Prevalence of Pain on Palpation of the Inferior Pole of the Patella Among Patients with Complaints of knee Pain

CONTEXT AND OBJECTIVE: Patellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy. METHODS: Palpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded. RESULTS: Of the total number of individuals evaluated, 124 (39%) felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3%) received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity. CONCLUSIONS: Palpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands

REABILITAÇÃO DO LIGAMENTO PATELOFEMORAL MEDIAL: UM RELATO DE CASO

Reabilitação pós-operatória tardia de um paciente submetido à reconstrução do ligamento patelofemoral medial. Foram utilizados os questionários Lysholm Knee Scoring Scale e Scoring of Patellofemoral Disorders como avaliação funcional, além de perimetria (5, 10, 20 e 30 centímetros acima da tuberosidade anterior da tíbia) e goniometria de flexão e extensão do joelho (decúbito dorsal). Foi observado que a lesão crônica sem intervenção precoce pode gerar hipotrofia e déficit de ativação do quadríceps; o início tardio de uma reabilitação pós-operatória específica pode prejudicar a evolução clínica do paciente. Como critério de alta foi utilizado avaliação clínica e o Biodex Stability System. Palavras chave: Ligamento, patelofemoral, reabilitação

Reconstrução transtúnel tibial do ligamento cruzado posterior: estudo anatômico em cadáveres para a feitura do túnel tibial

Objective: To determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia. Methods: Sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL) was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB) and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3) were measured. Results: In the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm. Conclusion: The guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL.Objetivo: Determinar os pontos de referência para a saída do fio-guia tibial em relação à cortical posterior da tíbia. Métodos: Foram usados para este estudo 16 joelhos de cadáveres frescos. Através de uma escopia e com um guia milimetrado, foi feita a passagem de três fios-guias a 0, 10 e 15 mm distalmente em relação à crista posterior da tíbia. Foram feitas dissecções e foi determinada a região do centro da inserção tibial do ligamento cruzado posterior (LCP) em cada joelho. Foram medidas as distâncias entre o centro da inserção tibial do LCP e a borda tibial posterior (CB) e entre o centro da inserção tibial do LCP e os fios 1-2 e 3 (CF1-CF2-CF3). Resultados: Nos joelhos dissecados, encontramos o centro da inserção tibial do LCP a 1,09 cm ± 0,06 da borda tibial posterior. As distâncias entre os fios 1,2 e 3 e o centro da inserção tibial do LCP foram respectivamente 1,01 ± 0,08; 0,09 ± 0,05 e 0,5 ± 0,05. Conclusão: A saída do fio- guia a 10 mm distalmente em relação à crista posterior da tíbia representa a melhor posição para tentar reproduzir o centro anatômico do LCP.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL