OSTEOTOMY AT THE BASE OF FEMORAL NECK AND OSTEOPLASTY FOR THE TREAMENT OF SCFE.

Objective: To compare the clinical outcomes between patients with moderate and severe slipped capital femoral epiphysis (SCFE) treated with osteotomy at the base of neck and osteoplasty and with healthy individuals. Methods: Comparative cohort with 12 patients (14 hips) with moderate and severe SCFE who underwent osteotomy at the base of neck and osteoplasty between 2007 and 2014. The mean age at surgery was 13.3 ± 2.5 years and the mean follow-up was 3.8 ± 2.2 years. We assessed the level of hip pain by the visual analog scale (VAS) and anterior impingement test (AIT); the level of function using the Harris Hip Score (HHS) and 12-Item Short Form Health Survey (SF-12), the range of motion (ROM) by goniometry and Drehmann sign, and the hip muscular strength by isokinetic and Trendelenburg sign. Results: The level of pain was slightly higher in the SCFE cohort compared with healthy hips (VAS, 0.8 ± 1.4 vs 0 ± 0, 0.007; AIT, 14% vs 0%, p = 0.06; respectively). No differences were observed between the SCFE and control cohort for the functional scores (HHS, 94 ± 7 vs 100 ± 1, p = 0.135); except for ROM, with increased internal rotation (37.3º ± 9.4º vs 28.7º ± 8.2º, p < 0.001), and strength, with decreased abduction torque (75.5 ± 36.9 Nm/Kg vs 88.5 ± 27.6 Nm/Kg, p = 0.045) in the SCFE cohort. Conclusion: The osteotomy at the base of neck and the osteoplasty restored the hip motion and muscle strength, except for the abductor strength, to near normal levels, representing a viable option for the treatment of moderate and severe SCFE. Level of Evidence III, Ambidirectional Cohort Study.

Objetivo: Comparar resultados clínicos de pacientes com escorregamento epifisário proximal do fêmur (EEPF) moderado e grave tratados com osteotomia basocervical e cervicoplastia com indivíduos saudáveis. Métodos: Coorte comparativa com 12 voluntários saudáveis e 12 pacientes (14 quadris) com EEPF moderado e grave submetidos à osteotomia basocervical e cervicoplastia entre 2007 e 2014. A média de idade na cirurgia foi de 13,3 ± 2,5 anos e o seguimento médio de 3,8 ± 2,2 anos. Avaliou-se nível de dor no quadril utilizando a escala visual analógica (EVA) e o teste de impacto anterior (TIA); nível de função usando o Harris Hip Score (HHS) e o 12-Item Short Form Health Survey (SF-12); amplitude de movimento (ADM) com goniometria e sinal de Drehmann; e força muscular do quadril com dinamômetro isocinético e sinal de Trendelenburg. Resultados: O nível de dor foi ligeiramente maior na coorte de EEPF comparado a quadris saudáveis (EVA, 0,8 ± 1,4 vs 0 ± 0, 0,007; TIA, 14% vs 0%, p = 0,06; respectivamente). Não foram observadas diferenças entre os grupos EEPF e controle para os escores funcionais (HHS, 94 ± 7 vs 100 ± 1, p = 0,135), exceto para ADM, com aumento da rotação interna (37,3º ± 9,4º vs 28,7º ± 8,2º, p < 0,001), e força, com diminuição do torque de abdução (75,5 ± 36,9 Nm/Kg vs 88,5 ± 27,6 Nm/Kg, p = 0,045), para o grupo EEPF. Conclusão: A osteotomia basocervical e a cervicoplastia restauraram o movimento do quadril e a força muscular, com exceção da força abdutora, a níveis próximos do normal, representando uma opção viável para o tratamento de EEPF moderado e grave. Nível de Evidência III, Estudo de Coorte Ambidirecional.

Osteotomy at the base of femoral neck and osteoplasty for the treament of scfe / Osteotomia na base do colo femoral e osteoplastia para o tratamento da epifisiolistese

