Common injuries in athletes' knee: experience of a specialized center

OBJECTIVE:The present cross-sectional study aims to identify the most common knee injuries in athletes cared at a Specialized Outpatient Clinics.METHOD:Analysis of patients cared at the Knee Outpatient Clinics of a Sports Trauma Center, divided by gender, age and diagnosed injury.RESULTS:Initially 440 patients were divided into 33 types of sports; after excluding the less statistically significant practices, nine sports remained. The most frequently performed sports were football with almost 50% of total patients presenting anterior cruciate ligament (ACL) injury, and road runs with great frequency of meniscal injury. There was no correlation of the disorder with the type of sports performed but a correlation was found with patient's age/gender.CONCLUSION:The complete ACL rupture was the most common injury found in football, basketball and volleyball players, followed by meniscal injury in street runners.Level of Evidence IV, Study Transversal.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Orthopedics and TraumatologyUniversidade Federal de São Paulo (UNIFESP) Department of Orthopedics and TraumatologyUNIFESP, EPM, Department of Orthopedics and TraumatologyUNIFESP, Department of Orthopedics and TraumatologySciEL

Treatment of forearm fractures in children and adolescents

OBJECTIVE: The treatment and the angular deviations tolerated in diaphyseal forearm fractures in children evoke divergent opinions in literature. In view of this controversy, we idealized this study to evaluate the preferred treatment methods for this injury, during the 39th Brazilian Congress on Orthopedics and Traumatology. METHODS: A total 759 questionnaires were answered (13% of total entrants). We addressed the general aspects of the study sample to obtain a profile of the orthopedic surgeons questioned. RESULTS: Two clinical subjects were presented, aged 12 (CASE 1) and 5 years old (CASE 2), along with radiographs depicting forearm diaphyseal fractures of these patients. Data was gathered and submitted to statistical analysis. The overall preferred treatment in CASE 1 was closed reduction and fixation with Kirschner wires (26%), while in case 2 it was closed reduction followed by plaster cast (46%). CONCLUSION: Among orthopedic surgeons less than 30 years old, the choice for less invasive treatments and greater acceptance of angular values prevailed in both cases. The traumatologists accepted lower angular values and tended towards more invasive treatments, particularly for CASE 2. On the other hand, the pediatric orthopedic surgeon prefers less invasive treatments and accepts greater angular deviations.OBJETIVO: O tratamento e os desvios angulares tolerados nas fraturas diafisárias do antebraço em crianças evoca opiniões divergentes na literatura. Frente a esta indefinição, idealizamos este trabalho com o objetivo de avaliar transversalmente os métodos terapêuticos preferenciais para esta lesão durante o 39º Congresso Brasileiro de Ortopedia e Traumatologia. MÉTODO: Foram respondidos 759 questionários (13% do total de inscritos). Abordamos os aspectos gerais da amostra estudada para traçar o perfil do ortopedista questionado. Foram expostas duas situações clínicas em indivíduos de 12 (CASO 1) e 5 anos (CASO 2), sendo apresentadas radiografias com fraturas do antebraço destes pacientes. Os dados obtidos foram compilados e submetidos à análise estatística. RESULTADO: O tratamento mais indicado no CASO 1 foi redução incruenta e fixação com fios de Kirschner (26%), enquanto no CASO 2 foi redução incruenta seguida de aparelho gessado (46%). CONCLUSÃO: Entre os ortopedistas com menos de 30 anos, a escolha por tratamentos menos invasivos e aceitação de maiores angulações prevaleceu para ambos os casos. Os traumatologistas aceitam menor angulação e tendem aos tratamentos invasivos, particularmente para o CASO 2. Já o ortopedista pediátrico opta por tratamentos menos invasivos e aceita maiores desvios angulares.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUNIFESP, Depto. de Ortopedia e TraumatologiaSciEL

Changes in the methodology of medical teaching due to the COVID-19 pandemic

ABSTRACT Objective To evaluate the perceptions of students and teachers regarding remote teaching modality in comparison with the traditional face-to-face method. Methods In this observational, retrospective, comparative, single-center study, questionnaires containing three major assessment domains were sent to two groups: university professors and undergraduate and graduate students. The first domain collected demographic and general data on the platforms used. The second and third domains contained questions that compared the perception of the quality of information offered by the two systems. Results Between May and September 2020, 162 students and 71 teachers participated in the study. A greater proportion of students demonstrated previous contact with the online method, while professors had presented a greater number of courses. Most participants reported that their expectations regarding the remote teaching method were met (students, 80.3%; teachers, 94.4%). A significant number of students (83.3%) and teachers (88.7%) rated the classes as easier to attend and manage. Despite difficulties, such as concentration retention, most of the participants agree (at least partially) that the format should be maintained. Conclusion The remote teaching methodology, although still incipient in Brazil, has become a reality in light of current health restrictions. Our study demonstrated a high level of overall satisfaction and a high sense of learning from both students and faculty. However, new challenges associated with this system have been identified, such as retention of attention and interference from the external environment. Longitudinal comparative studies that incorporate various aspects of medical education in all cycles are necessary to corroborate the findings of this study. Design Retrospective comparative study, level III evidence

Avaliação Da Degeneração Precoce Da Cartilagem Em Pacientes Com Lesão Do Ligamento Cruzado Anterior - Analise Por Biomarcador

Introduction: Anterior Cruciate Ligament (Acl) Rupture Occurs Predominantly In A Young Population And About 30% Of Individuals With This Lesion Will Present Osteoarthrosis 20 Years After Trauma, Despite The Treatment. This Can Be Explained By Metabolic Changes Occurring Soon After The Sprain That Results In The Injury Of This Ligament. Objective: To Verify, Through The Analysis Of Biomarkers Related To Cartilage Degeneration, That Soon After The Mechanism Of Trauma Leading To Acl Rupture There Are Intra-Articular Metabolic Changes In The Knee That Lead To Cartilage Degeneration. Method: A Cross-Sectional Study Was Carried Out Between Two Groups: Patients With An Acl Rupture And A Control Group (Each Group With 10 Male Subjects, Age Between 18 Years-Old And 35 Years-Old And With A Body Mass Index Below 30 Kg / M2). In Both Groups, A Urinary Biomarker Related To Degradation Of Type Ii Collagen (Ctx-Ii) Was Measured. For The Group With Acl Rupture We Attempted To Establish A Relationship Between Lesion Time AndIntrodução: A Lesão Do Ligamento Cruzado Anterior Ocorre Predominantemente Numa População Jovem E Cerca De 30% Dos Indivíduos Com Esta Lesão Irá Apresentar Osteoartrose 20 Anos Após O Trauma, Independente Do Tratamento Realizado. Isso Pode Ser Explicado Por Alterações Metabólicas Ocorridas Logo Após O Entorse Que Gerou A Lesão Ligamentar. Objetivo: Comprovar, Através Da Análise De Biomarcadores Relacionados À Degeneração Da Cartilagem, Que Logo Após O Mecanismo De Trauma Que Leva À Lesão Do Ligamento Cruzado Anterior Ocorrem Alterações Metabólicas Intraarticulares No Joelho Que Levarão À Degeneração Da Cartilagem. Método: Foi Realizado Um Estudo Comparativo Transversal Entre Dois Grupos: Pacientes Com Lesão Do Ligamento Cruzado Anterior E Um Grupo Controle (Cada Grupo Com 10 Indivíduos Do Sexo Masculino, Com Idade Entre 18 E 35 Anos E Com Índice De Massa Corpórea Abaixo De 30 Kg/M2). Em Ambos Grupos Foi Mensurado Um Biomarcador Urinário Relacionado À Degradação De Colágeno Tipo Ii (Ctx-Ii). Para O Grupo Com LDados abertos - Sucupira - Teses e dissertações (2018

Ultrasonography for evaluation of hamstring tendon diameter: is it possible to predict the size of the graft?

ABSTRACT Objective: Perform the preoperative measurement of the hamstring tendons using ultrasound imaging, validating and correlating the measured value with that found during surgical reconstruction of the ligament. Methods: A cross-sectional study was carried out with 24 patients who underwent ultrasonographic measurement of the semitendinosus and gracilis muscle tendons and were subsequently submitted to surgical reconstruction of the ACL, with ipsilateral semitendinosus and gracilis tendon grafting. Results: The patients’ ages ranged from 16 to 43 years, with a mean of 24.8 years (SD = 8.4 years), 79.2% were men, and the distribution by side was 41.7% right knees and 58.3% left knees. A non-significant correlation coefficient was found between the area calculated by ultrasound (2 × semitendinosus area + 2 × gracilis area) and the intraoperative measurement (r = 0.16; p = 0.443). No evidence of a difference between intraoperative measurements <8 mm and ≥8 mm was found for the area calculated by the ultrasound (p = 0.746). The difference observed between the groups was −0.01 (95% CI: −0.09 to 0.07). Conclusion: Preoperative ultrasound imaging of the semitendinosus and gracilis tendons does not present a statistically significant correlation with the intraoperative measurement of the quadruple hamstring graft for ligament reconstruction

Higher Gene Expression of Healing Factors in Anterior Cruciate Ligament Remnant in Acute Anterior Cruciate Ligament Tear

Background: Anterior cruciate ligament (ACL) reconstruction with remnant preservation has been described and related to potential advantages. Literature is lacking regarding gene expression of potential factors related to ligament healing in the ACL remnant and its relation to time from injury. Hypothesis: The mRNA expression of ligament healing factors in the ACL remnant would be higher in acute tears (12 months) injuries. Study Design: Controlled laboratory study. Methods: Gene expression of 21 genes related to ligament healing factors was analyzed in 46 ACL remnants biopsied during surgical reconstruction with quantitative real-time polymerase chain reaction technique. Specimens were divided into 3 groups according to time from injury: acute (12 monthsn = 15). Histological and immunohistochemical evaluation was performed by analysis of hematoxylin and eosin, CD-34, and S-100 staining. Results: Expression of COL1A1, COL1A2, COL3A1, COL5A1, COL5A2, COL12A1, LOX, PLOD1, and TNC genes in ACL remnant was greater in acute compared with chronic injuries. COL1A1, COL5A1, COL12A1, and TNC genes were also expressed more in the acute group compared with the intermediate group. Furthermore, expression of the genes COL1A1 and COL5A2 was significantly higher in female than in male patients. No difference in the number of blood vessels and mechanoreceptors among groups was observed in the microscopic evaluation. Conclusion: The present study demonstrates that expression of COL1A1, COL1A2, COL3A1, COL5A1, COL5A2, COL12A1, LOX, PLOD1, and TNC genes in ACL remnant is greater in acute (12 months) injuries. Furthermore, COL1A1, COL5A1, COL12A1, and TNC genes were expressed more in the acute group compared with the intermediate group (3-12 months from injury).Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Univ Fed Sao Paulo, Paulista Sch Med EPM, Dept Orthopaed & Traumatol, Orthopaed & Traumatol Sports Ctr CETE, Rua Estado Israel 636, BR-04022001 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilUniv Fed Sao Paulo, Paulista Sch Med EPM, Dept Orthopaed & Traumatol, Orthopaed & Traumatol Sports Ctr CETE, Rua Estado Israel 636, BR-04022001 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc