Navegando por Palavras-chave "Anterior Cruciate Ligament"
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- ItemSomente MetadadadosComparação da força muscular de quadríceps e isquiotibiais após exercícios com e sem oclusão vascular periférica no pós-operatório de ligamento cruzado anterior: um ensaio controlado randomizado(Universidade Federal de São Paulo (UNIFESP), 2021) Melo, Rafael Francisco Vieira de [UNIFESP]; Cohen, Moises [UNIFESP]; Universidade Federal de São PauloIntroduction: The anterior cruciate ligament (ACL) reconstruction surgery takes the patient for a period where muscle mass loss occurs. The blood flow restriction combined with strengthening exercises can be an alternative to improve the muscle strength of the quadriceps and hamstrings in the postoperative period of ACL reconstruction. Objective: Compare the gain in muscle strength between exercises with and without occlusion in the quadriceps and hamstring muscles in the postoperative period of reconstruction of the anterior cruciate ligament. Methods: This is a randomized, prospective, longitudinal clinical trial, parallel, analytical, experimental type, with random allocation, in which 50% of the participants were allocated to the intervention group and the remaining 50% to the control group. The study included the participation of postoperative patients, with reconstruction of the anterior cruciate ligament. The isometric muscle strength of knee extension and flexion was evaluated using the digital hand dynamometer MICROFET2® (Hoggan Health Industries, West Jordan, UTAH, USA) and the physical function of the knee, using the Lysholm, KOOS and IKDC questionnaires in the pre -operative and after 4, 8 and 12 weeks. Results: There was no difference between groups for any anthropometric variable. After comparing the rehabilitation of the groups, a statistical difference was observed in quadriceps muscle strength (p <0.01) after 12 weeks and hamstrings (p <0.01) after 8 and 12 weeks in the injured legs. In the analysis of the participants' physical function, there was a significant difference in the Lysholm questionnaire (p <0.01) after 8 and 12 weeks, in the KOOS pain questionnaire (p <0.01) after 4 weeks, symptoms and daily activities (p <0 , 01) after 8 and 12 weeks and quality of life (p <0.01) after 12 weeks and in the IKDC questionnaire (p <0.01) after 8 and 12 weeks. Conclusion: The blood flow restriction proved to be efficient for improving muscle strength of the quadriceps, hamstrings and physical function of the knee after reconstruction of the anterior cruciate ligament in early rehabilitation.
- ItemSomente MetadadadosDesenvolvimento do ligamento cruzado anterior e fossa intercondilar na população pediátrica: estudo por ressonância magnética(Universidade Federal de São Paulo (UNIFESP), 2020-10-15) Lima, Fernando Mesquita [UNIFESP]; Fernandes, Artur Da Rocha Correa [UNIFESP]; Universidade Federal de São PauloPurpose: To evaluate the characteristics of development of the anterior cruciate ligament (ACL) and intercondylar notch in the pediatric population with magnetic resonance imaging, emphasizing the differences between males and females. Methods: In this retrospective study, musculoskeletal radiologists evaluated length, area, coronal and sagittal inclination of the ACL, inclination of the intercondylar notch, intercondylar notch width, bicondylar distance and notch width index (NWI). A total of 253 MR examinations (130 males and 123 females between 6 and 18 years of age) were included. The association between measurements, sex and age was considered. Linear and fractional polynomial regression models were used to evaluate the relationships between measurements. Results: ACL Length showed significant progressive growth (p<0.001) with age in both sexes, without characterization of growth peaks. ACL Area in female showed more pronounced growth up to 11 years, stabilized from 11 to 14 years and then sustained a slight reduction. In male, ACL Area showed more pronounced growth up to 12 years, stabilized from 12 to 14 years and then sustained slight reduction. Coronal and sagittal inclination of the ACL showed a significant progressive increase (p<0.001) with age in both sexes, progressively verticalizing. The intercondylar roof inclination angle showed significant progressive reduction (p<0.001) with age in both sexes. Intercondylar notch width increased up to 10 years of age in females and 11 years of age in males, with relative stabilization up to 13 years in girls and 14 years in boys and a slight reduction in values at subsequent ages. Bicondylar distance showed significant progressive growth with age in both sexes. NWI showed a discrete and homogenous reduction with age in both sexes. Conclusion: The ACL area and the intercondylar notch width show a similar development pattern, interrupting its growth around 10—11 years of age in female and 11—12 years of age in males, with relative stabilization up to 13—14 years and a slight reduction in dimensions in subsequent ages. The ACL area does not accompany skeletal maturation or its longitudinal growth, interrupting its growth around 11—12 years. We also observed progressive verticalization of the ACL as well as of the intercondylar notch roof in the evaluated ages.
- ItemAcesso aberto (Open Access)Disestesia peri-incisional após reconstrução do ligamento cruzado anterior com terço central do tendão patelar(Sociedade Brasileira de Ortopedia e Traumatologia, 2011-01-01) Carvalho Júnior, Lúcio Honório De [UNIFESP]; Soares, Luiz Fernando Machado; Gonçalves, Matheus Braga Jacques; Pires Júnior, Paulo Randal; Baumfeld, Daniel Soares; Pereira, Marcelo Lobo; Lessa, Rodrigo Rosa; Costa, Lincoln Paiva; Bisinoto, Henrique Barra; Universidade Federal de São Paulo (UNIFESP); UFMG Faculdade de Medicina Departamento do Aparelho Locomotor; Hospital Madre Teresa Grupo do Joelho; Hospital Madre Teresa Serviço de Ortopedia; UFMGOBJECTIVE: To evaluate the prevalence and type of dysesthesia around the incision used to obtain the patellar tendon for anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Out of a population of 1368 ACL reconstructions using the central third of the patellar tendon, 102 patients (111 knees) were evaluated by means of telephone interview. RESULTS: The mean follow-up was 52 months (ranging from 12 to 88 months). The patients' ages ranged from 16 to 58 years (mean: 34.7 years). There was some degree of peri-incisional dysesthesia in 66 knees (59.46%). In 40.54% of the knees, this condition was not found. In all the cases of dysesthesia, the type encountered was Highet's type II. CONCLUSION: Peri-incisional dysesthesia following ACL reconstruction using the central third of the patellar tendon is highly prevalent. It affected more than half of the cases in this series.
- ItemAcesso aberto (Open Access)Estudo prospectivo randomizado entre as fixações transversas e extracorticais nas reconstruções do ligamento cruzado anterior(Sociedade Brasileira de Ortopedia e Traumatologia, 2012-01-01) Guarilha, Eduardo Da Silva; Caldeira, Paulo Roberto De Andrade Fígaro; Lira Neto, Ozorio De Almeida [UNIFESP]; Navarro, Marcelo Schmidt; Milani, Antonio; Carneiro Filho, Mario [UNIFESP]; Hospital IFOR; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina do ABC Grupo de Traumatologia EsportivaOBJECTIVE: This study had the objective of prospectively comparing transverse fixation (Cross-PinTM) with extracortical fixation (EZLocTM) for the femur, in surgical reconstruction of the anterior cruciate ligament, from a clinical, biomechanical and functional point of view. METHODS: Between April 2007 and November 2009, 50 patients with acute or chronic anterior cruciate ligament injuries underwent arthroscopic reconstruction using the homologous flexor tendons (gracilis and semitendinosus). Randomization of the femoral fixation method was done by means of a draw at the time of the procedure. Patients were excluded if they presented multiple ligament lesions, fractures, previous surgery, autoimmune disease and impairment of the contralateral knee. The Lysholm scale, SF36 quality-of-life questionnaire and KT1000TM arthrometer were used. RESULTS: After a mean follow-up of 18.1 months, there were no statistically significant differences between the groups regarding the Lysholm scale and KT1000TM measurements. However, the SF36 questionnaire showed a statistical difference such that transverse fixation was superior regarding pain and vitality. CONCLUSION: Both techniques were shown to be efficient for transfemoral fixation, but with almost no statistically significant difference between them. We believe that new studies will be necessary for better understanding of these differences.
- ItemAcesso aberto (Open Access)Exercício resistido unilateral versus bilateral na fisioterapia pós-operatória do LCA contralateral: ensaio clínico randomizado(Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Oliveira, Marcio de Paula e [UNIFESP]; Silva, Maria Stella Peccin da [UNIFESP]; Imoto, Aline Mizusaki [UNIFESP]; http://lattes.cnpq.br/2167061645955832; http://lattes.cnpq.br/0428199048138850; http://lattes.cnpq.br/0375748086527462; Universidade Federal de São Paulo (UNIFESP)Objective: This study aimed to verify if the use of unilateral isotonic resistance exercise is more effective than the bilateral form to obtain the highest level of muscular performance symmetry between the donor limb (DL) and ACL reconstructed limb (ACL-L) in the postoperative phase of the contralateral ACL rehabilitation. Methods: A randomized blinded trial was conducted with 88 patients divided into Control Group (N = 44) and Intervention Group (N = 44). It was included male and female practitioners of recreational sports whom were at the end of the third month of post-operative treatment. The intervention was done by submitting the groups to an eight week program of resistance training. The Control Group (CG) was maintained according to the conventional methodology, performing bilateral exercises. For the Intervention Group (IG), an alternative approach was adopted, with unilateral exercises for the DL - representing the segment with the greatest disability. Previously and at the end of the intervention period all participants were evaluated for the presence for the presence of inflammatory signs, range of motion (ROM), objective joint stability (KT-1000TM), muscle performance (peak torque and H/Q ratio at 60°/s on the isokinetic dynamometer), objective (Single Leg Hop Test - SLHT and Y Balance Test - Y Test) and subjective (Lysholm Questionnaire - LQ and Activities of Daily Living Scale - ADLS) functionality. Results: The results showed that both research groups evolved significantly with the intervention, except for Visual and Analog Pain Scale, ROM of hyperextension and flexion, joint line perimeter at the ACL-L, KT-1000TM, and H/Q ratio in ACL-L. Among the categorical variables, the CG maintained the largest number of patients with hypotrophy in the DL (87.8%), and in the IG there was a significant reduction in the number of cases, from 61.4% in the pre-intervention period to 13.6% in the post-intervention period (p <0.001). Regarding symmetry between the limbs, the only criteria that did not present significant differences between the groups was the perimeter at the joint line level. Regarding the differences found, it was possible to observe that there was an increase in IG symmetry in relation to the CG for all variables and, except for the H/Q ratio, the effect size was large (> 0.80). The final analysis of the sample showed that the IG was in release conditions for all variables, while in the CG were found changes in the perimeter parameters at 10, 20 and 30cm above the joint line, H/Q ratio and peak torque, demonstrating the presence of significant asymmetry between the DL donor and ACL-L. Conclusion: The use of unilateral isotonic resistance exercise is more effective than the bilateral form to obtain the highest level of symmetry of muscle performance between the donor and ACL reconstructed limb in the postoperative phase of the contralateral ACL rehabilitation.
- ItemAcesso aberto (Open Access)Lesão do ligamento cruzado anterior: tratamento e reabilitação. Perspectivas e tendências atuais(Sociedade Brasileira de Ortopedia e Traumatologia, 2012-04-01) Arliani, Gustavo Gonçalves [UNIFESP]; Astur, Diego Da Costa [UNIFESP]; Kanas, Michel [UNIFESP]; Kaleka, Camila Cohen; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade de Ciências Médicas Grupo do JoelhoOBJECTIVE: The aim of this study was to evaluate the procedures used by knee surgeons in Brazil for treating and rehabilitating anterior cruciate ligament injuries. METHODS: A questionnaire consisting of 21 closed questions was developed, addressing topics relating to treatment and rehabilitation after anterior cruciate ligament reconstruction. The questionnaire was applied to Brazilian knee surgeons during the three days of the 42nd Brazilian Congress of Orthopedics and Traumatology in 2010. RESULTS: A total of 226 surgeons filled out the questionnaire completely. The most commonly used types of graft were hamstrings tendons and the central third of the ipsilateral patellar tendon, which were used by 82.3% and 53.5% of the sample, respectively. The technique of reconstruction with a single transtibial band was the first preference and was used by 66.4% of the participants. A period of 1 to 4 weeks between injury and surgical procedure was considered ideal by most participants (52.65%). Complaints from patients that the knee was 'giving way' or unstable and presence of a positive pivot shift maneuver were the most decisive factors considered in making the decision to operate the patient. Patient satisfaction and absence of complaints of instability during the postoperative period were the criteria deemed to be most important for the surgery to be considered a success. CONCLUSIONS: There are clearly evolving trends in treating and rehabilitating the anterior cruciate ligament in Brazil. However, more prospective controlled studies are needed in order to evaluate the clinical and scientific benefits of these trends.
- ItemSomente MetadadadosMedidas cefalométricas e polissonográficas em pacientes com deficiência transversal e sagital da maxila tratados cirurgicamente(Universidade Federal de São Paulo (UNIFESP), 2019-11-30) Carvalho, Rogerio Teixeira De [UNIFESP]; Abdalla, Rene Jorge [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: The bicruciate knee lesion is considered disabling and can take to a loss of anteroposterior and rotational knee stability. The comprehension of different stages of ligamentous damage is crucial for the proper diagnosis. Purpose: To quantify the effects of sequential sectioning of ACL and PCL bundles on knee stability in translation and rotational, in human cadaveric models, in different angles of flexion Methods: Using a custom testing system mounted with a universal machine for mechanical tests, with 20 N of axial compression and loads applied (40-N anterior and posterior tibial load + 2.8 Nm tibial torque for internal and external rotation + 8.5-Nm tibial torque for varus and valgus rotation) were independently and continuously applied during flexion of twelve fresh-frozen cadaveric knees. Kinematics data was recorded using a Microscribe 3DLX digital system for four experimental knee states: intact, ACL cut, incomplete bicruciate tear (ACL cut + AL bundle cut or PM bundle cut of the PCL) and complete bicruciate tear (ACL and PCL cut) in the angular position at 0°, 30º, 60º and 90º of knee flexion. A repeated measures analysis of variance (ANOVA) with a post-hoc Tukey correction was used to analyze the variations in kinematics and forces at 0º, 30º, 60º, and 90º of knee flexion. Significance was set at p <0.05. Results: In comparison to the intact knees, incomplete BI and complete BI showed a significant increase of total anteroposterior tibial translation (p <0,001). The largest significant increase was observed at 90° of flexion after a complete bicruciate resection (p < 0,001). A threshold difference greater than 15 mm from the intact could be used to identify a complete BI from na incomplete BI evaluating the total antero-posterior translation at 90°. All sectioned states had significant increases compared with intact condition in internal - XV external rotation and varus-valgus stability at all tested flexion angles, mainly at 90°, but changes were small in comparison with total anteroposterior tibial translation. Conclusion: There was a significant progressive increase in total AP tibial translation after incomplete and complete BI at all angles tested, with 0° was the most stable position and 90° the most unstable. The internal and external rotation, varus and valgus rotation only small increments in knee laxity were verified after the sequential sectioning cuts of the ACL and PCL. The largest increase in kinematics was verified in total AP tibial translation after complete BI at 90° of flexion above 15mm that can be indicative of complete bicruciate lesion in comparison with intact knee condition.
- ItemAcesso aberto (Open Access)Reconstrução anatômica do LCA com duplo feixe: primeiros 40 casos(Sociedade Brasileira de Ortopedia e Traumatologia, 2011-01-01) Zekcer, Ari; Silva, Ricardo Soares Da; Carneiro Filho, Mario [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To discuss the technique of anatomical reconstruction of the anterior cruciate ligament (ACL) with double beam, the learning curve and preliminary results. METHODS: Forty patients with ACL injury underwent reconstruction with anatomical double-bundle, using the semitendinosus tendon to remake the band anterior medial (AM) and gracile to remake the band posterior lateral (PL) of the knee. RESULTS: We had two cases of limitation of extension, and in one of them were necessary to perform arthroscopic artrolise, and one case of deep vein thrombosis. CONCLUSION: ACL reconstruction with double bundle proved feasible, despite having a higher learning curve, and the advantages of the proposed technique still must be proven compared to the single-beam technique.