ABSTRACT Objective: To compare the clinical outcomes between patients with moderate and severe slipped capital femoral epiphysis (SCFE) treated with osteotomy at the base of neck and osteoplasty and with healthy individuals. Methods: Comparative cohort with 12 patients (14 hips) with moderate and severe SCFE who underwent osteotomy at the base of neck and osteoplasty between 2007 and 2014. The mean age at surgery was 13.3 ± 2.5 years and the mean follow-up was 3.8 ± 2.2 years. We assessed the level of hip pain by the visual analog scale (VAS) and anterior impingement test (AIT); the level of function using the Harris Hip Score (HHS) and 12-Item Short Form Health Survey (SF-12), the range of motion (ROM) by goniometry and Drehmann sign, and the hip muscular strength by isokinetic and Trendelenburg sign. Results: The level of pain was slightly higher in the SCFE cohort compared with healthy hips (VAS, 0.8 ± 1.4 vs 0 ± 0, 0.007; AIT, 14% vs 0%, p = 0.06; respectively). No differences were observed between the SCFE and control cohort for the functional scores (HHS, 94 ± 7 vs 100 ± 1, p = 0.135); except for ROM, with increased internal rotation (37.3º ± 9.4º vs 28.7º ± 8.2º, p < 0.001), and strength, with decreased abduction torque (75.5 ± 36.9 Nm/Kg vs 88.5 ± 27.6 Nm/Kg, p = 0.045) in the SCFE cohort. Conclusion: The osteotomy at the base of neck and the osteoplasty restored the hip motion and muscle strength, except for the abductor strength, to near normal levels, representing a viable option for the treatment of moderate and severe SCFE. Level of Evidence III, Ambidirectional Cohort Study.

RESUMO Objetivo: Comparar resultados clínicos de pacientes com escorregamento epifisário proximal do fêmur (EEPF) moderado e grave tratados com osteotomia basocervical e cervicoplastia com indivíduos saudáveis. Métodos: Coorte comparativa com 12 voluntários saudáveis e 12 pacientes (14 quadris) com EEPF moderado e grave submetidos à osteotomia basocervical e cervicoplastia entre 2007 e 2014. A média de idade na cirurgia foi de 13,3 ± 2,5 anos e o seguimento médio de 3,8 ± 2,2 anos. Avaliou-se nível de dor no quadril utilizando a escala visual analógica (EVA) e o teste de impacto anterior (TIA); nível de função usando o Harris Hip Score (HHS) e o 12-Item Short Form Health Survey (SF-12); amplitude de movimento (ADM) com goniometria e sinal de Drehmann; e força muscular do quadril com dinamômetro isocinético e sinal de Trendelenburg. Resultados: O nível de dor foi ligeiramente maior na coorte de EEPF comparado a quadris saudáveis (EVA, 0,8 ± 1,4 vs 0 ± 0, 0,007; TIA, 14% vs 0%, p = 0,06; respectivamente). Não foram observadas diferenças entre os grupos EEPF e controle para os escores funcionais (HHS, 94 ± 7 vs 100 ± 1, p = 0,135), exceto para ADM, com aumento da rotação interna (37,3º ± 9,4º vs 28,7º ± 8,2º, p < 0,001), e força, com diminuição do torque de abdução (75,5 ± 36,9 Nm/Kg vs 88,5 ± 27,6 Nm/Kg, p = 0,045), para o grupo EEPF. Conclusão: A osteotomia basocervical e a cervicoplastia restauraram o movimento do quadril e a força muscular, com exceção da força abdutora, a níveis próximos do normal, representando uma opção viável para o tratamento de EEPF moderado e grave. Nível de Evidência III, Estudo de Coorte Ambidirecional.

A comparison of isokinetic rotator cuff performance in wheelchair basketball athletes vs. non-athletes with spinal cord injury.

OBJECTIVES: This study aimed to compare the isokinetic peak torque and, secondarily, other parameters of the rotator cuff in the shoulders of paraplegic wheelchair basketball athletes and non-athletes controls. DESIGN: Cross-sectional study. METHODS: Thirty-six complete spinal cord injured individuals aged between 18 and 45 years performed an isokinetic evaluation of peak torque, power, and work exerted by the rotator cuff muscle group, in a Biodex System. All Concentric isokinetic tests were performed in the seated position with the shoulder at a 45° abduction from the scapular plane and flexed at 30° to the frontal plane. Subjects completed five repetitions at 60°/s and 180°/s, and ten repetitions at 300°/s, bilaterally, with an interval of one minute between each series. Statistical analysis (t-test, P < 0.05) compared athletes and non-athletes, dominant and non-dominant upper limbs according to all isokinetic parameters and angular velocities. RESULTS: Peak torque/weight, work, and muscle power of wheelchair basketball athletes were significantly greater than those of the control group (P < 0.05), but there were no statistical differences between dominant and non-dominant upper limb. Internal rotators were stronger than the external rotators both for athletes and for non-athletes. There is a positive correlation between peak torque and time since injury. CONCLUSIONS: Wheelchair basketball athletes showed greater peak torque and other muscle performance parameters, which suggest that wheelchair basketball influences the shoulder musculature of those with traumatic spinal cord injury.

The relationship between performance on the modified star excursion balance test and the knee muscle strength before and after anterior cruciate ligament reconstruction.

