Navegando por Palavras-chave "Ligamento Cruzado Anterior"

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    Avaliação da dor anterior do joelho de pacientes submetidos à reconstrução do ligamento cruzado anterior com o 1/3 central do ligamento da patela apos cinesioterapia em cadeia cinética aberta
    (Universidade Federal de São Paulo (UNIFESP), 2002) Bernardes, Ricardo Cunha [UNIFESP]; Cohen, Moises [UNIFESP]
    I Objetivo: Observamos a correlacao entre a utilizacao de exercicios) realizados em cadeia cinetica aberta e a presenca de dor anterior no joelho de pacientes com uma reconstrucao do ligamento cruzado anterior (LCA: Material e metodos: Realizamos a avaliacao da dor anterior no joelho em 42 pacientes pos reconstrucao do LCA com enxerto do ligamento da patela, por meio de questionario de SHELBOURNE & TRUIVE'ER (1997), composto de, 5 itens presenca de dor anterior na pratica de esporte ou atividade extenuante (atividades de condicionamento fisico); para subir escadas ao ficar muito tempo sentado (cinema e automovel); durante suas atividades de vida diaria e atividade da qual necessitasse estar ajoelhado. Os pacientes foram tratados no setor de fisioterapia pelo menos 3 vezes por semana. Foram constituidos dois grupos' Grupos - controle composto por 20 pacientes que realizaram exercicios em cadeia cinetica fechada e o grupo II - estudo composto por 22 pacientes que realizaram exercicios em cadeia cinetica fechada e cadeia cinetica aberta. Ambos os grupos foram tratados por seis meses. Resultados: Na analise da pontuacao final do questionario, realizado aos 3 meses, pode-se observar que nao havia diferenca significante entre o grupo I e o grupo II (p=0,601 teste Mann-Whitey). A diferenca entre o grupo I e o grupo II, aos 6 meses, tambem nao era significante (P=0,572 teste Mann-Whitey). Quando comparados isoladamente, a respeito da pontuacao final dos questionarios, aos 3 e 6 meses, nao houve diferenca significante (grupo I p=0,053 e grupo II p=0,175 teste de Wilcoxon). Avaliando os resultados do questionario em cada quesito, isoladamente, foi encontrada diferenca significante (P< 0,05 teste Mann-Whitey) entre os grupos estudados referente a presenca de dor anterior no joelho em suas atividades de vida diaria(questao 4), no terceiro mes de reabilitacao, sendo melhor (pontuacao mais alta) o resultado do grupo II (p+0,047 teste Mann-Whitey). No restante das variaveis nao houve diferenca significante aos 3 e 6 meses. Conclusao: Podemos concluir que a utilizacao de exercicios realizados em cadeia cinetica aberta, na amplitude de 90§ a 45§ de extensao do joelho, nao foi responsavel pelo aumento da dor anterior no joelho durante o processo de reabilitacao
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    Avaliacao experimental dos aspectos anatomo-funcionais dos ligamentos cruzados
    (Universidade Federal de São Paulo (UNIFESP), 2000) Garbelotti Junior, Silvio Antonio [UNIFESP]
    Neste trabalho estudamos o comportamento tridimensional dos feixes de fibras dos ligamentos cruzados do joelho humano atraves da variacao do seu comprimento durante a excursao articular dos movimentos de flexao e extensao de O a 900. Para tanto estudamos 18 joelhos de cadaveres humanos, que tiveram seus ligamentos cruzados divididos em tres feixes de fibras cada. Foram submetidos a exame de radiografia em duas incidencias (perfil e antero-posterior) de modo a obtermos as tres projecoes dos segmentos nos planos frontal, sagital e transversal. A partir destas imagens medimos o comprimento dos feixes de fibras com os conhecimentos teoricos de calculo geometrico e de uma rotina matematica que permitiram o cruzamento dos dados reproduzindo de forma real a situacao dos ligamentos cruzados no espaco tridimensionalmente. Observamos que os feixes medial e lateral dos ligamentos cruzados anterior e posterior, tem movimentacao nao significante, o que refere a participacao ativa destes feixes em todos os angulos de movimento. Os feixes posterior do ligamento cruzado anterior e anterior do ligamento cruzado posterior foram os feixes que mais alteraram seu comprimento, respectivamente 6,1 mm e 11,8 mm, alteracoes consideradas significantes, sendo que o feixe posterior do ligamento cruzado anterior apresentou seu maior comprimento e em consequencia seu maior estado de tensao na extensao a Oº, enquanto, o feixe anterior do ligamento cruzado posterior apresentou seu maior comprimento e em consequencia seu maior estado de tensao na flexao a 90º. Concluimos que e importante conhecermos a anatomia funcional dos feixes de fibras dos ligamentos cruzados para qualquer manobra clinica e principalmente cirurgica destes ligamentos
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    Comparação 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 Paulo
    Introduction: 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.
