Synovial giant cell tumor of the knee

Tumor gigantocelular sinovial é uma neoplasia benigna, raramente sendo relatada na forma de metástase maligna. A localização mais comum de ocorrer um tumor gigantocelular sinovial é na mão e as mais infrequentes são tornozelo e joelho. No presente estudo os autores têm como objetivo descrever um caso raro de tumor gigantocelular sinovial localizado no joelho e o tratamento escolhido. A artroscopia demonstrou, nesse caso, ser o método ideal para o tratamento da lesão, uma vez que permitiu abordagem pouco agressiva e, ao mesmo tempo, boa visualização de todos os compartimentos da articulação do joelho e a completa ressecção do tumor.Synovial giant cell tumor is a benign neoplasm, rarely reported in the form of malignant metastasis. Synovial giant cell tumor most frequently occurs on the hand, and, most uncommon, on the ankle and knee. In the present study, the authors describe a rare case of synovial giant cell tumor on the knee as well as the treatment approach. Arthroscopy has been shown, in this case, to be the optimal method for treating this kind of lesion, once it allowed a less aggressive approach, while providing good visualization of all compartments of knee joint and full tumor resection

Comparison between the results achieved in anterior cruciate ligament reconstruction with two kinds of autologous grafts: patellar tendon versus semitendinous and gracilis

OBJECTIVE: this study aims to compare the arthrometric and isokinetic examination results from two types of autologous grafts: the central third of the patellar ligament and a graft formed by the tendons of the semitendinosus and gracilis muscles, within the same rehabilitation protocol, six months after the surgery. METHODS: the results from examinations carried out on 63 patients were analyzed. These patients were divided in two groups: one group of 30 patients who received a patellar tendon graft and another group of 33 patients who received a graft from the tendons of the semitendinosus and gracilis muscles. Both the grafts were attached in the same way, with EndobuttonTM for suspensory fixation to the femur and a bioabsorbable interference screw for fixation in the tibial tunnel. RESULTS: arthrometry 30 did not present any statistical difference between the two study groups. On the other hand, the isokinetic evaluation showed that the patellar tendon group had a larger mean peak torque of flexion and greater extension deficit, while the semitendinosus/gracilis group had a better mean flexion/extension ratio and greater percentage of flexion deficit. There was no statistically significant difference between the groups when measuring peak torque extension. CONCLUSION: therefore, when the patellar tendon was used, there was greater extensor deficit and, when the semitendinosus/gracilis tendons were used, there was greater flexor deficit.OBJETIVO: O objetivo deste trabalho é comparar os resultados da artrometria e do exame isocinético entre dois tipos de enxertos autólogos: o terço central do ligamento patelar e o formado pelos tendões dos músculos semitendíneo e grácil, dentro de um mesmo protocolo de reabilitação no sexto mês pós-operatório. MATERIAIS E MÉTODOS: Foram analisados os resultados obtidos dos exames realizados em 63 pacientes divididos em dois grupos. Em um grupo de 30 pacientes, utilizou-se o tendão patelar como enxerto e em outro grupo de 33 pacientes, utilizou-se o tendão dos músculos semitendíneo e grácil. Ambos os enxertos foram fixados da mesma forma, com EndobuttonTM para fixação suspensória no fêmur e um parafuso de interferência bioabsorvível para fixação no túnel tibial. RESULTADOS: A artrometria 30 não apresentou diferença estatística entre os dois grupos observados. Já na avaliação isocinética, constatou-se que o grupo de tendão patelar possui em média maior pico de torque de flexão e maior déficit de extensão e o grupo de flexores possui, em média, melhor relação flexão/extensão e maior déficit de flexão percentual. Não há diferença estatística significante entre os grupos quanto à medida de pico de torque de extensão. CONCLUSÃO: portanto, no presente estudo, quando o tendão patelar é utilizado, há maior déficit extensor e quando são utilizados os tendões flexores, há maior déficit flexor.UNIFESP-EPM Departamento de Ortopedia e TraumatologiaCentro de Ortopedia e Reabilitação no Esporte Centro de EstudosFMUSP Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL

A study on the diagnostic accuracy of the arthrometer KT1000TM in anterior cruciate ligament injuries

