Proprioceptive deficit in individuals with unilateral tearing of the anterior cruciate ligament after active evaluation of the sense of joint position

AbstractObjectiveTo ascertain whether the proprioceptive deficit in the sense of joint position continues to be present when patients with a limb presenting a deficient anterior cruciate ligament (ACL) are assessed by testing their active reproduction of joint position, in comparison with the contralateral limb.MethodsTwenty patients with unilateral ACL tearing participated in the study. Their active reproduction of joint position in the limb with the deficient ACL and in the healthy contralateral limb was tested. Meta-positions of 20% and 50% of the maximum joint range of motion were used. Proprioceptive performance was determined through the values of the absolute error, variable error and constant error.ResultsSignificant differences in absolute error were found at both of the positions evaluated, and in constant error at 50% of the maximum joint range of motion.ConclusionWhen evaluated in terms of absolute error, the proprioceptive deficit continues to be present even when an active evaluation of the sense of joint position is made. Consequently, this sense involves activity of both intramuscular and tendon receptors

Déficit proprioceptivo em indivíduos com ruptura unilateral do ligamento cruzado anterior após a avaliação ativa do senso de posição articular

ResumoObjetivoVerificar se o déficit proprioceptivo no SPA permanece quando pacientes com um membro LCA deficiente são avaliados por meio do teste de reprodução ativa da posição articular, em comparação com o membro contralateral.MétodosParticiparam do estudo 20 pacientes com ruptura unilateral do LCA. Foi feito o teste de reprodução ativa da posição articular no membro LCA deficiente e contralateral saudável. Foram usadas as posições meta de 20% e 50% da amplitude articular máxima. O desempenho proprioceptivo foi determinado por meio dos valores de erro absoluto (EA), erro variável (EV) e erro constante (EC).ResultadosDiferenças significativas foram encontradas para o EA em ambas as posições avaliadas e para o EC em 50% AAM.ConclusãoO déficit proprioceptivo quando avaliado pelo EA permanece mesmo quando a avaliação do senso de posição articular é ativa e, consequentemente, envolve a atividade de receptores intramusculares e tendíneos.AbstractObjectiveTo ascertain whether the proprioceptive deficit in the sense of joint position continues to be present when patients with a limb presenting a deficient anterior cruciate ligament (ACL) are assessed by testing their active reproduction of joint position, in comparison with the contralateral limb.MethodsTwenty patients with unilateral ACL tearing participated in the study. Their active reproduction of joint position in the limb with the deficient ACL and in the healthy contralateral limb was tested. Meta‐positions of 20% and 50% of the maximum joint range of motion were used. Proprioceptive performance was determined through the values of the absolute error, variable error and constant error.ResultsSignificant differences in absolute error were found at both of the positions evaluated, and in constant error at 50% of the maximum joint range of motion.ConclusionWhen evaluated in terms of absolute error, the proprioceptive deficit continues to be present even when an active evaluation of the sense of joint position is made. Consequently, this sense involves activity of both intramuscular and tendon receptors

Insatisfação e complicações pós-cirúrgicas caracterizam erro médico?

Nota-se atualmente um crescente número de processos judiciais a médicos, com base em uma suposta quebra de contrato ao direito do consumidor, onde se exige do profissional médico resultados, enquanto este, pelo código de ética médica e bom senso, tem obrigação de meios. O objetivo deste estudo foi discutir os resultados, satisfação e complicações de três das principais cirurgias ortopédicas à nível do joelho (área de atuação dos autores) com o fim de estabelecer diferenças entre erro e insucesso, próprio do ato médico. Concluímos que a imperfeição faz parte da natureza humana e que, por diversos motivos, as cirurgias ortopédicas complicam, falham e pacientes ficam insatisfeitos, independente do grau de recursos que o profissional disponha, o que não caracteriza erro médico.There is currently a growing number of lawsuits against physicians, based on an alleged breach of contract to consumer law, where results are required from the medical professional, while the latter, according to the code of medical ethics and common sense, has an obligation of means. The aim of this study was to discuss the results, satisfaction and complications of three of the main orthopedic surgeries at the level of the knee (the authors' field of work) in order to establish differences between error and failure, which are characteristic of the medical act. We conclude that imperfection is part of human nature and that, for various reasons, orthopedic surgeries complicate, fail and patients are dissatisfied, regardless of the degree of resources available to the professional, which does not characterize medical error

Evaluation of multiple doses of tranexamic acid on blood loss in total knee arthroplasty

Objective: To evaluate the efficacy of multiple doses of tranexamic acid (TXA) in blood loss in patients undergoing total knee arthroplasty (TKA). Methods: Seven patients of both genders over 50 years old undergoingTKA, who received 15 mg/kg intravenous (IV) TXA 30 minutes before the surgical incision and another 3 doses thereafter were included in this report. Blood loss analysis included blood loss at the drain, hemoglobin loss, and estimated blood loss. Statistical analysis was performed. Results: There was a significant hemoglobin drop after 48 hours, compared to preoperative. Mean blood loss assessed by drain was 20.0 ± 25.17 mL after 24 h. Estimated blood loss was higher after 48 hours compared to 24 hours. No complications were reported in this sample, and no patient received transfusions. Conclusion: The use of TXA in multiple doses did not prevent the drop in postoperative hemoglobin levels and did not correlate with increased complications

Patellar Transskeletal Traction for the Treatment of Chronic Patellar Pseudoarthrosis

Patellar fractures, which constitute approximately 1% of bone lesions, may lead to severe impairment of the extensor mechanism. When conservative or surgical treatment fails, the patella may develop pseudoarthrosis. Neglect or delayed treatment of this type of injury may lead to significant diastasis between the patellar fragments. There is no consensus regarding the best treatment for such cases. This study is aimed at describing a rare case of patellar pseudoarthrosis in a patient who underwent two-step surgical treatment comprising transskeletal patellar traction followed by osteosynthesis with a tension band. A 17-year-old male patient presented with a left patellar fracture that resulted from a fall from a standing height 8 years ago. He did not undergo any type of surgical treatment during that time, but the fracture was immobilized for only 2 weeks. The two-step surgical treatment with transskeletal patellar traction and patellar osteosynthesis was performed and provided satisfactory functional clinical results in this patient. This two-step surgical treatment can be performed in cases similar to ours with satisfactory results

Posterior Root Repair of Medial Meniscus Combined With Valgus Opening Wedge Tibial Osteotomy

The medial meniscal root tear, a particular meniscal injury at the level of its posterior bone insertion, leads to a loss of impact absorption and load distribution capacity, similar to total meniscectomy. Therefore, its repair is fundamental for knee joint longevity. This type of injury often occurs in middle-aged patients with lower limbs varus malalignment, which results in mechanical overloading of the medial compartment and induces premature cartilage wear out. The success of meniscal root repair, with meniscal bone reinsertion, depends on the correction and realignment of varus deformities greater than 5° for physiological levels. In this situation, corrective tibial osteotomy combined with meniscal repair is indicated. Our goal is to describe the step-by-step technique of the valgus opening wedge tibial osteotomy combined with the arthroscopic reinsertion of the posterior meniscal root in tibia during the treatment of a patient with varus deformity and medial meniscus root tear