo Objetivo Comparar o efeito da infiltração intraarticular do plasma rico em plaqueta com a do ácido hialurônico no tratamento de pacientes com osteoartrose primária de joelho. Métodos Realizou-se um ensaio clínico randomizado com 29 pacientes, sendo um grupo submetido à infiltração com ácido hialurônico (controle) e o outro com plasma rico em plaquetas. Os desfechos clínicos avaliados foram a escala visual analógica da dor; o questionário Western Ontario and McMaster Universities Arthritis Index (WOMAC), antes e depois da intervenção; e os efeitos adversos após as aplicações. Utilizou-se os testes do qui-quadrado e exato de Fisher para as variáveis categóricas, e o teste t de Student, análise de variância, e Wilcoxon para as variáveis contínuas, através do software R. Resultados A análise independente de cada grupo revelou uma diferença estatística nos meses iniciais, com melhora dos escores de dor e função; porém, com piora no 6° mês após o procedimento. Não houve diferença dos desfechos avaliados entre os grupos que foram submetidos à infiltração com ácido hialurônico ou com plasma rico em plaquetas. Não houve efeito adverso grave ou reação alérgica durante todo o seguimento. Conclusão A infiltração intraarticular com ácido hialurônico ou plasma rico em plaquetas nos joelhos dos pacientes com gonartrose primária apresentou melhora temporária dos sintomas de função e dor. Não houve diferença entre as duas intervenções.

Glomagioma de rodilla / Knee glomangioma

El tumor glómico es una neoplasia benigna poco común que surge del aparato glómico de la piel. Ocurre con mayor frecuencia en los dedos de manos y pies y representa el 1.6% de todos los tumores de tejidos blandos. El diagnóstico clínico puede resultar difícil si el tumor aparece en una ubicación extradigital. Presentamos un caso de tumor glómico de tipo vascular (glomangioma) de localización atípica, suprapatelar externa y de presentación inusual ya que no evidenciaba cambios de color en la superficie, indicando su componente vascular

Glomus tumor are rare benign tumor of the glomus body from the skin. Often occurring in the subungual region and it represents 1.6% of all soft tissue tumors. Clinical diagnosis may result difficult if the tumor occurs in an extra digital location.We report a case of a solitary vascular Glomus Tumor (Glomangioma) with an atypical localization, suprapatellar external and unusual presentation because it did not present with surface color change, indicating the vascular component

Tumor benigno de la vaina neural en rodilla. Reporte de caso y revisión bibliográfica / Knee neural sheath benign tumor. Case report and bibliographic revision

El schwannoma es el tumor benigno de nervio periférico más frecuente. Su presencia en los nervios de miembros inferiores es excepcional, donde representan el 1% de todos los schwannomas. Presentamos el caso de una mujer de treinta y un años que consulta por dolor en la cara anterior de la rodilla derecha, donde se palpa una masa blanda, dolorosa, de 1 cm aproximadamente y dolor en interlínea externa con signo de McMurray positivo. La RM evidenció una estructura ovoidea de señal quística, superficial al retináculo medial en su tercio proximal, de 10 × 8 × 8 mm y lesión del menisco externo en su tercio medio. Se realizó tratamiento artroscópico de la lesión meniscal externa y por vía abierta la exéresis marginal quirúrgica del tumor de partes blandas, con diagnóstico histopatológico de schwannoma. Los schwannomas de nervio periférico, aunque sean una entidad poco frecuente, deben considerarse en el diagnóstico diferencial de las masas dolorosas de la rodilla. Su tratamiento es la exéresis quirúrgica

Schwannoma is the most common benign peripheral nerve tumor, its presence being exceptional in the nerves of the lower limbs, where it represents 1% of all schwannomas. We present the case of a thirty-one-year-old woman who consulted for anterior knee pain, where a soft, painful mass of approximately 1cm and pain on the lateral joint line was assessed. McMurray's sign was positive. MRI showed an ovoid structure with a cystic signal, superficial and proximal to the medial retinaculum, measuring 10 × 8 × 8 mm and a tear in the body and posterior horn of the lateral meniscus. Arthroscopic treatment for the lateral meniscus tear and open surgical marginal excision of the soft tissue tumor were performed, with pathological diagnosis of schwannoma. Peripheral nerve schwannomas, although a rare entity, should be considered in the differential diagnosis of painful knee masses, their treatment being surgical excision

