ORTHOPEDIC INJURIES IN MEN'S PROFESSIONAL SOCCER DURING THE CORONAVIRUS DISEASE PANDEMIC.

Objective: To assess the incidence and characteristics of injuries that occurred in the 2020 season of the Paulista Football Championship during the novel coronavirus disease pandemic. Methods: We conducted a prospective study using an electronic questionnaire developed by the Medical Committee of the Paulista Football Federation. Results were sent to the team doctors of series A1 and A2 after each round of the Paulista Football Championship. Results: Series A1 and A2 presented 12.17 and 15.6 injuries, respectively, per 1000 gaming hours. The strikers were the most affected, with muscle injuries being the most frequent and the lower limbs being the most affected. Most injuries occurred within 31-45 minutes of playing; only 4.5% of injuries required surgery. Conclusion: There was no statistical difference in the comparison between pre- and post-pandemic conditions. In relation to the variables studied, the most injuries occurred in the lower limbs; the most common type of injury was muscle strain, followed by sprain and contusion. The most requested exam was MRI; most injuries were classified as moderate (8-28 days). There was no difference between pre- and post-pandemic conditions. Level of Evidence IV, Case Series.

Objetivo: Avaliar a incidência e as características das lesões ocorridas na temporada 2020 do Campeonato Paulista de Futebol durante a pandemia de covid-19. Métodos: Foi realizado um estudo prospectivo por meio de questionário eletrônico desenvolvido pela Comissão Médica da Federação Paulista de Futebol. Os resultados foram enviados aos médicos das equipes das séries A1 e A2 após cada rodada do Campeonato Paulista de Futebol. Resultados: As Séries A1 e A2 apresentaram 12,17 e 15,6 lesões, respectivamente, por 1.000 horas de jogo. Os atacantes foram os mais acometidos, sendo as lesões musculares as mais frequentes e os membros inferiores os mais afetados. A maioria das lesões ocorreu dentro de 31 a 45 minutos de jogo; apenas 4,5% das lesões necessitaram de cirurgia. Conclusão: Não houve diferença estatística na comparação entre as condições pré e pós-pandemia. Em relação às variáveis estudadas, a maioria das lesões ocorreu nos membros inferiores; o tipo de lesão mais comum foi distensão muscular, seguida de entorse e contusão. O exame mais solicitado foi a ressonância magnética; a maioria das lesões foi classificada como moderada (8-28 dias). Não houve diferença entre as condições pré e pós-pandemia. Nível de Evidência IV, Série de Casos.

DOPING CONTROL IN MALE SOCCER PLAYERS IN BRAZIL: 10 YEARS OF FOLLOW-UP.

Objective: To understand the Adverse Analytical Finding (AAF) that have occurred in Brazilian soccer in a recent 10-year period, comparing them to international data, to know the Brazilian profile. Methods: A review of the AAR in the Doping Control Commission database of the Brazilian Football Association from 2008 to 2017. The AAR in professional male soccer players between 2008 and 2017 were considered. Results: The sample selected in this research was composed of 40,092 doping tests, with 113 AAR, identified in 18 different competitions (0.28%) in the professional category, in Brazilian national and state competitions between 2008 and 2017, flagged in doping control exams through urine samples. Stimulants were detected most frequently (31.0%), followed by glucocorticoids (21.2%), diuretics, and masking agents (19.5%). The Brazilian Championship series did not show a relationship with any of the World Anti-Doping Agency (WADA) groups of substances. Series A showed 0.07% of AAR, Series B 0.21%, Series C 0.75% and Series D 1.49. Conclusion: The rate of AAR in Brazilian soccer was 0.28%, lower than the average for all soccer worldwide, and shows similar percentages among field positions. Stimulants were the most prevalent drugs. The national elite soccer competitions showed significantly fewer cases than the lower divisions. Level of Evidence II; Retrospective Study.

Objetivo: Compreender os Resultados Analíticos Adversos (RAA) ocorridos no futebol brasileiro nos últimos 10 anos, comparando-os aos dados internacionais, para conhecer o perfil do futebol brasileiro. Métodos: Revisão dos RAA no banco de dados da Comissão de Controle de Doping da Confederação Brasileira de Futebol de 2008 a 2017. Foram consideradas os RAA entre 2008 e 2017. Resultados: A amostra selecionada nesta pesquisa foi composta por 40.092 exames antidoping com 113 RAA, os quais foram identificados em 18 competições diferentes (0,28%) em atletas da categoria professional, entre 2008 e 2017, sinalizadas em exames de controle de doping através de amostras de urina. Estimulantes foram detectados com maior frequencia (31%), seguidos de glicocorticoides (21,2%), diuréticos e agentes mascarantes (19,5%). A série do Campeonato Brasileiro não apresentou relação com nenhum dos grupos de substâncias da World Anti-Doping Agency (WADA). A série A apresentou 0,07% da AAR, Série B 0,21%, Série C 0,75% e Série D 1,49%. Conclusão: A taxa de RAA no futebol brasileiro foi de 0,28%, inferior à media do futebol mundial e apresenta percentuais semelhantes entre as posições do campo. Os estimulantes foram as drogas mais prevalentes. As competições nacionais de futebol das Séries superiores apresentaram significativamente menos casos do que as inferiores. Nível de Evidência II; Estudo Retrospectivo.

Surgical treatment of patients with chronic rupture of the pectoralis major muscle tendon. Prospective comparative study with 2 years of follow-up.

To compare outcomes between autologous fascia lata and autologous hamstring grafts for chronic pectoralis major muscle (PMM) rupture repair, and perform histological, and imaging analyses. Forty male patients with chronic PMM ruptures (time since injury ranging from >3 months to 5 years) and a mean age of 37.3 years (SD = 9.7 years) were evaluated. One group (20 patients) received an autologous semitendinosus graft, and another group (20 patients) received an autologous fascia lata graft for PMM reconstruction. These patients with fascia lata grafts by Bak 2criterium 60% of the patients presented excellent results, 20% presented good results, 15% presented fair results, and 5% presented poor results. In the hamstring group 65% of the patients presented excellent results, 30% presented good results, and 5% presented fair results. In this comparative study, no difference was observed regarding the functional result, image, and histology between groups.

Shoulder injuries in Brazilian professional football players: epidemiological analysis of 3828 games.

OBJECTIVES: Football is a globally played sport that poses potential risks for musculoskeletal injuries. Upper-limb injuries have a lower incidence rate than lower-limb injuries but can still cause absenteeism and performance impairment in football players. This descriptive epidemiological study aimed to evaluate and compare the epidemiological data on shoulder injuries among professional football players in two major Brazilian football championships. METHODS: Data were collected throughout the championships, and club physicians medically evaluated each player during official games using two online forms. The collected information included the player's age and position, injury diagnosis, laterality, location on the field where the injury occurred, playing time, imaging examinations performed, need for surgical treatment, time to return to play (TRP), and recurrence of the injury. The incidence of injuries was evaluated using the Federation Internationale de Football Association (FIFA) incidence formula. RESULTS: A total of 107 shoulder injuries were recorded (4.3% of all injuries), with a FIFA incidence of 0.847. Glenohumeral dislocations (GHDs) and acromioclavicular dislocations (ACDs) accounted for 37.38% and 35.51% of all shoulder injuries, respectively. Goalkeepers and defenders presented, respectively, a 2.15 and 1.57 times increased risk of suffering shoulder injuries, while attackers presented a 0.63 times decreased risk. Injury recurrence was observed in 14.95% of cases, with GHDs and ACDs showing recurrence rates of 35.00% and 5.26%, respectively. Surgery was performed in 9.35% of cases, with GHDs representing 50% of all surgeries. The average TRP was 22.37 days, with severe and major injuries accounting for 11.21% and 10.28% of all injuries, respectively. Goalkeepers had the highest average TRP of 36.15 days. Recurring injuries had a higher average TRP of 33.44 days compared to nonrecurring injuries, which had an average TRP of 20.43 days. Surgically treated injuries had the highest average TRP of 112.5 days. CONCLUSION: Shoulder injuries in the professional football scenario are of great concern due to the high recurrence rate and need for surgical treatment, which will lead to a long TRP. These findings emphasize the need to implement prevention protocols and effective treatments to reduce the consequences of such injuries, which are usually underestimated in this sport. LEVEL OF EVIDENCE: III.

Doping control in male soccer players in brazil: 10 years of follow-up / Controle de doping no futebol masculino no brasil: 10 anos de acompanhamento

ABSTRACT Objective: To understand the Adverse Analytical Finding (AAF) that have occurred in Brazilian soccer in a recent 10-year period, comparing them to international data, to know the Brazilian profile. Methods: A review of the AAR in the Doping Control Commission database of the Brazilian Football Association from 2008 to 2017. The AAR in professional male soccer players between 2008 and 2017 were considered. Results: The sample selected in this research was composed of 40,092 doping tests, with 113 AAR, identified in 18 different competitions (0.28%) in the professional category, in Brazilian national and state competitions between 2008 and 2017, flagged in doping control exams through urine samples. Stimulants were detected most frequently (31.0%), followed by glucocorticoids (21.2%), diuretics, and masking agents (19.5%). The Brazilian Championship series did not show a relationship with any of the World Anti-Doping Agency (WADA) groups of substances. Series A showed 0.07% of AAR, Series B 0.21%, Series C 0.75% and Series D 1.49. Conclusion: The rate of AAR in Brazilian soccer was 0.28%, lower than the average for all soccer worldwide, and shows similar percentages among field positions. Stimulants were the most prevalent drugs. The national elite soccer competitions showed significantly fewer cases than the lower divisions. Level of Evidence II; Retrospective Study.

RESUMO Objetivo: Compreender os Resultados Analíticos Adversos (RAA) ocorridos no futebol brasileiro nos últimos 10 anos, comparando-os aos dados internacionais, para conhecer o perfil do futebol brasileiro. Métodos: Revisão dos RAA no banco de dados da Comissão de Controle de Doping da Confederação Brasileira de Futebol de 2008 a 2017. Foram consideradas os RAA entre 2008 e 2017. Resultados: A amostra selecionada nesta pesquisa foi composta por 40.092 exames antidoping com 113 RAA, os quais foram identificados em 18 competições diferentes (0,28%) em atletas da categoria professional, entre 2008 e 2017, sinalizadas em exames de controle de doping através de amostras de urina. Estimulantes foram detectados com maior frequencia (31%), seguidos de glicocorticoides (21,2%), diuréticos e agentes mascarantes (19,5%). A série do Campeonato Brasileiro não apresentou relação com nenhum dos grupos de substâncias da World Anti-Doping Agency (WADA). A série A apresentou 0,07% da AAR, Série B 0,21%, Série C 0,75% e Série D 1,49%. Conclusão: A taxa de RAA no futebol brasileiro foi de 0,28%, inferior à media do futebol mundial e apresenta percentuais semelhantes entre as posições do campo. Os estimulantes foram as drogas mais prevalentes. As competições nacionais de futebol das Séries superiores apresentaram significativamente menos casos do que as inferiores. Nível de Evidência II; Estudo Retrospectivo.

Orthopedic injuries in men's professional soccer during the coronavirus disease pandemic / Lesões ortopédicas no futebol profissional masculino durante a pandemia do coronavírus

ABSTRACT Objective: To assess the incidence and characteristics of injuries that occurred in the 2020 season of the Paulista Football Championship during the novel coronavirus disease pandemic. Methods: We conducted a prospective study using an electronic questionnaire developed by the Medical Committee of the Paulista Football Federation. Results were sent to the team doctors of series A1 and A2 after each round of the Paulista Football Championship. Results: Series A1 and A2 presented 12.17 and 15.6 injuries, respectively, per 1000 gaming hours. The strikers were the most affected, with muscle injuries being the most frequent and the lower limbs being the most affected. Most injuries occurred within 31-45 minutes of playing; only 4.5% of injuries required surgery. Conclusion: There was no statistical difference in the comparison between pre- and post-pandemic conditions. In relation to the variables studied, the most injuries occurred in the lower limbs; the most common type of injury was muscle strain, followed by sprain and contusion. The most requested exam was MRI; most injuries were classified as moderate (8-28 days). There was no difference between pre- and post-pandemic conditions. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar a incidência e as características das lesões ocorridas na temporada 2020 do Campeonato Paulista de Futebol durante a pandemia de covid-19. Métodos: Foi realizado um estudo prospectivo por meio de questionário eletrônico desenvolvido pela Comissão Médica da Federação Paulista de Futebol. Os resultados foram enviados aos médicos das equipes das séries A1 e A2 após cada rodada do Campeonato Paulista de Futebol. Resultados: As Séries A1 e A2 apresentaram 12,17 e 15,6 lesões, respectivamente, por 1.000 horas de jogo. Os atacantes foram os mais acometidos, sendo as lesões musculares as mais frequentes e os membros inferiores os mais afetados. A maioria das lesões ocorreu dentro de 31 a 45 minutos de jogo; apenas 4,5% das lesões necessitaram de cirurgia. Conclusão: Não houve diferença estatística na comparação entre as condições pré e pós-pandemia. Em relação às variáveis estudadas, a maioria das lesões ocorreu nos membros inferiores; o tipo de lesão mais comum foi distensão muscular, seguida de entorse e contusão. O exame mais solicitado foi a ressonância magnética; a maioria das lesões foi classificada como moderada (8-28 dias). Não houve diferença entre as condições pré e pós-pandemia. Nível de Evidência IV, Série de Casos.

COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF CLINICAL DATA COLLECTION THROUGH ONLINE AND PHYSICAL ELECTRONIC QUESTIONNAIRE IN ORTHOPEDIC PATIENTS.

The collection of clinical data is an essential step for the development of any scientific research. Online digital data collection can optimize this step. Objective: To compare the response rate and the accuracy of the clinical data collection date through the online and physical digital questionnaire in orthopedic patients. Methods: Comparative study, level III of evidence, with forty patients who had ankle sprains were evaluated, followed up for a period of 12 weeks with the application of physical and digital Visual Analogue Scale, Foot Function Index and Cumberland Ankle Instability Tool questionnaires, and data were collected about the moment of collection of each questionnaire. Results: We obtained a response rate of 83.3% in the digital collection group and 60% in the physical collection group (p < 0.05), and the response rate in the digital collection group was higher at all times of collection (3, 6 and 12 weeks). Analysis of the time of collection shows greater variability in the larger physical collection group at all times of the study (2.8 vs 1.5; 4.0 vs 2.4; 8.6 vs 1.5). Conclusion: Digital data collection is effective for obtaining clinical data in patients with ankle sprains. Level of Evidence III, Comparative, Prospective, Longitudinal Study in Parallel Groups.

A coleta de dados clínicos é etapa essencial para o desenvolvimento de qualquer pesquisa científica, e a coleta de dados digital online pode otimizá-la. Objetivo: Comparar o índice de resposta e a precisão da data de coleta de dados clínicos por meio de aplicação de questionário digital online e físico a pacientes ortopédicos. Métodos: Estudo comparativo realizado com 40 pacientes que apresentaram entorse de tornozelo, acompanhados pelo período de 12 semanas, com aplicação dos questionários escala visual analógica, foot function index e Cumberland ankle instability tool físicos e digitais. Além disso, foram recolhidos dados sobre o momento da coleta dos questionários. Resultados: Obtivemos índice de resposta de 83,3% no grupo de coleta digital e 60% no grupo de coleta física (p < 0,05), sendo que o índice de resposta no grupo de coleta digital foi maior em todos os momentos de coleta (3, 6 e 12 semanas). A análise do momento da coleta apresenta maior variabilidade no grupo de coleta física em todos os momentos do estudo (2,8 vs 1,5; 4,0 vs 2,4; 8,6 vs 1,5). Conclusão: A coleta de dados digital é efetiva para a obtenção dos dados clínicos de pacientes que apresentam entorse do tornozelo. Nível de Evidência III, Estudo Comparativo, Prospectivo, Longitudinal em Grupos Paralelos.

The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis.

PURPOSE: To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years. METHODS: A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division. RESULTS: Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001). CONCLUSION: A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions. LEVEL OF EVIDENCE: IV.

Comparative analysis of the effectiveness of clinical data collection through online and physical electronic questionnaire in orthopedic patients / Análise comparativa da efetividade da coleta de dados clínicos por meio de questionários eletrônicos online e físicos em pacientes ortopédicos

ABSTRACT The collection of clinical data is an essential step for the development of any scientific research. Online digital data collection can optimize this step. Objective: To compare the response rate and the accuracy of the clinical data collection date through the online and physical digital questionnaire in orthopedic patients. Methods: Comparative study, level III of evidence, with forty patients who had ankle sprains were evaluated, followed up for a period of 12 weeks with the application of physical and digital Visual Analogue Scale, Foot Function Index and Cumberland Ankle Instability Tool questionnaires, and data were collected about the moment of collection of each questionnaire. Results: We obtained a response rate of 83.3% in the digital collection group and 60% in the physical collection group (p < 0.05), and the response rate in the digital collection group was higher at all times of collection (3, 6 and 12 weeks). Analysis of the time of collection shows greater variability in the larger physical collection group at all times of the study (2.8 vs 1.5; 4.0 vs 2.4; 8.6 vs 1.5). Conclusion: Digital data collection is effective for obtaining clinical data in patients with ankle sprains. Level of Evidence III, Comparative, Prospective, Longitudinal Study in Parallel Groups.

RESUMO A coleta de dados clínicos é etapa essencial para o desenvolvimento de qualquer pesquisa científica, e a coleta de dados digital online pode otimizá-la. Objetivo: Comparar o índice de resposta e a precisão da data de coleta de dados clínicos por meio de aplicação de questionário digital online e físico a pacientes ortopédicos. Métodos: Estudo comparativo realizado com 40 pacientes que apresentaram entorse de tornozelo, acompanhados pelo período de 12 semanas, com aplicação dos questionários escala visual analógica, foot function index e Cumberland ankle instability tool físicos e digitais. Além disso, foram recolhidos dados sobre o momento da coleta dos questionários. Resultados: Obtivemos índice de resposta de 83,3% no grupo de coleta digital e 60% no grupo de coleta física (p < 0,05), sendo que o índice de resposta no grupo de coleta digital foi maior em todos os momentos de coleta (3, 6 e 12 semanas). A análise do momento da coleta apresenta maior variabilidade no grupo de coleta física em todos os momentos do estudo (2,8 vs 1,5; 4,0 vs 2,4; 8,6 vs 1,5). Conclusão: A coleta de dados digital é efetiva para a obtenção dos dados clínicos de pacientes que apresentam entorse do tornozelo. Nível de Evidência III, Estudo Comparativo, Prospectivo, Longitudinal em Grupos Paralelos.

Medical planning for mass gathering sports events in brazil / Planificación médica para eventos deportivos masivos en brasil / Planejamento médico para eventos esportivos de massa no brasil

ABSTRACT Introduction: Medical planning for mass gathering events is founded on the structuring of assistance to the population involved and the preservation of the response capacities of the local healthcare system. Large sporting events attended by crowds are increasingly common in society. These events have been shown to be dangerous, generating higher incidences of injuries and illnesses than usual. Thus, planning and the interaction among various public and private sectors are required for the prevention of and response to emergencies and incidents involving multiple victims. Methods: Recently published studies on medical planning for large sports events and current federal agency legislation were selected to conduct an updated review on the subject. Results: After reading titles and abstracts, 159 papers were chosen for a full reading, 50 of which met the eligibility criteria and were included as the basis for this review. The size of the audience, the weather, and the behavior of the crowd seem to contribute significantly to the estimated need for resources in sporting events. Conclusion: Mass events require planning for prevention and to strengthen the resilience of host communities. There is a still a lack of evidence that these events increase the risk of the mass spreading of disease. Level of Evidence: V; Expert opinion .

RESUMEN Introducción: La planificación médica de eventos masivos tiene como pilares la estructuración de la atención a la población involucrada y la preservación de las capacidades de respuesta del sistema local de salud. Los grandes eventos deportivos a los que asisten multitudes son cada vez más comunes en la sociedad. Estos eventos han demostrado ser peligrosos, generando una mayor incidencia de lesiones y enfermedades de lo habitual. Por lo tanto, es necesaria la planificación y la interacción de diversos sectores, públicos y privados, para la prevención y respuesta a emergencias o incidentes con múltiples víctimas. Métodos: Se seleccionaron estudios recientes publicados sobre la planificación médica de grandes eventos deportivos y la legislación vigente en organismos federales con el objetivo de realizar una revisión actualizada sobre el tema. Resultados: Después de leer los títulos y resúmenes, se eligieron 159 artículos para lectura completa y 50 cumplieron los criterios de elegibilidad y se utilizaron como base para esta revisión. El tamaño del público, las condiciones climáticas y el comportamiento de la multitud parecen contribuir significativamente a la estimación de los requisitos de recursos en los eventos deportivos. Conclusión: Los eventos masivos requieren una planificación para la prevención y el fortalecimiento de la resiliencia de las comunidades anfitrionas. Todavía no hay pruebas de que estos eventos aumenten el riesgo de propagación masiva de enfermedades. Nivel de Evidencia: V; Opinión experta .

RESUMO Introdução: O planejamento médico para eventos de massa tem como pilares a estruturação dos atendimentos à população envolvida e a preservação da capacidade de resposta do sistema de saúde local. Grandes eventos esportivos frequentados por multidões são cada vez mais comuns na sociedade. Esses eventos têm se mostrado perigosos, gerando maiores incidências de lesões e doenças do que o habitual. Dessa forma, é necessário planejamento e interação de diversos setores, públicos e privados, para prevenção e resposta à ocorrência de emergências ou incidentes com múltiplas vítimas. Métodos: Foram selecionados trabalhos recentes publicados sobre o planejamento médico para grandes eventos esportivos e a legislação vigente em órgãos federais com o objetivo de realizar uma revisão atualizada sobre o assunto. Resultados: Após a leitura de títulos e resumos, 159 trabalhos foram escolhidos para leitura integral e 50 preencheram os critérios de elegibilidade e foram usados como base para esta revisão. O tamanho do público, as condições climáticas e o comportamento da multidão parecem contribuir significativamente para a estimativa da necessidade de recursos em eventos esportivos. Conclusão: Eventos de massa exigem planejamento para prevenção e fortalecimento da resiliência das comunidades anfitriãs. Ainda faltam evidências de que esses eventos aumentem o risco de propagação maciça de doenças. Nível de evidência: V; Opinião do especialista .

Rupture of the bilateral and simultaneous tendon of the pectoralis major muscle. Description of three cases.

Pectoralis major muscle tendon ruptures associated with physical activity or effort are no longer uncommon in the medical literature. Treatment has also evolved significantly in the last 20 years. However, simultaneous bilateral rupture has only been described in a few cases. This article reports three cases with simultaneous bilateral rupture and describes the examinations and treatment performed. Bilateral lesions, although infrequent, also require early diagnosis and treatment in the acute phase. The chronic phase requires tendon grafting for full correction and a slow rehabilitation process.

Impact of Hyaluronic Acid on the Viability of Mesenchymal Cells Derived from Adipose Tissue Grown in Collagen Type I/III Membrane.

