Liszt Palmeira de Oliveira

Translation and Cross-cultural Adaptation of the Lower Extremity Functional Scale Into a Brazilian Portuguese Version and Validation on Patients With Knee Injuries

STUDY DESIGN Clinical measurement. OBJECTIVE To translate and culturally adapt the Lower Extremity Functional Scale (LEFS) into a Brazilian Portuguese version, and to test the construct and content validity and reliability of this version in patients with knee injuries. BACKGROUND There is no Brazilian Portuguese version of an instrument to assess the function of the lower extremity after orthopaedic injury. METHODS The translation of the original English version of the LEFS into a Brazilian Portuguese version was accomplished using standard guidelines and tested in 31 patients with knee injuries. Subsequently, 87 patients with a variety of knee disorders completed the Brazilian Portuguese LEFS, the Medical Outcomes Study 36-Item Short-Form Health Survey, the Western Ontario and McMaster Universities Osteoarthritis Index, and the International Knee Documentation Committee Subjective Knee Evaluation Form and a visual analog scale for pain. All patients were retested within 2 days to determine reliability of these measures. Validation was assessed by determining the level of association between the Brazilian Portuguese LEFS and the other outcome measures. Reliability was documented by calculating internal consistency, test-retest reliability, and standard error of measurement. RESULTS The Brazilian Portuguese LEFS had a high level of association with the physical component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.82), the Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.87), the International Knee Documentation Committee Subjective Knee Evaluation Form (r = 0.82), and the pain visual analog scale (r = -0.60) (all, P<.05). The Brazilian Portuguese LEFS had a low level of association with the mental component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.38, P<.05). The internal consistency (Cronbach α = .952) and test-retest reliability (intraclass correlation coefficient = 0.957) of the Brazilian Portuguese version of the LEFS were high. The standard error of measurement was low (3.6) and the agreement was considered high, demonstrated by the small differences between test and retest and the narrow limit of agreement, as observed in Bland-Altman and survival-agreement plots. CONCLUSION The translation of the LEFS into a Brazilian Portuguese version was successful in preserving the semantic and measurement properties of the original version and was shown to be valid and reliable in a Brazilian population with knee injuries.

Medial Hip Arthroscopy Portals: An Anatomic Study

PURPOSE The main objective of this study was to investigate medial hip portals and evaluate their relation with anatomic structures in a cadaveric model. METHODS Placement of 3 medial arthroscopic portals was simulated in 10 fresh human paired cadaveric hip specimens by placing Steinmann pins into the joint under fluoroscopic control. Two portals were made at the groin, 1 anterior and 1 posterior to the adductor longus muscle, and the third portal was placed posterior to the adductor longus muscle, 5 cm distal to the groin. The specimens were then dissected, and the relation of the portals to the following structures was recorded: pectineus, adductor longus, gracilis, adductor brevis, adductor magnus, iliopsoas tendon, obturator nerve, femoral nerve, femoral artery, femoral vein, and profunda femoris artery. RESULTS Regarding the anteromedial portal, the closest neurovascular structure was the profunda femoris artery, which was 10.4 ± 2.7 mm (range, 6 to 14 mm) distal to the portal. Regarding the posteromedial portal, the nearest neurovascular structure was the obturator nerve, which was 6.0 ± 3.6 mm (range, 2 to 13 mm) posterior to the portal. Regarding the distal posteromedial portal, the nearest neurovascular structures were the obturator nerve, which was 4.6 ± 3.0 mm (range, 1 to 9 mm) distal to the portal, and the profunda femoris artery, which was 10.5 ± 3.9 mm (range, 6 to 17 mm) distal to the portal. CONCLUSIONS The use of the medial portals did not cause any damage to the neurovascular structures evaluated. Despite this, the portals are in close relation to the obturator nerve and profunda femoris, and care should be taken. CLINICAL RELEVANCE This study investigated 3 medial hip portals in a cadaveric model and also defined safety parameters for this approach. Medial hip portals may be useful to directly approach medial hip pathologies.

Translation and cultural adaptation of the Hip Outcome Score to the Portuguese language

Objective to translate the Hip Outcome Score clinical evaluation questionnaire into Portuguese and culturally adapt it for Brazil. Methods the Hip Outcome Score questionnaire was translated into Portuguese following the methodology consisting of the steps of translation, back-translation, pretesting and final translation. Results the pretesting was applied to 30 patients with hip pain without arthrosis. In the domain relating to activities of daily living, there were no difficulties in comprehending the translated questionnaire. In presenting the final translation of the questionnaire, all the questions were understood by more than 85% of the individuals. Conclusion the Hip Outcome Score questionnaire was translated and adapted to the Portuguese language and can be used in clinical evaluation on the hip. Additional studies are underway with the objective of evaluating the reproducibility and validity of the Brazilian translation.

Translation, cross-cultural adaptation and validation of the Brazilian version of the Nonarthritic Hip Score

CONTEXT AND OBJECTIVE The Nonarthritic Hip Score (NAHS) is a clinical evaluation questionnaire that was developed in the English language to evaluate hip function in young and physically active patients. The aims of this study were to translate this questionnaire into the Brazilian Portuguese language, to adapt it to Brazilian culture and to validate it. DESIGN AND SETTING Cohort study conducted between 2008 and 2010, at Universidade do Estado do Rio de Janeiro (UERJ). METHODS Questions about physical activities and household chores were modified to better fit Brazilian culture. Reproducibility, internal consistency and validity (correlations with the Algofunctional Lequesne Index and the Western Ontario and McMaster Universities Arthritis Index [WOMAC]) were tested. The NAHS-Brazil, Lequesne and WOMAC questionnaires were applied to 64 young and physically active patients (mean age, 40.9 years; 31 women). RESULTS The intraclass correlation coefficient (which measures reproducibility) was 0.837 (P < 0.001). Bland-Altman plots revealed a mean error in the difference between the two measurements of 0.42. The internal consistency was confirmed through a Cronbach alpha of 0.944. The validity between NAHS-Brazil and Lequesne and between NAHS-Brazil and WOMAC showed high correlations, r = 0.7340 and r = 0.9073, respectively. NAHS-Brazil showed good validity with no floor or ceiling effects. CONCLUSION The NAHS was translated into the Brazilian Portuguese language and was cross-culturally adapted to Brazilian culture. It was shown to be a useful tool in clinical practice for assessing the quality of life of young and physically active patients with hip pain.

Benefits of the Combined Use of NSAID and Early Exercise on Tendon Healing in a Murine Model

Achilles tendon rupture is one of the most frequent tendon injuries. The aim of this experimental study was to evaluate the effect of a non-steroidal anti-inflammatory drug (NSAID) and of aerobic exercise, in an isolated fashion and combined, on cell proliferation and on the biomechanical aspects of the Achilles tendon during healing process after a complete tenotomy in 156 male Wistar rats. Half of the animals received an intra-muscular injection of tenoxicam for 7 days and exercise was initiated on the 8th day for half the animals of each group. Animals were sacrificed at 1, 2, 4 and 8 weeks after the tenotomy and cell proliferation was evaluated by immunohistochemistry for PCNA, biomechanical evaluation was performed with ultimate load and gait cycle analysis was also carried out. Animals were divided into four treatment groups: A) no NSAID and no exercise (control group); B) NSAID plus exercise; C) no NSAID, with exercise; D) NSAID and no exercise. We used the test of two-way analysis of variance with equal cells number, Kruskal-Wallis test and also, Bonferroni method, in the R Project program 3.5.0. The highest intensity of PCNA immunostaining was found at 2 weeks in all groups except for group A (control) that had the highest intensity at 1 week. Animals submitted to exercise had significantly higher (P = 0.02) ultimate loads when compared to animals that were not submitted to exercise at 8 weeks after injury. The animals that received NSAID presented with a more stable gait cycle than the animals that did not receive NSAID. Aerobic exercise, initiated early after a complete Achilles tendon tenotomy, was beneficial to the biomechanical aspects of the tendon that occur during tendon regeneration and the combined use of NSAID improved the gait’s characteristics which could be protective against re-ruptures.

USE OF SPATIOTEMPORAL GAIT PARAMETERS TO DETERMINE RETURN TO SPORTS AFTER ACL RECONSTRUCTION

Objective : To compare gait spatiotemporal parameters of healthy and ACL reconstructed subjects in order to classify the status of gait normality. Methods : Fourteen healthy subjects and eight patients submitted to ACL reconstruction walked along a walkway while the lower limbs movement was captured by an infrared camera system. The frames where the initial contact and toe-off took place were determined and the following dependent variables, which were compared between groups through the Mann-Whitney test (a=0.05) were calculated: percentage of time in initial double stance, percentage of time in single stance, percentage of time in terminal double stance, stride length and gait velocity. Initially, all variables were compared between groups using a Mann-Whitney test. A logistic regression was applied, including all dependent variables, to create a model that could differentiate healthy and ACL reconstructed subjects. Results : ACL reconstructed group showed no differences in any spatiotemporal parameter of gait (p > 0.05) in relation to the control group, although the angular kinematic differences of the knee remained altered, as evidenced in a study with a similar sample. Conclusion : The regression classified all subjects as healthy, including the ACL reconstructed group, suggesting the spatiotemporal variables should not be used as the sole criterion of return to sports activities at the same level as prior to injury. Level of Evidence III, Case Control Study.

KNEE SYNERGISM DURING GAIT REMAIN ALTERED ONE YEAR AFTER ACL RECONSTRUCTION

ABSTRACT Objective: To compare the activation of the vastus lateralis (VL) and biceps femoris (BF) muscles during gait, as well VL/BF muscular co-contraction (MCC) between healthy (CG) and anterior cruciate ligament reconstructed (ACL-R) subjects. Methods: Nineteen subjects, ten controls and nine ACL-R patients had a VL and BF electromyogram (EMG) captured to calculate the MCC ratio. A Principal Component (PC) Analysis was applied to reduce the dimensionality effect of each of the MCC, VL and BF curves for both healthy and ACL reconstructed groups. The PC scores were used to calculate the standard distance (SD). SD values were employed in order to compare each dependent variable (MCC, VL and BF) between the two groups using unpaired t-test. Results: ACL-R group presented a lower VL activation at the beginning and at the end of the gait cycle, as compared to the control group. However, no difference was found for BF or VL/BF MCC. Conclusion: The gait analysis of ACL reconstructed patients demonstrated a persistent deficit in VL activation when compared to the control group, even one year after surgery. Level of Evidence III. Case Control Study