Effect of music therapy on anxiety and pain in the critical polytraumatised patient.

OBJECTIVE: To determine the effectiveness of music therapy on anxiety and pain in critical polytraumatised patients admitted to the resuscitation unit of a tertiary level hospital in Spain. MATERIAL AND METHOD: Randomised clinical trial conducted in a tertiary level hospital, from June 2016 to May 2018. The study sample was 60 patients, 30 belonging to the intervention group (IG), and 30 to the control group (CG). The IG were given a 30-minute music session and heart rate (HR) and blood pressure (BP) were measured. The VAS (Visual Analogue Scale) was applied for anxiety and pain before and after each session. The same measures and scales were applied in the CG who did not receive a music session. The music session comprised 3 parts: the first was standard music selected by music therapists; the second was personalised, chosen by the patient and the third was a new standard. The intervention took place in a booth with headphones. RESULTS: Significant changes in anxiety levels (P<.01) were detected in the group of patients undergoing the intervention, measured with the VAS scale for anxiety, and pain levels (P<.01), measured with the VAS scale for pain. No significant differences were found in the physiological parameters of HR and BP. CONCLUSION: The use of music in critical polytraumatised patients reduces anxiety and pain levels, increasing the patient's well-being and improving the quality of care. Music therapy, therefore, is considered beneficial as a complementary measure in critical care units. It would be worthwhile to continue studies in this and other hospital areas.

Efecto de la musicoterapia sobre la ansiedad y el dolor en el paciente crítico politraumatizado / Effect of music therapy on anxiety and pain in the critical polytraumatised patient

Objetivo Determinar la efectividad de la musicoterapia sobre la ansiedad y el dolor en pacientes críticos politraumatizados ingresados en la unidad de reanimación de un hospital de tercer nivel en España. Material y método Ensayo clínico aleatorizado realizado en un hospital de tercer nivel, desde junio de 2016 a mayo de 2018. La muestra del estudio fue de 60 pacientes, 30 pertenecientes al grupo intervención y 30 al grupo control. El grupo intervención recibió una sesión musical de 30minutos y se midieron los parámetros de frecuencia cardiaca y presión arterial. Se aplicaron las escalas visuales analógicas (EVA) desarrolladas para la ansiedad y para el dolor antes y después de cada sesión. Al grupo control se le aplicaron las mismas medidas y escalas sin recibir sesión musical. La sesión musical estaba compuesta de 3 partes: primera parte de música estándar, seleccionada por musicoterapeutas; segunda parte personalizada, elegida por el paciente, y tercera parte de nuevo estándar. La aplicación de la intervención se realizó en el box mediante auriculares. Resultados Se detectaron cambios significativos en el grupo de pacientes que recibieron la intervención, tanto en los niveles de ansiedad (p<0,01), medidos con la escala EVA para la ansiedad, como en los niveles de dolor (p<0,01), medidos con la escala EVA para el dolor. No se encontraron diferencias significativas en los parámetros fisiológicos de frecuencia cardiaca y presión arterial. Conclusión El uso de la música en pacientes críticos politraumatizados reduce los niveles de ansiedad y dolor, aumentando el bienestar del paciente y mejorando la calidad en sus cuidados. Por ello se considera beneficiosa la musicoterapia como medida complementaria en las unidades de cuidados críticos, y sería conveniente la continuidad de los estudios en esta y otras áreas de hospitalización. (AU)