Tumor de células gigantes de la bursa de la pata de ganso (bursitis villonodular pigmentada extraarticular): a propósito de un caso / Giant cell tumor of the pes anserine bursa (extraarticular pigmented villonodular bursitis): a case report

Resumen: La sinovitis villonodular pigmentada extraarticular, también llamada tumor de células gigantes de la vaina tendinosa, es frecuente en la mano, siendo extremadamente rara su localización en la rodilla. Se presenta el caso de un paciente con una bursitis villonodular pigmentada de la bursa de la pata de ganso sin afectación intraarticular. Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon sheath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.

Abstract: Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon seath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.

Analytical study of clinicopathological data of Saudi patients with osteoarthritis subjected to total knee arthroplasty / Estudio analítico de datos clínico-patológicos de pacientes sauditas con osteoartritis sometidos a artroplastia total de rodilla

Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological, and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient's clinical and radiological data were collected from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done. Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making relevant to TKA in knee OA in Saudi Arabia and elsewhere.

La artrosis de rodilla (OA, por sus siglas en inglés) es una enfermedad invalidante común. Los estudios epidemiológicos han revelado diversos factores de riesgo para la OA, que incluyen el sexo, el envejecimiento, la obesidad, las enfermedades profesionales y las enfermedades crónicas. Aquí evaluamos los hallazgos clínicos, patológicos y radiológicos de la OA de rodilla en un subconjunto de pacientes sauditas que fueron sometidos a reemplazo total de rodilla (RTR). La población de estudio incluyó a 30 pacientes saudíes con OA de rodilla que fueron operados por RTR (desde junio de 2014 hasta diciembre de 2015) en el Departamento de Ortopedia, Facultad de Medicina, King Abdulaziz University, Arabia Saudita. Los datos clínicos y radiológicos de los pacientes se obtuvieron de las fichas hospitalarias. Se realizó examen patológico de la superficie articular superior de la tibia extirpada y cóndilos femorales. Se utilizó el análisis Chi-cuadrado de Pearson para probar las diferencias entre las variables en los factores de riesgo asociados. El número de mujeres era mayor que los hombres. El 60 % de los pacientes eran mayores de 60 años [edad media, 59,2 (mujeres) y 61,7 (hombres) años]. Todos los pacientes superaron la obesidad clase 1, siendo las mujeres más obesas que los hombres. El examen patológico de la superficie articular superior de la tibia y los cóndilos femorales mostraron lesiones con puntaje alto, que fue más evidente en mujeres que en hombres. Los hallazgos radiológicos mostraron que la mayoría de las lesiones eran de alto grado. Los hallazgos de este estudio ayudarán a comprender la patogenia de la OA y mejorarán la toma de decisiones sobre el tratamiento relevante para el RTR en la OA de rodilla en Arabia Saudita y en otros lugares.

Lesiones y variantes normales de la rodilla pediátrica / Injuries and normal variants of paediatric knee

Abstract. Knee pathology is a reason for consultation and prevalent condition in children, making it important to know the normal variants as well as the most frequent pathologies. This review includes a brief description of the main pathologies and normal variants that affect the knee in children, with their main clinical features, as well as the findings described in the various, most-used, imaging techniques (X-ray, ultrasound, computed tomography, and magnetic resonance (MR).

Resumen. La patología de rodilla es un motivo de consulta y una entidad prevalente en la edad pediátrica, razón por la cual es importante conocer tanto las variantes normales como las patologías más frecuentes. En esta revisión se realiza una breve descripción de las principales patologías y variantes normales que afectan a la rodilla en la edad pediátrica, tanto de sus características clínicas principales como de los hallazgos descritos en las distintas modalidades de imagen más utilizadas (radiografía, ecografía, tomografía computarizada y resonancia magnética (RM).

