Luiz Antonio Munhoz da Cunha

Hamstring tendons insertion - an anatomical study

Objective To study the anatomy of the hamstring tendons insertion and anatomical relationships. Methods Ten cadaver knees with medial and anterior intact structures were selected. The dissection was performed from anteromedial access to exposure of the insertion of the flexor tendons (FT), tibial plateau (TP) and tibial tuberosity (TT). A needle of 40 × 12 and a caliper were used to measure the distance of the tibial plateau of the knee flexor tendons insertion at 15 mm from the medial border of the patellar tendon and tibial tuberosity to the insertion of the flexor tendons of the knee. The angle between tibial plateau and the insertion of the flexor tendons of the knee (A-TP-FT) was calculated using Image Pro Plus software. Results The mean distance TP-FT was 41 ± 4.6 mm. The distance between the TT-FT was 6.88 ± 1 mm. The (A-TP-FT) was 20.3 ± 4.9°. Conclusion In the anterior tibial flexor tendons are about 40 mm from the plateau with an average of 20°.

Transtrochanteric fractures: evaluation of data between hospital admission and discharge,

Objective to evaluate the data obtained from patients with transtrochanteric fractures who were attended at a tertiary-level trauma referral hospital, between admission and discharge, gathered prospectively by means of the SINPE© software. Methods 109 consecutive patients who were admitted between April 2011 and January 2012 were evaluated using an electronic storage and analysis database in SINPE©. The data were gathered prospectively, including evaluations on personal information about the patients, history-taking, fracture classification (Evans–Jensen, AO/OTA and Tronzo), treatment and discharge. Results the sample was composed of 43 men and 66 women. Their ages ranged from 20 to 105 years, with a mean of 69 years. Falling was the trauma mechanism for 92 patients and traffic accidents for 17. The most prevalent chronic diseases were systemic arterial hypertension and diabetes mellitus. According to the AO/OTA classification, the commonest fracture type was 31 A1. According to the Tronzo classification, type III was commonest. The fracture was fixed by means of a cephalomedullary nail in 64 cases and a sliding screw–plate in 44 cases. One fracture was fixed with a 95° screw–plate. Seven patients presented some form of clinical complication and three died during the hospital stay. All the patients who were discharged were instructed to only partially bear weight on the repair. Conclusion through SINPE©, it was possible to evaluate the personal information, history-taking, classification, treatment and discharge of patients with transtrochanteric fractures, from hospital admission to discharge.

Estudo anatômico das duas bandas do ligamento cruzado anterior com o joelho em 90º de flexão

OBJECTIVE To anatomically evaluate the femoral origin and tibial insertion of the anteromedial and posterolateral bands of the anterior cruciate ligament. METHODS We studied eight cadaver knees as for the following: in the femur, distance from the center of the anteromedial band to the deep cartilage and the ceiling; also in the femur, distance from the center of the posterolateral band to the deep cartilage, to the inferior cartilage and to the superficial cartilage. In the tibia, we measured the distances between the anterior tibial bone edge to the anterior region of the anteromedial band, to the center of the anteromedial band and to the center of the posterolateral band. We also measured the distance between the center of the posterolateral band to the tibial posterolateral bone and the total length of the anteroposterior tibial insertion of the anterior cruciate ligament. RESULTS In the femur, the distance from the center of the anteromedial band to the deep cartilage was 6.3 ± 1.4 mm, and 11.2 ± 2 mm to the ceiling. Also in the femur, the distance from the center of the posterolateral band to the deep cartilage was 9 ± 4 mm, to the superficial cartilage 7.6 ± 1.8 mm, and to the inferior cartilage 4.2 ± 0.9 mm. In the tibia, the distance from the anterior tibial bone edge to the anterior region of the anteromedial band was 11.9 ± 2.8 mm, to the center of the anteromedial band 18.8 ± 2.6 mm, and to the center of the posterolateral band 26.5 ± 2.3 mm. The distance from the center of the posterolateral band to the tibial posterior bone edge was 19.6 ± 4 mm and the total length of the anteroposterior tibial insertion of the anterior cruciate ligament was 19.4 ± 1.8 mm. CONCLUSION The center of the tibial insertion of the anteromedial band is approximately 20mm distant from the anterior edge of the tibia, while the center of the posterolateral band is approximately 30 mm. The distance between the center of the origin of the anteromedial band to the deep cartilage is 6mm, and to the posterior lateral 10mm.

Osteochondral sequelae of meningococcemia: radiographic aspects.

The authors retrospectively analyzed the files of 11 patients with osteochondral sequelae of meningococcemia, which were referred to this service between 1988 and 1996. The purpose of this study was to radiographically evaluate bone and physeal injuries observed in these patients, deformities caused by them and correlate these findings with the current literature. During radiographic evaluation of patients with sequelae of meningococcemia, two distinct parameters should be observed: bone injury and physeal plate injury patterns. The most frequent bone injury pattern was lytic lesion and the most common physeal plate injury pattern was peripheral asymmetric physis destruction. The most frequent deformities were lower limb length discrepancy, angular deformities and digital amputations. Based upon the findings of the present research, a descriptive radiographic classification was proposed.

Biomechanical analysis on transverse tibial fixation in anterior cruciate ligament reconstructions

Objective To verify whether the combination of tibial cross pin fixation and femoral screw fixation presents biomechanical advantages when compared to femoral cross pin fixation and tibial screw fixation for the reconstruction of the anterior cruciate ligament (ACL). Methods Thirty-eight porcine knees and bovine extensor digitorum tendons were used as the graft materials. The tests were performed in three groups: (1) standard, used fourteen knees, and the grafts were fixated with the combination of femoral cross pin and a tibial screw; (2) inverted, used fourteen knees with an inverted combination of tibial cross pin and a femoral screw; (3) control, ten control tests performed with intact ACL. After the grafts fixation, all the knees were subjected to tensile testing to determine yield strength and ultimate strength. Results There was no statistically significant difference in survival techniques in regard to strength, yield load and tension. There was a higher survival compared in the standard curves of yield stress (p < 0.05). Conclusion There is no biomechanical advantage, observed in animal models testing, in the combination of tibial cross pin fixation and femoral screw when compared to femoral cross pin fixation and tibial screw.

Anatomical study of the posterior cruciate ligament with the knee flexed at 90

Objective To study the anatomy of the posterior cruciate ligament (PCL) and define anatomical parameters with the knee flexed at 90°. Methods Eight knees from cadavers were dissected in order to make measurements from the center of the anterolateral band to the roof (AL1), from the center of the anterolateral band to the anterior cartilage (AL2), from the center of the posteromedial band to the roof (PM1), from the center of the posteromedial band to the anterior cartilage (PM2), from the center of the tibial insertion to the medial region of the tibia (TIM), from the center of the tibial insertion to the lateral region of the tibia (TIL), from the center of the medial insertion to the medial meniscus (IMM) and the width of the origin of the PCL (WO). To obtain the results from each anatomical structure, the means and standard deviations of the measurements were calculated. Results The measurements in millimeters that were found were AL1, 6.2; AL2, 4.9; PM1, 11.7; PM2, 5.5; TIM, 32.5; TIL, 40.6; IMM, 9.4; and WO, 32.5. Conclusions The PCL has an extensive origin. The center of the anterolateral band is 6 mm from the roof and 5 mm from the anterior cartilage of the knee. The tibial insertion is slightly medial and 10 mm distal to the posterior cornu of the medial meniscus.

