Questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale": tradução e validação para a língua portuguesa Specific questionnaire for knee symptoms - the "Lysholm Knee Scoring Scale": translation and validation into Portuguese

As doenças do joelho apresentam conseqüências variadas para a função e a qualidade de vida do indivíduo. Para traduzir, validar e verificar as propriedades de medida do questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale" para a língua portuguesa, selecionamos, por conveniência, 50 pacientes (29 homens e 21 mulheres, média de idade 38,7 anos) com lesão de joelho (lesão meniscal, lesão do ligamento cruzado anterior, condromalácia ou artrose). A reprodutibilidade e a concordância ordinal inter e intra-entrevistador foram excelentes (alfa = 0,9). A concordância nominal inter-entrevistadores foi boa (Kappa = 0,7) e intra-entrevistador, excelente (Kappa = 0,8). No processo de validação, correlacionamos o questionário Lysholm com a escala numérica da dor (r=-0,6; p=0,001) e com o índice de Lequesne (r= -0,8; p=0,001). As correlações entre o Lysholm e a avaliação global da saúde pelo paciente e pelo terapeuta apresentaram-se fracas e não significantes. As correlações entre o questionário Lysholm e o SF-36 foram significantes nos aspectos físicos (r = 0,4; p = 0,04), de dor (r = 0,5; p = 0,001) e de capacidade funcional (r = 0,7; p = 0,0001). Concluímos que a tradução e adaptação cultural do "Lysholm knee scoring scale" para o nosso idioma apresentou reprodutibilidade e validade em pacientes com lesão meniscal, lesão do ligamento cruzado anterior, condromalácia ou artrose do joelho.<br>Knee diseases present variable consequences for an individual’s function and quality of life. For the purposes of translating, validating and checking the measurement properties of the specific questionnaire for knee symptoms - the "Lysholm Knee Scoring Scale" - into Portuguese, we selected, for convenience, 50 patients (29 males and 21 females, mean age = 38.7 years) with knee injuries (meniscal injury, anterior cruciate ligament injury, chondromalacia or arthrosis). Reproducibility and ordinal consistency inter- and intra-interviewer were excellent (alpha = 0.9). The nominal consistency inter-interviewers was good (Kappa = 0.7) and intra-interviewer was excellent (Kappa = 0.8). During validation process, we correlated the Lysholm questionnaire with the pain numerical scale (r=-0.6; p=0.001) and with he Lequesne index (r= -0.8; p=0.001). Correlations between Lysholm questionnaire and the global health evaluation by patient and by therapist were poor and not significant. The correlations between Lysholm questionnaire and SF-36 were significant for physical aspects (r = 0.4; p = 0.04), pain (r = 0.5; p = 0.001) and function (r = 0.7; p = 0.0001). We concluded that the translation and cultural adaptation of the "Lysholm knee scoring scale" into our language have proven to be reproducible and valid in patients with meniscal injury, anterior cruciate ligament injury, chondromalacia or knee arthrosis

Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature

Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity, which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique are donor site morbidity and a long rehabilitation period. In the 1980s, artificial ligaments became an attractive alternative to biological grafts. The initial enthusiasm surrounding their introduction stemmed from their lack of donor morbidity, their abundant supply and significant strength, immediate loading and reduced postoperative rehabilitation. Synthetic grafts made of different materials such as carbon fibers, polypropylene, Dacron and polyester have been utilised either as a prosthesis or as an augmentation for a biological ACL graft substitute. Nevertheless, every material presented serious drawbacks: cross-infections, immunological responses, breakage, debris dispersion leading to synovitis, chronic effusions, recurrent instability and knee osteoarthritis. Recently, a resurgence of interest in the use of synthetic prostheses has occurred and studies regarding new artificial grafts have been reported. Although many experimental studies have been made and much effort has been put forth, currently no ideal prosthesis mimicking natural human tissue has been found

Knee scoring System

Knee injuries are among the most common clinical conditions treated everyday by orthopaedic clinicians and sport medicine doctors. A single joint can be affected by a large variety of pathology, ranging from ligament lesions to cartilage defects and many others. As a consequence, this is a field of intense basic and clinical research, and there is a growing interest in better understanding how to evaluate knee condition at the moment of injury and after conservative or surgical treatments. Therefore it has been observed a great interest over time in developing clinical scores in order to make correlations with objective findings and give the clinician a suitable instrument for the assessment of the therapy outcome. In the past years it has been observed a progressive trend from clinician-based outcome tools to patient-reported outcome measures. The necessity of assessing the knee condition in the most effective way possible is one of the peculiar aspects justifying this growing interest; moreover, it must be also considered the drastic increase in patient consciousness about health and expected outcome after therapies and lastly, the interest by health insurers to better evaluate the expense concerning knee injuries and their recovery1. These outcome evaluation instruments are patient-oriented2, strenghtening this way the importance of patient perception, which must be considered prevalent over the mere surgical result. Some studies have proved that patient satisfaction is strictly linked to outcome scores concerning subjective symptoms and function3. On the opposite side, some clinicians are not sure about the validity of this patient-reported tests, arguing that their subjective nature is a weak point, especially if compared to the more objective clinician-based findings4,5; even in this case, recent studies have proved that these clinical scores are often superior than the aforementioned clinical \u201cobjective\u201d measures6-10. In this chapter we will discuss in detail the scores employed in clinical studies focusing on knee treatments, in order to help the orthopedic surgeon in the choice of the most accurate evaluation tool according to the specific procedure performed