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- ItemSomente MetadadadosComparação biomecânica das técnicas de sutura vertical e cruzada, em configurações de fileira única e dupla, para o tratamento da lesão meniscal medial em alça de balde(Universidade Federal de São Paulo (UNIFESP), 2020-07-01) Nakama, Gilberto Yoshinobu [UNIFESP]; Cohen, Moises [UNIFESP]; Universidade Federal de São PauloBackground: Due to a variety of suturing techniques for bucket-handle meniscal repair, it is important to assess which suturing technique best restores native biomechanics. Purpose: To biomechanically compare vertical mattress and cross-stitch suture techniques, in single- and doublerow configurations, in their ability to restore native knee kinematics in a bucket-handle medial meniscus tear model. Methods: Ten matched pairs of human cadaver knees were randomly assigned to vertical mattress (n = 10) or cross-stitch (n = 10) repair groups. Each knee underwent four consecutive testing conditions: (1) intact, (2) displaced bucket-handle tear, (3) single-row suture configuration on the femoral meniscus surface, and (4) double-row suture configuration (repair of both femoral and tibial meniscus surfaces). Knees were loaded with a 1000 N axial compressive force at 0°, 30°, 60°, 90° and 120° of flexion for each condition. Resultant medial compartment contact area, average contact pressure, and peak contact pressure data were recorded. Results: Intact state contact area was not restored at 0° (P = 0.027) for the vertical double-row configuration and at 0° (P = 0.032), 60° (P < 0.001) and 90° (P = 0.007) of flexion for the cross-stitch double-row configuration. No significant differences were found in the average contact pressure and peak contact pressure between the intact state and the vertical mattress and cross-stitch repairs with either single- and double-row configurations at any flexion angles. When comparing the vertical and crossstich repairs across all flexion angles, no significant differences were observed in single-row configurations, but in double-row configurations, cross-stitch repair resulted in a significantly decreased contact area, average contact pressure and peak contact pressure (all P < 0.001). Conclusion: XVII Single- and double-row configurations of both vertical mattress and crossstitch inside-out meniscal repair techniques restored native tibiofemoral pressure after a medial meniscus bucket-handle tear at all assessed knee flexion angles. Despite decreased contact area using a double-row configuration, mainly related to the cross-stitch repair, in comparison to the intact state, the cross-stitch double-row repair led to decreased pressure in comparison to the vertical double-row repair. These findings are only applicable at the time of the surgery.
- ItemSomente MetadadadosThe ineffectiveness of fibrin glue and cyanoacrylate on fixation of meniscus transplants in rabbits(Elsevier B.V., 2009-08-01) Reckers, Leandro Jose; Fagundes, Djalma José [UNIFESP]; Cohen, Moises [UNIFESP]; Pelotas Catholic Univ; Universidade Federal de São Paulo (UNIFESP)Our aim was to evaluate whether a fibrin glue and octyl-cyanoacrylate can promote fixation of meniscal allograft in rabbits. the medial menisci of 18 rabbits were frozen and stored at - 73 degrees C (30 days) and then was allotransplantation and fixed by: GSu (n=6) soft tissue; GFi (n=6) fibrin glue; GCy (n=6) cyanoacrylate. They were evaluated by daily surgery recovery score (4 weeks), gross inspection and cells density on scaffold. A severe inflammatory response with caseous necrosis from the inside of the joint on through the approach incision led us to an early sacrifice (16th day) of all animals of GCy. the daily score of recovery was similar in both groups GSu and GFi, with a peak of 40% of mild Suffering score in the 12th day. At the 4th week in all animals of GFi the menisci were loose into the joint and the density of cells of collagen matrix was significantly fewer (p<0.001) than the GSu. the octyl-cyanoacrylate adhesive was totally inadequate for use on fixation of an allograft implant due to the severe inflammatory response. the fibrin glue was inappropriate to promote the allograft fixation and subsequently impaired the cells spread into the collagen matrix of allograft implant. (C) 2008 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)O papel do adesivo de fibrina e da sutura na fixação do transplante de menisco preservado por ultracongelamento em coelhos(Sociedade Brasileira de Ortopedia e Traumatologia, 2009-10-01) Reckers, Leandro José [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Raymundo, José Luiz Pozo; Granata Júnior, Geraldo Sérgio De Mello [UNIFESP]; Moreira, Márcia Bento [UNIFESP]; Paiva, Vanessa Carla [UNIFESP]; Fagundes, Anna Luiza Negrini; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Pelotas Departamento de Ortopedia; Universidade de Santo AmaroOBJECTIVE: To evaluate the ability of fibrin adhesive in promoting the meniscus fixation within two, four and eight weeks compared to the conventional soft-tissue suture technique. MATERIALS AND METHODS: 36 right medial menisci of rabbits preserved at negative 73° Celsius for 30 days were transplanted to animals of the same sample and fixed with soft-tissue suture or fibrin glue. After 2, 4 or 8 weeks, the appearance of the menisci and the quality of fixation were macroscopically checked and evaluated by a scoring system. The findings were subjected to the statistical study of variance analysis (p < 0.05%). RESULTS: The deep-frozen meniscus preservation maintained the integrity of the meniscus transplant, and, macroscopically, there was no significant reduction of the length of the meniscus in all post-transplant periods (p = 0.015). The menisci fixed with fibrin showed slight changes in color and surface roughness. There were no signs of rejection or infection in both groups. Suture fixation scoring was superior (p = 0.015) in all periods (80% of total fixation) as compared to the setting promoted by fibrin (20% of total fixation). CONCLUSION: The homologous transplantation of the meniscus of rabbits experienced various degrees of integration to the knee according to the fixation method; the surgical soft tissues suturing technique was shown to be superior in the evaluation of scores compared to the fixation with fibrin adhesive.
- 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.