Functional Evaluation and Pain Symptomatology of the Foot and Ankle in Individuals with Severe Obesity - Controlled Transversal Study.

Objective The present study aims to evaluate the prevalence of foot and ankle pain complaints, radiographic parameters, and functional performance in subjects with severe obesity (body mass index [BMI] > 40) who are candidates to bariatric surgery. Methods Forty severely obese patients were evaluated at a bariatric surgery outpatient facility. These severely obese subjects (BMI > 40) were divided into two subgroups: those with BMI < 50 (n = 24) and BMI > 50 (n = 16). These patients were compared with a control group of 42 volunteers with a mean BMI value of 24. The following parameters were assessed: foot pain (according to the visual analog scale [VAS]), functional performance (according to the American Orthopeadic Foot and Ankle Society [AOFAS] scale, including forefoot, midfoot and hindfoot domains), age, gender, hallux metatarsal-phalangeal angle, hallux intermetatarsal angle, talocalcaneal angle, calcanean pitch angle and Meary angle. Results Incidence of foot pain was higher in the severely obese group compared with the control group ( p < 0.0001; odds ratio [OR]: 4.2). Functional performance according to the AOFAS scale was lower in obese subjects compared with the control group ( p < 0.0001; OR for hindfoot, 4.81; OR for midfoot, 3.33). Conclusion The incidence of foot pain was higher in the group of severely obese patients compared with the control group. According to the AOFAS scale, functional forefoot, midfoot and hindfoot performance was worse in severely obese individuals.

Functional Evaluation and Pain Symptomatology of the Foot and Ankle in Individuals with Severe Obesity - Controlled Transversal Study / Avaliação funcional e de sintomatologia dolorosa do pé e tornozelo em indivíduos com obesidade grave - Estudo controlado transversal

Abstract Objective The present study aims to evaluate the prevalence of foot and ankle pain complaints, radiographic parameters, and functional performance in subjects with severe obesity (body mass index [BMI] > 40) who are candidates to bariatric surgery. Methods Forty severely obese patients were evaluated at a bariatric surgery outpatient facility. These severely obese subjects (BMI > 40) were divided into two subgroups: those with BMI < 50 (n = 24) and BMI > 50 (n = 16). These patients were compared with a control group of 42 volunteers with a mean BMI value of 24. The following parameters were assessed: foot pain (according to the visual analog scale [VAS]), functional performance (according to the American Orthopeadic Foot and Ankle Society [AOFAS] scale, including forefoot, midfoot and hindfoot domains), age, gender, hallux metatarsal-phalangeal angle, hallux intermetatarsal angle, talocalcaneal angle, calcanean pitch angle and Meary angle. Results Incidence of foot pain was higher in the severely obese group compared with the control group (p < 0.0001; odds ratio [OR]: 4.2). Functional performance according to the AOFAS scale was lower in obese subjects compared with the control group (p < 0.0001; OR for hindfoot, 4.81; OR for midfoot, 3.33). Conclusion The incidence of foot pain was higher in the group of severely obese patients compared with the control group. According to the AOFAS scale, functional forefoot, midfoot and hindfoot performance was worse in severely obese individuals.