Effect of hyaluronic acids as chondroprotective in experimental model of osteoarthrosis

Objective to analyze the effects of hyaluronic acid of different molecular weights in an experimental model of osteoarthritis in rabbits. Methods forty‐four male California rabbits were divided randomly into three groups and underwent resection of the anterior cruciate ligament in his right knee. After three weeks of the surgical procedure began three weekly intra‐articular injections of hyaluronic acid native (Polireumin®)‐PR, hyaluronic acid branched chain (Synvisc®)‐S and 0.9% saline‐P. All animals were sacrificed after twelve weeks of surgery and tibial plateau infiltrated the knees were dissected. Histological cartilage of the support areas of the tibial plateaus were stained with Alcian Blue pH 1.0, Alcian Blue pH = 2.5 and toluidine blue for research on the amount of proteoglycans. The intensity of staining was quantified on a Zeiss microscope apparatus Imager Z2 MetaSystems and analyzed by software MetaferMsearch. Results the effect of chondroprotetor hyaluronic acids used in the study was confirmed when compared to the control group, but the comparison made between them, there was no statistically significant difference regarding chondroprotetion. Conclusion the hyaluronic acids tested had chondroprotective effect, with no statistical difference with regard to the different molecular weights.

É possível prever o comprimento de tendões flexores do joelho por antropometria

OBJECTIVE To compare the anthropometric data and the sportive way of life with the hamstring tendons dimensions, prospectively, in order to create a rule to predetermine its dimensions. METHODS General and anthropometric data were collected from 30 patients that were submitted to anterior cruciate ligament reconstruction. These data were correlated to the diameter and length of the hamstring tendons. The data collected were: height, weight, age, knee lesion side, body mass, sportive training level, femoral length, tibia length, thigh circumference, and knee circumference. The correlation was made by Pearson coefficient. RESULTS Statistic significant correlation occurred only with height and tibia length versus the gracilis and semitendinous tendon length. Using linear regression the relations found could be expressed with the following formulas: semitendinous length = -2.276 + 0.177 x height; semitendinous length = 13.048 + 0.46 x tibia height; gracilis length = -9.413 + 0.207 x height; gracilis length = 7.036 + 0.583 x tibia height. CONCLUSION It is possible to predetermine hamstring tendons length through linear regression formulas before surgical intervention.

Intra-articular viscosupplementation of hyaluronic acids in an experimental osteoarthritis model

Objective To analyze, from the immunohistochemical perspective, the effects of hyaluronic acid of different molecular weights in an experimental model of osteoarthritis in rabbits. Methods Forty-four male California rabbits were randomly assigned to three different groups (PR, S, and P) and submitted to the resection of the anterior cruciate ligament of the right knee. Three weeks after the surgical procedure, three intra-articular weekly injections were carried out with low-molecular-weight native hyaluronic acid (Hyalgan®) to PR group, high molecular weight branched chain hyaluronic acid (Synvisc®) to group S, and saline solution 0.9% to group P. All animals were sacrificed 12 weeks after the surgical procedure, and the tibial plateaus of the infiltrated knees were then dissected. Histological sections of cartilage from the tibial plateau support areas were stained with immunohistochemical markers in order to investigate the amount of metalloproteases (MMPs 3 and 13) and their inhibitors (TIMPs 1 and 3). The staining intensity was quantified on a Zeiss Imager.Z2 Metasystems microscope and analyzed by Metafer4 Msearch software. Results The chondroprotective effect of the hyaluronic acids used in the study was demonstrated when compared to the control group. However, the comparison between them presented no significant statistical difference regarding chondroprotection. Conclusion The injection of saline solution demonstrated signs of OA development, while adding native hyaluronic acid of low molecular weight (Hyalgan®) and hyaluronic acid of high molecular weight (Synvisc®) protected the articular cartilage in this model of OA.

Biomechanical analysis of a double fixation method for tendon graft in porcine tibia – using an interference screw plus staple

Objective The aim of the study was to compare the mechanical behavior of interference screw tibial fixation vs. screw-plus-staple tibial fixation in an animal model. Methods Thirty-six pieces of swine knee specimens were selected and divided into two groups: Group 1, tibial fixation with interference screw (n = 17), and Group 2, fixation with interference screw and staple (n = 19). The models were submitted to a single cycle of tension testing. The following variables were measured: graft cross-sectional area, failure point on 10 mm (F10), yield load (Fy), and stiffness. Results The mean values of graft cross-sectional area, F10, Fy, and stiffness did not present significant differences between the groups. Conclusion The addition of a second staple-type ligament fixation device, complementing the interference screw, did not increase the mechanical safety of the system.