Objective To evaluate in vitro the viability of mesenchymal stem cells derived from adipose tissue (AD-MSCs) in different commercial solutions of hyaluronic acid (HA) before and after being sowed in collagen I/III membrane. Methods In the first stage, the interaction between AD-MSCs was analyzed with seven different commercial products of HA, phosphate buffered saline (PBS), and bovine fetal serum (BFS), performed by counting living and dead cells after 24, 48 and 72 hours. Five products with a higher number of living cells were selected and the interaction between HA with AD-MSCs and type I/III collagen membrane was evaluated by counting living and dead cells in the same time interval (24, 48 and 72 hours). Results In both situations analyzed (HA + AD-MSCs and HA + AD-MSCs + membrane), BFS presented the highest percentage of living cells after 24, 48 and 72 hours, a result higher than that of HA. Conclusion The association of HA with AD-MSCs, with or without membrane, showed no superiority in cell viability when compared with BFS.

Epidemiology of Upper Limb Injuries in two major Brazilian Soccer Championships from 2016 to 2019.

PURPOSE: To evaluate epidemiological data of upper limb injuries in professional athletes who participated in two major Brazilian soccer championships between 2016 and 2019. METHODS: A prospective cohort study was conducted to evaluate the teams of two divisions over four seasons within the Brazilian Soccer Championship and the Paulista Soccer Championship. Clubs and their doctors were contacted to participate in the study and guided on the correct way to enter data via online platforms: Transfermarkt (Transfermarkt GmbH & Co. KG) and Survey Monkey (Momentive.AI). Demographic data, injury characteristics, and FIFA Incidence Formula were analyzed. RESULTS: Overall, the study analyzed 3,828 matches and 126,357 hours of play. Upper limb injuries were registered 169 times, representing 6.8% of total injuries, with a FIFA incidence of 1.34. Most lesions occurred in forward players (21.3%), the shoulder exhibited the highest number of injuries (63.3%). The player's position was related to the location on the field where the injury occurred (p < 0.001); however, there was no relationship between the type of injury and the location on the body (p > 0.001). The average time to return to play was 19.1 days (range 0-200 days) and it was longer for goalkeepers. The necessity of surgical treatment was statistically associated with additional time to return to play (p < 0.001). CONCLUSIONS: Shoulder injuries were the most frequent upper limb injury sustained during the two major Brazilian soccer championships. Forward players suffered the most upper limb injuries and goalkeepers experienced the longest time to return to play.

Impact of Hyaluronic Acid on the Viability of Mesenchymal Cells Derived from Adipose Tissue Grown in Collagen Type I/III Membrane / Impacto do ácido hialurônico na viabilidade das células mesenquimais derivadas do tecido adiposo cultivadas em membrana de colágeno tipo I/III

Abstract Objective To evaluate in vitro the viability of mesenchymal stem cells derived from adipose tissue (AD-MSCs) in different commercial solutions of hyaluronic acid (HA) before and after being sowed in collagen I/III membrane. Methods In the first stage, the interaction between AD-MSCs was analyzed with seven different commercial products of HA, phosphate buffered saline (PBS), and bovine fetal serum (BFS), performed by counting living and dead cells after 24, 48 and 72 hours. Five products with a higher number of living cells were selected and the interaction between HA with AD-MSCs and type I/III collagen membrane was evaluated by counting living and dead cells in the same time interval (24, 48 and 72 hours). Results In both situations analyzed (HA + AD-MSCs and HA + AD-MSCs + membrane), BFS presented the highest percentage of living cells after 24, 48 and 72 hours, a result higher than that of HA. Conclusion The association of HA with AD-MSCs, with or without membrane, showed no superiority in cell viability when compared with BFS.

Resumo Objetivo Avaliar in vitro a viabilidade das células-tronco mesenquimais derivadas do tecido adiposo (AD-CTMs) em diferentes soluções comerciais de ácido hialurônico (AH) antes e após serem semeadas em membrana de colágeno I/III. Métodos Na primeira etapa, analisou-se a interação entre AD-CTMs com sete diferentes produtos comerciais de AH, salina tamponada com fosfato (PBS, na sigla em inglês) e soro fetal bovino (SFB), realizada pela contagem das células vivas e mortas após 24, 48 e 72 horas. Foram selecionados cinco produtos com maior número de células vivas e avaliou-se a interação entre o AH com AD-CTMs e a membrana de colágeno tipo I/III pela contagem de células vivas e mortas no mesmo intervalo de tempo (24, 48 e 72 horas). Resultados Em ambas as situações analisadas (AH + AD-CTM e AH + AD-CTM + membrana), o SFB apresentou a maior porcentagem de células vivas após 24, 48 e 72 horas, resultado superior ao do AH. Conclusão A associação do AH com as AD-CTMs, com ou sem a membrana, não demonstrou superioridade na viabilidade celular quando comparado com SFB.

Comparison of Quadriceps and Hamstring Muscle Strength after Exercises with and without Blood Flow Restriction following Anterior Cruciate Ligament Surgery: A Randomized Controlled Trial.

BACKGROUND: Muscle mass loss occurs following anterior cruciate ligament reconstruction surgery. OBJECTIVE: To compare the gain in muscle strength in the quadriceps and hamstring muscles in patients following anterior cruciate ligament reconstruction surgery, using exercises with and without blood flow restriction. METHODS: This is a randomized controlled trial, in which 50% (n = 14) of the participants were allocated to the intervention group and the remaining 50% (n = 14) to the control group. The study included the participation of postoperative patients, with reconstruction of the anterior cruciate ligament. RESULTS: After comparing the rehabilitation of the groups, a statistical difference was observed in the quadriceps with an increase in muscle strength (p < 0.01) after 12 weeks and an increase in muscle strength hamstrings (p < 0.01) after 8 and 12 weeks in the injured legs of the intervention group compared to the control. In the analysis of the participants' physical function, there was an significant increase difference in the Lysholm questionnaire (p < 0.01) after 8 and 12 weeks, in the KOOS pain questionnaire (p < 0.01) after 4 weeks a decrease was observed, symptoms and daily activities (p < 0.01) after 8 and 12 weeks, quality of life (p < 0.01) after 12 weeks, and in the IKDC questionnaire (p < 0.01) after 8 and 12 weeks there was an significant increase difference of the intervention group compared to the control. CONCLUSION: After anterior cruciate ligament surgery, exercises with blood flow restriction proved more efficient for improving the muscle strength of the quadriceps and hamstrings, and the physical function of the knee than the same exercises without blood flow restriction.

Analysis of micro-costing through the Time-Driven Activity-Based Costing (TDABC) method in viscosupplementation procedures in different application regimens / Análise do microcusteio por meio de método Time-Driven Activity-Based Costing (TDABC) nos procedimentos de viscossuplementação do joelho em diferentes regimes de aplicação

Objective: To evaluate the micro-costing of viscosupplementation procedures compared to different infiltration regimens. Methods: This study compared, through the Time-Driven ActivityBased Costing method, the micro-costing of these different application regimens using national cost averages as a basis for calculation in a medium-sized outpatient service. Results: The results demonstrated that the difference in costs with the single application is 31.47% less for three and 119.13% for five applications. Conclusions: No study showed a superiority of the five-application regimen over the three-application regimen, which leads one to believe that there is no justification for this procedure from an economic or quality-of-life point of view.

Objective: Avaliar o microcusteio dos procedimentos de viscossuplementação do joelho em diferentes regimes de aplicação. Métodos: Este estudo comparou, por meio do método Time-Driven Activity-Based Costing, o microcusteio desses diferentes regimes de aplicação, usando com base de cálculo médias nacionais de custo em um serviço ambulatorial de porte médio. Resultados: Os resultados encontrados demonstraram que a diferença nos custos com a aplicação única é 31,47% menor para três aplicações e 119,13% para cinco aplicações. Conclusão: Em nenhum estudo houve superioridade do regime de cinco aplicações ao regime de três, fato que leva a acreditar que não há nenhuma justificativa para esse procedimento do ponto de vista econômico ou de qualidade de vida do paciente.

Report of a clinical and laboratory management of cell therapy for knee cartilage in the face of mycoplasma contamination.

To describe a case of autologous chondrocyte implantation after cell culture contamination by Mycoplasma pneumoniae and the measures taken to successfully complete cell therapy in a patient with focal chondral lesion. A 45-year-old male patient, complaining of chronic pain on the knee and no history of trauma. He had a chondral lesion in the trochlear region of the femur and clinical tests compatible with pain in the anterior compartment of the knee. Conservative treatment failed to alleviate symptoms. Surgical treatment was indicated, but due to the size of the lesion, membrane-assisted autologous chondrocyte implantation was the technique of choice. Cartilage biopsies were collected from the intercondylar region of the distal femur. After isolation, chondrocytes were expanded ex vivo in a trained laboratory, for three weeks, and seeded onto a commercially available collagen membrane prior to implantation in the knee. Two days before surgery, a cell culture sample tested positive for Mycoplasma pneumoniae. The source of contamination was found to be autologous blood serum, extracted from the patient´s peripheral vein, and used to supplement the cell culture medium. After treating the patient with antibiotics, all procedures were repeated and the new final cell product, free from contaminants, was successfully implanted. We discuss the strategies available to deal with this situation, and describe the results of this particular case, which led to modifications in the autologous chondrocyte implant protocol.