OBJECTIVES: The objective of this study was to evaluate the dynamic balance of the injured and uninjured limb before and after the anterior cruciate ligament (ACL) reconstruction and compare with the control group. STUDY DESIGN: Prospective longitudinal. SETTING: Biomechanics laboratory. PARTICIPANTS: Participants are 24 males (mean age, 27.5 years) with unilateral ACL injury (ACLG) and 24 male healthy volunteers (CG). MAIN OUTCOMES MEASURES: The modified star excursion balance test (SEBT) and isokinetic knee extensor and flexor strength were applied in the ACLG preoperatively and after surgery. The dominant limb of CG was evaluated at a single time. RESULTS: There was no difference between the injured and the uninjured limb of the ACLG (P > 0.05) before and after surgery. Preoperatively, both ACLG limbs had a significantly lower reach distance in posteromedial (PM) and posterolateral (PL) directions and in composite reach (CR) score compared to the control group (P < 0.001). Postoperatively, no significant differences were found between ACLG and CG (P > 0.05). There was a positive correlation between preoperative PL (0.59) and CR (0.51), postoperative PM (0.36), PL (0.36) and CR (0.46) with flexor strength at 12 months after surgery. CONCLUSION: Patients with ACL injury presented a worse performance in the SEBT in the preoperative period compared to the control group. After ligament reconstruction, the performance in the SEBT became equivalent to that of the control group. The strong correlation between flexor strength and posterior directions of the injured limb demonstrates the importance of the knee flexor muscles in the neuromuscular control of patients submitted to ACL reconstruction.

Proposta de programa de intervenção fisioterapêutica em grupo para pacientes com osteoartrite de joelho no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto HCFMRP-USP / The proposed program of physical therapy intervention group for patients with osteoarthritis of the knee at the Hospital of the Faculdade de Medicina de Ribeirão Preto HCFMRP-USP

A osteoartrite (OA) é uma doença crônico-degenerativa que afeta milhões de pessoas, sendo considerada uma epidemia mundial. Estima-se um aumento de 30% em 10 anos em sua prevalência. O evento primário é um desequilíbrio homeostático entre a síntese e a degradação da cartilagem articular. Sua etiologia não esta bem definida. Pode ter origem idiopática onde a causa esta ligada a um defeito intrínseco da cartilagem ou secundária a outros eventos como traumas ou infecções. Dentre os tratamentos para OA, o medicamentoso não vem obtendo bons resultados. A prescrição de exercício é a principal ação não farmacológica. A justificativa para sua prescrição é baseada em observações biomecânicas e biológicas como a fraqueza dos músculos periarticulares, especialmente do quadríceps, levando a uma falha da função de amortecedor e acentuando cargas mecânicas na articulação. Os exercícios de resistência, flexibilidade e força tem sido descritos como benéficos para vários fatores como diminuição da dor e nível de atividade. Entretanto, nenhum mostra clara vantagem sobre o outro. O acompanhamento diário em caráter ambulatorial geraria alto custo na saúde pública, levando em consideração a grande quantidade de pacientes e a necessidade de um longo período de tratamento. Assim, estratégias educacionais e programas de auto-gestão de exercícios devem ser incorporados. No presente trabalho foi elaborado um programa de acompanhamento terapêutico, educacional e de auto-gestão de curto e longo prazo para pacientes com OA de joelho. No período de agosto a novembro ano de 2010 foram encaminhados nove pacientes dos quais oito se encaixavam nos critérios de inclusão do grupo de OA. Destes oito, seis completaram o programa com duas desistências. O percentual médio de faltas foi de 12 + 5,58%, mostrando um índice satisfatório de adesão ao tratamento.

Osteoarthritis (OA) is a chronic degenerative disease that affects millions and isconsidered a worldwide epidemic. It is estimated at 30% increase in its prevalence in10 years. The primary event is a homeostatic imbalance between synthesis anddegradation of articular cartilage. Its etiology is not well defined. May have idiopathicwhere the cause is linked to an intrinsic defect of cartilage or secondary to otherevents such as trauma or infection. Among the treatments for OA, the drug is notgetting good results. The exercise prescription is the primary non-pharmacologicalaction. The justification for its prescripition is based on biomechanical and biologicalobservations such as periarticular muscle weakness, especially the quadriceps,leading to a failure of the function of mechanical loading buffer and stressing thejoint. Resistance exercise, flexibility and strength have been described as beneficialto many factors such as decreased pain and activity level. However, none shows aclear advantage over the other. The daily monitoring on an outpatient basis wouldgenerate high costs in public health, considering the large amount of patients and theneed for a long period of treatment. Thus, educational strategies and programs forself-management exercises should be incorporated in the present work a program ofmonitoring therapeutic, educational and self-management of short and long term forpatients with knee osteoarthritis. In the period from August to November 2010 ninepatients were referred eight of which fit the inclusion criteria for the OA group. Ofthese eight, six completed the program with two withdrawals. The averagepercentage of absences was 12 + 5.58%, showing a satisfactory rate of adherence totreatment.