The Brazilian Football Association (CBF) model for epidemiological studies on professional soccer player injuries

OBJECTIVE: This study aims to establish a national methodological model for epidemiological studies on professional soccer player injuries and to describe the numerous relevant studies previously published on this topic. INTRODUCTION: The risk of injury in professional soccer is high. However, previous studies of injury risk in Brazil and other countries have been characterized by large variations in study design and data collection methods as well as definitions of injury, standardized diagnostic criteria, and recovery times. METHODS: A system developed by the Union of European Football for epidemiological studies on professional soccer players is being used as a starting point to create a methodological model for the Brazilian Football Association. To describe the existing studies on professional soccer player injuries, we developed a search strategy to identify relevant epidemiological studies. We included the Latin American and Caribbean Center on Health Sciences and Medline databases in our study. RESULTS: We considered 60 studies from Medline and 16 studies from the Latin American and Caribbean Center on Health Sciences in the final analysis. Twelve studies were selected for final inclusion in this review: seven from the Latin American and Caribbean Center on Health Sciences and five from Medline. We identified a lack of uniformity in the study design, data collection methods, injury definitions, standardized diagnostic criteria, and the definition of recovery time. Based on the information contained within these articles, we developed a model for epidemiological studies for the Brazilian Football Association. CONCLUSIONS: There is no uniform model for epidemiological studies of professional soccer injuries. Here, we propose a novel model to be applied for epidemiological studies of professional soccer player injuries in Brazil and throughout the world.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Centro de Traumatologia do EsporteBrazilian Football AssociationClube de Regatas do Flamengo's Department HeadUNIFESP, Depto. de Ortopedia e Traumatologia Centro de Traumatologia do EsporteSciEL

Early osteoarthritis and reduced quality of life after retirement in former professional soccer players

OBJECTIVES: This study aims to compare the prevalence of osteoarthritis in two groups: one comprising former professional soccer players and the other comprising non-professional-athlete participants. METHODS: Twenty-seven male former professional soccer players and 30 male volunteers from different non-sports professional areas participated in the study. All participants underwent bilateral knee radiography and magnetic resonance imaging. In addition, the quality of life, knee pain and joint function were evaluated and compared using questionnaires given to all participants in both groups. Specific knee evaluations, with regard to osteoarthritis and quality of life, were performed in both groups using the Knee Injury and Osteoarthritis Outcome Score subjective questionnaires and the Short-form 36. The chi-squared test, Fisher's exact test, the Mann-Whitney U test and Student's t-test were used for group comparisons. RESULTS: The between-groups comparison revealed significant differences in the following: pain, symptoms and quality of life related to the knee in the Knee Injury and Osteoarthritis Outcome Score subscales; the physical aspects subscale of the SF-36; total whole-organ magnetic resonance imaging scores with regard to the dominant and non-dominant knees. Former soccer players had worse scores than the controls in all comparisons. CONCLUSIONS: Both the clinical and magnetic resonance evaluations and the group comparisons performed in this study revealed that former soccer players have a worse quality of life than that of a control group with regard to physical aspects related to the knee; these aspects include greater pain, increased symptoms and substantial changes in radiographic and magnetic resonance images of the knee

Unicompartmental knee arthroplasty: current perspectives and trends in Brazil

OBJECTIVE: The aim of this study was to evaluate the approaches and procedures used by Brazilian orthopedic surgeons for treating osteoarthrosis by means of unicompartmental knee arthroplasty and high tibial osteotomy of the knee. METHODS: A questionnaire with 14 closed questions was developed and applied to Brazilian knee surgeons during the three days of the 43rd Brazilian Congress of Orthopedics and Traumatology. RESULTS: A total of 113 surgeons filled out the questionnaire completely and became part of the sample analyzed. In this study, the majority of the surgeons performed fewer than five unicompartmental knee arthroplasty procedures/year (61.1%) and between 5 and 15 high tibial osteotomy procedures/year (37.2%). Use of computerized navigation systems during surgery remains uncommon in our environment, since only 0.9% of the specialists were using it. 65.5% of the surgeons reported that they had chosen to use total knee arthroplasty rather than partial arthroplasty due to lack of familiarity with the surgical technique. When asked about the possibility that the number of unicompartmental prostheses used in Brazil would grow as surgeons in this country become increasingly familiar with the technique, 80.5% of the respondents believed in this hypothesis. In this sample, we found that the greater the surgeon's experience was, the greater the numbers of unicompartmental prostheses and tibial osteotomies performed annually were (r = 0.550 and r = 0.465, respectively; p < 0.05). CONCLUSIONS: There is a clear evolutional trend towards treatment of unicompartmental osteoarthritis using partial knee arthroplasty in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefits of these trends.OBJETIVO: O objetivo deste estudo é avaliar as condutas e procedimentos realizados pelos cirurgiões de joelho do Brasil no tratamento da osteoartrose com artroplastia unicompartimental e osteotomia tibial alta do joelho. MÉTODOS: Um questionário de 14 questões fechadas foi elaborado e aplicado a cirurgiões brasileiros de joelho durante os três dias do 43º Congresso Brasileiro de Ortopedia e Traumatologia. RESULTADOS: Um total de 113 cirurgiões de joelho preencheram completamente o questionário e fizeram parte da amostra analisada. Neste estudo, a maioria dos cirurgiões realizava menos de cinco artroplastias unicompartimentais do joelho/ano (61,1%) e entre cinco e 15 osteotomias tibiais altas/ano (37,2%). A utilização de navegação computadorizada no intraoperatório é ainda infrequente em nosso meio, sendo realizada por apenas 0,9% dos especialistas. A opção pelo uso da artroplastia total do joelho em detrimento da parcial devido à falta de familiaridade com a técnica cirúrgica foi relatada por 65,5% dos cirurgiões. Quando arguidos sobre a possibilidade de crescimento no número de próteses unicompartimentais no Brasil com o aumento da familiaridade com a técnica pelos cirurgiões do País, 80,5% dos entrevistados responderam que acreditam nesta hipótese. Nesta amostra, constatamos que quanto maior a experiência do cirurgião maior o número de próteses unicompartimentais e osteotomias tibiais realizadas anualmente (r = 0,550 e r = 0,465, respectivamente, e p < 0,05). CONCLUSÕES: Existem claras tendências em evolução no tratamento da osteoartrose unicompartimental com artroplastia parcial do joelho no Brasil. No entanto, mais estudos prospectivos controlados são necessários para avaliar o benefício clínico e científico destas tendências.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Centro de Traumatologia do EsporteUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUNIFESP, Depto. de Ortopedia e Traumatologia Centro de Traumatologia do EsporteUNIFESP, Depto. de Ortopedia e TraumatologiaSciEL

Updating of the anatomy of the extensor mechanism of the knee using a three-dimensional viewing technique

The knee extensor mechanism is a complex structure formed by the quadriceps muscle and tendon, the patella, the patellar tendon and the ligaments that surround and help stabilize the knee. Through using a three-dimensional viewing technique on images of the knee extensor apparatus, we aimed to didactically show the structures that compose this bone-muscle-ligament complex. Anatomical dissection of the knee with emphasis on the structures of its extensor mechanism was performed, followed by taking photographs using a camera and lenses suitable for simulating human vision, through a technique for constructing three-dimensional images. Then, with the aid of appropriate software, pairs of images of the same structure from different angles simulating human vision were overlain with the addition of polarizing layer, thereby completing the construction of an anaglyphic image. The main structures of the knee extensor mechanism could be observed with a three-dimensional effect. Among the main benefits relating to this technique, we can highlight that in addition to teaching and studying musculoskeletal anatomy, it has potential use in training for surgical procedures and production of images for diagnostic tests.O mecanismo extensor do joelho é uma estrutura complexa formada pelo músculo e tendão quadricipital, a patela, o tendão patelar e os ligamentos que os circundam e auxiliam na estabilização do joelho. Através do uso de técnica de visualização tridimensional de imagens do aparelho extensor do joelho pretendemos mostrar de forma didática as estruturas que compõem este complexo ósteo-músculo-ligamentar. Dissecção anatômica do joelho com ênfase nas estruturas do seu mecanismo extensor foi realizada seguida de fotografias com câmera e lentes adequadas para simulação da visão humana através de técnica de construção de imagem tridimensional. Em seguida, com a ajuda de software apropriado, as duas imagens da mesma estrutura de diferentes ângulos simulando a visão humana são sobrepostas com adição de camada polarizante, concluindo a construção da imagem anaglífica. As principais estruturas do mecanismo extensor do joelho podem ser observadas com efeito tridimensional. Dentre os principais benefícios relacionados a esta técnica, destacamos, além do ensino e estudo da anatomia musculoesquelética, o potencial uso em treinamento de procedimentos cirúrgicos e a realização de imagens em exames diagnósticos.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Centro de Traumatologia do EsporteInstituto CohenSanta Casa de Misericórdia de São Paulo Faculdade de Ciências MédicasFaculdade de Medicina de São José do Rio PretoUniversidade de BarcelonaUNIFESP Departamento de Ortopedia e TraumatologiaCentro de Traumatologia do EsporteUNIFESP, Depto. de Ortopedia e Traumatologia Centro de Traumatologia do EsporteUNIFESP, Depto. de Ortopedia e TraumatologiaSciEL

OSTEOCHONDRAL AUTOLOGOUS TRANSPLANTATION FOR TREATING CHONDRAL LESIONS IN THE PATELLA

ABSTRACTObjective: The primary aim of this study was to assess the clinical and functional evolution of patients with total-thickness symptomatic cartilaginous injury of the patellar joint surface, treated by means of osteochondral autologous transplantation. Methods: This prospective study was conducted from June 2008 to March 2011 and involved 17 patients. The specific questionnaires of Lysholm, Kujala and Fulkerson were completed preoperatively and one year postoperatively in order to assess the affected knee, and SF-36 was used to assess these patients’ general quality of life. The nonparametric paired Wilcoxon test was used for statistical analysis on the pre and postoperative questionnaires. The data were analyzed using the SPSS for Windows software, version 16.0, and a significance level of 5% was used. Results: The Lysholm preoperative and postoperative average scores were 54.59 and 75.76 points (p < 0.05). The Fulkerson pre and postoperative average scores were 52.53 and 78.41 points (p < 0.05). Conclusions: We believe that autologous osteochondral transplantation is a good treatment method for total-thickness symptomatic chondral lesions of the joint surface of the patella

The effects of one-half of a soccer match on the postural stability and functional capacity of the lower limbs in young soccer players

OBJECTIVE: Most injuries occur during the final 15 minutes of each half of a soccer match, suggesting that physical exertion may influence changes in neuromuscular control and the body's ability to stabilize the joints of the lower extremities. The aim of this study was to analyze the effects of one-half of a soccer match on the functional capacity and stability of the lower limbs in young soccer players. METHODS: We analyzed 27 soccer players by evaluating the functional capacity of their lower limbs using the hop test protocol and their level of postural stability using the Biodex Stability System. The evaluations were performed before and after 45 minutes of game time. RESULTS: After the match, there was a decrease in the overall stability index (OSI) (F(1,23) = 5.64, p = 0.026) and the anterior-posterior stability index (APSI) (F(1,23) = 5.24,p = 0.032). In the single and triple hop tests, there was a higher functional capacity in the dominant limb compared to the non dominant limb in the pre- and post-game comparisons. CONCLUSION: The results of this study show that there is a decrease in the stability of the lower limbs in young soccer players after a 45 minutes soccer match, but the same result was not found for the functional capacity.Universidade Federal de São Paulo (UNIFESP) Centro de Traumatologia do Esporte Departamento de Ortopedia e TraumatologiaUNIFESP, Centro de Traumatologia do Esporte Depto. de Ortopedia e TraumatologiaSciEL

Correlation between avascular necrosis and early stabilization of proximal femoral fractures in childhood

OBJETIVE: This study was developed with the main purpose of evaluating treatment results of proximal femoral fractures in a series of cases. We sought to observe the influence of the most frequent complications on the final results after a minimum follow-up of 2 years. We have especially considered the relationship between development of avascular necrosis and time between the accident and therapeutic intervention. METHOD: We retrospectively studied proximal femoral fractures in 29 patients under 14 years of age from 1988 to 2007. The following parameters were analyzed: sex, age, mechanism of injury, fracture classification (Delbet), treatment, complications (pseudoarthrosis, coxa vara, leg length discrepancy and avascular necrosis), time for surgery, and results (Ratliff). Statistical analysis was performed according to the descriptive evaluation of each parameter by using Fisher's exact test. RESULTS: Five (17.2%) patients had avascular necrosis, 3 of whom (60.0%) were older than 10 years of age. Seventy-three point three percent of patients treated in the first 24 hours showed good results. The most common cause of fracture was traffic accident (44.8%). The best results were observed in patients who were treated surgically; 41.4% developed some type of complication. CONCLUSIONS: Among the 29 patients treated, 58.6% had good, 27.6% had regular and 13.8% had poor results according to Ratliff criteria. When conservative treatment was applied, only 17.0% had good results, while surgical intervention results were 69.3% good. In addition, we obtained 73.3% good results when surgery was performed within the first 24 hours and only 42.8% good results in patients submitted to surgery after this period. Patients operated in the first 24 hours developed avascular necrosis in 13.3% of cases, while 21.4% of those operated after that period developed this complication.OBJETIVO: Desenvolvemos este trabalho, com o intuito de avaliar o resultado do tratamento de pacientes portadores de fraturas do fêmur proximal, em uma série de casos. Procuramos observar a influência das complicações mais prevalentes nos resultados finais após o mínimo de dois anos de seguimento. Correlacionamos especialmente a instalação da necrose avascular e o tempo entre o acidente e a instituição da terapêutica. MÉTODOS: Estudamos, retrospectivamente, 29 pacientes com fraturas da extremidade proximal do fêmur, com idade inferior a 14 anos entre 1988 e 2007. Analisamos as seguintes variáveis: sexo, idade, mecanismo de trauma, classificação da fratura (Delbet), tratamento realizado, complicações (pseudartrose, deformidade em varo, anisomelia e necrose avascular), tempo para cirurgia e resultado (Ratliff). Obtivemos uma análise descritiva individual de cada variável. Os testes foram utilizados de acordo com a adequação das premissas de normalidade e para avaliação utilizamos o teste exato de Fisher. RESULTADOS: Obtivemos cinco (17,2%) pacientes com necrose avascular sendo três (60,0%) com idade superior a 10 anos; 73,3% dos pacientes tratados nas primeiras 24 horas apresentaram bons resultados; a causa mais comum de fratura foi acidente automobilístico (44,8%); os melhores resultados foram observados nos pacientes tratados cirurgicamente; 41,4% evoluíram com algum tipo de complicação. CONCLUSÕES: Entre os 29 pacientes tratados, segundo os critérios de Ratliff, obtivemos 58,6% de bons, 27,6% de regulares e 13,8% de maus resultados. Quando aplicado o tratamento incruento, obtivemos apenas 17,0% de bons resultados, enquanto que após o tratamento cirúrgico obtivemos 69,3%. Da mesma forma, observamos que houve 73,3% de bons resultados quando a cirurgia foi realizada nas primeiras 24 horas e apenas 42,8% nos pacientes submetidos à intervenção terapêutica após este período. Pacientes submetidos à cirurgia nas primeiras 24 horas evoluíram com necrose da cabeça do fêmur em 13,3%, enquanto os que foram operados após este período tiveram esta complicação em 21,4% dos casos.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Clínica da Disciplina de Ortopedia PediátricaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Disciplina de Ortopedia PediátricaUNIFESP, Depto. de Ortopedia e TraumatologiaUNIFESP, EPMUNIFESP, Depto. de Ortopedia e Traumatologia Clínica da Disciplina de Ortopedia PediátricaUNIFESP, Depto. de Ortopedia e Traumatologia Disciplina de Ortopedia PediátricaSciEL

CrossFits: Injury prevalence and main risk factors

OBJECTIVES: This study sought to determine prevalences of injuries associated with CrossFits training and assess profiles of these injuries and the affected athletes. METHODS: Data were collected over a 12-month period using a questionnaire administered directly to practitioners at CrossFits-affiliated fitness centers in the state of Sa˜o Paulo, Brazil. Of the 414 participants, 157 (37.9%) participants reported having suffered an injury while practicing CrossFits. RESULTS: The injury rate was 3.24 injuries per 1,000 hours of training. The probability of injury for athletes who had practiced CrossFits for longer than 12 months was 82.2%, which was higher than the corresponding probability for beginner athletes. The probability of injury was 5-fold higher among competitive-level athletes than that among less-experienced athletes. No evidence of an association between the occurrence of injuries during CrossFits practice and any of the following athlete characteristics was found: age, gender, practice of other sports, weight, and height. The incidence of injuries in this sports modality was similar to that in other modalities, including Olympic weight lifting (OWL), basic weight lifting, and artistic gymnastics. CONCLUSION: CrossFits appears to be a training program that is suitable for different age groups when performed in a safe environment and with assistance from qualified professionals