Andrea Forgas

A Comparison of Hip Strength Between Sedentary Females With and Without Patellofemoral Pain Syndrome

STUDY DESIGN Cross-sectional study. OBJECTIVE To compare the hip strength of sedentary females with either unilateral or bilateral patellofemoral pain syndrome (PFPS) to a control group of sedentary females of similar demographics without PFPS. BACKGROUND It has been suggested that hip muscle weakness may be an important factor in the etiology of young female athletes with PFPS. This syndrome is also common in sedentary females and it is unclear if similar findings of hip weakness would be present in this population. METHODS Females between 15 and 40 years of age (control group, n = 50; unilateral PFPS, n = 21; bilateral PFPS, n = 29) participated in the study. Strength for all 6 hip muscle groups was measured bilaterally on all subjects using a handheld dynamometer. RESULTS The hip musculature of sedentary females with bilateral PFPS was statistically weaker (range, 12%-36%; P<.05) than that of the control group for all muscle groups. The hip abductors, lateral rotators, flexors, and extensors of the injured side of those with unilateral PFPS group were statistically weaker (range, 15%-20%; P<.05)than that of the control group, but only the hip abductors were significantly weaker when compared to their uninjured side (20%; P<.05). CONCLUSION This study demonstrates that hip weakness is a common finding in sedentary females with PFPS.

Low-Intensity Pulsed Ultrasound Accelerates Healing in Rat Calcaneus Tendon Injuries

STUDY DESIGN Controlled laboratory study. OBJECTIVE To evaluate the effect of low-intensity therapeutic ultrasound on the murine calcaneus tendon healing process. BACKGROUND Therapeutic ultrasound promotes formation and maturation of scar tissue. METHODS Calcaneus tendon tenotomy and tenorrhaphy was performed on 28 Wistar rats. After the procedure, the animals were randomly divided into 2 groups. The animals in the experimental group received a 5-minute ultrasound application, once a day, at a frequency of 1 MHz, a spatial average temporal average intensity of 0.1 W/cm2, and a spatial average intensity of 0.52 W/cm2 at a 16-Hz frequency pulse mode (duty cycle, 20%). Data for the injured side were normalized in relation to the data from the contralateral healthy calcaneus tendon (relative values). The animals in the control group received sham treatment. After a 28-day treatment period, the animals were sacrificed and their tendons surgically removed and subjected to mechanical stress testing. The parameters analyzed were cross-sectional area (mm2), ultimate load (N), tensile strength (MPa), and energy absorption (mJ). RESULTS A significant difference between groups was found for the relative values of ultimate load and tensile strength. The mean ± SD ultimate load of the control group was -3.5% ± 32.2% compared to 33.3% ± 26.8% for the experimental group (P = .005). The mean tensile strength of the control group was -47.7% ± 19.5% compared to -28.1% ± 24.1% for the experimental group (P = .019). No significant difference was found in cross-sectional area and energy absorption. CONCLUSION Low-intensity pulsed ultrasound produced by a conventional therapeutic ultrasound unit can positively influence the calcaneus tendon healing process in rats.

Artroplastia unicompartimental no tratamento da artrose medial do joelho

OBJETIVO: Analisar a evolucao de um grupo de pacientes submetido a artroplastia unicompartimental de joelho para tratamento das artroses e nas osteonecroses que comprometem exclusivamente o comportamento medial. METODOS: Foram avaliados 49 pacientes portadores de artrose unicompartimental de joelho com idade variando entre 47 e 88 anos de idade, sendo 12 homens e 37 mulheres. Todos foram submetidos a artroplastia unicompartimental do tipo Miller-Galante. Apos seguimento minimo de quatro anos, os pacientes foram avaliados subjetivamente pelo exame ortopedico e objetivamente pelo sistema Hospital for Special Surgery (HSS). RESULTADOS: Apenas uma paciente necessitou de revisao para artroplastia total; quatro apresentaram dor nao incapacitante; e tres, queixas de instabilidade esporadica nao incapacitante. Na avaliacao do HSS, 30 pacientes apresentaram resultados excelentes; 18, resultados bons; e um, resultado regular. CONCLUSAO: A artroplastia unicompartimental e uma boa opcao para casos de artrose e osteonecrose do compartimento medial do joelho.

