Navegando por Palavras-chave "anterior cruciate ligament"
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- ItemSomente MetadadadosBony Morphology: Comparative Anatomy and its Importance for the Anterior Cruciate Ligament(W B Saunders Co-Elsevier Inc, 2017) Ingham, Sheila J. McNeill [UNIFESP]; de Carvalho, Rogerio Teixeira [UNIFESP]; Abdalla, Rene J. [UNIFESP]; Fu, Freddie H.; Lovejoy, C. OwenBone morphology is related to static and dynamic parameters during anterior cruciate ligament (ACL) kinematics and can affect injury mechanism patterns, gait analysis, biomechanical properties, and surgical references for ligament reconstructions. It does not only depend on mechanical factors but also reflects a developmental program with many other factor involved, including nutrition and hormones, especially those involved in the calcium metabolism. Although Wolff's law continues to be a dominant paradigm in Orthopaedics, in the past 15 years enormous advances have been made that have improved our understanding of how individual bones achieve their internal and external structure. Transition from the quadrupedal mode of locomotion to bipedalism compelled changes in the femur morphology and the modem human knee has an extensive history of modifications produced by natural selection acting on its function in habitually upright walking and running. The human ACL is a band-like structure of dense connective tissues that binds the femur to the tibia. The femoral ACL attachment is located on the posterior aspect of the medial surface of the lateral femoral condyle and is composed of both direct and indirect fibers
- ItemAcesso aberto (Open Access)Differences in muscle strength after ACL reconstruction do not influence cardiorespiratory responses to isometabolic exercise(Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia, 2014-05-16) Andrade, Marilia dos Santos [UNIFESP]; Lira, Claudio Andre Barbosa de; Vancini, Rodrigo Luiz [UNIFESP]; Nakamoto, Fernanda Patti [UNIFESP]; Cohen, Moises [UNIFESP]; Silva, Antonio Carlos da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Goiás Faculty of Physical Education Department of Human and Exercise Physiology; Universidade Federal do Espírito Santo Center for Physical Education and SportObjectives: To investigate whether the muscle strength decrease that follows anterior cruciate ligament (ACL) reconstruction would lead to different cardiorespiratory adjustments during dynamic exercise.Method: Eighteen active male subjects were submitted to isokinetic evaluation of knee flexor and extensor muscles four months after ACL surgery. Thigh circumference was also measured and an incremental unilateral cardiopulmonary exercise test was performed separately for both involved and uninvolved lower limbs in order to compare heart rate, oxygen consumption, minute ventilation, and ventilatory pattern (breath rate, tidal volume, inspiratory time, expiratory time, tidal volume/inspiratory time) at three different workloads (moderate, anaerobic threshold, and maximal).Results:There was a significant difference between isokinetic extensor peak torque measured in the involved (116.5±29.1 Nm) and uninvolved (220.8±40.4 Nm) limbs, p=0.000. Isokinetic flexor peak torque was also lower in the involved limb than in the uninvolved limb (107.8±15.4 and 132.5±26.3 Nm, p=0.004, respectively). Lower values were also found in involved thigh circumference as compared with uninvolved limb (46.9±4.3 and 48.5±3.9 cm, p=0.005, respectively). No differences were found between the lower limbs in any of the variables of the incremental cardiopulmonary tests at all exercise intensities.Conclusions: Our findings indicate that, four months after ACL surgery, there is a significant deficit in isokinetic strength in the involved limb, but these differences in muscle strength requirement do not produce differences in the cardiorespiratory adjustments to exercise. Based on the hypotheses from the literature which explain the differences in the physiological responses to exercise for different muscle masses, we can deduce that, after 4 months of a rehabilitation program after an ACL reconstruction, individuals probably do not present differences in muscle oxidative and peripheral perfusion capacities that could elicit higher levels of peripheral cardiorepiratory stimulus during exercise.
- ItemAcesso aberto (Open Access)Estudo radiográfico da reconstrução do ligamento cruzado anterior pela via transtibial(Soc Brasileira Med Esporte, 2014-07-01) Fernandes, Rafael de Souza Campos; Franciozi, Carlos Eduardo da Silveira [UNIFESP]; Campos Fernandes, Ricardo de Souza; Subtil de Oliveira, Marlon Alves; Nascimento, Laura; McNeill Ingham, Sheila Jean [UNIFESP]; Daher, Samir Salim; Waisberg, Jaques; Abdalla, Rene Jorge [UNIFESP]; Hosp Coracao HCor; Inst Assistencia Med Servidor Publ Estadual IAMSP; Universidade Federal de São Paulo (UNIFESP)Introduction: the rupture of the anterior cruciate ligament (ACL) is often due to sports activities and its reconstruction methods have undergone constant changes due to improvements in the surgical techniques. Objective: To evaluate the radiological placement of the tibial and femoral tunnels using the transtibial technique assisted by the femoral pre-drilling. Method: Radiological analysis (AP and lateral), at 4 weeks postoperatively in 98 patients, totaling 100 cases of ACL reconstruction. Three examiners evaluated the placement of the tibial and femoral tunnels. Methods for assessing the positioning of the tunnels were: Scanlan, Staubli and Rauschning and Bernard. Results: the a angle (AP) was 64.13 degrees (+/- 4.29 degrees) and the beta angle (lateral) was 57.28 degrees (+/- 4.41 degrees). the mean tibial positioning was 41.99% (+/- 5.14%). the ACL graft was inserted into the lateral condyle of the femur and the average percentage of radiographic positioning in the green quadrant was 62%, the yellow quadrant, 37% and 1% in the red quadrant. Conclusions: the transtibial technique for ACL reconstruction, assisted by the femoral pre-drilling provides the anatomical position of the graft in the majority of the cases, as radiological evidence.
- ItemSomente MetadadadosThe fetal anterior cruciate ligament: an Anatomic and histologic study(Elsevier B.V., 2007-03-01) Ferretti, Mario; Levicoff, Eric A.; Macpherson, Trevor A.; Moreland, Morey S.; Cohen, Moises; Fu, Freddie H.; Univ Pittsburgh; Universidade Federal de São Paulo (UNIFESP)Purpose: the purposes of this study were to better understand the fetal development of the anterior cruciate ligament (ACL); to identify the gross anatomy of the ACL; to perform a complete histologic evaluation of the ligament, particularly with respect to the distinction between bundles; and to evaluate ACL length, diameter, cellularity, vascularity, and insertion sites. Methods: By use of 40 intact knee joints of human fetuses, the gross anatomy of the ACL was inspected under a stereomicroscope (n = 40). the histologic evaluation was performed on the sagittal (n = 20) and transverse (n = 10) sections. Results: the gross observations revealed the presence of 2 distinct bundles: anteromedial (AM) and posterolateral (PL). the femoral origin of each ACL bundle was located in the posterior aspect of the medial surface of the lateral femoral condyle. the footprint of the tibial insertion was ovoid, with the AM bundle located anterior and medial to the PL bundle. the mean length of the ACL was 3.7 mm, the mean width was 1.1 mm, and the mean thickness was 0.9 mm. There was high cellularity, with approximately 5,600 Cells/mm(2), and intense vascularity. the AM and PL bundles were divided by a well-defined septum. the femoral origin had less dense connective tissue compared with the tibial insertion. Conclusions: From the time of fetal development, the ACL is composed of 2 bundles, AM and PL. the gross morphology of the ACL in fetuses is similar to that reported in adults; the histology is diverse in cellularity and vascularity. Clinical Relevance: This study provides useful information about the anatomy and histology of the fetal ACL.
- ItemAcesso aberto (Open Access)Glycosaminoglycan loss from cartilage after anterior cruciate ligament rupture: influence of time since rupture and chondral injury(Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia, 2008-02-01) Mattiello, Stela Márcia; Cintra Neto, Paulo Felix de Araujo; Lima, Geovane Elias Guidini de; Pinto, Karina Nogueira Zambone; Cohen, Moises [UNIFESP]; Pimentel, Edson Rosa; Universidade Federal de São Carlos Department of Physiotherapy; Universidade Federal de São Carlos Department of Morphology and Pathology; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)OBJECTIVE: To quantify the concentration of sulfated glycosaminoglycans (GAGs) concentration in the synovial fluid (SF) of knees with chronic anterior cruciate ligament (ACL) rupture and to identify possible associations between GAG concentration in SF and the time elapsed since rupture and degree of chondral injury. METHOD: Fourteen adult male subjects with total unilateral ACL rupture, which had occurred between 5 and 144 months earlier, were assessed. All subjects underwent joint aspiration; it was possible to collect SF from ten individuals. The samples were quantified to determine the GAG concentration using dimethylmethylene blue (DMMB) staining. The degree of chondral injury was macroscopically evaluated using the modified Mankin histological scale. Spearman correlation test (< 0.05) was used to evaluate the association between GAG concentration and chondral injury, and Pearson correlation test (< 0.05) was used to evaluate the association between GAG concentration and the time elapsed since rupture. RESULTS: The GAG concentration in SF showed a mean variation of 73.84 ± 40.75 µg/ml, with a mean time of 40.4 ± 40.3 months since the rupture. There was no correlation between GAG concentration and time since the rupture (r= -0.09, p= 0.81). The chondral injury grades found were 0, 1, 4 and 5. There was no correlation between chondral injury grade and GAG concentration in SF (r= -0.41, p= 0.24). CONCLUSION: After at least 5 months, the GAG concentration in SF from knees with ACL rupture is independent of the time elapsed since rupture and/or the severity of chondral injury.
- ItemSomente MetadadadosHigher Gene Expression of Healing Factors in Anterior Cruciate Ligament Remnant in Acute Anterior Cruciate Ligament Tear(Sage Publications Inc, 2018) Novaretti, Joao Victor [UNIFESP]; Astur, Diego Costa [UNIFESP]; Casadio, Davi [UNIFESP]; Nicolini, Alexandre Pedro [UNIFESP]; Pochini, Alberto de Castro [UNIFESP]; Andreoli, Carlos Vicente [UNIFESP]; Ejnisman, Benno [UNIFESP]; Cohen, Moises [UNIFESP]Background: Anterior cruciate ligament (ACL) reconstruction with remnant preservation has been described and related to potential advantages. Literature is lacking regarding gene expression of potential factors related to ligament healing in the ACL remnant and its relation to time from injury. Hypothesis: The mRNA expression of ligament healing factors in the ACL remnant would be higher in acute tears (<3 months from injury) than in intermediate (3-12 months) and chronic (>12 months) injuries. Study Design: Controlled laboratory study. Methods: Gene expression of 21 genes related to ligament healing factors was analyzed in 46 ACL remnants biopsied during surgical reconstruction with quantitative real-time polymerase chain reaction technique. Specimens were divided into 3 groups according to time from injury: acute (<3 months from injury
- ItemSomente MetadadadosIsokinetic hamstrings-to-quadriceps peak torque ratio: the influence of sport modality, gender, and angular velocity(Taylor & Francis Ltd, 2012-01-01) Andrade, Marilia Dos Santos [UNIFESP]; Barbosa de Lira, Claudio Andre; Koffes, Fabiana de Carvalho [UNIFESP]; Mascarin, Naryana Cristina [UNIFESP]; Benedito-Silva, Ana Amelia; Da Silva, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Goiás (UFG); Universidade de São Paulo (USP)The purpose of this study was to determine differences in hamstrings-to-quadriceps (H/Q) peak torque ratios evaluated at different angular velocities between men and women who participate in judo, handball or soccer. A total of 166 athletes, including 58 judokas (26 females and 32 males), 39 handball players (22 females and 17 males), and 69 soccer players (17 females and 52 males), were evaluated using an isokinetic dynamometer. the H/Q isokinetic peak torque ratios were calculated at angular velocities of 1.05 rad . s(-1) and 5.23 rad . s(-1). in the analysis by gender, female soccer players produced lower H/Q peak torque ratios at 1.05 rad . s(-1) than males involved in the same sport. However, when H/Q peak torque ratio was assessed at 5.23 rad . s(-1), there were no significant differences between the sexes. in the analysis by sport, there were no differences among females at 1.05 rad . s(-1). in contrast, male soccer players had significantly higher H/Q peak torque ratios than judokas (66 +/- 12% vs. 57 +/- 14%, respectively). Female handball players produced significantly lower peak torque ratios at 5.23 rad . s(-1) than judokas or soccer players, whereas males presented no ratio differences among sports At 5.23 rad . s(-1). in the analysis by velocity, women's muscular ratios assessed at 1.05 rad . s(-1) were significantly lower than at 5.23 rad . s(-1) for all sports; among men, only judokas presented lower ratios at 1.05 rad . s(-1) than at 5.23 rad . s(-1). the present results suggest that sport modality and angular velocity influence the isokinetic strength profiles of men and women.
