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- 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 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.
- ItemSomente MetadadadosVaginal reconstruction by McIndoe technique with a vaginal expander mold(Elsevier B.V., 2001-05-01) Neto, M. S.; Baracat, Edmund Chada [UNIFESP]; Ferreira, L. M.; Universidade Federal de São Paulo (UNIFESP)