Efficacy of treatment with glucosamine sulfate in patients with knee effusion due to osteoarthritis

Evaluation of anti-inflammatory effect of Glucosamine sulfate [GS] versus diclofenac sodium [DS] in effusion of osteoarthritic knees. In this study, patients were included in this study from 2007-2010 based on American College of Rheumatology criteria with OA and physical examination in effusion of osteoarthritic knees. The patients were divided into two groups. First group [27 patients] DS was given in doses 75 mg twice daily for ten day. In the group II [25 patients] GS was used in doses of 1500 mg two times daily over the first 12 weeks of the study. A closed aspiration was performed. The knee circumference was measured in patients before and 12 week after treatment. Before and after 12 weeks of treatments, both groups of patients were assessed according to the WOMAC questionnaire of knee pain and function scores. Comparison of knee mean circumference between the two groups was not statistically significant before treatment [p=0.938], but significant after treatment [p < 0.001]. At the end of the 12 week, there was 66.6% complete resolution of effusion in the DS group [18 patients] and 24.0% [6 patients] in the GS group, this was statistically significant [P < 0.001]. DS groups, results of the beginning and at the end of 12 week measurement showed significant differences in WOMAC pain mean score [P < 0.001] but GS groups not statistically significant [P=0.160]. The WOMAC function mean scores in pre and post-treatment periods of follow-up showed significant variation between the two groups [P < 0.001, P < 0.001]. Our observations suggest that GS is not able to suppress the progression of adjuvant arthritis in OA with effusion of knee osteoarthritis. GS should not be expected as anti-inflammatory influence as DF in the treatment of OA-related effusion

Detección de alteraciones posturales en niños de 6 a 11 años en campaña del Hospital Nacional Arzobispo Loayza, 2012 - 2013 / Detection of postural alterations in children of 6 to 11 years at campaign organized by the National Hospital Arzobispo Loayza, 2012-2013

Se realizó la Detección de alteraciones posturales en niños de 6 a 11 años, en Campaña del Hospital Nacional Arzobispo Loayza, en la Institución Educativa Estatal No 1019 "Chavín" de Breña, donde fueron evaluados236 niños de ambos sexos, previa recepción del formato de Consentimiento informado llenado y firmado por sus padres. El objetivo de este trabajo fue conocer las alteraciones posturales en los escolares que participaron durante la Campaña. Para realizar la toma de datos durante la evaluación postural se empleó una "FICHA DE EVALUACIÓN POSTURAL PARA CAMPAÑA COMUNITARIA DEL HOSPITAL NACIONAL ARZOBISPO LOAYZA" previamente validada por 9 expertos, médicos especialistas en Medicina Física y Rehabilitación. Participaron en la evaluación 129 niños y 107 niñas. Las alteraciones posturales de columna vertebral (lordosis lumbar, escoliosis dorsal y cifosis dorsal) fueron las más frecuentes, constituyendo el 66.5 por ciento (157 escolares), seguidas de alteraciones de los pies (pies planos, talo valgo) que estuvieron presentes en el 64 por ciento de los evaluados (151 niños).

A detection of postural alterations in children of 6-11 years old was performed in the medical campaignorganized by the National Hospital Arzobispo Loayza in the library of the Public School Number 1019 "Chavin" located in Breña, where 236 children of both genders from this school were evaluated, previous consent of their parents through a document completed, approved and signed by them. The aim of this work was to detect the prevalence of postural disorders in children of this school. To collect information during the postural evaluation, it was necessary to use a "POSTURE EVALUATION FORM FOR THE COMMUNITY CAMPAIGN OF THE NATIONAL HOSPITAL ARZOBISPO LOAYZA" previously validated by nine experts, specialists in Physical Medicine and Rehabilitation. There were a total of 129 boys and 107 girls evaluated in this activity. Spinal Postural disorders (lumbar lordosis, scoliosis and kyphosis dorsal) were the most common, 66.5 per cent (157 cases), followed by feet abnormalities (flat feet, talus valgus) which were present in 64 per cent (151 children).

Glomus Tumor of Hoffa's Fat Pad and Its Management by Arthroscopic Excision

We present a rare case of glomus tumor of Hoffa's fat pad in a 42-year-old woman. Magnetic resonance imaging findings along with the characteristic clinical picture led us to suspect a glomus tumor as the possible etiology. An ischemia test was found to be positive and this further substantiated our diagnosis. An arthroscopic excision was performed and the histology confirmed the diagnosis of glomus tumor of Hoffa's fat pad. The patient responded well to the excision with immediate complete resolution of pain and she remains asymptomatic at the last follow-up after 15 months. To our knowledge, this is the second reported case of glomus tumor of Hoffa's fat pad and the first ever to be managed by simple arthroscopic excision. The tumor poses a great challenge to an orthopedic surgeon. However, knowledge of its characteristic clinical presentation and the recognition of such a rare entity can help achieve an early diagnosis and timely management.

Ruptura bilateral e simultânea do mecanismo extensor do joelho em um pré-adolescente: relato de caso / Simultaneous bilateral tear of the knee extensor mechanism in a pre-adolescent: case report

A ruptura do tendão patelar de um lado e um sleeve fracture contralateral em um pré-adolescente são uma lesão rara. Nós relatamos um caso em um pré-adolescente que caiu enquanto saltava durante uma partida de futebol. Não foram diagnosticados fatores predisponentes. As lesões foram tratadas com os reparos cirúrgicos e suturas transósseas. O objetivo desta pesquisa foi apresentar um caso de ruptura concorrente e espontânea do mecanismo extensor do joelho em um pré-adolescente.

Unilateral tearing of a patellar tendon and a contralateral sleeve fracture in a pre-adolescent are rare lesions. We report a case in which a pre-adolescent sustained a fall while jumping during a soccer match. No predisposing risk factors were identified. The injuries were treated with surgical repairs and transosseous suturing. The aim of this study was to present a case of spontaneous concurrent tearing of the extensor mechanism of the knee in a pre-adolescent.

Atualização no diagnóstico e tratamento das lesões condrais do joelho / Updating on diagnosis and treatment of chondral lesion of the knee

O tratamento das lesões condrais no joelho ainda permanece um desafio para o cirurgião ortopédico, principalmente pelas próprias características da cartilagem, que promovem um baixo potencial de regeneração. As lesões condrais podem ser causadas por estímulos metabólicos, genéticos, vasculares e traumáticos e são classificadas de acordo com o tamanho e espessura da cartilagem acometida. O diagnóstico clínico pode ser difícil, principalmente pela sintomatologia insidiosa, sendo necessário o uso de exames complementares, em especial, a ressonância magnética. O tratamento dessas lesões é, em geral, iniciado de forma conservadora, ficando o tratamento cirúrgico reservado para pacientes com fragmentos condrais destacados, com bloqueio do arco de movimento, ou pacientes refratários ao tratamento clínico. As técnicas cirúrgicas mais usadas para o tratamento dos defeitos de espessura parcial são o desbridamento e a ablação por radiofrequência. Essas técnicas têm o objetivo de melhorar os sintomas, já que não restauram a estrutura e a função normal da cartilagem. Para os defeitos de espessura total (lesão osteocondral), os tratamentos disponíveis são a abrasão, drilling, microfratura, transplante osteocondral autólogo e alógeno e técnicas biológicas como o uso de transplante autólogo de condrócitos, técnica da cartilagem picada (minced cartilage) e o transplante de células-tronco.

The treatment of chondral knee injuries remains a challenge for the orthopedic surgeon, mainly owing to the characteristics of the cartilage tissue, which promote low potential for regeneration. Chondral lesions can be caused by metabolic stimulation, or by genetic, vascular and traumatic events, and are classified according to the size and thickness of the affected cartilage. Clinical diagnosis can be difficult, especially due to insidious symptoms. Additional tests, as Magnetic Resonance Imaging (MRI), may be needed. The treatment of these lesions usually starts with non-operative management. Surgery should be reserved for patients with detached chondral fragments, blocked range of motion, or the failure of non-operative treatment. The surgical techniques used for the treatment of partial thickness defects are Debridement and Ablation. These techniques aim to improve symptoms, since they do not restore normal structure and function of the cartilage. For full-thickness defects (osteochondral lesion), available treatments are Abrasion, Drilling, Microfracture, Osteochondral Autologous and Allogeneic Transplantation, and biological techniques such as the use of Autologous Chondrocyte Transplantation, Minced Cartilage and stem cells.

Osteonecrose espontânea do joelho em atleta tratamento com o uso de câmara hiperbárica: relato de caso e revisão de literatura / Spontaneous osteonecrosis in an athlete's knee treated using a hyperbaric chamber: case report and review of the literature

A osteonecrose é uma síndrome clínica caracterizada pela necrose óssea de uma porção de sustentação de carga do côndilo femoral, seguida de fratura subcondral, colapso segmentar tardio e artrose. Acomete mais frequentemente mulheres com mais de 55 anos de idade e obesas. O tratamento ainda é assunto controverso na literatura. Os autores relatam o caso de um paciente do sexo masculino, 24 anos, jogador profissional de futebol, que apresentou queixa de dor no joelho um dia após atividade física. Os exames de imagem realizados precocemente já demonstraram o início da lesão. Foram utilizados no tratamento, com sucesso: retirada de apoio, fisioterapia, medicamentos (como AINH e bifosfonados) e câmara hiperbárica. Apesar de ser uma terapia nova, a câmara hiperbárica associada à terapia medicamentosa e retirada do apoio pode trazer bons resultados no tratamento da osteonecrose idiopática mesmo em atletas de alta demanda física. No entanto, existe a necessidade de novos relatos e estudos com maior evidência para demonstrar sua validade.

Osteonecrosis is a clinical syndrome characterized by osseous necrosis of a load-bearing portion of the femoral condyle, followed by subchondral fracturing, subsequent segmental collapse and arthrosis. It most frequently affects obese women over the age of 55 years. Its treatment is still a matter of controversy in the literature. The authors report the case of a 24-year-old male patient who was a professional soccer player, who presented with a complaint of knee pain one day after physical activity. Imaging examinations performed early on already demonstrated the start of the lesion. The treatment, which was successful, used the following: withdrawal of support, physiotherapy, medications (such as NSAIDs and bisphosphonates) and a hyperbaric chamber. Although hyperbaric chamber therapy is new, its use in association with drug therapy and withdrawal of support may bring good results in treating idiopathic osteonecrosis, even for athletes with high physical demands. However, there is a need for further reports and studies with greater evidence, in order to demonstrate the validity of this treatment.

Protocolo de reabilitação para as reconstruções isoladas do ligamento cruzado posterior / Rehabilitation protocol after isolated posterior cruciate ligament reconstruction

Elaborar um protocolo de reabilitação pós-reconstrução do ligamento cruzado posterior (LCP) através de revisão da literatura. Foi realizada uma revisão da literatura em busca de dados referentes a conceitos e estudos biomecânicos relacionados com o ligamento cruzado posterior do joelho, utilizando-se os bancos de dados Medline e Embase. A estratégia de busca foi montada com a seguinte regra: problema ou lesão, associado a termos de localização anatômica, procedimento de intervenção cirúrgica associado a termos de reabilitação. Iniciamos o processo desta forma e posteriormente realizamos restrições a termos específicos para melhorar a especificidade da busca. Para confecção do protocolo, uma tabela foi construída para melhor direcionamento dos dados, com base no tempo decorrido do procedimento cirúrgico até o início da fisioterapia. Um protocolo de reabilitação foi criado para melhor controle da descarga de peso nas primeiras semanas com o auxílio de imobilizador de joelho. Objetivamos o ganho da amplitude de movimento total do joelho, que deve ser conseguido até o terceiro mês, evitando-se, assim, contraturas resultantes do processo de cicatrização tecidual. Os exercícios de fortalecimento e treino sensório-motor foram orientados de acordo, evitando-se sobrecarga sobre o enxerto e respeitando os períodos de cicatrização do mesmo. O protocolo proposto nesta revisão foi enquadrado dentro das evidências atuais sobre o assunto.

To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject.

Existence of a Neuropathic Pain Component in Patients with Osteoarthritis of the Knee

PURPOSE: Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA. MATERIALS AND METHODS: Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman's correlation coefficient by rank test. RESULTS: Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant. CONCLUSION: PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.

Condromatose sinovial de joelho: relato de caso / Synovial chondromatosis of the knee: case report

Os autores apresentam o relato de caso de um paciente ex-atleta de futebol com osteocondromatose sinovial em joelho.

The authors report the case of a patient with synovial osteochondromatosis of the knee, who had previously been a soccer player.