ABSTRACT
OBJECTIVE: To compare bone marrow aspirate concentrate (BMAC) with the standard treatment for gluteal tendinopathies. METHODS: 48 patients diagnosed with gluteal tendinopathy at a university hospital were selected by a randomized clinical trial and divided into two groups: (G1) bone marrow aspirate concentrate and (G2) corticosteroid injections. RESULTS: 40 of the 48 selected patients were monitored for six months and both groups showed better scores. Visual analog scale (VAS) scores and Lequesne index were statistically significant higher in patients submitted to BMAC treatment when compared to standard treatment. Both groups improved their quality of life, without statistically significant difference. CONCLUSION: BMAC constitutes an alternative to gluteal tendinopathy standard treatment, proving to be a safe technique with promising results when combined with multidisciplinary team behavioral therapy. Level of Evidence II, Randomized Clinical Trial.
OBJETIVO: Estudo comparativo entre tratamento com corticóide e aspirado de medula óssea concentrado (BMAC) para o tratamento de tendinopatias glúteas. MÉTODOS: O ensaio clínico randomizado selecionou pacientes diagnosticados com tendinopatia glútea e os dividiu em dois grupos: (G1) aspirado de medula óssea concentrada e (G2) injeção de corticosteróide. RESULTADOS: Foram selecionados 48 pacientes, dos quais 40 foram monitorados por 6 meses, com melhora nos escores nos dois grupos. Os pacientes que foram submetidos ao tratamento com BMAC tiveram uma melhora estatisticamente significativa nos escores de EVA e nos escores de Lequesne em comparação ao tratamento padrão. Houve uma melhora na avaliação da qualidade de vida em ambos os grupos, sem diferença estatisticamente significativa. CONCLUSÃO: O aspirado de medula óssea concentrada surge como uma alternativa ao tratamento padrão da tendinopatia glútea, provando ser uma técnica segura e com resultados promissores quando combinada à terapia comportamental de equipe multidisciplinar. Nível de Evidência II, O ensaio clínico randomizado.
ABSTRACT
ABSTRACT Objective: To compare bone marrow aspirate concentrate (BMAC) with the standard treatment for gluteal tendinopathies. Methods: 48 patients diagnosed with gluteal tendinopathy at a university hospital were selected by a randomized clinical trial and divided into two groups: (G1) bone marrow aspirate concentrate and (G2) corticosteroid injections. Results: 40 of the 48 selected patients were monitored for six months and both groups showed better scores. Visual analog scale (VAS) scores and Lequesne index were statistically significant higher in patients submitted to BMAC treatment when compared to standard treatment. Both groups improved their quality of life, without statistically significant difference. Conclusion: BMAC constitutes an alternative to gluteal tendinopathy standard treatment, proving to be a safe technique with promising results when combined with multidisciplinary team behavioral therapy. Level of Evidence II, Randomized Clinical Trial.
RESUMO Objetivo: Estudo comparativo entre tratamento com corticóide e aspirado de medula óssea concentrado (BMAC) para o tratamento de tendinopatias glúteas. Métodos: O ensaio clínico randomizado selecionou pacientes diagnosticados com tendinopatia glútea e os dividiu em dois grupos: (G1) aspirado de medula óssea concentrada e (G2) injeção de corticosteróide. Resultados: Foram selecionados 48 pacientes, dos quais 40 foram monitorados por 6 meses, com melhora nos escores nos dois grupos. Os pacientes que foram submetidos ao tratamento com BMAC tiveram uma melhora estatisticamente significativa nos escores de EVA e nos escores de Lequesne em comparação ao tratamento padrão. Houve uma melhora na avaliação da qualidade de vida em ambos os grupos, sem diferença estatisticamente significativa. Conclusão: O aspirado de medula óssea concentrada surge como uma alternativa ao tratamento padrão da tendinopatia glútea, provando ser uma técnica segura e com resultados promissores quando combinada à terapia comportamental de equipe multidisciplinar. Nível de Evidência II, O ensaio clínico randomizado.