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    Comparação entre o ângulo Q de indivíduos com sintomas de síndrome femoropatelar e assintomáticos
    (Universidade Federal de São Paulo (UNIFESP), 2008) Catarin, Juliana Kopko [UNIFESP]; Oliveira, Acary Souza Bulle [UNIFESP]
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    Desenvolvimento 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 Paulo
    Purpose: 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.
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    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; UFMG
    OBJECTIVE: 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.
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    Efetividade e seguranca da crioterapia no tratamento pos-operatorio imediato de reconstrucao do ligamento cruzado anterior
    (Universidade Federal de São Paulo (UNIFESP), 2012) Martimbianco, Ana Luiza Cabrera [UNIFESP]
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    Estudo anatomico e histologico do ligamento cruzado anterior do joelho fetal
    (Universidade Federal de São Paulo (UNIFESP), 2008) Ferretti Filho, Mario [UNIFESP]
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    Estudo comparativo das caracteristicas morfologicas, histoquimicas e imunohistoquimicas dos tendoes dos musculos semitendineo e gracil entre os sexos
    (Universidade Federal de São Paulo (UNIFESP), 2003) Pereira Junior, Edgard dos Santos [UNIFESP]
    O objetivo deste estudo foi comparar as caracteristicas morfologicas, histoquimicas e imunoistoquimicas dos tendoes dos musculos semitendineo e gracil entre os sexos utilizados como auto-enxerto nas cirurgias de reconstrucao do ligamento cruzado anterior. Avaliaram-se amostras dos tendoes dos musculos semitendineo e gracil de 36 pacientes (36 joelhos). As idades variaram de 15 a 46 anos, com media de 29,3 anos. Com relacao a cor, 33 brancos e 3 nao brancos, e ao lado, 23 joelhos do lado direito e 13 do esquerdo. Os pacientes foram divididos em dois grupos, sexo masculino (n=20) e feminino (n=16). As amostras dos tendoes foram submetidas a analise histologica, histoquimica e imunoistoquimica. Nao se observaram diferencas estatisticamente significantes em relacao a idade, ao sexo, a raca, ao lado, ao processo inflamatorio, a vascularizacao, e a alcianofilia entre os grupos avaliados. Houve um aumento da celularidade nos tendoes do musculo semitendineo em relacao aos tendoes do musculo gracil (sexo masculino p=0,03* e sexo feminino p=0,22). Pode-se observar uma tendencia nas mulheres de maior presenca de calcificacoes dos tendoes dos musculos semitendineo e gracil (p=0,06 e p=0,09), e do aumento da degeneracao das fibras colagenas dos tendoes do musculo semitendineo (p=0,06). Em relacao a presenca de receptores de estrogeno nos tendoes dos musculos semitendineo e gracil, observou-se um aumento do numero de receptores nos pacientes do sexo masculino. Concluiu-se que houveram diferencas morfologicas, histoquimicas e imunoistoquimicas dos tendoes dos musculos semitendineo entre os sexos e dos tendoes entre si, no sexo masculino
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    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 Esportiva
    OBJECTIVE: 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.
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    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.
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    Fisioterapia domiciliar X ambulatorial na reconstrucao do ligamento cruzado anterior: ensaio clinico-controlado
    (Universidade Federal de São Paulo (UNIFESP), 2005) Wolff, Alvaro Luiz Perseke [UNIFESP]
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    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 Joelho
    OBJECTIVE: 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.
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    Medidas 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.
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    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.
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    Reconstrução do ligamento cruzado anterior com o terço central do ligamento da patela: avaliação dos resultados com seguimentos de dez a quinze anos
    (Universidade Federal de São Paulo (UNIFESP), 2001) Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo [UNIFESP]
    Objetivo: Estudar os pacientes submetidos a reconstruçao do ligamento cruzado anterior com o terço central do ligamento da pateia após dez a quinze anos quanto aos níveis de qualidade de vida, alteraçoes degenerativas e de volta ao esporte. Métodos: Sessenta e dois pacientes foram avaliados retrospectivamente por meio de questionários, exame físico, teste funcional, KT-1000r, radiografias contidas nos protocolos de Lysholm, SF-36 e IKDC objetivo. Foram considerados o grau subjetivo de satisfaçao e os níveis de retorno ao esporte. Resultados: Após seguimento de dez a quinze anos, a pontuaçao de Lysholm mostrou 23 (37,1 por cento) pacientes considerados excelentes (95-100); 26 (41,9 por cento), bons (84-94); 11 (17,7 por cento), regulares (65-83) e 2 (3,2 por cento) ruins (<64). Na associaçao entre o grau de satisfaçao subjetiva e o questionário SF-36, o resultado subjetivo foi classificado como insatisfatório por apenas 5 (8,1 por cento) pacientes. Apesar do alto índice de satisfaçao subjetiva (91,9 por cento) a avaliaçao final do IKDC objetivo classificou nenhum paciente como normal (A), 31 (50 por cento) como quase normais (B), 23 (37,1 por cento) anormais (C) e 8 (12,9 por cento) como severamente anormais. O arco de movimento mostrou-se com maior limitaçao nos joelhos operados. A manobra de Lachman resultou negativa em 27,4 por cento, (+) em 40,3 por cento, (++) em 20,9 por cento e (+++) em 11,3 por cento. O sinal de pivot shift foi considerado normal em 33,9 por cento, (+) em 56,3 por cento e (++) em 9,7 por cento. A avaliaçao com KT-1000r demonstrou 32,3 por cento de resultados considerados anormais (>3mm). Em relaçao a artrose, foram detectados sinais degenerativos radiográficos no compartimento medial em 41 (66,1 por cento) pacientes; no lateral, em 36 (58 por cento) e na femoropatelar em 46 (74,2 por cento) pacientes. Foi detectada relaçao significativa entre a meniscectomia e a presença de artrose do lado correspondente. A altura patelar no joelho operado avaliada pelo índice CatonDeschamps se mostrou normal em 54 (87,1 por cento) pacientes e baixa em 8 (12,9 por cento), sem relaçao significativa com artrose femoropatelar. O retorno ao mesmo esporte ocorreu em 66,1 por cento; mudança de esporte em 16,1 por cento e abandono em 17,7 por cento. Os piores resultados do Lachman e do sinal de pivot shift corresponderam aos piores níveis de retorno aos esportes. Conclusoes ...(au)
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    Reconstrucao intra-articular do ligamento cruzado anterior com enxerto duplo do trato iliotibial e reforco extra-articular
    (Universidade Federal de São Paulo (UNIFESP), 1999) Goncalves, Romeu Krause [UNIFESP]
    O autor estuda 60 pacientes portadores da sindrome da instabilidade antero-lateral do joelho, por insufiCiência do LCA, definida pela historia clinica de instabilidade, associada a sensacao de falseio e a positividade dos testes ligamentares, Lachman, gaveta em rotacao externa, e Pivot Shift. Associa o teste funcional, no qual o paciente salta sobre o membro inferior lesionado, que confirma o quadro clinico de instabilidade antero-lateral do joelho. O objetivo e avaliar os resultados obtidos em 60 pacientes portadores de instabilidade antero-lateral de joelho, que foram submetidos a tratamento cirurgico em que foi utilizado uma tecnica com enxerto duplo intra-articular do trato iliotibial e com reforco extra-articular. O tempo minimo de seguimento dos pacientes foi de cinco anos. Com os resultados finais da tecnica utilizada, o autor pode chegar as seguintes conclusoes: 1) Que o reforco extra-articular corrige o afrouxamento dos restritores secundarias e protege o enxerto intra-articular. 2) E uma tecnica cirurgica que nao necessita de instrumental sofisticado para sua realizacao. 3) Os resultados obtidos quando comparados com os de outra tecnicas descritas sao similares
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    Relação 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.
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    Acesso 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 Médicas
    OBJECTIVE: 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.