Matrix-assisted autologous chondrocyte transplantation for treatment of focal chondral lesions in the knee: the Hospital Israelita Albert Einstein experience.

OBJECTIVE: Phase 1 clinical trial to determine feasibility, safety, and efficacy of a new advanced cell therapy product for treatment of knee articular cartilage injuries. METHODS: Three participants with knee focal chondral lesions were included, with no signs of osteoarthritis. Chondrocytes were obtained through knee arthroscopy, cultured in collagen membrane for 3 weeks at the laboratory, subjected to tests to release the cell therapy product, and implanted. All patients underwent a specific 3-month rehabilitation protocol, followed by assessments using functional and imaging scales. The main outcome was the incidence of severe adverse events. RESULTS: Three participants were included and completed the 2-year follow-up. There was one severe adverse event, venous thrombosis of distal leg veins, which was no associated with therapy, was treated and left no sequelae. The clinical and radiological scales showed improvement in the three cases. CONCLUSION: The preliminary results, obtained with the described methodology, allow concluding that this product of advanced cell therapy is safe and feasible. ReBEC platform registration number: RBR-6fgy76.

Are the popliteofibular ligament, the arcuate ligament, and the fibular insertion of the popliteus muscle the same structure? An anatomic and terminological study.

Lesions in the lateral region of the knee can result in severe disability due to instability and articular degeneration. The structures in the posterolateral side of the knee function as a unit contributes to rotation and translation limits. Anatomical descriptions of the lateral corner of the knee are incomplete and contradictory. This study aims to verify, through anatomical dissections in cadavers, if the fibular insertion of the popliteus muscle, the arcuate ligament, and the popliteofibular ligament are distinct or the same structure with different terminology and descriptions in the literature. Fifteen cadavers were dissected. Photographs were taken, and in some cases, a video was recorded. Also, the correct terminology for ligament and insertion was searched. The dissections allowed the popliteus muscle to be identified proximally in the lateral femoral condyle, in the fibula head's posterolateral region, and through a meniscocapsular insertion. In none of the anatomy books reviewed, this fibular insertion of the popliteus muscle is mentioned. However, our findings and data from other experimental studies provide evidence of its presence. The aponeurotic portion of the arcuate ligament is distinguished from the short lateral ligament, which is the fibular insertion of the popliteus muscle with its tendinous attachment. Therefore, the term popliteofibular ligament should be abandoned based on the anatomic terminology, and the term "fibular insertion of the popliteus muscle" should be used instead.

Preoperative Meniscal Extrusion Predicts Unsatisfactory Clinical Outcomes and Progression of Osteoarthritis after Isolated Partial Medial Meniscectomy: A 5-Year Follow-Up Study.

The objective of this study was to examine the association between preoperative meniscal extrusion of patients undergoing partial medial meniscectomy with clinical outcomes and progression of osteoarthritis and to determine the extent of meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis. Ninety-five patients who underwent partial medial meniscectomy with a minimum follow-up of 5 years were retrospectively reviewed. Preoperative meniscal extrusion was evaluated with magnetic resonance imaging. Patients were assessed preoperatively and postoperatively with Lysholm and International Knee Documentation Committee (IKDC) subjective scores for clinical outcomes and with IKDC radiographic scale for osteoarthritis. An ANOVA (Analysis of Variance) was used to analyze the variations in meniscal extrusion and the clinical and radiological outcomes. A regression analysis was performed to identify factors that affect preoperative medial meniscus extrusion and that influence results after partial meniscectomy. An optimal cutoff value for meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis was established. Significance was set at p < 0.05. The mean ± SD preoperative and postoperative Lysholm scores were 59.6 ± 15.5 versus 83.8 ± 13.1 (p < 0.001) and the mean preoperative and postoperative IKDC subjective scores were 59.4 ± 16.8 versus 82.0 ± 15.8 (p < 0.001). Meniscal extrusion greater than 2.2 mm (sensitivity, 84%; specificity, 81%) and 2.8 mm (sensitivity, 73%; specificity, 85%) was associated with unsatisfactory (poor/fair) Lysholm and IKDC subjective scores, respectively. The progression of osteoarthritis, characterized as a change of at least one category on the IKDC radiographic scale, occurred when meniscal extrusion was greater than 2.2 mm (sensitivity, 63%; specificity, 75%). Patients with higher body mass index (BMI) had significantly greater meniscal extrusion that patients with normal BMI (p < 0.001). The medial meniscus was more extruded in patients with horizontal and root tears. In conclusion, patients with preoperative meniscal extrusion of 2.2 mm or greater had unsatisfactory clinical outcomes and progression of osteoarthritis after partial medial meniscectomy at a minimum of 5 years follow-up. Higher BMI and horizontal and root tears were associated with greater preoperative meniscal extrusion.