- ItemSomente MetadadadosRelação entre o risco rotura do ligmento cruzado anterior e inclinação tibial posterior em atletas profissionais de futebol(Universidade Federal de São Paulo (UNIFESP), 2019-11-01) Ikawa, Marcos Hiroyuki [UNIFESP]; Arliani, Gustavo Goncalves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Several anatomical parameters and external factors have been related to increased risk of anterior cruciate ligament injury. However, published studies have conflicting results. Objectives: The aim of this study was to evaluate if the is a relationship between the risk of anterior cruciate ligament rupture and the posterior tibial slope. The secundary objective was to evaluate if the is a relationship between posterior meniscal slope, delta-posterior tibial slope, delta-posterior mesnical slope, intercondylar notch width and intercondylar notch width index. Method: A retrospective case-control study was conducted on samples of professional male soccer players, using knee magnetic resonance imaging, divided into case groups, those with clinical or radiological diagnosis of anterior cruciate ligament rupture; and control group, those without signs of ligament rupture. Orthopedic measurements were performed based on previus published. Results: Lateral and medial posterior tibal slopes, lateral and medial posterior meniscal slopes, delta-posterior tibial and meniscal slopes, intercondylar notch width and intercondylar notch width index presented statistically significant difference between the groups (p < 0,05). Through multivariate logistic regression analysis, lateral and medial posterior meniscal slope were predictor for increased risk of anterior cruciate ligament rupture. Conclusion: Lateral and medial posterior tibal slope, lateral and medial posterior meniscal slope, delta-posterior tibial and meniscal slope, intercondylar notch width and intercondylar notch width index have statistically significant relationship with higher risk of anterior cruciate ligament rupture in professional male soccer players. Lateral and medial posterior meniscal slopes are predictors of ligament injury.
- ItemAcesso aberto (Open Access)Riscos e consequências do uso da técnica transportal na reconstrução do ligamento cruzado anterior: relação entre o túnel femoral, a artéria genicular lateral superior e o epicôndilo lateral do côndilo femoral(Sociedade Brasileira de Ortopedia e Traumatologia, 2012-10-01) Astur, Diego Costa [UNIFESP]; Aleluia, Vinicius; Santos, Ciro Veronese; Arliani, Gustavo Gonçalves [UNIFESP]; Badra, Ricardo; Oliveira, Saulo Gomes; Kaleka, Camila Cohen; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Cohen; Santa Casa de Misericórdia de São Paulo Faculdade de Ciências MédicasOBJECTIVE: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. METHODS: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. RESULTS: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. CONCLUSION: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentização graft.
- ItemSomente MetadadadosTratamento das lesões do ligamento cruzado anterior em jogadores profissionais de futebol por médicos ortopedistas(Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Pereira, Vitor Luis [UNIFESP]; Arliani, Gustavo Goncalves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Anterior cruciate ligament (ACL) knee injury treatment and rehabilitation in professional soccer players consists a controversial issue. There is no agreement about the best treatment for this kind of lesion, even about the time for rehabilitation and when safe return to the athletic and competitive activities can be done. Faced with these challenges, we pretend to describe, based on the interview of 61 orthopaedic surgeons linked to athletic clubs participating of the Brazilian Soccer Championship, technical and practical matters linked to the preferences and tendencies followed in the treatment of the ACL lesions in professional soccer players. The results showed that the interviewed specialists had an average age of 47 years old and a mean age of 20 years of experience in orthopaedics surgery. They wait between one to four weeks after the ACL injury to perform the surgical treatment (45,9%). They use preferably a single incision, arthroscopically assisted, single-bundle reconstruction (78,7%), femoral tunnel drilling by an accessory medial portal (50,8%) and use of quadrupled hamstring tendons autografts or patellar tendon autografts (49,2% and 34,4% respectively). The players are allowed to begin straight ahead running after three or four months (68,9%), noncontact ball handling and ball drills after four to six months (72,1%) and return to play without restrictions after six to eight months of the surgery (65,6%). The baseline to return to play is the isokinetic force test (49,2%), without the use of functional bracing after surgery (90,2%). According to the interviewed, more than 90% of elite soccer players return to professional play after an ACL reconstruction, and 60 to 90% return to play at their prior or greater level of performance. We conclude that this article successfully describes the main surgical practice and post-surgery management adopted by specialists in orthopaedic surgery associated to great soccer clubs of the Brazilian Soccer Championship when treating ACL injuries in professional soccer players.