The main objective of this study was to verify the sensitiveness of the Electronic Arthrometer KT-1000TM in detecting ACL injuries. Thirty-six patients with knee sprain history and clinical tests compatible to ACL injury were evaluated. Group 1 was composed of 18 patients evaluated within less than four weeks after the sprain episode. Group 2 (two) was formed by 18 patients evaluated within more than 4 (four) weeks after the sprain episode. Both Groups were submitted to arthrometric (KT-1000TM) and magnetic resonance imaging (MR) evaluation. After the analysis of data obtained from imaging and arthrometric evaluations, the patients were submitted to arthroscopic procedures for injury evaluation and treatment, enabling the comparison of arthroscopic findings to the results of arthrometry and Magnetic Resonance Imaging. The diagnostic accuracy of the arthrometer KT-1000 TM was 100% for both groups, with the most sensible test regarding the presence of ACL injury being the Maximum Manual Traction Test. The diagnostic accuracy of the magnetic resonance imaging test was 94.4% for Group 1 and 100% for Group 2.Este trabalho teve como objetivo principal averiguar a sensibilidade do Artrômetro Eletrônico KT-1000TM, na detecção das lesões do LCA. Foram avaliados 36 pacientes com histórico de entorse do joelho e exame clínico compatível com lesão do LCA. Os pacientes foram divididos em dois grupos. O Grupo 1 foi composto por 18 pacientes avaliados com menos de quatro semanas após o episódio do entorse. O Grupo 2 (dois) foi composto por 18 pacientes avaliados com mais de 4 (quatro) semanas após o episódio de entorse. Ambos os Grupos realizaram avaliação artrométrica (KT-1000TM) e avaliação pela ressonância magnética (RM). Após a análise dos dados obtidos pelas avaliações de imagem e Artrométrica, os pacientes foram submetidos a procedimentos artroscópicos para avaliação e tratamento da lesão, permitindo a comparação dos achados artroscópicos com os resultados da artrometria e da Ressonância Magnética. A precisão diagnóstica do artrômetro KT-1000TM foi de 100% em ambos os grupos, sendo que o teste mais sensível à presença de lesão do LCA foi o Teste de Tração Manual Máxima. A precisão diagnóstica da avaliação pela ressonância magnética foi de 94,4% no Grupo 1 e de 100% no grupo 2.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Ortopedia e TraumatologiaCentro de Ortopedia e Reabilitação no Esporte do Hospital do CoraçãoUniversidade de São Paulo Instituto de Ortopedia e TraumatologiaHospital Santa MarcelinaCentro de Estudos do Centro de Ortopedia e Reabilitação no Esporte do Hospital do CoraçãoUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL

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

A manual method to obtain platelet rich plasma

OBJECTIVE:This study is to report a manual method to obtain platelet rich plasma (PRP).METHODS:For this study 61 ml of peripheral blood was obtained and submitted to centrifugation at 541g for 5 min. The centrifugation separates the blood into three components: red blood cells, buffy coat and platelet rich plasma. Blood and platelet rich plasma samples were sent to the Hospital's Laboratory and platelets and leukocytes were measured.RESULTS:A sample of 637 blood donors was evaluated. The platelet yield efficiency was 86.77% and the increase in platelet concentration factor was 2.89 times. The increase in leukocyte concentration factor was 1.97 times.CONCLUSION:The method described here produces leukocyte-rich and platelet-rich plasma with a high platelet and leukocyte increased factor.Level of Evidence IV, Controlled Laboratory Study.Hospital do Coração Knee InstituteUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Orthopedics and TraumatologyUNIFESP, EPM, Department of Orthopedics and TraumatologySciEL

Radiological study of reconstruction of the anterior cruciate ligament by transtibial approach

Introduction: the rupture of the anterior cruciate ligament (ACL) is often due to sports activities and its reconstruction methods have undergone constant changes due to improvements in the surgical techniques. Objective: To evaluate the radiological placement of the tibial and femoral tunnels using the transtibial technique assisted by the femoral pre-drilling. Method: Radiological analysis (AP and lateral), at 4 weeks postoperatively in 98 patients, totaling 100 cases of ACL reconstruction. Three examiners evaluated the placement of the tibial and femoral tunnels. Methods for assessing the positioning of the tunnels were: Scanlan, Staubli and Rauschning and Bernard. Results: the a angle (AP) was 64.13 degrees (+/- 4.29 degrees) and the beta angle (lateral) was 57.28 degrees (+/- 4.41 degrees). the mean tibial positioning was 41.99% (+/- 5.14%). the ACL graft was inserted into the lateral condyle of the femur and the average percentage of radiographic positioning in the green quadrant was 62%, the yellow quadrant, 37% and 1% in the red quadrant. Conclusions: the transtibial technique for ACL reconstruction, assisted by the femoral pre-drilling provides the anatomical position of the graft in the majority of the cases, as radiological evidence.Hosp Coracao HCor, Inst Joelho, São Paulo, SP, BrazilInst Assistencia Med Servidor Publ Estadual IAMSP, São Paulo, SP, BrazilUniversidade Federal de São Paulo Unifesp, São Paulo, SP, BrazilUniversidade Federal de São Paulo Unifesp, São Paulo, SP, BrazilWeb of Scienc

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London