Mario Massatomo Namba

Análise biomecânica da solidarização de tendões para reconstrução do ligamento cruzado anterior

OBJECTIVE:To evaluate the difference of the mechanical behavior of bended tied (sewed) and not tied hamstring tendons in order to evaluate if it has any effective function. METHODS: Twenty-four fresh bovine digital tendons had been used. Alginate to determine the area of the tendon transversal section was used. Ten bovine tendons had been bended and tied following the manufacturer orientation, ten others pairs had not been tied. Claws had been developed for the grafts fixation to the universal machine, for the setting simulation. The superior one was characterized to be bipartite and to have controlled passage for the pins and the inferior claw is characterized to have alternating teeth. RESULTS: The maximum load of the not tied samples of the test was 849,4 N ± 386,8 the area was 30,4 mm2 ± 7,7, and 29 ± 17 Mpa of tension. The tied ones had gotten maximum load of 871,8 N ± 484,9, area of 35 mm2 ± 5,8, and 24 ± 10 Mpa of tension. It did not have statistical difference between the two groups (p>0,05). CONCLUSION: The probability distribution showed that with 400 N the not tied tendons represents 83,8% of trustworthiness and the tied ones represents 78,5%.

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°.

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.

Pseudoaneurysm after arthroscopic procedure in the knee

The aim of this study was to review all cases of pseudoaneurysm in the literature, in predominantly arthroscopic procedures on the knee, and to report on a case of pseudoaneurysm that we treated. A bibliographic search was conducted for scientific articles published in Brazilian and foreign periodicals over the last 23 years. Forty-seven cases were found, in 40 articles. In addition to these 47 cases, there was the case that we treated, which was also included in the data. Among the operations that progressed with formation of a pseudoaneurysm, 60% were cases of meniscal injuries and 23%, anterior cruciate ligament injuries. In 46% of the cases, the artery affected with the popliteal, and in 21%, the inferomedial genicular artery. The commonest clinical symptom was pain (37%), followed by pulsating tumor (31%), edema of the calf (12%) and hemarthrosis (11%). The median time taken to make the diagnosis was 11 days, but it ranged from one day to 10 weeks after the procedure. Although rare, pseudoaneurysms are a risk that is inherent to arthroscopic surgery. All patients should be made aware of the vascular risks, even in small-scale procedures.

Oblique popliteal ligament - an anatomical study

Objective To study the anatomy of the oblique popliteal ligament, as regards its dimensions, expansion and anatomical relationships. Methods Eleven cadaver knees were dissected in order to study the anatomy and take measurements of anatomical structures and relationships of the oblique popliteal ligament. The dissection was for posterior access to the proper exposure of the oblique popliteal ligament, the semimembranosus muscle and its expansions. For measurement of dimensions, 40 × 12 needles were used for marking the specific points and a caliper. The angles were calculated using the software ImagePro Plus®. Results The distance from the origin of the oblique popliteal ligament to the tibial plateau was 7.4 mm, the thickness at its origin was 7.3 mm, length was 33.6 mm and the tibial plateau angle 34.8°. The length of the expansion of the proximal oblique popliteal ligament was 39.2 mm, thickness 7.8 mm and angle of the oblique popliteal ligament with its expansion 32.2°. Conclusion The oblique popliteal ligament is thick, rises in the semimembranosus and protrudes proximally forming an acute angle with the joint interline, crossing the popliteal fossa. In some cases it has a proximal expansion.

MACROSCOPIC ANALYSES OF THE EFFECTS OF HYALURONATES AND CORTICOSTEROIDS ON INDUCED OSTEOARTHRITIS IN RABBITS’ KNEES

Objective: To evaluate the effects of intra-articular injections of corticosteroids, native hyaluronic acid and branched-chain hyaluronic acid in experimentally-induced osteoarthrosis. Methods: 44 rabbits underwent anterior cruciate ligament resection and were then divided into four groups of eleven. Group 1: one intra-articular injection of saline solution per week, for three weeks; Group 2: three injections (one per week) of native hyaluronic acid; Group 3: three injections (one per week) of branched-chain hyaluronic acid; Group 4: two injections of betamethasone with an interval of three weeks. The cartilage of the tibial plateaus was evaluated macroscopically twelve weeks after surgery. Changes to the joint surface were graded as follows: Grade 0: smooth joint surface without relief changes; Grade 1: rough surface without any depressions; Grade 2: similar to grade 1, but with depressions on the joint surface; and Grade 3: subchondral bone exposure. The statistical analysis consisted of the use of Students t test, chi-square test and analysis of variance (ANOVA). The significance level used was 5%. Results: A statistical difference was found between the control group and the three study groups 2, 3, 4 in relation to the development and severity of arthrosis. However, there was no difference between the groups regarding the drugs studied. Conclusion: A similar degree of attenuation of the osteoarthrosis process in the rabbits’ knees was found with the use of intra-articular injections of low-molecular-weight and high-molecular-weight glycosaminoglycans, and the corticosteroid betamethasone, compared with placebo.

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.

ANÁLISE DA ALTURA DO SORO NO FLUXO DE SAÍDA DE EQUIPO USADO PARA ARTROSCOPIA

Introduction: This study aims to analyze the influence of the height of the saline bags in output stream or flow of fluid through a 4-spike gravity tubing set delivery unit coupled to a arthroscopic sheath and 4 mm arthroscope. Methods: Was analyzed the flow time of 0.9% saline by 4-spike gravity tubing set, engaged in a arthroscopic sheath and arthroscope, to achieve the volume of 2000 and 4000 mL. Were performed 20 experimental tests, divided in two groups: Group 1 - support raised to a height of 80 cm, Group 2 - support raised to a height of 150 cm. Results: The mean flow on tests with saline bags raised to 80 cm was 7,78 cm3/s in the time period elapsed until the flow of 2000 mL and 6.82 cm3/s to 4000 mL. With the elevation of saline bags to 150 cm, the average flux was 12.11 cm3/s during the filling of 2000 mL and 10.59 cm3/s to 4000 mL. Conclusion: The increases height of the saline bags of 80 cm to 150 cm increased to 60% in the flow of saline solution.