Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone-patellar tendon-bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. PURPOSE: To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. RESULTS: The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 (P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain (P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. CONCLUSION: The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.

Redução de prolapso uterino e cesariana seguido de osh em cadela: um relato de caso / Reduction of uterine prolapse and cesarean section following of ohe in a dog - a case report

The uterine prolapse is defined as the eversion and protrusion of a portion of the uterus through thecervix, through the vagina. This condition is not common in dogs, so this report aims to describe a case ofuterine prolapse in a dog treated at the Veterinary Hospital of the Federal University of Piaui. In anamnesis, theowner complained of a reddish mass in the vulva after giving birth, during the clinical examination it wasobserved apathy, cachexia and enlargement of the vulva, leading us to consider the possibility of a uterineprolapse. The animal was immediately sent to the operating room for reduction of the prolapsed uterus. Thesurgical approach was required for both to remove the fetus as a definitive treatment of the prolapse.

Redução de prolapso uterino e cesariana seguido de osh em cadela: um relato de caso / Reduction of uterine prolapse and cesarean section following of ohe in a dog - a case report

The uterine prolapse is defined as the eversion and protrusion of a portion of the uterus through thecervix, through the vagina. This condition is not common in dogs, so this report aims to describe a case ofuterine prolapse in a dog treated at the Veterinary Hospital of the Federal University of Piaui. In anamnesis, theowner complained of a reddish mass in the vulva after giving birth, during the clinical examination it wasobserved apathy, cachexia and enlargement of the vulva, leading us to consider the possibility of a uterineprolapse. The animal was immediately sent to the operating room for reduction of the prolapsed uterus. Thesurgical approach was required for both to remove the fetus as a definitive treatment of the prolapse.(AU)

Limites e possibilidades do idoso frente à aposentadoria / Limits and possibilities of elderly face to retirement

Estudo qualitativo cujo objetivo foi identificar a visão de idosos frente à aposentadoria, mediante entrevista semiestruturada com 15 idosos aposentados, participantes do Programa de Geriatria e Gerontologia da Universidade Federal Fluminense, em Niterói (RJ), com projeto aprovado pelo CEP da Instituição sob número 125.294. Concluiu-se que tanto os limites tidos como pontos negativos, quanto as possibilidades tidas como pontos positivos estão associados a um planejamento prévio da aposentadoria associada à melhor qualidade de vida do idoso.(AU)

This qualitative study whose objective was identify the vision of elderly facing retirement through structured interviews with 15 elderly retirees participating in the Program of Geriatrics and Gerontology at the Universidade Federal Fluminense in Niterói-RJ, with CEP approved by the Institution under number 125. 294 project interview. It was concluded that both limits considered negatives, as the possibilities are taken as positive points associated with a prior retirement planning associated with better quality of life of the elderly.(AU)

Limites e possibilidades do idoso frente à aposentadoria / Limits and possibilities of elderly face to retirement

Estudo qualitativo cujo objetivo foi identificar a visão de idosos frente à aposentadoria, mediante entrevista semiestruturada com 15 idosos aposentados, participantes do Programa de Geriatria e Gerontologia da Universidade Federal Fluminense, em Niterói (RJ), com projeto aprovado pelo CEP da Instituição sob número 125.294. Concluiu-se que tanto os limites tidos como pontos negativos, quanto as possibilidades tidas como pontos positivos estão associados a um planejamento prévio da aposentadoria associada à melhor qualidade de vida do idoso.

This qualitative study whose objective was identify the vision of elderly facing retirement through structured interviews with 15 elderly retirees participating in the Program of Geriatrics and Gerontology at the Universidade Federal Fluminense in Niterói-RJ, with CEP approved by the Institution under number 125. 294 project interview. It was concluded that both limits considered negatives, as the possibilities are taken as positive points associated with a prior retirement planning associated with better quality of life of the elderly.

Periosteum as a source of mesenchymal stem cells: the effects of TGF-ß3 on chondrogenesis.

INTRODUCTION: Numerous experimental efforts have been undertaken to induce the healing of lesions within articular cartilage by re-establishing competent repair tissue. Adult mesenchymal stem cells have attracted attention as a source of cells for cartilage tissue engineering. The purpose of this study was to investigate chondrogenesis employing periosteal mesenchymal cells. METHODS: Periosteum was harvested from patients who underwent orthopedic surgeries. Mesenchymal stem cells were characterized through flow cytometry using specific antibodies. The stem cells were divided into four groups. Two groups were stimulated with transforming growth factor ß3 (TGF-ß3), of which one group was cultivated in a monolayer culture and the other was cultured in a micromass culture. The remaining two groups were cultivated in monolayer or micromass cultures in the absence of TGF-ß3. Cell differentiation was verified through quantitative reverse transcription-polymerase chain reaction (RT-PCR) and using western blot analysis. RESULT: In the groups cultured without TGF-ß3, only the cells maintained in the micromass culture expressed type II collagen. Both the monolayer and the micromass groups that were stimulated with TGF-ß3 expressed type II collagen, which was observed in both quantitative RT-PCR and western blot analysis. The expression of type II collagen was significantly greater in the micromass system than in the monolayer system. CONCLUSION: The results of this study demonstrate that the interactions between the cells in the micromass culture system can regulate the proliferation and differentiation of periosteal mesenchymal cells during chondrogenesis and that this effect is enhanced by TGF-ß3.

COMPLICATIONS FOLLOWING MEDIAL OPENING WEDGE OSTEOTOMY OF THE KNEE: RETROSPECTIVE STUDY.

OBJECTIVE: To retrospectively survey the most frequent complications from medial opening wedge high-tibial osteotomy. This procedure is becoming increasingly important in treating knee arthrosis, as one of the options for young and active patients. Despite satisfactory results and its benefits, it is not a complication-free procedure. METHODS: All cases of medial opening wedge high-tibial osteotomy above the tibial tubercle with fixation using a Puddu plate that were performed at the Celso Pierro Hospital and Maternity Hospital, Pontifical Catholic University of Campinas (PUC-Campinas) and the Wilson Mello Institute, Campinas, between October 1, 1987, and October 30, 2008, were evaluated retrospectively. Patients with less than 12 months of follow-up or incomplete medical files, and those who underwent bilateral osteotomy, were excluded. RESULTS: Out of the 67 cases evaluated, 55 were males and 12 were females, with a mean age of 49.5 years. The mean wedge size was 10.15 mm and the most common complications were moderate to severe pain (13.04%), stiffness (6.52%), material breakage (4.4%), intraoperative fracture of the lateral cortical bone (4.4%) and infection (4.4%). It was observed that patients with delayed consolidation of the osteotomy had a greater chance of presenting complications (p < 0.05). CONCLUSION: Complications from medial wedge osteotomy are more frequent when associated with delayed consolidation.

Complicações da osteotomia em cunha de abertura medial do joelho: estudo retrospectivo / Complications following medial opening wedge osteotomy of the knee: retrospective study

OBJETIVO: Realizar um levantamento retrospectivo das complicações mais frequentes da osteotomia tibial alta (OTA) em cunha de abertura medial. Esse procedimento vem a cada vez ganhando mais espaço no tratamento da artrose do joelho como uma das opções para pacientes jovens e ativos. Apesar dos resultados satisfatórios e seus benefícios, não é procedimento isento de complicações. MÉTODOS: Foram avaliados, retrospectivamente, todos os pacientes submetidos à OTA supratuberositária medial de cunha de abertura e fixados com placa do tipo Puddu, realizadas no período de 1 de outubro de 1987 a 30 de outubro de 2008, no Hospital e Maternidade Celso Pierro da Pontifícia Universidade Católica de Campinas (PUC-Campinas) e no Instituto Wilson Mello em Campinas. Foram excluídos pacientes com menos de 12 meses de seguimento, com prontuários incompletos, e os que tinham osteotomias bilaterais. RESULTADOS: Dos 67 casos avaliados, 55 eram do sexo masculino e 12 do feminino, com média de idade de 49,5 anos. O tamanho médio da cunha foi de 10,15mm e as complicações mais frequentes foram dor moderada e grave (13,04 por cento), seguida de rigidez (6,52 por cento), quebra de material (4,4 por cento), fratura da cortical lateral intraoperatória (4,4 por cento) e infecção (4,4 por cento). CONCLUSÃO: Foi observado aumento de probabilidade de complicações quando há retardo na consolidação da osteotomia (p < 0,05). Foi possível concluir que as complicações da osteotomia de cunha medial são mais frequentes quando há associação de retardo de consolidação.

OBJECTIVE: To retrospectively survey the most frequent complications from medial opening wedge high-tibial osteotomy. This procedure is becoming increasingly important in treating knee arthrosis, as one of the options for young and active patients. Despite satisfactory results and its benefits, it is not a complication -free procedure. METHODS: All cases of medial opening wedge high-tibial osteotomy above the tibial tubercle with fixation using a Puddu plate that were performed at the Celso Pierro Hospital and Maternity Hospital, Pontifical Catholic University of Campinas (PUC -Campinas) and the Wilson Mello Institute, Campinas, between October 1, 1987, and October 30, 2008, were evaluated retrospectively. Patients with less than 12 months of follow-up or incomplete medical files, and those who underwent bilateral osteotomy, were excluded. RESULTS: Out of the 67 cases evaluated, 55 were males and 12 were females, with a mean age of 49.5 years. The mean wedge size was 10.15 mm and the most common complications were moderate to severe pain (13.04 percent), stiffness (6.52 percent), material breakage (4.4 percent), intraoperative fracture of the lateral cortical bone (4.4 percent) and infection (4.4 percent). It was observed that patients with delayed consolidation of the osteotomy had a greater chance of presenting complications (p < 0.05) . CONCLUSION: Complications from medial wedge osteotomy are more frequent when associated with delayed consolidation.

Periosteum as a source of mesenchymal stem cells: the effects of TGF-β3 on chondrogenesis

INTRODUCTION: Numerous experimental efforts have been undertaken to induce the healing of lesions within articular cartilage by re-establishing competent repair tissue. Adult mesenchymal stem cells have attracted attention as a source of cells for cartilage tissue engineering. The purpose of this study was to investigate chondrogenesis employing periosteal mesenchymal cells. METHODS: Periosteum was harvested from patients who underwent orthopedic surgeries. Mesenchymal stem cells were characterized through flow cytometry using specific antibodies. The stem cells were divided into four groups. Two groups were stimulated with transforming growth factor β3 (TGF-β3), of which one group was cultivated in a monolayer culture and the other was cultured in a micromass culture. The remaining two groups were cultivated in monolayer or micromass cultures in the absence of TGF-β3. Cell differentiation was verified through quantitative reverse transcription-polymerase chain reaction (RT-PCR) and using western blot analysis. RESULT: In the groups cultured without TGF-β3, only the cells maintained in the micromass culture expressed type II collagen. Both the monolayer and the micromass groups that were stimulated with TGF-β3 expressed type II collagen, which was observed in both quantitative RT-PCR and western blot analysis. The expression of type II collagen was significantly greater in the micromass system than in the monolayer system. CONCLUSION: The results of this study demonstrate that the interactions between the cells in the micromass culture system can regulate the proliferation and differentiation of periosteal mesenchymal cells during chondrogenesis and that this effect is enhanced by TGF-β3.

Avaliação radiológica da osteoartrose de joelhos: vista póstero-anterior do túnel ou ântero-posterior com carga em extensão? / Radiological evaluation of osteoarthrosis of the knee: weight bearing posteroanterior tunnel view or weight bearing anteroposterior view in extension?

Objetivo: Verificar se há diferença entre as medidas da fenda articular do joelho nas incidências radiográficas em ântero-posterior (AP), com carga e o joelho totalmente estendido, e a vista póstero-anterior do túnel (VPAT), com carga e joelho flexionado cerca de 30 graus. Materiais e métodos: Foram avaliados radiologicamente 50 pacientes do sexo feminino, acima de 40 anos, com sintomas clínicos e sinais radiológicos de osteoartrose (OA) nos joelhos, enquadradas nos graus II e III, de acordo com a classificação de Kellgren e Lawrence. As medidas foram feitas por dois ortopedistas cegos entre si que utilizaram um paquímetro digital. Os pontos da fenda articular determinados para medida foram a 10 mm da borda e no ponto médio dos compartimentos medial e lateral. As medidas em ambas as técnicas foram comparadas segundo teste t Student. Resultados: O método AP com carga apresentou médias maiores para as medidas realizadas nos pontos médios do compartimento lateral em ambos os lados. Para todos os demais pontos de medidas, as médias foram inferiores às observadas na incidência vista póstero-anterior do túnel. Conclusões: Não houve diferença estatística nas medições do espaço articular do joelho nas duas incidências, AP e VPAT.

Tratamento da osteoartrose unicompartimental medial do joelho com a utilizaçäo da prótese unicompatimental do tipo Allergretto. Resultado precose de 26 intervençöes em 24 pacientes / Treatment of medial unicompartmental osteoarthrosis of the knee with the use of Allergretto type unicompartmental prosthesis. Early results of 26 intervention in 24 patients

Os autores apresentam os resultados da avaliaçäo do tratamento da osteoartrose do comportamento medial do joelho com a artroplastia unicompartimental, quanto à técnica cirúrgica e os resultados de curto prazo. A prótese unicompartimental utilizada é a do tipo Allegretto, desenvolvida por Broc & Romagnoli. Os componentes tibial e femoral säo compostos por ligas metálicas e separados por um dispositivo de polietileno que forma a parte articular. Com um seguimento médio de 11,5 meses, 24 pacientes adultos foram submetidos a 26 artroplastias. Utilizando o protocolo de avaliaçäo do HSS modificado, os resultados foram excelentes em 13 pacientes (50 por cento), bons em 6 (23,08 por cento), regulares em 3 (11,54 por cento) e ruins em 4 (15,38 por cento), somando-se 73,08 por cento de resultados satisfatórios e 26,92 por cento de insatisfatórios. Houve 2 casos de soltura do componente tibial que necessitaram de revisäo com a prótese total. Os autores concluem que a prótese unicompartimental do tipo Allegretto é uma boa alternativa de tratamento da osteoartrose do compartimento medial a curto prazo, quando utilizada em pacientes cuidadosamente selecionados para os quais a osteotomia e a prótese total säo contra-indicadas.

Fraturas transtrocanterianas do fêmur: causa prováveis das falhas de osteossíntese / Intertrochanteric fractures of femur: probable causes of bone fixations failure

Analisa o tratamento de 12 pacientes portadores de fraturas transtrocantéricas do fêmur em que ocorreram falhas na osteossíntese, com o objetivo de encontrar as suas causas. As complicaçöes mais encontradas foram: migraçäo do implante, quebra do material, falta de impactaçäo na regiäo do cálcar, falta de valgizaçäo ou de reduçäo anatômica, todas provocadas por erros no procedimento cirúrgico. Recomenda-se uma avaliaçäo pré-operatória precisa para possibilitar a escolha do melhor material de implante.

Análise crítica de possíveis falhas em osteossíntese de fratura transtrocanterianas: estudo de 12 pacientes / Critical analysis of possible failures in intertrochanteric fracture osteosynthesis: report of 12 cases

Os autores analisam 12 pacientes portadores de fraturas transtrocantéricas do fêmur em que ocorreram falhas no material de implante. As complicaçoes mais encontradas foram: migraçao do implante, quebra do material, falta de impacçao na regiao do calcar, falta de valgizaçao ou de reduçao anatômica, todas provocadas por erros no procedimento cirúrgico. Os autores recomendam avaliaçao pré-operatória precisa para possibilitar a escolha do melhor material de implante.

Fraturas transtrocanterianas do femur: causas provaveis das falhas de osteossintese

Analisa o tratamento de 12 pacientes portadores de fraturas transtrocantericas do femur em que ocorreram falhas na osteossintese, com o objetivo de encontrar as suas causas. As complicacoes mais encontradas foram: migracao do implante, quebra do material, falta de impactacao na regiao do calcar, falta de valgizacao ou de reducao anatomica, todas provocadas por erros no procedimento cirurgico. Recomenda-se uma avaliacao pre-operatoria precisa para possibilitar a escolha do melhor material de implante.