Acute knee pain in elderly patients

A dor aguda no joelho de pacientes idosos é freqüente, sendo caracterizada por seu aparecimento súbito, sem causa aparente, com exame radiográfico dentro dos padrões da normalidade, na maioria dos casos. A etiologia da dor aguda no joelho é decorrente de insuficiência das estruturas, e seu quadro clínico difere completamente daquele determinado pela osteoartrose, sendo sempre unilateral e ocorre na grande maioria em pacientes do sexo feminino, após a quinta década de vida, e na região medial do joelho (local de maior carga). Com o propósito de analisar as possíveis etiologias para a dor aguda do joelho de pacientes acima de 60 anos de idade, suas características e tratamento, os autores discutem as etiologias relacionadas à dor aguda: lesão meniscal, fratura por fadiga e osteonecrose idiopática.Acute knee pain in elderly patients is not uncommon, and is characterized by a sudden onset, no apparent cause, and by normal radiographic findings in most cases. The etiology of acute knee pain is the result of insufficient structures, and clinical symptoms are totally different from the symptoms seen in osteoarthrosis. This acute pain in the knee is always unilateral and in the medial region of the knee joint (site with the heaviest load), predominantly in females after the fifth decade of live. In order to consider the possible etiologies for acute knee joint pain in patients older than 60 years, its characteristics and treatment, the authors discuss etiologies related to acute pain: lesion of the meniscus, stress fracture, and idiopathic osteonecrosis

Total arthroplasty in ankylosed knees: a case series

OBJECTIVE: To present nine patients with ankylosis in their knees that were submitted to a total arthroplasty to lessen their pain and improve their functional limitation. For these patients, arthrodesis remained a possibility in the event of arthroplasty failure. INTRODUCTION: Ankylosis of the knee is a severe functional limitation that becomes worse when pain is present. Arthrodesis of the knee is a classical indication for such patients, since it resolves the pain; however, the severe functional limitation remains. METHODS: In the present study, we evaluated the clinical course of nine patients who underwent total arthroplasty of the knee, and were followed up for at least five years. RESULTS: The results demonstrate that all of the patients experienced a significant reduction in pain and some improvement in the degree of knee flexion and extension. CONCLUSION: Based on the latest follow-up, there has been no need to perform arthrodesis for any of our patients, showing that a total arthroplasty could be a option for treatment in knee ankylosis

Treatment of Pathological Synovial Plicae of the Knee

OBJECTIVE: To analyze the incidence, clinical significance, and clinical manifestations of pathological synovial plicae of the knee. MATERIAL AND METHODS: Between 2002 and 2006, 63 patients with pathological synovial plicae of the knee were studied. Of those 63 patients, 21 had the diagnosis confirmed by previously performed magnetic resonance imaging. All of the patients initially underwent conservative treatment for 90 days that involved strengthening and improving the flexibility of the muscles surrounding the knee as well as modification of their sports activities. RESULTS: A total of 55 patients improved after conservative treatment. Six of these patients eventually experienced a recurrence of symptoms, but the symptoms were not incapacitating in any of these patients. The other eight patients underwent arthroscopic removal of the synovial plica. Of these eight patients, six returned to their pretreatment physical activities, and two had persistent symptoms during physical activity. CONCLUSION: The presence of a synovial plica of the knee should be considered as a potential diagnosis in patients with knee pain, especially those who practice sports inappropriately. Conservative treatment is effective in most cases, and surgical treatment should be reserved for exceptional cases that do not improve with conservative treatment

Immunohistochemical analysis of the neural structures of the posterior cruciate ligament in osteoarthritis patients submitted to total knee arthroplasty: an analysis of thirty-four cases

OBJECTIVES: Many authors recommend posterior cruciate ligament-retaining arthroplasty with the intention to maintain the proprioception properties of this ligament. Preservation of the neuroreceptors and nervous fibers may be essential for retaining the proprioception function of the posterior cruciate ligament. The present study was thus developed to evaluate the presence of neural structures in the posterior cruciate ligament resected during posterior stabilized arthroplasty in osteoarthritis patients. In particular, clinical, radiographic and histological parameters were correlated with the presence or absence of neural structures in the posterior cruciate ligament. METHODS: In total, 34 posterior cruciate ligament specimens were stained with hematoxylin-eosin and Gomori trichrome. An immunohistochemical analysis using antibodies against the S100 protein and neurofilaments was also performed. The presence of neural structures was correlated with parameters such as tibiofemoral angulation, histological degeneration of the posterior cruciate ligament, Ahlbäck radiological classification, age, gender and the histologic pattern of the synovial neurovascular bundle around the posterior cruciate ligament. RESULTS: In total, 67.5% of the cases presented neural structures in the posterior cruciate ligament. In 65% of the cases, the neurovascular bundle was degenerated. Nervous structures were more commonly detected in varus knees than in valgus knees (77% versus 50%). Additionally, severe histologic degeneration of the posterior cruciate ligament was related to neurovascular bundle degeneration. CONCLUSIONS: Severe posterior cruciate ligament degeneration was related to neurovascular bundle compromise. Neural structures were more commonly detected in varus knees. Intrinsic neural structures were detected in the majority of the posterior cruciate ligaments of patients submitted to knee arthroplasty for osteoarthritis

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