Objective To determine the effectiveness of music therapy on anxiety and pain in critical polytraumatised patients admitted to the resuscitation unit of a tertiary level hospital in Spain. Material and methodRandomised clinical trial conducted in a tertiary level hospital, from June 2016 to May 2018. The study sample was 60 patients, 30 belonging to the intervention group (IG), and 30 to the control group (CG). The IG were given a 30-minute music session and heart rate (HR) and blood pressure (BP) were measured. The VAS (Visual Analogue Scale) was applied for anxiety and pain before and after each session. The same measures and scales were applied in the CG who did not receive a music session. The music session comprised 3 parts: the first was standard music selected by music therapists; the second was personalised, chosen by the patient and the third was a new standard. The intervention took place in a booth with headphones. Results Significant changes in anxiety levels (P<.01) were detected in the group of patients undergoing the intervention, measured with the VAS scale for anxiety, and pain levels (P<.01), measured with the VAS scale for pain. No significant differences were found in the physiological parameters of HR and BP. Conclusion The use of music in critical polytraumatised patients reduces anxiety and pain levels, increasing the patient's well-being and improving the quality of care. Music therapy, therefore, is considered beneficial as a complementary measure in critical care units. It would be worthwhile to continue studies in this and other hospital areas. (AU)

Effect of music therapy on anxiety and pain in the critical polytraumatised patient. / Efecto de la musicoterapia sobre la ansiedad y el dolor en el paciente crítico politraumatizado.

OBJECTIVE: To determine the effectiveness of music therapy on anxiety and pain in critical polytraumatised patients admitted to the resuscitation unit of a tertiary level hospital in Spain. MATERIAL AND METHOD: Randomised clinical trial conducted in a tertiary level hospital, from June 2016 to May 2018. The study sample was 60 patients, 30 belonging to the intervention group (IG), and 30 to the control group (CG). The IG were given a 30-minute music session and heart rate (HR) and blood pressure (BP) were measured. The VAS (Visual Analogue Scale) was applied for anxiety and pain before and after each session. The same measures and scales were applied in the CG who did not receive a music session. The music session comprised 3 parts: the first was standard music selected by music therapists; the second was personalised, chosen by the patient and the third was a new standard. The intervention took place in a booth with headphones. RESULTS: Significant changes in anxiety levels (P<.01) were detected in the group of patients undergoing the intervention, measured with the VAS scale for anxiety, and pain levels (P<.01), measured with the VAS scale for pain. No significant differences were found in the physiological parameters of HR and BP. CONCLUSION: The use of music in critical polytraumatised patients reduces anxiety and pain levels, increasing the patient's well-being and improving the quality of care. Music therapy, therefore, is considered beneficial as a complementary measure in critical care units. It would be worthwhile to continue studies in this and other hospital areas.

Off-Label Use of Sirolimus and Everolimus in a Pediatric Center: A Case Series and Review of the Literature.

BACKGROUND: It has been 15 years since sirolimus, an mTOR inhibitor, received Food and Drug Administration approval to prevent acute rejection in kidney transplantation, and 8 years since its analog everolimus acquired the same status. Since then, these drugs have become more and more utilized and their immunosuppressive and antiproliferative properties have been tested in a great variety of clinical conditions, often achieving excellent results. Despite such positive evidence, the on-label indications for these rapalogs are still very restrictive, especially in children. AIMS: The aims of this study were to describe our center's experience with sirolimus and everolimus in managing rare pediatric conditions for which mTOR inhibitors have been reported as a therapeutic option, although without conclusive approval from regulatory agencies, and to evaluate safety and tolerability of the treatment at the prescribed doses. METHODS: All the subjects who received off-label sirolimus or everolimus at the Pediatric Department of the IRCCS Burlo Garofolo in the last 13 years were included. For each disease found in our case series, we reviewed the current scientific literature. RESULTS: Off-label treatment with rapalogs was prescribed in 16 children (11 males, 5 females, median age of 9.5 years, range 1-16 years). Seven had immunologic disorders: four autoimmune lymphoproliferative syndrome (ALPS), one multicentric Castleman disease (mCD), one activated PI3K delta kinase syndrome (APDS), and one immunodysregulation with polyendocrinopathy enteropathy X-linked (IPEX). Eight had proliferative disorders or vascular anomalies: one cystic lymphangioma, two Bannayan-Riley-Ruvalcaba syndrome (BRRS), one blue rubber bleb nevus syndrome (BRBNS), two tuberous sclerosis complex (TSC), and one low-flow mixed arterial and venous malformation. One case had congenital hyperinsulinism (CHI). The average dosage administered was 1 mg/m2 for sirolimus and 7 mg/m2 for everolimus. We experienced a good measurable clinical improvement in 14 patients. Nobody experienced serious adverse events (SAEs). The therapy was interrupted in two cases, for lack of efficacy and poor tolerance in one case and for occurrence of bacterial pneumonia in the other one. A review of the literature identified 101 published reports that met our inclusion criteria. CONCLUSIONS: Although use of mTOR inhibitors has been considered to be complicated, our experience shows that, using low dosages, it is possible to obtain relevant clinical improvements, with a good profile of safety and tolerability.

