Joint lavage followed by viscosupplementation and triamcinolone in patients with severe haemophilic arthropathy: objective functional results.

INTRODUCTION: Viscosupplementation can improve function in haemophilia patients. Viscosupplementation results can be improved by prior joint lavage and triamcinolone administration. AIM: To objectively assess whether viscosupplementation and associated triamcinolone use in patients with severe haemophilic arthropathy following joint lavage improves force and balance and reduces bleeding events. METHODS: Fourteen patients with haemophilic knee arthritis with and without the involvement of other joints underwent joint lavage and subsequent injections of Hylan G-F20 and triamcinolone into all affected joints. Patients were evaluated with NeuroCom® force and balance platforms using the step-up-and-over task (STP), sit-to-stand test (STS), one-leg stance (UNI) and weight-bearing squat (WBS) at baseline and at 1, 3, 6 and 12 months after the procedure. Bleeding events in the year prior to and the year after the procedure were analysed. RESULTS: Sixteen knees, 15 ankles, eight elbows and one shoulder were treated. The STP results indicated improvements in the lift-up indices (right leg) at all time points evaluated (P = 0.03). The STS results revealed coupled improvement in weight transfer and the rising index for up to a year (P = 0.02). Balance (UNI) with eyes open or closed improved in all evaluations. The WBS results revealed improvements at all degrees of flexion (0, P = 0.003; 30°, P = 0.001; 60°, P < 0.001 and 90°, P < 0.001). The numbers of total and traumatic bleeding events were reduced (P = 0.04). CONCLUSION: Joint lavage followed by injections of triamcinolone and Hylan G-F20 improved balance, function and bleeding events in severe haemophilic arthropathy patients.

Efeito de duas tecnicas de alongamento muscular dos isquiotibiais na amplitude de extensao ativa do joelho e no pico de torque / Effect of two hamstring muscle stretching techniques on the range of motion of active knee extension and on peak torque

Os exercicios de alongamento sao amplamente utilizados na fisioterapia. No entanto, seus reais beneficios nao estao compoletamente esclarecidos. Objetivo: o proposito deste estudo foi investigar o efeito do alongamento dos isquiotibiais na amplitude de movimento de extensao ativa do joelho e no pico de torque desse grupo muscular. Metodo: participaram da pesquisa 14 individuos de ambos os sexos, com idade media de 222,92+-0,9 anos, sedentarios, os quais foram submetidos a 5 ciclos de alongamentos diarios, com 30, segundos cada, por um periodo de tres semanas. Foram utilizados dois protocolos de alongamento: o primeiro grupo (G1), representado pelos membros inferiores esquerdos, realizou manobras passivas/estaticas. para a avalicao da ADM utilizou-se um goniometro universal e para o pico de torque, um dinamometro isocinetico da marca Cybex - 6000. Analise estatistica foi realizada por meio dos testes ANOVA e post-hoc Dunn`s, considerando o nivel de significancaia (<-5 por cento). Resultados: observou-se o aumento na ADM em ambos os grupos: 149+-14º para 162+-11º(p<0,01) para o G1 e de 148+-14º para 162+-11º(p<0,01) para o G2. No entanto nao houve difrenca entre os grupos. Ocorreu aumento sgnificativo no torque dos membros do grupo G1 apos a aplicacao da tecnica de alongamento do tipo FNP a 60º/s(de 89+-36Nm para 96+-40Nm) e a 240º/s(de 59+-24Nm para 68+-27Nm) - p<0,01. Por outro lado, nao houve diferenca estatisticamente significativa no torque dos membros do G2. Conclusoes: Esses dados sugerem que o programa de alongamento muscular utilizando a tecnica contrair-relaxar pode influenciar na ADM e no torque muscular. Entretanto, a tecnica de alongamento estatico/passivo produziu ganhos apenas na ADM

Isokinetic assessment of the flexor-extensor balance of the knee in athletes with total rupture of the anterior cruciate ligament.

The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average internal between occurrence of the injury and assessment was 10.2 months (range 2-48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60 degrees/sec and 240 degrees/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60 degrees/sec was greater than that at 240 degrees/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60 degrees/sec or at 240 degrees/sec. The average value for the flexor-extensor relationship at 60 degrees/sec on the injured was 60% ((6), compared to 57% ((10) on the contra-lateral side. At 240 degrees/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60 degrees/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury.