Neurectomia do nervo interósseo anterior e posterior para controle da dor de pacientes com artrose de punho

Introdução: a osteoartrose é a doença articular de maior ocorrência no mundo, sendo definida como uma insuficiência da cartilagem articular devido a fatores mecânicos, genéticos, hormonais, ósseos e metabólicos, acarretando um desequilíbrio entre degradação e síntese da cartilagem articular e do osso subcondral. Objetivos: este estudo avalia quantitativamente a dor dos pacientes selecionados para o procedimento de neurectomia. Material e métodos: estudo longitudinal, prospectivo e analítico, com abordagem quantitativa das variáveis através da avaliação e acompanhamento de pacientes com dor crônica no punho devido a artrose de tal articulação. Resultados: 55,6% dos pacientes analisados eram do sexo masculino com variadas manifestações clínicas de dor e melhora do quadro álgico após o teste da xilocaína nos tempos de 5 e 10 minutos. A avaliação após 1 mês da neurectomia do nervo interósseo apresentou uma melhora significativa do quadro álgico, onde todos os pacientes analisados qualificaram a dor como fraca. Após 3 meses da cirurgia observou-se resultados semelhantes ao encontrado na avaliação após 1 mês da cirurgia; dos nove pacientes avaliados, apenas um relatou dor moderada. Conclusão: pacientes que foram submetidos a neurectomia do nervo interósseo apresentaram uma melhora significativa do quadro álgico associado a osteoartrose

Index of fatigue quadriceps in soccer athletes after anterior cruciate ligament reconstruction

ABSTRACT OBJECTIVE: The present study aimed to evaluate the muscle fatigue of the quadriceps muscle in high-performance soccer players undergoing (anterior cruciate ligament) ACL reconstruction. METHODS: We evaluated 17 high-performance soccer players from three professional soccer teams of a state in Brazil from August 2011 to July 2012. All subjects were evaluated between 5.5 and 7 months after ACL reconstruction with a Biodex(r) isokinetic dynamometer (System 4 Pro) with test protocol CON/CON at 60°/s and 300°/s with 5 and 15 repetitions, respectively. In the calculation of local muscle fatigue, the fatigue index was used, which is calculated by dividing the labor done in the first one-third of the repetitions by that done at the final one-third of the repetitions, and multiplying by 100 to express a unit in percentage (i.e., as a discrete quantitative variable). RESULTS: All subjects were male, with a mean age of 21.3 ± 4.4 years and mean BMI 23.4 ± 1.53 cm; left dominance was observed in 47% (n = 8) of athletes, and right dominance, in 53% (n = 9) of athletes; and the limb involved in the lesion was the dominant in 29% (n = 5) and the non-dominant in 71% (n = 12). Fatigue rates were 19.6% in the involved limb and 29.0% in the non-involved limb. CONCLUSION: The results allow us to conclude that there was no significant difference between the limbs involved and not in ACL injuries regarding local muscle fatigue. No association was observed between the dominant side and the limb involved in the ACL injury

Bilateral Avulsion Fracture of the Fibula Head of the Knee Associated with Avulsion Fracture of the Iliotibial Band: A Rare Case of Fracture Segond Associated with Arcuate Fracture

Fibular head avulsion fractures are rare and are so-called the arcuate signal. Avulsion fracture of the iliotibial band and anterolateral ligament is known as a Segond fracture, and it is another rare entity. We describe the case of a 27-year-old woman who was hit by a car and suffered polytrauma, mainly suffering injuries to both knees. Radiographs of the knees showed a Segond fracture associated with the arched signal bilaterally. The aim of this study is to present a rare case report and literature review of a bilateral fibular head avulsion fracture associated with an anterolateral tibial avulsion fracture

Anterolateral ligament of the knee: a step-by-step dissection

Abstract Background The number of studies and clinical interest in the anterolateral ligament of the knee (ALL) has grown in recent years. A meticulous and accurate ALL dissection is vital in anatomic and biomechanical studies, and a standardized technique is not yet established. As such, the aim of this study was to describe a step-by-step ALL dissection technique that could help authors consistently identify the ALL. Methods Twenty knees from frozen adult cadavers, with no preference for sex or age, were included in the study. All the cadavers were dissected using the same technique to determine the incidence of the ALL. Results A transverse incision is performed in the iliotibial band (ITB), around 10 cm proximal to the topography of the lateral epicondyle of the femur. Next, the ITB undergoes anterograde blunt dissection until its insertion at Gerdy’s tubercle in the tibia. Maintaining biceps femoris insertion, a dissection is performed anteriorly to it, until the lateral collateral ligament (LCL) is found. Using the LCL, internal rotation and 30 to 60° flexion as references, the ALL can be located in the anterolateral topography of the knee, with its origin near the lateral epicondyle (proximal and posterior) and insertion between Gerdy’s tubercle and the fibula (4.0 mm to 7.0 mm below the tibial plateau), expanding to the lateral meniscus (between the body and anterior horn), exhibiting a mean length of 4.0 ± 0.4 cm and mean width of 5.5 ± 0.8 mm. Conclusions The present article describes an effective and reproducible ALL dissection technique that made it was possible to identify the ligament in 100% of the cases in the present study