Resumo Objetivo Avaliar a prevalência de queixas álgicas no pé e tornozelo, parâmetros radiográficos e o desempenho funcional de indivíduos com obesidade grave, Índice de Massa Corpórea (IMC) com valor > 40 e indicação de cirurgia bariátrica. Métodos Foram avaliados 40 pacientes com obesidade grave acompanhados em ambulatório de cirurgia bariátrica. Este grupo de obesos graves (IMC > 40) foi subdividido em dois subgrupos: obesos com IMC < 50 (n = 24); e outro de obesos com IMC > 50 (n = 16). Foi realizada comparação com grupo controle de 42 indivíduo voluntários com IMC médio de 24. Foram avaliados a presença de dor no pé pela escala visual (EVA), o desempenho funcional pela escala da Associação Americana de Cirurgia do Pé e Tornozelo (AOFAS, na sigla em inglês) (domínios antepé, mediopé e retropé), idade, gênero, ângulo (âng) metatarso-falangeano do hálux, âng intermetatarsal do hálux , âng talocalcaneano, "pitch" calcaneano e âng de Meary. Resultados Foi observada maior incidência de dor no pé no grupo de obesos graves em relação ao controle (p < 0,0001, razão de chances [odds ratio, OR]: 4,2). O desempenho funcional pela escala AOFAS foi inferior no grupo de obesos em relação ao controle (p < 0,0001, retropé com OR = 4,81; mediopé com OR = 3,33). Conclusão Houve maior incidência de dor no pé no grupo de obesos graves em relação ao controle. Houve pior desempenho funcional pela escala AOFAS nas regiões do antepé, mediopé e retropé no grupo de obesos graves.

Back pain and sagittal spine alignment in obese patients eligible for bariatric surgery.

OBJECTIVE: The objective of this research was to evaluate the prevalence of cervical and lumbar pain in obese patients eligible for bariatric surgery and to investigate possible changes in sagittal spine alignment in these patients. METHODS: The following parameters were compared in 30 obese patients and a control group of 25 non-obese volunteers: body mass index, prevalence of cervical and lumbar pain assessed by visual analog scale (VAS), Neck Disability Index [NDI] and Oswestry Disability Index [ODI], as well as radiographic parameters of the spine and pelvis measured with Surgimap software. RESULTS: The cervical and lumbar VAS and the NDI and ODI were significantly worse in obese patients. Compared with the control group, the cervical sagittal vertical axis (cSVA) of the obese group had higher variance (p value = 0.0025) and the cervical lordosis was diminished (p value = 0.0023). Thoracic kyphosis, lumbar lordosis, and the pelvic parameters were not significantly different between the groups. CONCLUSIONS: Obese patients demonstrated lower functional performance compared with their non-obese counterparts, while cervical lordosis was diminished and the cSVA was increased in obese patients. These slides can be retrieved under Electronic Supplementary Material.

Radiographic evaluation and pain symptomatology of the knee in severely obese individuals - controlled transversal study / Avaliação radiográfica e de sintomatologia dolorosa do joelho em indivíduos com obesidade grave - estudo controlado transversal

ABSTRACT Objective: To evaluate the prevalence of pain and radiographic degenerative arthritis in a group of severe obese patients (body mass index [BMI] > 35). Methods: 41 patients with an indication of bariatric surgery were studied. The group of severely obese patients was subdivided into two subgroups: those with BMI < 50 and those with BMI > 50 (n = 14). They were compared to control group (n = 39). The following parameters were analyzed and correlated: radiographic arthritis by Kellgren-Lawrence's classification, tibiofemoral axis, gender, age, and knee pain (visual analog scale [VAS]). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to evaluate in 21 severe obese patients and IN 19 controls. Results: A higher incidence of knee pain was observed in the severely obese group when compared with the control group (p < 0.0001, odds ratio: 2.96). In the severely obese group, increasing levels of pain with aging were observed (p = 0.047). A positive correlation was observed between the incidence of radiographic arthritis and increasing age in the severely obese (p = 0.001) and control (p = 0.037) groups. The WOMAC index results were worse in the severely obese group when compared with the control group (p = 0.001, odds ratio: 18.2). Conclusion: A higher incidence of knee pain was observed in the severely obese group when compared with the control group. In the severely obese group, there increasing levels of pain with aging. A positive relation between the incidence of arthritis and increasing age was observed in the severely obese and control groups. The WOMAC index results were worse in the severely obese group.

RESUMO Objetivo: Avaliar a prevalência de queixas álgicas no joelho e de alterações radiográficas degenerativas (artrose) em grupo obesos graves (índice de massa corporal [IMC] > 35). Métodos: Foram avaliados 41 pacientes com obesidade grave acompanhados em ambulatório de cirurgia bariátrica. Esse grupo foi subdividido em dois: obesos com IMC < 50 (n = 27); e obesos com IMC > 50 (n = 14). Os resultados foram comparados com os do grupo controle (n = 39). Foram avaliados a presença de artrose radiológica pela classificação de Kellgren-Lawrence, eixo tibiofemoral, idade, gênero e dor no joelho pela escala visual (EVA), foi feita correlação dos parâmetros entre si. Em 21 pacientes obesos e em 19 controles foi avaliada com o índice das universidades Western Ontario e McMaster (Womac). Resultados: Observou-se maior incidência de dor no grupo de obesos graves em relação ao grupo controle (p < 0,0001, coeficiente de risco de 2,96). No grupo de obesos graves observou-se aumento da dor com a idade (p = 0,047). Houve correlação positiva entre progressão da idade e artrose radiográfica tanto no grupo de obesos graves (p = 0,001) como no controle (p = 0,037). A escala Womac detectou pior desempenho funcional no grupo de obesos graves em relação ao controle (p = 0,0001, coeficiente de risco de 18,2). Conclusão: Observou-se maior incidência de dor no grupo de obesos graves em relação ao controle. No grupo de obesos graves, a dor aumentou com a idade. Houve correlação positiva entre progressão da idade e artrose nos grupos de obesos graves e controle. O índice Womac apresentou pior desempenho no grupo de obesos graves.

Radiographic evaluation and pain symptomatology of the knee in severely obese individuals - controlled transversal study.

OBJECTIVE: To evaluate the prevalence of pain and radiographic degenerative arthritis in a group of severe obese patients (body mass index [BMI] > 35). METHODS: 41 patients with an indication of bariatric surgery were studied. The group of severely obese patients was subdivided into two subgroups: those with BMI < 50 and those with BMI > 50 (n = 14). They were compared to control group (n = 39). The following parameters were analyzed and correlated: radiographic arthritis by Kellgren-Lawrence's classification, tibiofemoral axis, gender, age, and knee pain (visual analog scale [VAS]). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to evaluate in 21 severe obese patients and IN 19 controls. RESULTS: A higher incidence of knee pain was observed in the severely obese group when compared with the control group (p < 0.0001, odds ratio: 2.96). In the severely obese group, increasing levels of pain with aging were observed (p = 0.047). A positive correlation was observed between the incidence of radiographic arthritis and increasing age in the severely obese (p = 0.001) and control (p = 0.037) groups. The WOMAC index results were worse in the severely obese group when compared with the control group (p = 0.001, odds ratio: 18.2). CONCLUSION: A higher incidence of knee pain was observed in the severely obese group when compared with the control group. In the severely obese group, there increasing levels of pain with aging. A positive relation between the incidence of arthritis and increasing age was observed in the severely obese and control groups. The WOMAC index results were worse in the severely obese group.

OBJETIVO: Avaliar a prevalência de queixas álgicas no joelho e de alterações radiográficas degenerativas (artrose) em grupo obesos graves (índice de massa corporal [IMC] > 35). MÉTODOS: Foram avaliados 41 pacientes com obesidade grave acompanhados em ambulatório de cirurgia bariátrica. Esse grupo foi subdividido em dois: obesos com IMC < 50 (n = 27); e obesos com IMC > 50 (n = 14). Os resultados foram comparados com os do grupo controle (n = 39). Foram avaliados a presença de artrose radiológica pela classificação de Kellgren-Lawrence, eixo tibiofemoral, idade, gênero e dor no joelho pela escala visual (EVA), foi feita correlação dos parâmetros entre si. Em 21 pacientes obesos e em 19 controles foi avaliada com o índice das universidades Western Ontario e McMaster (Womac). RESULTADOS: Observou-se maior incidência de dor no grupo de obesos graves em relação ao grupo controle (p < 0,0001, coeficiente de risco de 2,96). No grupo de obesos graves observou-se aumento da dor com a idade (p = 0,047). Houve correlação positiva entre progressão da idade e artrose radiográfica tanto no grupo de obesos graves (p = 0,001) como no controle (p = 0,037). A escala Womac detectou pior desempenho funcional no grupo de obesos graves em relação ao controle (p = 0,0001, coeficiente de risco de 18,2). CONCLUSÃO: Observou-se maior incidência de dor no grupo de obesos graves em relação ao controle. No grupo de obesos graves, a dor aumentou com a idade. Houve correlação positiva entre progressão da idade e artrose nos grupos de obesos graves e controle. O índice Womac apresentou pior desempenho no grupo de obesos graves.

Histopathological analysis of the posterior cruciate ligament in primary osteoarthritis.

BACKGROUND: According to some authors, the indication of an arthroplasty maintaining the posterior cruciate ligament (PCL) demands adequate structural preservation and proprioceptive function of this ligament. The nervous fibers contained in the synovial neurovascular bundle (NVB) around the PCL are involved in proprioception. A study evaluating the grade of PCL and NVB degeneration by using clinical, radiological, and perioperative parameters in knee arthritis patients, in theory, could help surgeons in the decision of preserving or not preserving the PCL in a particular patient. QUESTIONS: (1) Can the degree of the PCL collagen fibers degeneration be predicted by clinical, radiographic, and perioperative parameters in knee arthritis patients? (2) Is the NVB histological degeneration status predictable using clinical, radiographic, and perioperative parameters in the same subset of patients? (3) Is there a correlation between the degree of the PCL collagen fibers degeneration and NVB status in knee arthritis patients? METHODS: Eighty-nine PCLs (85 patients) obtained from total knee replacement surgery were studied. The histologic degeneration of PCL collagen fibers and the NVB status (preserved, degenerated, not detected) were evaluated. These histological degeneration patterns were correlated with clinical and radiographic parameters and with anterior cruciate ligament (ACL) status. RESULTS: A small prevalence of preserved NVB was related to Grades IV and V of Ahlbäck's classification, ACL absence, and severe PCL degeneration. The clinical and radiological parameters studied were not able to predict the grade of histological degeneration of the PCL. CONCLUSIONS: Ahlbäck's classification and ACL status provided useful information about NVB integrity. LEVEL OF EVIDENCE: Basic Science Level IV.

Correlation between Ahlbäck radiographic classification and anterior cruciate ligament status in primary knee arthrosis.

OBJECTIVE: To correlate the Ahlbäck radiographic classification with the anterior cruciate ligament (ACL) status in knee arthritis patients. METHODS: The study evaluated 89 knees of patients who underwent total knee arthroplasty due to primary osteoarthritis: 16 male and 69 females, with mean age 69.79 years (53-87 years). Osteoarthritis was classified radiographically by the Ahlbäck radiographic classification into five grades. The ACL was classified in the surgery as present or absent. The correlation of ACL status and Ahlbäck classification was assessed, as well as those of ACL status and the parameters age, gender, and tibiofemoral angulation (varus-valgus). RESULTS: In cases of varus knees, there was a correlation between grades I to III and ACL presence in 41/47 (86.7%) cases and between grades IV and V and ACL absence in 15/17 (88.2%) cases (p < 0.0001). In valgus knees, no statistically significant correlation was observed between the ACL status and the Ahlbäck classification. In the present study, absence of the ACL was more common in men (9/17; 52%) than in women (19/72; 26%). CONCLUSION: In cases of medial osteoarthritis, the Ahlbäck radiographic classification is a useful parameter to predict ACL status (presence or absence). In gonarthritis in genu valgum, ACL status was not predicted by Ahlbäck's classification.

OBJETIVO: Correlacionar a classificação radiográfica de Alhbäck com o estado de conservação do ligamento cruzado anterior (LCA). MÉTODOS: Avaliados 85 pacientes (89 joelhos) submetidos à artroplastia total de joelho por osteoartrose primária. Foram 16 homens e 69 mulheres com média de 69,79 anos (53 a 87). A osteoartrose foi subdividida em cinco graus de acordo com a classificação radiográfica de Alhbäck. O LCA foi avaliado na cirurgia como presente ou ausente. Foi feita a correlação entre o estado do LCA e a classificação de Alhbäck. Foi também analisada a correlação entre o estado do LCA e os parâmetros idade, sexo, angulação tibiofemoral (varo-valgo). RESULTADOS: Nos casos de joelho varo, foi observada uma correlação entre os graus I até III e a presença do LCA em 41/47 (86,7%) casos, bem como entre a ausência do LCA e os graus IV e V em 15/17 (88,2%) casos (p < 0,0001). Por outro lado, nos casos de joelho valgo não houve relação estatisticamente significante entre a presença ou ausência do LCA e a classificação de Alhbäck. Nesta série, foi observado que a ausência do LCA foi mais comum entre os homens 9/17 (52%) do que em mulheres 19/72 (26%). CONCLUSÕES: Nos casos de gonartrose do compartimento medial, a classificação de Alhbäck é parâmetro confiável para prever a condição do LCA (presente ou ausente). Nos casos de gonartrose em genu valgo não se observou correlação entre a classificação de Alhbäck e a condição do LCA.

Correlation between Ahlbäck radiographic classification and anterior cruciate ligament status in primary knee arthrosis / Correlação entre a classificação radiográfica de Ahlbäck e o estado de conservação do ligamento cruzado anterior em gonartrose primária

ABSTRACT OBJECTIVE: To correlate the Ahlbäck radiographic classification with the anterior cruciate ligament (ACL) status in knee arthritis patients. METHODS: The study evaluated 89 knees of patients who underwent total knee arthroplasty due to primary osteoarthritis: 16 male and 69 females, with mean age 69.79 years (53-87 years). Osteoarthritis was classified radiographically by the Ahlbäck radiographic classification into five grades. The ACL was classified in the surgery as present or absent. The correlation of ACL status and Ahlbäck classification was assessed, as well as those of ACL status and the parameters age, gender, and tibiofemoral angulation (varus-valgus). RESULTS: In cases of varus knees, there was a correlation between grades I to III and ACL presence in 41/47 (86.7%) cases and between grades IV and V and ACL absence in 15/17 (88.2%) cases (p < 0.0001). In valgus knees, no statistically significant correlation was observed between the ACL status and the Ahlbäck classification. In the present study, absence of the ACL was more common in men (9/17; 52%) than in women (19/72; 26%). CONCLUSION: In cases of medial osteoarthritis, the Ahlbäck radiographic classification is a useful parameter to predict ACL status (presence or absence). In gonarthritis in genu valgum, ACL status was not predicted by Ahlbäck's classification.

RESUMO OBJETIVO: Correlacionar a classificação radiográfica de Alhbäck com o estado de conservação do ligamento cruzado anterior (LCA). MÉTODOS: Avaliados 85 pacientes (89 joelhos) submetidos à artroplastia total de joelho por osteoartrose primária. Foram 16 homens e 69 mulheres com média de 69,79 anos (53 a 87). A osteoartrose foi subdividida em cinco graus de acordo com a classificação radiográfica de Ahlbäck. O LCA foi avaliado na cirurgia como presente ou ausente. Foi feita a correlação entre o estado do LCA e a classificação de Ahlbäck. Foi também analisada a correlação entre o estado do LCA e os parâmetros idade, sexo, angulação tibiofemoral (varo-valgo). RESULTADOS: Nos casos de joelho varo, foi observada uma correlação entre os graus I até III e a presença do LCA em 41/47 (86,7%) casos, bem como entre a ausência do LCA e os graus IV e V em 15/17 (88,2%) casos (p < 0,0001). Por outro lado, nos casos de joelho valgo não houve relação estatisticamente significante entre a presença ou ausência do LCA e a classificação de Ahlbäck. Nesta série, foi observado que a ausência do LCA foi mais comum entre os homens 9/17 (52%) do que em mulheres 19/72 (26%). CONCLUSÕES: Nos casos de gonartrose do compartimento medial, a classificação de Ahlbäck é parâmetro confiável para prever a condição do LCA (presente ou ausente). Nos casos de gonartrose em genu valgo não se observou correlação entre a classificação de Ahlbäck e a condição do LCA.

Immunohistochemical analysis of the neural structures of the posterior cruciate ligament in osteoarthritis patients submitted to total knee arthroplasty: an analysis of thirty-four cases.

OBJECTIVES: Many authors recommend posterior cruciate ligament-retaining arthroplasty with the intention to maintain the proprioception properties of this ligament. Preservation of the neuroreceptors and nervous fibers may be essential for retaining the proprioception function of the posterior cruciate ligament. The present study was thus developed to evaluate the presence of neural structures in the posterior cruciate ligament resected during posterior stabilized arthroplasty in osteoarthritis patients. In particular, clinical, radiographic and histological parameters were correlated with the presence or absence of neural structures in the posterior cruciate ligament. METHODS: In total, 34 posterior cruciate ligament specimens were stained with hematoxylin-eosin and Gomori trichrome. An immunohistochemical analysis using antibodies against the S100 protein and neurofilaments was also performed. The presence of neural structures was correlated with parameters such as tibiofemoral angulation, histological degeneration of the posterior cruciate ligament, Ahlbäck radiological classification, age, gender and the histologic pattern of the synovial neurovascular bundle around the posterior cruciate ligament. RESULTS: In total, 67.5% of the cases presented neural structures in the posterior cruciate ligament. In 65% of the cases, the neurovascular bundle was degenerated. Nervous structures were more commonly detected in varus knees than in valgus knees (77% versus 50%). Additionally, severe histologic degeneration of the posterior cruciate ligament was related to neurovascular bundle degeneration. CONCLUSIONS: Severe posterior cruciate ligament degeneration was related to neurovascular bundle compromise. Neural structures were more commonly detected in varus knees. Intrinsic neural structures were detected in the majority of the posterior cruciate ligaments of patients submitted to knee arthroplasty for osteoarthritis.

Immunohistochemical analysis of the neural structures of the posterior cruciate ligament in osteoarthritis patients submitted to total knee arthroplasty: an analysis of thirty-four cases

OBJECTIVES: Many authors recommend posterior cruciate ligament-retaining arthroplasty with the intention to maintain the proprioception properties of this ligament. Preservation of the neuroreceptors and nervous fibers may be essential for retaining the proprioception function of the posterior cruciate ligament. The present study was thus developed to evaluate the presence of neural structures in the posterior cruciate ligament resected during posterior stabilized arthroplasty in osteoarthritis patients. In particular, clinical, radiographic and histological parameters were correlated with the presence or absence of neural structures in the posterior cruciate ligament. METHODS: In total, 34 posterior cruciate ligament specimens were stained with hematoxylin-eosin and Gomori trichrome. An immunohistochemical analysis using antibodies against the S100 protein and neurofilaments was also performed. The presence of neural structures was correlated with parameters such as tibiofemoral angulation, histological degeneration of the posterior cruciate ligament, Ahlbäck radiological classification, age, gender and the histologic pattern of the synovial neurovascular bundle around the posterior cruciate ligament. RESULTS: In total, 67.5% of the cases presented neural structures in the posterior cruciate ligament. In 65% of the cases, the neurovascular bundle was degenerated. Nervous structures were more commonly detected in varus knees than in valgus knees (77% versus 50%). Additionally, severe histologic degeneration of the posterior cruciate ligament was related to neurovascular bundle degeneration. CONCLUSIONS: Severe posterior cruciate ligament degeneration was related to neurovascular bundle compromise. Neural structures were more commonly detected in varus knees. Intrinsic neural structures were detected in the majority of the posterior cruciate ligaments of patients submitted to knee arthroplasty for osteoarthritis. .

Análise histopatológica do ligamento cruzado posterior na osteoartrite primária / Histopathological analysis of the posterior cruciate ligament in primary osteoarthritis

OBJETIVO: Avaliar o padrão de degeneração histológica do ligamento cruzado posterior (LCP) em pacientes com artrose submetidos à artroplastia total de joelho com prótese com substituição do ligamento cruzado posterior (LCP). A degeneração histológica foi classificada em leve, moderada e grave. Os achados histológicos foram correlacionados com dados clínicos, radiográficos e do transoperatório (presença ou ausência do ligamento cruzado anterior) com a finalidade de aferir se estes parâmetros seriam capazes de predizer o grau de degeneração histológica do LCP em pacientes com gonartrose. MÉTODOS: foram avaliados 89 ligamentos cruzados posterior de 85 pacientes com idade média de 69,79 anos, sendo 69 do sexo feminino, 16 do masculino. O LCP foi corado em hematoxilina-eosina e Tricrômio de Gomori e classificado quanto ao comprometimento histológico em leve, moderado e grave. A degeneração histológica foi correlacionada aos parâmetros idade, artrose radiográfica classificada por Ahlbãck (grau I ao V), eixo radiográfico tíbio-femoral (varo, neutro e valgo), e estado do ligamento cruzado anterior (LCA), presença ou ausência.Os achados histológicos de hipercelularidade, infiltração linfocitária crônica, proliferação vascular; presença de cistos; clones de condrócitos; degenerações colágena, fibrinóide, cartilaginosa ,gordurosa e mucoide foram correlacionados com o grau de degeneração do LCP e ao estado de conservação do LCA. RESULTADO: Não foram identificadas relações entre o grau de degeneração histológica do LCP e faixa etária (abaixo ou acima de 70 anos), sexo, classificação radiográfica de Ahlbãck e presença ou ausência do LCA. Os achados histológicos de degeneração fibrinóide, proliferação vascular e presença de cistos estiveram estatisticamente relacionados à degeneração histológica grave do LCP. CONCLUSÃO: Os parâmetros clínicos e radiográficos não foram capazes de predizer o grau de degeneração histológica do LCP .Os achados histológicos de degeneração...

OBJECTIVE: Evaluate the histologic degeneration pattern of the posterior cruciate ligament (PCL) in osteoarthrosis patients submitted to total knee replacement with a cruciate substituting prosthesis. The histologic degeneration was classified in mild, moderate and severe. The histologic pattern was related to clinical, per-operatory (presence or absence of anterior cruciate ligament) and radiographic parameters with the aim to settle if these parameters would be reliable to predict the PCL degeneration grade. METHODS: 89 PCLs from 85 patients, 16 men, 69 women, mean age 69, 79 years old. PCL was stained with hematoxylin and eosin and trichromium of Gomori. The PCL histologic degeneration was graded from normal-minimum to severe. The histologic PCL degeneration pattern was related to age, radiographic arthrosis classification (Ahlbãck - grades I to V), knee radiographic axis (varus, neutral, valgus) and to the ACL status (presence or absence).The histologic findings of hipercellularity, chronic lymphocit infiltration, neoangiogenesis, cysts, collagen degeneration (deg), fibrinoid deg, mucoid deg., cartilaginous, deg., fat deg. and condrocyte clones were related to the grade of PCL degeneration and to ACL status. RESULTS: There was no correlation of histologic degeneration to sex or age (above or below 70 years), arthrosis radiographic classification (Ahlbãck) and presence or absence of ACL. The histological findings of fibrinoid degeneration, vascular proliferation and cysts were statistically related to severe histologic LCP degeneration. CONCLUSION: The parameters studied were not capable of predicting the grade of LCP degeneration. The histological findings of fibrinoid degeneration, vascular proliferation and cysts were characteristic of severe PCL histologic degeneration.