ABSTRACT
BACKGROUND: The purpose of our study was to evaluate safety, feasibility and clinical results of bone marrow mononuclear cell (BMC) implantation for early-stage osteonecrosis of the knee (OK) secondary to sickle cell disease. METHODS: Thirty-three SCD patients (45 knees) with OK treated with BMC implantation in the osteonecrotic lesion were clinically and functionally evaluated through the American Knee Society Clinical Score (KSS), Knee Functional Score (KFS) and Numeric Rating Scale (NRS) pain score. MRI and radiographic examinations of the knee were assessed during a period of five years after intervention. RESULTS: No complications or serious adverse event were associated with BMC implantation. From preoperative assessment to the latest follow-up, there was a significant (p < 0.001) improvement of clinical KSS (64.3 ± 9.7, range: 45-80 and 2.2 ± 4.1, range: 84-100, respectively), KFS (44.5 ± 8.0, range: 30-55 and 91.6 ± 5.8, range: 80-100, respectively) and reduction of NRS pain score (6.7 ± 1.2, range: 4-9 and 3.4 ± 1.0, range: 2-5, respectively). In total, 87% of patients (29/33) consistently experienced improvements in joint function and activity level as compared to preoperative score. No patient had additional surgery following BMC implantation. Radiographic assessment showed joint preservation and no progression to subchondral collapse at most recent follow-up. CONCLUSIONS: The technique of BMC implantation is a promising, relatively simple and safe procedure for OK in SCD patients. Larger and long-term controlled trials are needed to support its clinical effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT02448121 . Retrospectively registered 19 May 2015.
Subject(s)
Anemia, Sickle Cell/diagnostic imaging , Anemia, Sickle Cell/therapy , Bone Marrow Transplantation/methods , Knee Joint/diagnostic imaging , Osteonecrosis/diagnostic imaging , Osteonecrosis/therapy , Adolescent , Adult , Female , Humans , Male , Pilot Projects , Prospective Studies , Transplantation, Autologous/methods , Young AdultABSTRACT
PURPOSE: The aim of this study was to describe the clinical features of osteonecrosis (ON) in sickle cell disease (SCD) patients in Bahia, a Northeast state with the highest prevalence of the disease in Brazil. METHODS: Between 2006 and 2017, 283 cases of osteonecrosis in SCD patients were enrolled to analyse the age at diagnosis, genotype, gender, pain, distribution of the lesions and disease staging. MRI and radiograph were obtained at the participation. RESULTS: Of the 283 SCD cases, 120 (42.4%) were haemoglobin SS genotype while 163 (57.6%) were SC genotype. Two hundred and forty-six cases were bilateral and 37 were unilateral, with an average age at diagnosis of 33.7 (range 10-67) years. The most frequent identified ON site not only was the hip (74.6%), but also affected shoulder, knee and ankle. Most cases presented at early stage I (172, 60.8%) disease. No significant differences on the features of osteonecrosis were identified between haemoglobin SS and haemoglobin SC cases. CONCLUSIONS: Given the relatively high prevalence of bilateral osteonecrosis at early stages, painful symptoms and rather late age at diagnosis, SCD patients should have radiological examination of their joints more often in order to prevent severe functional disability and increase patient's life quality.
Subject(s)
Anemia, Sickle Cell/complications , Femur Head Necrosis/complications , Adolescent , Adult , Aged , Brazil , Child , Cross-Sectional Studies , Female , Femur Head Necrosis/diagnosis , Femur Head Necrosis/epidemiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prevalence , Young AdultABSTRACT
Selecionar os estudos relacionados à cirurgia do joelho publicados na literatura ortopédica nacional por meio da Acta Ortopédica Brasileira (AOB) e da Revista Brasileira de Ortopedia (RBO) e classificá-los de acordo com os níveis de evidência. Foram selecionados todos os estudos publicados de 2000 a 2011. A seguinte categorização foi adotada: nível1- revisão sistemática; nível 2 - ensaio clínico; nível 3 - estudos de coorte e caso-controle; nível 4 - série de casos; níve l5 - revisão narrativa e outros. Foram encontrados 255. Na região Sudeste foram 212 artigos (83,1%), na Sul 30 (11,7%), na Nordeste cinco (2%), na Norte e na Centro-Oeste dois cada (0,8%). Quatro trabalhos foram desenvolvidos no exterior (1,6%). O tema mais comum foi ligamento cruzado anterior, em 58 estudos (22,7%), e artroplastias, em 55 estudos (21,5%). A maior parte dos estudos apresentou nível de evidência IV (27,8%) e V (50,2%). A produção científica nacional relacionada à cirurgia do joelho apresenta-se em expansão, com predomínio de expressão na região Sudeste. A maioria dos estudos tem baixo nível de evidência e concentra-se na abordagem do ligamento cruzado anterior e das artroplastias.
Select the studies related to knee surgery in the orthopedic literature published by Acta Ortopédica Brasileira (AOB) and the Revista Brasileira de Ortopedia (RBO) and classify them according to the levels of evidence. We selected all studies published from 2000 to 2011 related to knee surgery in AOB and RBO. The following categorization was adopted: level 1: systematic review; level 2: clinical trial; level 3: cohort studies and case-control; level 4: number of cases; level 5: narrative review and others. We found in the national literature selected 255 studies related to knee surgery. In the Southeast were developed 212 articles (83.1%), 30 publications in the South (11.7%), Northeast 5 (2%), North and Central West 2 jobs each (0.8%). Four work performed in other country (1.6%). The most common issue was the anterior cruciate ligament in 58 studies (22.7%) and arthroplasty in 55 studies (21.5%). Most studies presented evidence level IV (27.8%) and V (50.2%). The national scientific production related to knee surgery presents itself expanding with predominant expression in the Southeast. Most studies related to knee surgery published in national journals have low level evidence and focuses on the approach of the anterior cruciate ligament and arthroplasty.
Subject(s)
Bibliometrics , Evidence-Based Medicine , KneeABSTRACT
Select the studies related to knee surgery in the orthopedic literature published by Acta Ortopédica Brasileira (AOB) and the Revista Brasileira de Ortopedia (RBO) and classify them according to the levels of evidence. We selected all studies published from 2000 to 2011 related to knee surgery in AOB and RBO. The following categorization was adopted: level 1: systematic review; level 2: clinical trial; level 3: cohort studies and case-control; level 4: number of cases; level 5: narrative review and others. We found in the national literature selected 255 studies related to knee surgery. In the Southeast were developed 212 articles (83.1%), 30 publications in the South (11.7%), Northeast 5 (2%), North and Central West 2 jobs each (0.8%). Four work performed in other country (1.6%). The most common issue was the anterior cruciate ligament in 58 studies (22.7%) and arthroplasty in 55 studies (21.5%). Most studies presented evidence level IV (27.8%) and V (50.2%). The national scientific production related to knee surgery presents itself expanding with predominant expression in the Southeast. Most studies related to knee surgery published in national journals have low level evidence and focuses on the approach of the anterior cruciate ligament and arthroplasty.
Selecionar os estudos relacionados à cirurgia do joelho publicados na literatura ortopédica nacional por meio da Acta Ortopédica Brasileira (AOB) e da Revista Brasileira de Ortopedia (RBO) e classificá-los de acordo com os níveis de evidência. Foram selecionados todos os estudos publicados de 2000 a 2011. A seguinte categorização foi adotada: nível 1 - revisão sistemática; nível 2 - ensaio clínico; nível 3 - estudos de coorte e caso-controle; nível 4 - série de casos; nível 5 - revisão narrativa e outros. Foram encontrados 255. Na região Sudeste foram 212 artigos (83,1%), na Sul 30 (11,7%), na Nordeste cinco (2%), na Norte e na Centro-Oeste dois cada (0,8%). Quatro trabalhos foram desenvolvidos no exterior (1,6%). O tema mais comum foi ligamento cruzado anterior, em 58 estudos (22,7%), e artroplastias, em 55 estudos (21,5%). A maior parte dos estudos apresentou nível de evidência IV (27,8%) e V (50,2%). A produção científica nacional relacionada à cirurgia do joelho apresenta-se em expansão, com predomínio de expressão na região Sudeste. A maioria dos estudos tem baixo nível de evidência e concentra-se na abordagem do ligamento cruzado anterior e das artroplastias.
ABSTRACT
An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause.
ABSTRACT
A associação entre dor no quadril, anormalidade do músculo quadrado femoral na ressonância magnética (RM) e estreitamento do espaço isquiofemoral tem sido relatada na literatura atual, levantando a possibilidade de que essa lesão muscular seja causada pelo impacto isquiofemoral. Tal diagnóstico foi observado em algumas mulheres de meia-idade com ou sem história de trauma ou cirurgia. Os autores relatam aqui uma mulher de 31 anos de idade, que apresentava dor no quadril sem história de trauma, com evidência de estreitamento do espaço isquiofemoral e edema no músculo quadrado femoral. Foi realizado tratamento não cirúrgico com alívio dos sintomas. O diagnóstico de impacto isquiofemoral deve ser considerado em pacientes do sexo feminino com queixa de dor no quadril sem outra causa evidente.
An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause.
