Ricardo Bastos

MRI-Based Laxity Measurement for Return to Play

The objective measurement of knee sagittal and rotation laxity upon the anterior cruciate ligament (ACL) lesion has an essential role in the knee stability assessment. These measurements can further be evaluated through magnetic resonance imaging (MRI), which in combination with instrumented assessment and physical examination can correlate both the “anatomy” and “function” of the ligament. The Porto-Knee Testing Device (PKTD) is a knee laxity testing device compatible with MRI that is capable of measuring the posterior-anterior tibial translation and tibial internal and external rotation. In this sense, the PKTD is a useful tool for the assessment of knee sagittal and rotatory laxity in the follow-up of football players that underwent ACL reconstruction. Hence, this tool may allow to identify individuals presenting residual knee laxity with increased risk of sustaining secondary ACL injuries and assist in the planning of secondary prevention programs.

Clinical Management in Early OA

Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.

Management of Cartilage Injuries in Handball

Articular cartilage lesions of the knee are complex injuries, posing a serious threat to the handball player competitive career. Returning to competition at the pre-injury sports activity level as early and as safe as possible is the ultimate goal to be achieved. There is no consensus on the best surgical technique, and clinical algorithms have been proposed to manage the different articular cartilage defects. The chapter will also overview and summarize the available conservative and surgical management options and stepwise criteria-based rehabilitation strategy and return to play considerations in handball players with focal cartilage defects and osteochondral lesions.

Return to Play Following Cartilage Injuries

Articular cartilage lesions are serious injuries, particularly in the football player, once these may endanger the athlete’s competitive career. Returning to competition at the preinjury sports activity level as fast and as safe as possible is the ultimate goal to be achieved. Although there is no consensus on the best surgical technique, clinical algorithms have been proposed to manage the different articular cartilage defects. Herein, we summarize the available clinical treatment possibilities for addressing focal cartilage defects and osteochondral lesions. We also overview the three rehabilitation phases and the progression of the patient within these plans shall follow objective criteria. The considerations to return to play are also briefly discussed herein.

Traumatic Lesions of the Elbow and Wrist

Football is a sport characterized by physical contact, which explains the high rate of musculoskeletal injuries in players described in the literature. The most common injuries are lower limb injuries. Herein, we discuss the main injuries involving the elbow and wrist encountered in football players.

TIBIOFEMORAL LATERAL COMPARTMENT'S MORPHOLOGY AS A RISK FACTOR: A RADIOGRAPHIC COMPARISON BETWEEN ACL-RUPTURED AND NON-INJURED SUBJECTS

Background Tibiofemoral bone morphology has been proposed as a potential risk factor for anterior cruciate ligament (ACL) rupture, with recent increasing interest in the lateral femoral condyle. Objective Investigate several tibiofemoral bone morphology measurements as risk factors for rupturing the ACL. Design Retrospective case–control study. Setting Clinical setting. Patients (or Participants) 200 ACL-ruptured patients and 200 normal subjects without history of previous knee injuries, with a mean age of 24 years old. Main Outcome Measurements Presence or not of ACL rupture. Assessment of Risk Factors Radiographic measurements of the distal epiphysis/diaphysis of the femur and proximal epiphysis of the tibia were performed, including: anteroposterior-flattened surface of the femurs lateral condyle; femurs diaphysis anteroposterior distance; anteroposterior distance of the femurs lateral condyle; height of the femurs lateral condyle; anteroposterior distance of the tibial plateaus; tibial slope. In addition, three morphological ratios were calculated. Results Most of the bone morphological parameters were different between genders (P<0.001). Similarly, there were significant differences between ACL-ruptured and control subjects (P<0.001), either for total sample or subgrouped by gender. Logistic regression model showed that 5 bone morphological parameters were significantly associated with ACL rupture (AUC=0.967, P<0.001). The calculated ratios showed significant accuracy in identifying individuals with higher risk of sustaining an ACL injury (P<0.001). Conclusions Several tibiofemoral bone morphology radiographic measurements are associated with an ACL rupture. Morphological ratios based on these measurements seem to identify individuals at higher risk of sustaining an ACL rupture. These findings might contribute to health counselling on level of sports participation. Moreover, it may help to identify individuals who may benefit the most from secondary prevention programs, where the risk of new injury is very high.