Selection of red deer spermatozoa with different cryoresistance using density gradients.

The objective of sperm selection media is selecting the best spermatozoa and to remove seminal plasma and diluent for using them in assisted reproductive techniques. It is known that individuals show different cryoresistance in response to the same freezing procedure. Our hypothesis was that the efficacy of selection media could be dissimilar for samples with different sperm quality after thawing. Epididymal sperm samples from mature Iberian red deer were collected and frozen. Males were classified as with high post-thaw sperm quality when sperm motility (SM) ≥ 70%, or as with low post-thaw sperm quality when SM ≤ 69%. Samples were centrifuged using the following density gradients (DG): Percoll® , Puresperm® and Bovipure™ , and several functional sperm parameters were assessed after sperm selecting and washing. Males classified with high sperm quality had higher post-thawing values (p > .05) for all parameters evaluated, except for linearity index, than those categorized as low sperm quality. After selection, some sperm characteristics improved (viability, apoptosis and mitochondrial activity) for both groups, showing the males with high sperm quality higher values in all sperm parameters except for kinematic traits and DNA fragmentation index (%DFI), regardless of DG. Bovipure™ yield lower values of sperm motility, viability, apoptosis and mitochondrial activity in relation to Percoll® and Puresperm® considering both quality groups. There was an interaction between the type of DG and sperm quality group for sperm viability (p = .040) and apoptosis (p = .003). Thus, Percoll® selected less live and more apoptotic spermatozoa than Puresperm® and Bovipure™ for males with low sperm quality. In conclusion, the DG are more efficient selecting spermatozoa from samples with high sperm quality, acting differently depending on initial sperm quality.

Romiplostim for secondary thrombocytopenia following allogeneic stem cell transplantation in children.

The outcome of romiplostim for secondary failure of platelet recovery (SFPR) was investigated in children who had undergone hematopoietic stem cell transplantation (HSCT). Seven transfusion-dependent pediatric patients (median age 11 years), with platelet counts below 10 × 10(9)/L, received four weekly doses of subcutaneous romiplostim to treat SFPR developed after HSCT. All patients, except one (patient 4), became platelet transfusion-independent in the second week from the beginning of treatment and no patient needed to discontinue drug treatment because of adverse events. Romiplostim could represent a beneficial first-line treatment, but further studies are required.

Path-integral Monte Carlo method for Rényi entanglement entropies.

We introduce a quantum Monte Carlo algorithm to measure the Rényi entanglement entropies in systems of interacting bosons in the continuum. This approach is based on a path-integral ground state method that can be applied to interacting itinerant bosons in any spatial dimension with direct relevance to experimental systems of quantum fluids. We demonstrate how it may be used to compute spatial mode entanglement, particle partitioned entanglement, and the entanglement of particles, providing insights into quantum correlations generated by fluctuations, indistinguishability, and interactions. We present proof-of-principle calculations and benchmark against an exactly soluble model of interacting bosons in one spatial dimension. As this algorithm retains the fundamental polynomial scaling of quantum Monte Carlo when applied to sign-problem-free models, future applications should allow for the study of entanglement entropy in large-scale many-body systems of interacting bosons.

Study of nano-emulsion formation by dilution of microemulsions.

