Rogério Teixeira de Carvalho

Anatomic Relation Between the Posterior Cruciate Ligament and the Joint Capsule

PURPOSE The aim of this anatomic study on cadavers was to determine the anatomic relation between the posterior cruciate ligament (PCL) and the posterior joint capsule attachment. METHODS Thirty knees were dissected by means of a posterior approach to the knee. The presence of the posterior popliteal ligament and Wrisberg meniscofemoral ligament was observed and a U-shaped capsulotomy was performed while preserving the distal insertion of the ligament. After detaching the PCL and determining its area on the tibia, we determined its geometric center and posterior margin and measured the distances between the tibial insertion of the capsule and these points. RESULTS The distance between the center of the PCL and the posterior capsule was 10.3 mm, and the distance between the posterior margin of the PCL and the capsule was 1.7 mm. The posterior popliteal ligament was easy to see in all the specimens, measuring around 42 mm in length. The Wrisberg meniscofemoral ligament was seen in 12 specimens. CONCLUSIONS We can conclude that the distances from the center of the tibial insertion and the margin of the PCL to the joint capsule were 10.3 mm and 1.7 mm, respectively, thus enabling greater knowledge of the anatomy of the posterior compartment of the knee. CLINICAL RELEVANCE Our findings provide anatomic data that increase the safety and knowledge regarding the surgical procedures related to the PCL, because we have supplied information that can contribute to obtaining the best arthroscopic view of this area, thus decreasing the risk of vascular and nerve damage.

Prevalence of Pain on Palpation of the Inferior Pole of the Patella Among Patients with Complaints of knee Pain

CONTEXT AND OBJECTIVE Patellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy. METHODS Palpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded. RESULTS Of the total number of individuals evaluated, 124 (39%) felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3%) received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity. CONCLUSIONS Palpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands.

Anterolateral ligament anatomy: a comparative anatomical study

AbstractPurpose Some anatomical studies have indicated that the anterolateral ligament (ALL) of the knee is distinct ligamentous structure in humans. The purpose of this study is to compare the lateral anatomy of the knee among human and various animal specimens.MethodsFifty-eight fresh-frozen knee specimens, from 24 different animal species, were used for this anatomical study. The same researchers dissected all the specimens in this study, and dissections were performed in a careful and standardized manner.ResultsAn ALL was not found in any of the 58 knees dissected. Another interesting finding in this study is that some primate species (the prosimians: the red and black and white lemurs) have two LCLs.ConclusionThe clinical relevance of this study is the lack of isolation of the ALL as a unique structure in animal species. Therefore, precaution is recommended before assessing the need for surgery to reconstruct the ALL as a singular ligament.

Common injuries in athletes' knee: experience of a specialized center

OBJECTIVE: The present cross-sectional study aims to identify the most common knee injuries in athletes cared at a Specialized Outpatient Clinics. METHOD: Analysis of patients cared at the Knee Outpatient Clinics of a Sports Trauma Center, divided by gender, age and diagnosed injury. RESULTS: Initially 440 patients were divided into 33 types of sports; after excluding the less statistically significant practices, nine sports remained. The most frequently performed sports were football with almost 50% of total patients presenting anterior cruciate ligament (ACL) injury, and road runs with great frequency of meniscal injury. There was no correlation of the disorder with the type of sports performed but a correlation was found with patients age/gender. CONCLUSION: The complete ACL rupture was the most common injury found in football, basketball and volleyball players, followed by meniscal injury in street runners. Level of Evidence IV, Study Transversal.

Updates in biological therapies for knee injuries: full thickness cartilage defect

Full thickness cartilage defect might occur at different ages, but a focal defect is a major concern in the knee of young athletes. It causes impairment and does not heal by itself. Several techniques were described to treat symptomatic full thickness cartilage defect. Recently, several advances were described on the known techniques of microfracture, osteochondral allograft, cell therapy, and others. This article brings an update of current literature on these well-described techniques for full thickness cartilage defect.

An Anatomic Study of the Posterior Septum of the Knee

PURPOSE To evaluate the posterior septum of the knee and determine the presence of a safe zone that could be removed, without significant damage to blood vessels and nerves. METHODS Nineteen fresh unpaired adult human cadaveric knees, with no macroscopic degenerative or traumatic changes, were used in this study. Microscopic evaluation was performed by analysis of H&E, CD-34, and S-100 staining. RESULTS The posterior septum of the knee is rich in type II and type IV mechanoreceptors and blood vessels. The superior half has a greater number of blood vessels (21.52 ± 6.36 v 12.05 ± 4.1, P < .001), higher-caliber vessels (2.2 ± 0.89 μm v 1.41 ± 0.45 μm, P < .006), and a greater number of mechanoreceptors per field (type II, 1.8 ± 1.8 v 0.42 ± 1, P = .04; type IV, 22.6 ± 14 v 14.5 ± 9.4, P = .04) than the inferior half of the septum. CONCLUSIONS This study has shown that the posterior septum of the knee is highly vascularized and has a great number of type II and IV mechanoreceptors. The presence of these structures is significantly higher in the superior half of the septum. CLINICAL RELEVANCE If debridement of the posterior septum is necessary, it should be done at the inferior aspect so that a greater number of blood vessels and mechanoreceptors can be preserved.

Síndrome compartimental em perna após reconstrução de ligamento cruzado anterior: relato de caso

The authors report a case of a patient that was submitted to a surgery of reconstruction of anterior cruciate ligament and collateral medial ligament repair of the left knee that complicated to a compartment syndrome.

Surgical treatment for muscle injuries

Muscle injury causes functional impairment. The healing process takes time and fibrotic tissue can result. Recurrence and delayed recovery remain as unsolved problems. Surgical intervention can be a feasible alternative to avoid early and late complications associated with complete muscle tear in attempt to improve functional results. This article hopes to provide an update about surgical treatments for muscle tears in different scenarios.

Return to sport after surgical treatment for pubalgia among professional soccer players.

Objective to evaluate the return to sport after surgical treatment for pubalgia among 30 professional soccer players and describe the surgical technique used. Method this case series was evaluated by means of a questionnaire and physical examination on 30 male professional soccer players of mean age 24.4 years (range: 18–30). The mean duration of the symptoms was 18.6 months (range: 13–28). The diagnosis was made through clinical investigation, special maneuvers and complementary examinations, by the same examiner. All the patients underwent surgical treatment after conservative treatment failed; all procedures were performed by the same surgeon using the same technique. Nonparametric comparisons were made to investigate the time taken to recover after the surgery, for the patients to return to their sport. Results five patients evolved with hematoma, with the need to remove the stitches three weeks after the operation because of a small dehiscence at the site of the operative wound. The wound healed completely in all these cases by five weeks after the surgery. Four patients presented dysuria in the first week, but improved in the second postoperative week. The mean time taken to return to training was around eight weeks (range: seven–nine). All the players returned to competitive soccer practice within 16 weeks. When asked about their degree of satisfaction after the operation (satisfied or dissatisfied), taking into consideration their return to the sport, there was 100% satisfaction, and they returned to professional practice at the same competitive level as before the injury. This degree of satisfaction continued to the last assessment, which was made after 36 months of postoperative follow-up. Conclusion the surgical technique presented in this case series, with trapezoidal resection of the pubic symphysis in association with bilateral partial tenotomy of the long adductor, was a fast and effective procedure with a low rate of postoperative complications. It was shown to be an excellent treatment option for refractory cases, with a return to sports activity among professional soccer players.

Condromatose sinovial de joelho: relato de caso

The authors report the case of a patient with synovial osteochondromatosis of the knee, who had previously been a soccer player.