Comparação entre os resultados obtidos na reconstrução do ligamento cruzado anterior do joelho utilizando dois tipos de enxertos autólogos: tendão patelar versus semitendíneo e grácil

OBJETIVO: O objetivo deste trabalho e comparar os resultados da artrometria e do exame isocinetico entre dois tipos de enxertos autologos: o terco central do ligamento patelar e o formado pelos tendoes dos musculos semitendineo e gracil, dentro de um mesmo protocolo de reabilitacao no sexto mes pos-operatorio. MATERIAIS E METODOS: Foram analisados os resultados obtidos dos exames realizados em 63 pacientes divididos em dois grupos. Em um grupo de 30 pacientes, utilizou-se o tendao patelar como enxerto e em outro grupo de 33 pacientes, utilizou-se o tendao dos musculos semitendineo e gracil. Ambos os enxertos foram fixados da mesma forma, com EndobuttonTM para fixacao suspensoria no femur e um parafuso de interferencia bioabsorvivel para fixacao no tunel tibial. RESULTADOS: A artrometria 30 nao apresentou diferenca estatistica entre os dois grupos observados. Ja na avaliacao isocinetica, constatou-se que o grupo de tendao patelar possui em media maior pico de torque de flexao e maior deficit de extensao e o grupo de flexores possui, em media, melhor relacao flexao/extensao e maior deficit de flexao percentual. Nao ha diferenca estatistica significante entre os grupos quanto a medida de pico de torque de extensao. CONCLUSAO: portanto, no presente estudo, quando o tendao patelar e utilizado, ha maior deficit extensor e quando sao utilizados os tendoes flexores, ha maior deficit flexor.

Estudo da precisão diagnóstica do artrômetro KT1000TM na lesões do ligamento cruzado anterior

The main objective of this study was to verify the sensitiveness of the Electronic Arthrometer KT-1000TM in detecting ACL injuries. Thirty-six patients with knee sprain history and clinical tests compatible to ACL injury were evaluated. Group 1 was composed of 18 patients evaluated within less than four weeks after the sprain episode. Group 2 (two) was formed by 18 patients evaluated within more than 4 (four) weeks after the sprain episode. Both Groups were submitted to arthrometric (KT-1000TM) and magnetic resonance imaging (MR) evaluation. After the analysis of data obtained from imaging and arthrometric evaluations, the patients were submitted to arthroscopic procedures for injury evaluation and treatment, enabling the comparison of arthroscopic findings to the results of arthrometry and Magnetic Resonance Imaging. The diagnostic accuracy of the arthrometer KT-1000 TM was 100% for both groups, with the most sensible test regarding the presence of ACL injury being the Maximum Manual Traction Test. The diagnostic accuracy of the magnetic resonance imaging test was 94.4% for Group 1 and 100% for Group 2.

TUMOR GIGANTOCELULAR SINOVIAL DO JOELHO

Tumor gigantocelular sinovial e uma neoplasia benigna, raramente sendo relatada na forma de metastase maligna. A localizacao mais comum de ocorrer um tumor gigantocelular sinovial e na mao e as mais infrequentes sao tornozelo e joelho. No presente estudo os autores tem como objetivo descrever um caso raro de tumor gigantocelular sinovial localizado no joelho e o tratamento escolhido. A artroscopia demonstrou, nesse caso, ser o metodo ideal para o tratamento da lesao, uma vez que permitiu abordagem pouco agressiva e, ao mesmo tempo, boa visualizacao de todos os compartimentos da articulacao do joelho e a completa resseccao do tumor.

A manual method to obtain platelet rich plasma.

OBJECTIVE: This study is to report a manual method to obtain platelet rich plasma (PRP). METHODS: For this study 61 ml of peripheral blood was obtained and submitted to centrifugation at 541g for 5 min. The centrifugation separates the blood into three components: red blood cells, buffy coat and platelet rich plasma. Blood and platelet rich plasma samples were sent to the Hospitals Laboratory and platelets and leukocytes were measured. RESULTS: A sample of 637 blood donors was evaluated. The platelet yield efficiency was 86.77% and the increase in platelet concentration factor was 2.89 times. The increase in leukocyte concentration factor was 1.97 times. CONCLUSION: The method described here produces leukocyte-rich and platelet-rich plasma with a high platelet and leukocyte increased factor. Level of Evidence IV, Controlled Laboratory Study.

Quadriceps Strength Deficit at 6 Months After ACL Reconstruction Does Not Predict Return to Preinjury Sports Level

Background: There is a lack of literature-based objective criteria for return to sport after anterior cruciate ligament (ACL) injury. Establishing such objective criteria is crucial to improving return to sport after ACL reconstruction (ACLR). Hypotheses: Patients who return to their preinjury level of sport will have higher isokinetic, postural stability, and drop vertical jump test scores 6 months after surgery and greater patient satisfaction compared with those who did not. Additionally, quadriceps strength deficit cutoff values of 80% and 90% would differentiate patients who returned to preinjury sports level from those who did not. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A retrospective search was conducted to identify all patients who underwent ACLR and completed isokinetic evaluation, postural stability analysis, and drop vertical jump testing at 6 months postoperatively. Patients were asked to complete 3 questionnaires at a minimum 1 year after surgery. Chi-square and logistic regression analyses were used for categorical dependent variables, while the Student t test, Pearson correlation, or analyses of variance with Bonferroni post hoc testing were used for continuous dependent variables. A post hoc power analysis was completed. Based on the results regarding correlations between return to preinjury level and all other variables, effect sizes from 0.24 to 3.03 were calculated. With these effect sizes, an alpha of 0.05 and sample size of 58, a power ranging from 0.15 to 0.94 was calculated. Results: The rates of return to preinjury level and to any sports activity were 53.4% and 84.4%. Those who were able to return to their preinjury level of sport (n = 33) showed significantly higher Lysholm (91.6 ± 9.7 vs 76.7 ± 15.4) and International Knee Documentation Committee (IKDC) (83.6 ± 10.6 vs 69.8 ± 14.6) values compared with those who were unable to return to their preinjury level of sport (n = 25) (P < 0.001). No significant differences were found for the clinical evaluations between those who were and those who were not able to return at the same level for the clinical evaluations (isokinetic evaluation, postural stability, drop vertical jump test) (P > 0.05). No significant differences were found when comparing quadriceps strength deficit with cutoff values of 80% and 90% for return to preinjury activity level (Tegner), Lysholm, and IKDC scores. Conclusion: Quadriceps strength deficit, regardless of cutoff value (80% or 90%), at 6 months after ACLR does not predict return to preinjury level of sport. Patients who returned to sport at their preinjury level were more satisfied with their reconstruction compared with those who did not. Clinical Relevance: Quadriceps strength deficit is not a reliable predictor of return to sports, and therefore it should not be used as the single criterion in such evaluations.

Synovial giant cell tumor of the knee

Synovial giant cell tumor is a benign neoplasm, rarely reported in the form of malignant metastasis. Synovial giant cell tumor most frequently occurs on the hand, and, most uncommon, on the ankle and knee. In the present study, the authors describe a rare case of synovial giant cell tumor on the knee as well as the treatment approach. Arthroscopy has been shown, in this case, to be the optimal method for treating this kind of lesion, once it allowed a less aggressive approach, while providing good visualization of all compartments of knee joint and full tumor resection.

COMPARISON BETWEEN THE RESULTS ACHIEVED IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH TWO KINDS OF AUTOLOGOUS GRAFTS: PATELLAR TENDON VERSUS SEMITENDINOUS AND GRACILIS

Objective: this study aims to compare the arthrometric and isokinetic examination results from two types of autologous grafts: the central third of the patellar ligament and a graft formed by the tendons of the semitendinosus and gracilis muscles, within the same rehabilitation protocol, six months after the surgery. Methods: the results from examinations carried out on 63 patients were analyzed. These patients were divided in two groups: one group of 30 patients who received a patellar tendon graft and another group of 33 patients who received a graft from the tendons of the semitendinosus and gracilis muscles. Both the grafts were attached in the same way, with Endobutton™ for suspensory fixation to the femur and a bioabsorbable interference screw for fixation in the tibial tunnel. Results: arthrometry 30 did not present any statistical difference between the two study groups. On the other hand, the isokinetic evaluation showed that the patellar tendon group had a larger mean peak torque of flexion and greater extension deficit, while the semitendinosus/gracilis group had a better mean flexion/extension ratio and greater percentage of flexion deficit. There was no statistically significant difference between the groups when measuring peak torque extension. Conclusion: therefore, when the patellar tendon was used, there was greater extensor deficit and, when the semitendinosus/gracilis tendons were used, there was greater flexor deficit.