- ItemSomente MetadadadosA proposal for a new tibial guide system for posterior cruciate ligament reconstruction(Elsevier B.V., 2007-07-01) Abdalla, Rene Jorge [UNIFESP]; Pacagnan, Andre Valente; Guimaraes Loyola, Hugo Alexandre; Cohen, Moises [UNIFESP]; Camanho, Gilberto Luis [UNIFESP]; Forgas, Andrea; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Posterior cruciate ligament reconstruction is always a challenge to the orthopaedic surgeon. It is difficult when the anterior cruciate ligament (ACL) is intact. We propose a new guide system through the posterornedial portal, avoiding ACL damage. the arthroscope is inserted anteromedially (30 degrees), and anterolateral portals are used for instruments to confirm the diagnosis and inspect the joint to search for and treat associated lesions that may appear eventually. the posteromedial portal is located posterior to the collateral medial ligament superficially, adjacent to a portion of the posteromedial femoral condyle, which is located I cm proximal to the posteromedial tibial plate (where a skin marker must be used before insufflation of the knee). Our system is designed with an articular end in the form of a rasp, which helps prepare the area of the posterior tibia to be stripped before the tibia] tunnel is drilled while being protected by the drill guide; this simplifies the preparation and creation of the tibial tunnel via a single device, which can be done with a 30 degrees arthroscope but is easier with a 70 degrees arthroscope. the guide system through the posteromedial. portal is used to determine a fixed 40 degrees angle of approach to the tibia in the anteroposterior direction to drill the tibial tunnel; this approach is particularly helpful in the presence of an intact ACL. the graft into the femoral tunnel is fixed with a bioabsorbable interference screw whose size must fit the graft and the tunnel walls. Before tibial graft fixation, it is necessary to reduce the posterior drawer. in the tibia the bundle corresponding to the anterolateral portion is tensioned and fixed under flexion, followed by the posteromedial portion in extension, by means of a Bottom Fix system (Smith & Nephew, Mayfield, MA) placed near the exit of the tibial tunnel.
- ItemSomente MetadadadosQuadriceps Strength Deficit at 6 Months After ACL Reconstruction Does Not Predict Return to Preinjury Sports Level(Sage Publications Inc, 2018) Novaretti, Joao Victor [UNIFESP]; Franciozi, Carlos Eduardo [UNIFESP]; Forgas, Andrea; Sasaki, Pedro Henrique; Ingham, Sheila Jean McNeill [UNIFESP]; Abdalla, Rene Jorge [UNIFESP]Background: There is a lack of literature-based objective criteria for return to sport after anterior cruciate ligament (ACL) injury. Establishing such objective criteria is crucial to improving return to sport after ACL reconstruction (ACLR). Hypotheses: Patients who return to their preinjury level of sport will have higher isokinetic, postural stability, and drop vertical jump test scores 6 months after surgery and greater patient satisfaction compared with those who did not. Additionally, quadriceps strength deficit cutoff values of 80% and 90% would differentiate patients who returned to preinjury sports level from those who did not. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A retrospective search was conducted to identify all patients who underwent ACLR and completed isokinetic evaluation, postural stability analysis, and drop vertical jump testing at 6 months postoperatively. Patients were asked to complete 3 questionnaires at a minimum 1 year after surgery. Chi-square and logistic regression analyses were used for categorical dependent variables, while the Student t test, Pearson correlation, or analyses of variance with Bonferroni post hoc testing were used for continuous dependent variables. A post hoc power analysis was completed. Based on the results regarding correlations between return to preinjury level and all other variables, effect sizes from 0.24 to 3.03 were calculated. With these effect sizes, an alpha of 0.05 and sample size of 58, a power ranging from 0.15 to 0.94 was calculated. Results: The rates of return to preinjury level and to any sports activity were 53.4% and 84.4%. Those who were able to return to their preinjury level of sport (n = 33) showed significantly higher Lysholm (91.6 9.7 vs 76.7 15.4) and International Knee Documentation Committee (IKDC) (83.6 +/- 10.6 vs 69.8 +/- 14.6) values compared with those who were unable to return to their preinjury level of sport (n = 25) (P < 0.001). No significant differences were found for the clinical evaluations between those who were and those who were not able to return at the same level for the clinical evaluations (isokinetic evaluation, postural stability, drop vertical jump test) (P > 0.05). No significant differences were found when comparing quadriceps strength deficit with cutoff values of 80% and 90% for return to preinjury activity level (Tegner), Lysholm, and IKDC scores. Conclusion: Quadriceps strength deficit, regardless of cutoff value (80% or 90%), at 6 months after ACLR does not predict return to preinjury level of sport. Patients who returned to sport at their preinjury level were more satisfied with their reconstruction compared with those who did not. Clinical Relevance: Quadriceps strength deficit is not a reliable predictor of return to sports, and therefore it should not be used as the single criterion in such evaluations.