The influence of different dilution procedures on the properties of oil-in-water (O/W) nano-emulsions obtained by dilution of oil-in-water (O/W) and water-in-oil (W/O) microemulsions has been studied. The system water/SDS/cosurfactant/dodecane with either hexanol or pentanol as cosurfactant was chosen as model system. The dilution procedures consisted of adding water (or microemulsion) stepwise or at once over a microemulsion (or water). Starting emulsification from O/W microemulsions, nano-emulsions with droplet diameters of 20 nm are obtained, independently on the microemulsion composition and the dilution procedure used. In contrast, starting emulsification from W/O microemulsions, nano-emulsions are only obtained if the emulsification conditions allow reaching the equilibrium in an O/W microemulsion domain during the process. These conditions are achieved by stepwise addition of water over W/O microemulsions with O/S ratios at which a direct microemulsion domain is crossed during emulsification. The nature of the alcohol used as cosurfactant has been found to play a key role on the properties of the nano-emulsions obtained: nano-emulsions in the system using hexanol as cosurfactant are smaller in size, lower in polydispersity, and have a higher stability than those with pentanol.

Comportamiento biomecánico bajo carga estática de diferentes sistemas de fijación femoral para la reconstrucción del ligamento cruzado anterior / Static load biomechanical behaviour of different femoral fixation systems for anterior cruciate ligament reconstruction

Objetivo. Analizar el comportamiento biomecánico de diferentes sistemas de fijación femoral empleados en la reconstrucción del ligamento cruzado anterior (LCA), ante una sobrecarga estática. Material y método. Reconstrucción LCA en 33 fémures porcinos. Como injerto se utilizó un cabo de alta resistencia, a fin de eliminar la variabilidad y las roturas prematuras. Fueron analizados 9 dispositivos: Biosteon, Biocryl y Softsilk (compresión); Biosteon Cross-Pin y Cross-Pin ACL (suspensión córtico-esponjosa); Endobutton y XO Button (suspensión cortical); grapa (compresión cortical); Rigidfix (transfixión). Se realizaron ensayos estáticos de resistencia al fallo, calculando la rigidez lineal, la carga de fallo y la elongación en dicha carga. Se seccionó el hueso para observar el modo de fallo. Resultados. La grapa mostró una carga de fallo mayor (1.173,7±220,0N), pero con una gran elongación (58,8±13,2mm). Del resto de fijaciones, las más resistentes fueron Cross-Pin ACL (1.054,6±150,8N) y Endobutton (1.018,6±230,1N), presentando la primera una mayor rigidez (43,5±7,1N/mm). Discusión. Las fijaciones de suspensión cortical parecen muy influenciadas por la geometría del hueso en la superficie cortical de apoyo, mientras que las de suspensión córtico-esponjosa producen un mejor reparto de carga. Las fijaciones de compresión y de transfixión ven modificadas sus propiedades mecánicas por la utilización del injerto sintético. Conclusiones. Atendiendo al comportamiento exhibido del modelo estudiado, las fijaciones de suspensión córtico-esponjosa se muestran como una opción muy buena, al realizar un reparto de cargas sobre el hueso equilibrado y poco agresivo (AU)

Objective. To analyse the biomechanical behaviour of different femoral fixation systems employed in the reconstruction of the anterior cruciate ligament (ACL) using a static load. Material and method. ACL reconstruction of 33 pig femurs. A high resistance braided cord was used as graft, with the aim of eliminating variability and premature fractures. Nine devices were analysed: Biosteon, Biocryl and Softsilk (compression); Biosteon Cross-Pin and Cross-Pin ACL (cortical-cancellous suspension); Endobutton and XO Button (cortical suspension); staple (cortical compression); Rigidfix (transverse fixation). Static resistance failure tests were performed, calculating the linear rigidity, failure load, and elongation of that load. The bone was sectioned to observe the failure mode. Results. The staple showed a higher load failure (1,173.7±220.0N), but with a greater elongation (58.8±13.2mm). Of the rest of the fixations, the most resistant were Cross-Pin ACL (1,054.6±150.8N) and Endobutton (1,018.6±230.1N), with the former having greater rigidity (43.5±7.1N/mm). Discussion. Cortical suspension fixations seem to be very affected by the geometry of the bone in the cortical support surface, while those of the cortical-cancellous suspension produced a better load distribution. Compression and transverse fixations changed their mechanical properties due to using a synthetic graft. Conclusions. Taking into account the behaviour shown by the model studied, cortical-cancellous suspension fixation was shown to be a very good option, on having a balanced load distribution on the bone and not very aggressive (AU)

Calculation of the expected zero-field muon relaxation rate in the geometrically frustrated rare earth pyrochlore Gd(2)Sn(2)O(7) antiferromagnet.

The magnetic insulator Gd(2)Sn(2)O(7) is one of many geometrically frustrated magnetic materials known to exhibit a nonzero muon spin polarization relaxation rate, λ(T), down to the lowest temperature (T) studied. Such behaviour is typically interpreted as signalling the presence of persistent spin dynamics (PSD) of the host material. In the case of Gd(2)Sn(2)O(7), such PSD comes as a surprise since magnetic specific heat measurements suggest conventional gapped magnons, which would naively lead to an exponentially vanishing λ(T) as T → 0. In contrast to most materials that display PSD, the ordered phase of Gd(2)Sn(2)O(7) is well characterized and both the nature and the magnitude of the interactions have been inferred from the magnetic structure and the temperature dependence of the magnetic specific heat. Based on this understanding, the temperature dependence of the muon spin polarization relaxation through the scattering of spin waves (magnons) is calculated. The result explicitly shows that, despite the unusual extensive number of weakly dispersive (gapped) excitations characterizing Gd(2)Sn(2)O(7), a remnant of the zero modes of the parent frustrated pyrochlore Heisenberg antiferromagnet, the temperature dependence of the calculated λ(T) differs dramatically from the experimental one. Indeed, the calculation conforms to the naive expectation of an exponential collapse of λ(T) at temperatures below ∼ 0.7 K. This result, for the first time, illustrates crisply and quantitatively the paradox that presents itself with the pervasive occurrence of PSD in highly frustrated magnetic systems as evinced by muon spin relaxation measurements.

Rheology of poly(methyl methacrylate) Langmuir monolayers: percolation transition to a soft glasslike system.

An experimental study of the equilibrium properties and of the surface rheology of Langmuir monolayers of poly(methyl methacrylate) (PMMA) at the air/water interface has been carried out as a function of polymer concentration (Γ) and molecular weight (M(w)). Dilational and shear complex elasticity moduli covering a frequency range from 10(-3) to 0.2 Hz have been discussed. It was found that the air∕water interface behaves as a poor solvent for PMMA monolayers, thus suggesting that the polymer coils take collapsed soft-disks (pancakes) shape at the interface. The equilibrium and dynamic results suggest a fluid-to-soft-glass transition as the polymer concentration increases above a critical packing fraction at constant temperature. This two-dimensional transition is in agreement with results previously discussed for the dilational rheology of poly(4-hydroxystyrene) [F. Monroy, F. Ortega, R. G. Rubio, H. Ritacco, and D. Langevin, J. Chem. Phys. 95, 056103 (2005)]. Furthermore, the Γ-dependence of the relaxation dynamics of the monolayers suggests that the gel state may be considered as a fragile soft glass.

Effect of the spreading solvent on the three-phase contact angle of microparticles attached at fluid interfaces.

We address a systematic study of the three-phase contact angle, θ, of microparticles at flat fluid-liquid interfaces by using different experimental methods. We measured the dependence of θ not only on the particle chemical composition and size, but also on the solvent used to spread the microparticles onto the fluid interface. We found a non-expected and non-regular dependence of θ with size, chemical nature and spreading solvent used for the different particles studied. We propose that these dependences are due to porosity/roughness of the particles that allows the adsorption of the spreading solvent onto the solid particle surface. This conclusion is supported by the values of the line tensions estimated for the different systems.

Análisis biomecánico de la fijación del ligamento cruzado anterior / Biomechanical analysis of the anterior cruciate ligament fixation

Objetivo: Desarrollar la metodología experimental para analizar la biomecánica de la fijación del ligamento cruzado anterior. Material y métodología: Se realizó una plastia de LCA en 16 rodillas de cerdo, utilizando el tendón del músculo extensor lateral de los dedos del cerdo. Se ensayaron tres sistemas de fijación diferentes, clasificados como compresión, expansión y suspensión cortico-esponjosa. Todos los especímenes fueron ensayados a tracción hasta el fallo. Se calculó la carga de fallo, elongación y rigidez para cada fijación. Resultados: Atendiendo a la carga de fallo y a la rigidez, los mayores valores medios se obtuvieron para los dispositivos de expansión y suspensión operados con la técnica de doble injerto. Los dispositivos de compresión y expansión implantados con la técnica de un sólo injerto mostraron peores resultados. Conclusiones: El fallo siempre sobrevino en los injertos por lo que no se pudo evaluar ni comparar correctamente el comportamiento de los diferentes tipos de fijación utilizados (AU)

Objective: The aim of the present study was to develop the experimental methodology for the biomechanical analysis of the anterior cruciate ligament reconstruction. Material and method: An ACL reconstruction was performed on 16 porcine knees. The graft used was the pig doubled lateral extensor of toes (DLET). Three different femoral fixation devices were tested and classified according to their fixation mechanism: compression, expansion and cortical-cancellous suspension. A fixation device was developed in order to analyze the unfavorable load case. All GFC were subjected to a load-to-failure test. Failure load, elongation and stiffness were calculated for each device. Results: Regarding stiffness and failure load, cortical-cancellous suspension and expansion, both with the double graft technique, showed the highest mean values. Compression and expansion, both with the single graft technique, showed worse results. Conclusions: Failure always took place in the graft, and thus was impossible to compare correctly the different fixation devices behavior (AU)

Amorphous freezing in two dimensions: from soft coils to rigid particles.

The topic of the gel transition in two dimensions is revisited by considering data on the shear elasticity of Langmuir monolayers of different spherical objects. Amorphous freezing can be associated to structural percolation in a lattice able to resist shear stresses. The shear modulus and its dependence on the packing fraction are found to strongly depend on the details of the interaction potential and largely differ from expectations for entropic networks. This behaviour can be interpreted in terms of more elaborated percolation theories including central forces and bond-bending forces.

Molecular weight dependence of the shear rheology of poly(methyl methacrylate) Langmuir films: a comparison between two different rheometry techniques.

The surface shear rheology of Langmuir monolayers of poly(methyl methacrylate) (PMMA) has been studied as a function of polymer concentration (Gamma) and molecular weight (N). Two different rheology techniques were used, one based on free damped oscillations of a ring with a sharp edge and the other based on a forced oscillation of a biconical disk. Both instruments were used in the oscillatory mode at comparable oscillation frequency and amplitude, which gave access to the viscoelastic shear modulus (S). The two instruments, working in different viscosity ranges, provide complementary and mutually compatible data. The results obtained for four PMMA samples of molecular weight between 8x10(3) and 2.7x10(5) g.mol(-1) show powerlike behavior as S approximately Gamma10 and S approximately N4. These strong dependences suggest a structural scenario based on the 2D percolation of the polymer pancakes.

Utilidad de la neurocrioestimulación en el tratamiento de los esguinces leves y moderados de tobillo / Neuroprotective effect of adult mesenchymal stem cells in the early phases of spinal cord injury

Objetivo: El objetivo de este estudio es valorar si la aplicación de la neurocrioestimulación junto con los vendajes funcionales mejora los resultados y acorta la duración del tratamiento de los esguinces de tobillo grado I y II, en comparación con el tratamiento funcional aislado. Material y metodología: La realización del estudio se efectuó con dos grupos de 13 pacientes cada uno, siendo asignados a cada grupo de forma aleatoria; el primer grupo realizó vendaje funcional y tratamiento funcional y el segundo grupo se trató con vendaje funcional y neurocrioestimulación. Se evaluaron y compararon los parámetros de tumefacción, dolor y días de baja laboral. Resultados: La neurocrioestimulación es efectiva en los esguinces grado I, mejorando el dolor y la tumefacción, pero sin diferencias en los días de baja. En los esguinces grado II no se apreciaron diferencias significativas entre ambos tratamientos. Conclusión: la neurocrioestimulación fue efectiva en los casos de esguince de tobillo grado I, pero insuficiente en los grado II que necesitaron la asociación de tratamiento médico y rehabilitador (AU)

Objectives: To explore the effect of the early administration of adult mesenchymal stem cells upon apoptosis in the early phases of experimental spinal cord injury. Material and methods: Twenty adult Wistar rats were subjected to standard contusion injury at mid-dorsal level. Two hours after injury, 10 animals received an intralesional injection of 10 Ìl of physiological saline, while the other 10 received 106 adult bone marrow mesenchymal stem cells. Five animals in each group were sacrificed after 8 hours, and another 5 were sacrificed 72 hours after injury. Histological and histomorphometric studies with hematoxylin-eosin and MAb F7 26 (apostain) were made. Results: In the controls, the mean number of nerve cells expressing apostain was 138 ± 16 measured 8 hours after injury, and 82 ± 13 measured after 72 hours. In contrast, in the treated animals the number of nerve cells expressing apostain was 76 ± 11 measured 8 hours after injury, and 57 ± 7 measured after 72 hours – the differences between the two groups being statistically significant (p<0.05). Conclusion: The intralesional administration of adult mesenchymal stem cells exerts a neuroprotective effect in the early phases of severe spinal cord injury, with a reduction in the number of apoptotic nerve cells (AU)

Central aponeurosis tears of the rectus femoris: practical sonographic prognosis.

OBJECTIVE: This study is a statistical analysis to establish whether a correlation exists between the level and degree of rectus femoris (RF) central tendon injury and the amount of time that an athlete is unable to participate subsequently, referred to as "sports participation absence" (SPA). DESIGN: Causal-comparative study. PATIENTS: 35 players from two high-level Spanish soccer teams with an injury to the central tendon of the RF based on clinical and ultrasound criteria. MAIN OUTCOME MEASURE: Ultrasound examination was performed with an 8-2 MHz linear multifrequency transducer. All studies included both longitudinal and transverse RF sections. RESULTS: At the proximal level the SPA time is 45.1 days when the injury length is 4.0 cm. This value increases by 5.3 days with each 1 cm increase in the length of injury. In the case of distal level injury, SPA time is 32.9 days when the injury length is 3.9 cm. This value increases by 3.4 days with each 1 cm increase. In the total representative sample, SPA time when the injury length is 4.2 cm corresponds to 39.1 days. This value increases by 4.2 days per length unit. CONCLUSIONS: RF central tendon injury at the proximal level is associated with a greater SPA time than at the distal level. Patients with a grade II injury have an SPA time longer than those with a grade I injury whether the injury is located proximal or distal.

Reconstrucción anatómica bifascicular del ligamento cruzado anterior / Double-bundle anterior cruciate ligament reconstruction

Objetivodiseñar una técnica que mejore las laxitudes residuales en las cirugías del ligamento cruzado anterior (LCA). Material y métodose efectuó un estudio anatómico en 20 rodillas de cadáver y en 50 fémures y 50 tibias humanas. Además, se analizó mecánicamente el comportamiento tras la sección de los fascículos en la rodilla del cadáver. Resultadosel LCA presentó una inserción piriforme en la tibia, con eje mayor oblicuo y un área de 15,8×11,6mm. La inserción femoral fue ovoidea (15×8mm) con 15¿30° de inclinación respecto a la cortical posterior. La longitud del fascículo anteromedial (AM) fue de 34±4,5mm y el posterolateral (PL) de 22±4mm. La técnica de doble fascículo mostró un 32,8% más de resección ósea que el monotúnel, pero con un 62,5% menos exigencias para el sistema de fijación; las cargas máximas hasta la rotura fueron de 785N. La sección de los fascículos mostró, en rotación neutra y 30° de flexión, un comportamiento idéntico de ambos fascículos; con la rodilla en flexión de 95° y rotación neutra, el fascículo AM soportó mayores tensiones mientras el PL las mantuvo en extensión y en rotación externa. Conclusionesla reproducción de la morfología bifascicular del LCA se adapta a la biomecánica y a la anatomía del LCA, siendo posible hacerlo a través de un único orificio tibial

Purpose: To design a technique Ahmed at reducing the incidence of residual laxity in anterior cruciate ligament (ACL) surgery. Materials and methodsAn anatomic study was performed in 20 cadaver knees and in 50 human femurs and 50 human tibias. In addition, a mechanical study was made of the consequences of sectioning the bundles in the cadaver knee. ResultsThe ACL presented with a tibial piriformis attachment, with an oblique greater axis and ana rea of 15.8×11.6mm. The femoral attachment was egg-shaped (15×8mm) with a 15¿30° inclination with respect to the posterior cortex. The length of the anteromedial (AM) bundle was 34±4,5mm and of the posterolateral (PL) bundle 22±4mm. The double-bundle technique afforded 32.8% more bone resection than the single tunnel, but causing 62.5% less stress on the fixation system; maximum loading strength of 785N. On being sectioned, both bundles showed, at neutral rotation and 30° flexion, identcal behaviors; with the knee at 95° flexion and neutral rotation the AM bundle had to withstand greater strains while the PL bundle had to withstand them in extension and external rotation. ConclusionsReproducing the double-bundle morphology of the ACL is a successful method that is well-adapted to the anatomy and biomechanics of the ACL and that can be carried out through a single tibial tunnel (AU)

Implante meniscal de colágeno asociado a rotura del ligamento cruzado anterior / Collagen meniscal implants with an associated tear of the anterior cruciate ligament

Objetivo: analizar el resultado clínico de los implantes meniscales de colágeno (CMI) combinados con roturas del ligamento cruzado anterior (LCA). Pacientes y métodose realizó el seguimiento de 37 varones y 1 mujer, con edades entre 22 y 50 años, a los que se implantó artroscópicamente un CMI en el compartimento medial de la rodilla asociado a plastia de ligamento cruzado anterior, semitendinoso y recto interno en 35 casos y con aloinjerto en 3. De los pacientes, 10 presentaban una lesión del menisco lateral en la misma rodilla. El intervalo de tiempo entre la lesión del LCA y la cirugía varió entre 3 semanas y 6 meses. Se evaluó a todos los paciente con la escala IKDC, radiografías en carga y resonancia magnética. La evolución fue entre 24 y 84 meses. Resultadosel IKDC, en 19 de los pacientes fue normal (A), en 14 casi normal (B), en 4 anormal (C) y en uno severamente anormal (D). El rango de movilidad fue normal en 26 pacientes y cercano al normal en 12. El KT-1000 fue normal en 30 pacientes, casi normal en 5, anormal en 1 y severamente anormal en 2. El estudio radiográfico en carga fue normal en 24 pacientes, casi normal en 7 y anormal en 7. Como complicaciones encontramos 8 implantes reabsorbidos a los 6 meses; 7 disestesias en territorio del nervio safeno, una rotura de plastia, una pérdida del CMI y 2 rigideces que precisaron movilización bajo anestesia. Conclusionesel CMI es una alternativa funcional en pacientes jóvenes con lesiones meniscales graves que asocian roturas del LCA, pero requiere futuros estudios y desarrollos técnicos antes de ser generalizada

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Fracturas periprotésicas de rodilla / Periprosthetic knee fractures

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