Evaluating the center of gravity of dislocations in soccer players with and without reconstruction of the anterior cruciate ligament using a balance platform

OBJECTIVE: The objective of this study was to compare the dislocation of the center of gravity and postural balance in sedentary and recreational soccer players with and withoutanterior cruciate ligament (ACL) reconstruction using the Biodex Balance System (BBS). METHOD: Sixty-four subjects were divided into three groups: a) soccer players who were post- anterior cruciate ligament reconstruction; b) soccer players with no anterior cruciate ligament injuries; and c) sedentary subjects. The subjects were submitted to functional stability tests using the Biodex Balance System. The instability protocols used were level eight (more stable) and level two (less stable). Three stability indexes were calculated: the anteroposterior stability index, the mediolateral stability index, and the general stability index. RESULTS: Postural balance (dislocation) on the reconstructed side of the athletes was worse than on the side that had not undergone reconstruction. The postural balance of the sedentary group was dislocated less on both sides than the reconstructed knees of the athletes without anterior cruciate ligament injuries. There were no differences in postural balance with relation to left/right dominance for the uninjured athletes and the sedentary individuals. CONCLUSION: The dislocation of the center of gravity and change in postural balance in sedentary individuals and on the operated limb of Surgery Group are less marked than in the soccer players from the Non Surgery Group and on the non-operated limbs. The dislocation of the center of gravity and the change in postural balance from the operated limb of the soccer players is less marked than in their non-operated limbs

Localized Pigmented Villonodular Synovitis of the knee: an arthroscopic treatment

The authors present a series of seven case reports of Localized Pigmented Villonodular Synovitis (LPVNS) treated by arthroscopy resection between June of 1994 and October of 2001. At the baseline evaluation, symptoms ranged from diffuse pain to localized swelling of the knee, with or without mechanical blockage of the joint. Magnetic Resonance helped in localizing the lesion and in the follow up evaluation. Diagnosis was confirmed through anatomicopathological examination. By the end point evaluation, none of the patients presented recurrence of the pre-operative symptoms referred before. Magnetic resonance imaging also showed absence of symptoms. Despite of the small number of patients, typical of this affection, the authors believe that arthroscopic excision of the LPVNS is an effective method, with low morbidity, providing remission of the symptoms and a low recurrence potential.Os autores apresentam sete pacientes portadores de Sinovite Vilonodular Pigmentada Localizada (SVNPL) tratados através de ressecção artroscópica, entre o período de junho de 1994 e Outubro de 2001. À avaliação inicial, os sintomas variaram desde dor difusa, até um aumento do volume localizado, com ou sem bloqueio mecânico do movimento articular. A ressonância magnética auxiliou na localização das lesões e no controle pós-operatório. O diagnóstico foi confirmado pelo exame anatomo-patológico. Na última avaliação nenhum dos pacientes apresentou recidivas dos sintomas do pré-operatório, nem no exame por imagem com ressonância magnética. Apesar da casuística pequena, própria dessa afecção, os autores acreditam que a excisão artroscópica da SVNPL é um método eficaz, de baixa morbidade, proporciona remissão dos sintomas e com pouca possibilidade de recidivas.Universidade de São Paulo Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Autologous chondrocyte implantation

Esta revisão da literatura descreve o processo do transplante autólogo de condrócitos em todas as suas etapas, indicações clínicas, técnica operatória, técnica laboratorial, reabilitação e resultados clínicos. Desde 1994, quando a técnica de ACI foi descrita pela primeira vez, este procedimento foi aprimorado e tornou-se uma das mais importantes alternativas cirúrgicas para o tratamento das lesões condrais do joelho. Nivel de Evidência II, Prospectivo Comparativo.This literature review article describes the autologous chondrocyte implantation (ACI) process - its stages, clinical indications, surgical technique, laboratory protocol, rehabilitation and clinical outcomes. Since 1994, when the ACI was described for the first time, the procedure has improved to become one of the most important surgical alternatives for the treatment of chondral lesions of the knee

Correlation between body mass index and postural balance

OBJECTIVE: To evaluate the correlation between body mass index (BMI) and postural balance in unipodal support. METHOD: 40 males, age 26 ± 5 yrs, body mass 72.3 ± 11 kg, height 176 ± 6 cm and BMI 23.3 ± 3.2 kg/m², were submitted to functional stability tests using the Biodex® Balance System (stability evaluation protocol level 2, which allows an inclination of up to 20° in the horizontal plane in all directions) to compare stability with BMI. RESULTS: The general stability index showed a correlation between BMI and postural balance - measured as imbalance (R=0.723-dominant side and R=0.705-non-dominant side). The anteroposterior stability index - measured as instability - showed correlations on the dominant (R=0.708) and non-dominant side (R=0.656). Lateral instability showed a correlation on the dominant side (R=0.721) and non-dominant side (R=0.728). The comparison of the balance indexes for dominant and non-dominant sides showed no statistically significant differences. CONCLUSION: High BMI demands more displacements to maintain postural balance.OBJETIVO: Avaliar a correlação entre o índice de massa corporal (IMC) e o equilíbrio postural no suporte unipodal. MÉTODOS: 40 homens, idade: 26 ± 5 anos, massa corporal: 72.3 ± 11 kg, altura: 176 ± 6 cm and IMC: 23.3 ± 3.2 kg/m² foram submetidos a testes funcionais de estabilidade corporal usando o Biodex Balance System (protocolo de avaliação nível 2, que permite uma inclinação acima de 20° no plano horizontal em todas as direções, índice que foi comparado ao IMC RESULTADOS: O índice de estabilidade geral - medido como instabilidade - mostrou correlação entre IMC e o equilíbrio postural (R=0.723- lado dominante) e (R=0.705 - lado não dominante). O índice de estabilidade ântero-posterior e médio-lateral mostraram correlação no lado dominante (R=0.708 e R=0728) e não dominante (R=0.656 e R=0,721). A comparação entre os indices do lado dominante e não dominante não mostrou diferença estatística. CONCLUSÃO: IMC alto exige maior deslocamento corporal para manter o equilíbrio postural

The use of platelet rich plasma enriched with bone marrow aspirate in puddu tibial osteotomy

OBJETIVO: O presente estudo procurou avaliar a aplicação do plasma rico em plaquetas associado ao aspirado de medular óssea como substituto ósseo ao enxerto autólogo do ilíaco nas osteotomias tibiais proximais de cunha de adição medial (OTCAM). MÉTODOS: Foram estudados 25 pacientes submetidos a OTCAM divididos de forma randomizada em dois grupos, grupo ilíaco, 14 pacientes submetidos a OTCAM nos quais se utilizou o enxerto autólogo do ilíaco para preencher o sitio da osteotomia, grupo PRP, 11 pacientes submetidos a OTCAM nos quais se utilizou um composto formado por plasma rico em plaquetas associado ao aspirado de medular ósseo para preencher o sitio da osteotomia. Foram avaliados o sangramento (variação dos níveis de hemoglobina e hematócrito) e a dor (escala visual analógica -EVA), comparando os grupos em relação a essas variáveis. RESULTADOS: Não foram observadas diferenças entre os grupos no que se refere à variação dos níveis de hemoglobina (p = 0,820) e hematócrito (p = 0,323). Os grupos não foram diferentes em relação à intensidade da dor segundo a EVA (p = 0,538). CONCLUSÃO: O uso do PRP associado ao aspirado de medular óssea nas OTCAM não demonstrou vantagem sobre a utilização do enxerto autólogo do ilíaco no que se refere a dor e sangramento.OBJECTIVE: The present study was performed in order to evaluate the use of platelet rich plasma associated to bone marrow aspirate, substituting autologous iliac bone graft in medial opening wedge osteotomy (OWHTO). METHODS: Twenty-five patients were submitted to tibial opening wedge osteotomy, being divided into two groups. Iliac group: 14 patients submitted to OWHTO, using autologous iliac bone graft to fill the gap. PRP group: 11 patients using platelet rich plasma associated to bone marrow aspirate to fill the gap. We evaluated bleeding (hemoglobin and hematocrit levels) and pain (visual analogic scale-VAS), then we compared the groups regarding these variables. RESULTS: Differences between the groups were not found regarding hemoglobin levels (p=0.820) and hematocrit levels (p=0.323). The groups were not different regarding pain measured with VAS (p=0.538). CONCLUSION: The use of platelet rich plasma associated to bone marrow aspirate in medial opening wedge osteotomy did not offer advantages over autologous iliac bone graft regarding bleeding and pain

Comparison of Floseals and Tranexamic Acid for Bleeding Control after Total Knee Arthroplasty: a Prospective Randomized Study

OBJECTIVE: Tranexamic acid (TXA) and the hemostatic agent Floseals have already been used to minimize bleeding during total knee arthroplasty (TKA). METHODS: We conducted a prospective, randomized study of 90 patients with indications for TKA. Following inclusion, the participants were randomly allocated in blocks to the following 3 groups: control, Floseals and TXA. Bleeding parameters, including decreases in hemoglobin (Hb), drain output, number of blood transfusions and complications, were assessed. ClinicalTrials.gov: NCT02152917. RESULTS: The mean decrease in Hb was highest in the control group (4.81±1.09 g/dL), followed by the Floseals (3.5±1.03 g/dL) and TXA (3.03±1.2 g/dL) groups. The Floseals and TXA groups did not differ, and both performed better than the control group. The mean total drain output was 901.3±695.7 mL in the control group, 546.5±543.5 mL in the TXA group and 331.2±278.7 mL in the Floseals group. Both TXA and Floseals had significantly less output than the control group, and Floseals had significantly less output than TXA. The number of blood transfusions was very small in all 3 groups. CONCLUSION: The use of TXA or Floseals was associated with less blood loss than that of the control group among patients undergoing primary TKA, as measured both directly (intraoperative bleeding + drainage) and on the basis of a decrease in Hb, without differences in the rate of complications. TXA and Floseals showed similar decreases in Hb and total measured blood loss, but the drain output was smaller in the Floseals group